Yale School of Medicine, New Haven, CT, USA.
J Interpers Violence. 2022 Oct;37(19-20):NP18376-NP18393. doi: 10.1177/08862605211041375. Epub 2021 Aug 31.
Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs.
受伤严重的个体在从急性护理环境出院后再次受伤的风险升高，并且心理健康和社会需求未得到满足的比例很高。虽然有越来越多的针对这些需求的项目干预措施，包括基于医院的暴力干预计划，但关于医生对该患者群体当前实践的看法的数据却很少。了解当前的实践情况对于将新计划纳入工作流程以及制定循证医学教育以改善护理至关重要。本研究的目的是阐明急诊医学和普通外科住院医师当前的创伤知情护理实践，为围绕暴力受伤患者护理的未来课程开发提供信息。在这项研究中，至少有一年住院医师经验的急诊医学和外科住院医师通过模拟启动的访谈进行了双人或小组访谈。访谈收集了医生在治疗暴力受伤青年方面的角色观点，将模拟作为一个针对先前已知患者关注点的启动事件。出现的定性主题包括参与者（1）认为自己的角色是处理医疗/手术问题，并寻求他人建立信任和处理心理社会和法律问题，（2）对 ED 压力源和降级策略有很高的了解，（3）认为患者的不信任会对他们提供护理的能力产生负面影响，以及（4）认为执法部门会对护理产生负面影响，并且有时对如何与执法部门互动感到不确定。这些发现支持对提供者的医学教育应侧重于医学法律问题，特别是管理执法部门在 ED 的存在、不信任医疗提供者和医疗系统的结构和人际原因，以及解决出院后的心理健康和社会需求。
