Siddle Jennica, Tolleson-Rinehart Sue, Brice Jane
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Pediatrics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Am J Disaster Med. 2016 Winter;11(1):5-18. doi: 10.5055/ajdm.2016.0220.
In the domestic response to the outbreak of Ebola virus disease from 2013 to 2015, many US hospitals developed and implemented specialized training programs to care for patients with Ebola. This research reports on the effects of targeted training on Emergency Department (ED) staff's Ebola-related perceptions and attitudes.
One hundred fifty-nine members of the UNC Health Care System ED staff participated in a voluntary cross-sectional, anonymous Web survey administered using a one-time "post then pre" design. Participants responded to questions about risk, roles, willingness to provide care, preparedness, and the contributions of media, training, or time to opinion change using a Likert agree-disagree scale. The authors conducted t test comparisons of Likert responses to pretraining and post-training attitudes about Ebola preparedness. The authors conducted multinomial logistic regression analyses of index scores of change and positivity of responses, controlling for the effects of independent variables.
ED staff's opinions supported training; 73 percent felt all workers should receive Ebola education, 60 percent agreed all hospitals should prepare for Ebola, 66 percent felt UNC was better prepared, and 66 percent felt it had done enough to be ready for an Ebola case. Most staff (79 percent) said they had gotten more training for Ebola than for other disease outbreaks; 58 percent had experienced prior epidemics. After training, workers' attitudes were more positive about Ebola preparation including perceived risk of transmission, readiness and ability to manage a patient case, understanding team roles, and trust in both personal protective equipment and the hospital system's preparations (13 measures, p < 0.0001 to p < 0.001). Overall, total opinion indices also changed significantly over the training period (Mean Difference [MD] = 17.45, SD = 9.89) and in the intended positive direction (MD = 15.80, SD = 0.91, p < 0.0001). Positive change and overall change from pre to post were significantly associated with more hours of training (p = 0.003). Despite different occupations, mean scores were similar. Staff rated training most important and media least important, as the sources of change in their attitudes (p < 0.0001).
These findings suggest that diseasespecific training for novel pathogens such as Ebola may result in positive staff perceptions of self-efficacy and occupational efficacy to treat potentially infected patients in the ED setting. Training, in this case, outweighed media content in changing staff perceptions of Ebola management.
在2013年至2015年国内应对埃博拉病毒病疫情期间，许多美国医院制定并实施了专门的培训计划，以护理埃博拉患者。本研究报告了针对性培训对急诊科（ED）工作人员埃博拉相关认知和态度的影响。
北卡罗来纳大学医疗保健系统急诊科的159名工作人员参与了一项自愿性横断面匿名网络调查，采用一次性“后测然后前测”设计。参与者使用李克特同意-不同意量表回答有关风险、角色、提供护理的意愿、准备情况以及媒体、培训或时间对观点改变的影响等问题。作者对培训前和培训后关于埃博拉准备情况的李克特回答进行了t检验比较。作者对反应变化指数得分和反应积极性进行了多项逻辑回归分析，控制自变量的影响。
急诊科工作人员的意见支持培训；73%的人认为所有工作人员都应接受埃博拉教育，60%的人同意所有医院都应为埃博拉做好准备，66%的人认为北卡罗来纳大学准备得更好，66%的人认为该校在应对埃博拉病例方面做得足够。大多数工作人员（79%）表示，他们接受的埃博拉培训比其他疾病疫情培训更多；58%的人经历过先前的疫情。培训后，工作人员对埃博拉准备情况的态度更为积极，包括对传播风险的认知、处理患者病例的准备情况和能力、对团队角色的理解以及对个人防护设备和医院系统准备工作的信任（13项指标，p<0.0001至p<0.001）。总体而言，在培训期间，总体意见指数也有显著变化（平均差[MD]=17.45，标准差=9.89），且朝着预期的积极方向变化（MD=15.80，标准差=0.91，p<0.0001）。从培训前到培训后的积极变化和总体变化与更多的培训时长显著相关（p=0.003）。尽管职业不同，但平均得分相似。工作人员将培训评为态度改变的最重要来源，而将媒体评为最不重要的来源（p<0.0001）。
这些研究结果表明，针对埃博拉等新型病原体的特定疾病培训可能会使工作人员在急诊科环境中对治疗潜在感染患者的自我效能感和职业效能感产生积极认知。在改变工作人员对埃博拉管理的认知方面，培训的作用超过了媒体内容。
