A Multi-site Intervention to Reduce Violence in Hospital Emergency Departments

减少医院急诊科暴力的多地点干预

• 批准号: 7596802
• 负责人: DONNA M GATES
• 金额: $ 34.15万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7596802
• 关键词: Multi; site; Intervention; Reduce; Violence

DESCRIPTION (provided by applicant): In 2006, the Bureau of Labor reported that 60% of workplace assaults occurred in healthcare, and most of the assaults were committed by patients. Healthcare support occupations had an injury rate of 20.4 per 10,000 workers due to assaults, and healthcare practitioners had a rate of 6.1 per 10,000; this compares to the general sector rate of only 2.1 per 10,000. As significant as these numbers are the actual number of incidents is much higher due to the gross underreporting in healthcare that is related to the perception that assaults are part of the job. Recent evidence indicates that nurses and other direct care providers who work in emergency departments (EDs) are at greater risk of violence than other providers. Although there are numerous epidemiological studies that have emphasized that ED violence is a prevalent and serious problem, there are no published accounts of interventions to reduce this alarming trend. The purpose of this intervention study is to partner with six hospitals to test a multi-dimensional intervention to prevent assaults against ED workers and reduce the related negative consequences. Primary study aims are to test the effectiveness of an intervention to: 1) reduce assaults against ED workers from patients and visitors, 2) decrease acute stress disorder symptoms, absences, and loss of productivity after assaults and physical threats, and 3) increase employees' feelings of safety and self-confidence in managing aggressive patients and visitors. Secondary study aims are to: 1) develop and implement processes and procedures for ensuring the intervention is planned with stakeholder input and involvement, and 2) develop and implement processes that increase the capacity of the EDs to sustain the intervention. The EDs will be randomly assigned as an intervention or control site. The intervention was developed using the Haddon Matrix, violence research, and feedback from ED managers. All ED employees who provide direct care at the six hospitals will be invited to participate in the study. Data on assaults, physical threats, stress, and productivity will be collected for nine months before and nine months after implementation of the program. The Diffusion of Innovations Theory will be used to plan, implement, evaluate and sustain the intervention. Focus groups with ED employees, managers and patients will be conducted to obtain information that will guide the implementation of the intervention. The research methods will include strategies that focus on fostering collaborations among the participating EDs and among the researchers, practitioners, and employees. In addition to having experienced violence researchers, this interdisciplinary team also includes an ED physician and nurses who have working relationships with key players in our partnering EDs. The proposed research is essential to advance progress in the field of violence in the healthcare sector and could serve as a model for EDs as well as high risk settings such as psychiatric, long-term care, and critical care units. PUBLIC HEALTH RELEVANCE: Emergency Departments (EDs) are becoming dangerous work settings for employees due to the increased violence from patients and visitors. There are no published accounts of strategies that will reduce this alarming trend. This study will test an intervention that could improve the work conditions for over 1 million ED healthcare workers and improve the care for millions of patients who visit EDs each year.

描述（由申请人提供）：2006年，劳工局报告说，60%的工作场所攻击发生在医疗保健，大多数攻击是由病人犯下的。医疗保健支持职业的工伤率为每10，000名工人中有20.4人因袭击而受伤，医疗保健从业人员的工伤率为每10，000人中有6.1人;相比之下，一般部门的工伤率仅为每10，000人中有2.1人。尽管这些数字很重要，但实际事件的数量要高得多，这是由于医疗保健方面的严重漏报，这与人们认为袭击是工作的一部分有关。最近的证据表明，在急诊科工作的护士和其他直接护理提供者比其他提供者面临更大的暴力风险。虽然有许多流行病学研究强调，艾德暴力是一个普遍和严重的问题，有没有公布的干预措施，以减少这一惊人的趋势。这项干预研究的目的是与六家医院合作，测试一种多维度的干预措施，以防止对艾德工作人员的攻击，并减少相关的负面后果。主要研究目的是测试干预措施的有效性：1）减少患者和访客对艾德工作人员的攻击，2）减少急性应激障碍症状，缺勤和攻击和身体威胁后的生产力损失，3）增加员工在管理攻击性患者和访客时的安全感和自信心。次要研究目的是：1）制定和实施流程和程序，确保在利益相关者的投入和参与下规划干预措施; 2）制定和实施流程，提高执行主任持续开展干预措施的能力。ED将被随机分配为干预或对照部位。该干预措施是使用哈登矩阵，暴力研究，并从艾德经理的反馈。将邀请在六家医院提供直接护理的所有艾德员工参加本研究。有关攻击、身体威胁、压力和生产力的数据将在实施该计划之前和之后的九个月内收集。创新扩散理论将用于规划、实施、评估和维持干预措施。将与艾德员工、管理人员和患者组成焦点小组，以获得指导干预实施的信息。研究方法将包括战略，重点是促进参与ED之间的合作和研究人员，从业人员和员工之间。除了有经验丰富的暴力研究人员，这个跨学科的团队还包括一个艾德医生和护士谁有工作关系的关键球员在我们的合作ED。拟议的研究对于推动医疗保健部门暴力领域的进展至关重要，可以作为ED以及精神病，长期护理和重症监护室等高风险环境的模型。 公共卫生关系： 急诊室（ED）正在成为危险的工作环境的员工，由于来自病人和访客的暴力增加。没有任何公开的战略说明可以减少这一令人震惊的趋势。这项研究将测试一种干预措施，可以改善超过100万艾德医疗工作者的工作条件，并改善每年数百万急诊患者的护理。