Bresler Scott, Gaskell Michael B
Clinical Director of Forensic Psychiatry, University of Cincinnati, Cincinnati, OH, USA.
Department of Psychology, Xavier University, Cincinnati, OH, USA.
Work. 2015;51(1):73-7. doi: 10.3233/WOR-141888.
Workplace violence in healthcare settings is a complex topic with many different environments in which aggression is sometimes expressed by patients toward those entrusted with providing their healthcare. The assessment of violence risk in a nursing home containing many patients with organic brain syndrome is quite distinct from assessment in forensic psychiatric units, inner city emergency rooms, or outpatient pain clinics. Three cases are presented that are composite summaries of actual assaults which took place across different hospital settings, all within an urban Midwestern city in the United States: (1) an emergency department; (2) a psychiatric emergency services (PES) center; (3) a short stay (typically 72 hours to 5 days) civil psychiatric inpatient unit. These case studies exemplify specific risk factors that violent patients have, depending upon the specific healthcare setting where the patient presents. Research is cited relevant to all three case studies and how one should assess their risk. Lastly, the complexity of this issue is highlighted by a brief discussion of the pitfalls entailed in profiling ``the dangerous patient.'' It is demonstrated that when violence is expressed by a patient toward a healthcare provider, it is usually a maladaptive response, one in which characteristics of that setting and behavior of those who work within it must be carefully considered when determining what factors precipitated the patient's violent act.
医疗环境中的工作场所暴力是一个复杂的话题，存在许多不同的环境，在这些环境中，患者有时会对负责为其提供医疗服务的人员表现出攻击性。对一家收治许多患有器质性脑综合征患者的养老院中的暴力风险评估，与法医精神病科病房、市中心急诊室或门诊疼痛诊所的评估截然不同。本文介绍了三个案例，这些案例是对发生在美国中西部一个城市不同医院环境中的实际袭击事件的综合总结：（1）急诊科；（2）精神科急诊服务（PES）中心；（3）短期（通常为72小时至5天）民事精神科住院病房。这些案例研究例证了暴力患者所具有的特定风险因素，这取决于患者就诊的具体医疗环境。文中引用了与所有三个案例研究相关的研究，以及应如何评估这些案例的风险。最后，通过简要讨论描绘“危险患者”所涉及的陷阱，突出了这个问题的复杂性。研究表明，当患者对医疗服务提供者表现出暴力行为时，这通常是一种适应不良的反应，在确定是什么因素引发了患者的暴力行为时，必须仔细考虑该环境的特征以及在其中工作的人员的行为。
