Lehmann L S, McCormick R A, Kizer K W
Department of Veterans Affairs (116A), Washington, DC 20420, USA.
Psychiatr Serv. 1999 Mar;50(3):384-9. doi: 10.1176/ps.50.3.384.
To more clearly define the scope and impact of violence in health care facilities, national data on assaults in VA medical centers and freestanding clinics were examined.
A survey was distributed to all VA medical centers and freestanding clinics asking for cumulative data for one fiscal year (October 1990 through September 1991). Data were obtained on number, types, and locations of physical assaults and other assaultive behavior; the types of staff assaulted and number of workdays lost due to injuries; diagnoses of perpetrators; recommendations made after the incidents were reviewed; training in prevention and management of assaultive behavior; and the impact of training on rates of assaultive behavior.
During the survey year, 24,219 incidents of assaultive behavior were reported by 166 VA facilities; 8,552 incidents involved battery or physical assault. Weapon possession by perpetrators was common (8.5 percent of incidents), and weapons were used in 130 assaults (1.5 percent of assaults). Assaults occurred most frequently in psychiatric units (43.1 percent), followed by long-term-care units (18.5 percent) and admitting or triage areas (13.4 percent). Assault-related injuries were most common among nursing personnel. Perpetrators of assaults were most typically diagnosed as having psychoses, substance use disorders, or dementia. On inpatient psychiatry units, an inverse correlation was found between expenditures on staffing and the frequency of assaultive incidents. Staff training on management of assaultive behavior varied widely.
Assaultive behavior is a significant problem for health care workers. Staff in all clinical areas need to be prepared to deal with assaultive patients. More research is needed on staff training and interventions for preventing and limiting assaults.
为了更清晰地界定医疗保健机构中暴力行为的范围和影响，对退伍军人事务部（VA）医疗中心和独立诊所的袭击事件的全国数据进行了研究。
向所有VA医疗中心和独立诊所发放了一份调查问卷，要求提供一个财政年度（1990年10月至1991年9月）的累积数据。获取了以下数据：身体袭击和其他攻击性行为的数量、类型和地点；受袭击工作人员的类型以及因受伤而损失的工作日数量；肇事者的诊断情况；事件审查后提出的建议；针对攻击性行为预防和管理的培训；以及培训对攻击性行为发生率的影响。
在调查年度，166家VA机构报告了24,219起攻击性行为事件；其中8,552起涉及殴打或身体袭击。肇事者持有武器的情况很常见（占事件的8.5%），130起袭击事件中使用了武器（占袭击事件的1.5%）。袭击事件最常发生在精神科病房（43.1%），其次是长期护理病房（18.5%）和入院或分诊区域（13.4%）。与袭击相关的伤害在护理人员中最为常见。袭击事件的肇事者最常被诊断为患有精神病、物质使用障碍或痴呆症。在住院精神科病房，发现人员配置支出与攻击性行为事件的频率之间存在负相关。针对攻击性行为管理的工作人员培训差异很大。
攻击性行为对医护人员来说是一个重大问题。所有临床领域的工作人员都需要做好应对攻击性患者的准备。需要对预防和限制袭击的工作人员培训及干预措施进行更多研究。
