Holmes Colin A
School of Nursing Sciences, James Cook University, Townsville, Queensland.
Contemp Nurse. 2006 May;21(2):212-27. doi: 10.5172/conu.2006.21.2.212.
Assaults on health care staff have been a fact of life since the earliest years of organised health services, but it is only in recent years that governments have begun to acknowledge the problem. Assaults not only inflict physical and emotional injury, but undermine morale, create a climate of fear, and subvert the quality of care. They are also costly in terms of lost labour, compensation, and legal and procedural expenses. The response to violence in health care settings has thus far ranged from what might be called the 'Ostrich position', in which it is simply ignored, to training in self-defence, the deployment of security staff in clinical areas, conflict resolution training and, more recently, the policy of 'zero tolerance'. This paper examines the rationale for zero tolerance policies, drawing on their origins and applications in the United States and Britain. It suggests that zero tolerance is an ineffective response to violence in health care settings, and its adoption by authorities in Australia should be rejected. It is further argued, that resource allocation and marginalisation are identifiable and modifiable factors contributing to violence in our health care systems.
自有组织的医疗服务出现之初，袭击医护人员就一直是个现实问题，但直到近年来政府才开始承认这一问题。袭击不仅会造成身体和情感上的伤害，还会削弱士气、营造恐惧氛围并破坏护理质量。此外，袭击在劳动力损失、赔偿以及法律和程序费用方面的成本也很高。到目前为止，针对医疗环境中的暴力行为的应对措施五花八门，从可称为“鸵鸟政策”（即完全忽视）到自卫培训、在临床区域部署安保人员、冲突解决培训，以及最近的“零容忍”政策。本文借鉴美国和英国“零容忍”政策的起源及应用情况，探讨了实施该政策的基本原理。文章认为，“零容忍”对医疗环境中的暴力行为是一种无效的应对方式，澳大利亚当局不应采用。文章还进一步指出，资源分配和边缘化是导致我们医疗系统中暴力行为的可识别且可改变的因素。
