University of Virginia School of Medicine, Charlottesville, VA, USA.
Middle Tennessee State University, Murfreesboro, TN, USA.
J Clin Psychol Med Settings. 2022 Mar;29(1):54-61. doi: 10.1007/s10880-021-09775-3. Epub 2021 Apr 15.
Workplace violence in healthcare is a significant and costly problem. The majority of violent events that occur in the medical inpatient setting are perpetrated by patients against staff and occur during a behavioral emergency. The primary purpose of this study was to evaluate the impact of an innovative model of behavior management on occurrence of behavioral emergencies and staff comfort and competence in managing difficult patient behaviors. This model consists of primary, secondary, and tertiary interventions provided by a clinical psychologist which include proactive training for hospital staff and consultation-liaison services for behavior management. Forty-six staff at the University of Virginia Medical Center completed a 1-h training on preventing and managing difficult patient behavior. Self-report data on comfort and competence in managing challenging patient behaviors was collected at baseline, immediately following the intervention, and one and three months post-intervention. Behavioral emergencies were tracked for the intervention unit and a comparison unit. The occurrence of behavioral emergencies decreased by 50% in the three months following the intervention compared to a 142% increase on the comparison unit. Staff reported the greatest increase in confidence from baseline to three months post-intervention on caring for patients with psychiatric illnesses, managing verbal abuse, being supported by medical center leadership, having clear roles and responsibilities, and effectiveness of the skills and strategies used to manage difficult patient behavior. The results of this study provide preliminary support for the use of a comprehensive model for managing the behavioral needs of medical inpatients.
医疗机构工作场所暴力是一个严重且代价高昂的问题。大多数发生在医疗住院环境中的暴力事件是由患者针对工作人员而发生的，发生在行为紧急情况下。本研究的主要目的是评估一种创新的行为管理模式对行为紧急情况的发生以及工作人员管理困难患者行为的舒适度和能力的影响。该模式由临床心理学家提供的初级、二级和三级干预措施组成，包括为医院工作人员提供的主动培训以及行为管理的咨询联络服务。弗吉尼亚大学医疗中心的 46 名工作人员完成了 1 小时的预防和管理困难患者行为的培训。在基线、干预后立即以及干预后一个月和三个月收集了关于管理挑战性患者行为的舒适度和能力的自我报告数据。在干预单元和比较单元中跟踪了行为紧急情况。与比较单元的 142%的增加相比，干预后的三个月内行为紧急情况的发生率下降了 50%。工作人员报告说，从基线到三个月后，在照顾精神病患者、处理言语虐待、得到医疗中心领导的支持、明确角色和责任以及管理困难患者行为的技能和策略的有效性方面，信心增加最多。这项研究的结果初步支持使用综合模型来管理医疗住院患者的行为需求。
