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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

基本信息

批准号：
8101139
负责人：
DONNA M GATES
金额：
$ 33.55万
依托单位：
UNIVERSITY OF CINCINNATI
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-01 至 2013-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8101139
关键词：
Multi site Intervention Reduce Violence

项目摘要

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，劳动局报告说，60%的工作场所攻击发生在医疗保健领域，其中大多数攻击是由患者实施的。医疗保健支持职业的伤害率为20.4 / 10,000，医疗保健从业人员的伤害率为6.1 / 10,000；相比之下，一般部门的比率仅为每万人2.1人。与这些数字一样重要的是，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，这与人们认为攻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。尽管有大量的流行病学研究强调勃起功能障碍暴力是一个普遍而严重的问题，但没有发表任何干预措施来减少这一令人担忧的趋势。这项干预研究的目的是与六家医院合作，测试一种多维干预措施，以防止对急诊科工作人员的攻击，并减少相关的负面后果。研究的主要目的是测试干预措施的有效性：1)减少患者和访客对急诊科工作人员的攻击，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，以及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。次要研究目标是：1)制定和实施流程和程序，以确保在利益相关者的投入和参与下计划干预措施；2)制定和实施流程，以提高教育部门维持干预措施的能力。急诊室将被随机分配作为干预点或控制点。干预是利用哈登矩阵、暴力研究和ED经理的反馈开发的。所有在这六家医院提供直接护理的急诊科员工都将被邀请参加这项研究。在该计划实施前9个月和实施后9个月内，将收集有关攻击、人身威胁、压力和生产力的数据。创新扩散理论将用于计划、实施、评估和维持干预。将与急诊科员工、管理人员和患者进行焦点小组讨论，以获取指导干预措施实施的信息。研究方法将包括侧重于促进参与的教育部门之间以及研究人员、从业人员和员工之间的合作的策略。除了有经验丰富的暴力研究人员外，这个跨学科团队还包括一名急诊科医生和护士，他们与我们合作的急诊科的主要参与者有工作关系。拟议的研究对于推动医疗部门在暴力领域取得进展至关重要，并可作为急诊科以及精神病、长期护理和重症监护等高风险环境的典范。