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: 7683836
• 负责人: DONNA M GATES
• 金额: $ 34.9万
• 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/7683836
• 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，美国劳工局报告称，60% 的工作场所袭击事件发生在医疗保健领域，而且大多数袭击事件都是由患者实施的。医疗保健支持职业因袭击而受伤的比率为每 10,000 名工人 20.4 人，而医疗保健从业人员的受伤率为每 10,000 人 6.1 人；相比之下，一般部门的比率仅为每 10,000 人 2.1 人。与这些数字一样重要的是，由于医疗保健领域的严重漏报，这与人们认为袭击是工作的一部分有关，实际事件数量要高得多。最近的证据表明，在急诊科 (ED) 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。尽管有大量流行病学研究强调急诊室暴力是一个普遍且严重的问题，但尚未发表有关减少这种令人震惊的趋势的干预措施的报道。这项干预研究的目的是与六家医院合作，测试多维干预措施，以防止针对急诊室工作人员的袭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，以：1）减少患者和访客对急诊室工作人员的攻击，2）减少急性应激障碍症状、缺勤以及攻击和人身威胁后的生产力损失，3）提高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规划干预措施；2) 制定和实施提高 ED 维持干预能力的流程。急诊室将被随机分配为干预或对照地点。该干预措施是根据哈登矩阵、暴力研究和急诊室管理人员的反馈制定的。所有在六家医院提供直接护理的 ED 员工都将被邀请参加这项研究。有关攻击、人身威胁、压力和生产力的数据将在该计划实施前九个月和实施后九个月内收集。创新扩散理论将用于规划、实施、评估和维持干预措施。将与急诊室员工、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 ED 之间以及研究人员、从业者和员工之间合作的策略。除了经验丰富的暴力研究人员之外，这个跨学科团队还包括一名急诊室医生和护士，他们与我们合作的急诊室的主要参与者有工作关系。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，并且可以作为急诊室以及精神科、长期护理和重症监护室等高风险环境的模型。 公共卫生相关性： 由于患者和访客的暴力行为不断增加，急诊科 (ED) 正在成为员工危险的工作环境。目前还没有公开的策略来减少这种令人担忧的趋势。这项研究将测试一种干预措施，该干预措施可以改善超过 100 万急诊科医护人员的工作条件，并改善每年数百万到急诊科就诊的患者的护理。