EFFECTS OF OSHA GUIDELINES ON VIOLENCE PREVENTION IN MEN

工作场所暴力在精神卫生保健环境中普遍存在。华盛顿州医院工作人员关于身体攻击发生率的调查发现，每年每100名病房工作人员中有386-437人受到身体攻击，造成至少轻伤(1993年)。1996年，针对这样的数据，联邦职业安全与健康管理局发布了针对卫生和社区工作者的暴力预防指南。尽管这些指南是基于健全的安全和健康原则，但它们从未在现场进行过正式评估。迫切需要在精神健康环境中对指南进行评估，以证明建议的有效性，并检查与实施指南相关的真实成本和收益。该项目将评估OSHA指南在NYSOMH的三个设施中的有效性：一个成人精神病院，一个儿童精神病院和一个法医机构。干预措施将在选定的三个设施中的每个设施中的两个单元中实施，并包括职业安全与健康准则的关键内容。管理层承诺和员工参与是拟议研究的设计中所固有的，并包括联合劳动-管理咨询小组的组成和工作。工作场所分析将包括审查OIRS数据、焦点小组、干预前调查、风险测绘和走访评估。危险预防和控制将通过实施走访调查中的建议来实现。咨询小组将与项目工作人员协商，审查并就医疗管理和事故后报告、培训和教育方面的政策和程序提出建议。将每年提供关于全面预防暴力计划的培训。将继续对该项目进行形成性评估。将通过对干预措施实施一年后的干预后调查和OIR数据进行分析，完成对该计划的评估。将对干预的成本和收益进行深入分析。这项研究的具体目标如下。1)记录并描述在三种类型的精神卫生机构中实施OSHA暴力预防指南的过程：一家成人精神病院，一家儿童精神病院和一家法医机构；2)比较三种类型机构在实施基于OSHA指南的综合(暴力预防计划)一年之前和一年后的打击率、袭击风险因素和工作满意度；3)评估在州精神卫生机构实施OSHA暴力预防指南的成本和收益。

Workplace violence is pervasive in the mental health care setting. Washington State hospital workers surveyed regarding the incidence of physical assaults were found to have a rate of 386-437 physical assaults resulting in at least minor injury per 100 ward staff members per year (1993). In 1996, in response to data such as these, Federal OSHA published violence prevention guidelines for health and community workers. Although the guidelines are based on sound principles of safety and health, they have never been formally evaluated in the field. Evaluation of the guidelines in mental health settings is critically needed to demonstrate the effectiveness of the recommendations, and to examine the true costs and benefits associated with their implementation. This project will evaluate the effectiveness of the OSHA guidelines in three NYSOMH facilities: one adult psychiatric, one child psychiatric and one forensic facility. The intervention will be implemented in two units in each of the three facilities selected and include key elements of the OSHA guidelines. Management Commitment and Employee Involvement are inherent in the design of the proposed study and include the formation and work of joint labor-management advisory groups. A Worksite Analysis will include review of OIRS data, focus groups, a pre-intervention survey, risk mapping and walk-through evaluation. Hazard Prevention and Control will be accomplished by implementing recommendations from the walk-through surveys. The advisory groups in consultation with project staff will review and make recommendations for policies and procedures on Medical Management and Post-incident Reporting and Training and Education. Training on a comprehensive violence prevention program will be offered annually. Formative evaluation of the project will be on-going. Evaluation of the Program, will be accomplished through analysis of a post-intervention survey and OIRS data one year following the implementation of the intervention. An in-depth analysis of the cost and benefit of the intervention will be conducted. The study has the following specific aims. 1) To document and describe a process for implementing OSHA violence prevention guidelines within three types of mental health facilities: one adult psychiatric, one child psychiatric and one forensic facility; 2) To compare assault rates, risk factors for assault and job satisfaction in three types of facilities one year prior to and one year following implementation of a comprehensive OSHA guideline-based (violence prevention program; 3) To assess the cost and benefit of implementing OSHA violence prevention guidelines within a state mental health facility.