Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Mistler, Friedman); New Hampshire Hospital, Concord (Mistler); National Center for PTSD, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont (Friedman).
Psychiatr Serv. 2022 Jun;73(6):650-657. doi: 10.1176/appi.ps.202000297. Epub 2021 Sep 15.
Violence by patients against inpatient psychiatric unit staff is common, causing considerable suffering. Despite the Joint Commission's 2018 requirement for behavioral health organizations to use standardized instruments, no identified gold standard measures of violence and aggression exist. Therefore, accurate data are lacking on the frequency of patient-to-staff violence to guide development of safer institutional clinical policies or to assess the impact of targeted interventions to reduce violence. To inform recommendations for developing standardized scales, the authors reviewed the scoring instruments most commonly used to measure violence in recent studies.
A comprehensive literature search for violence measurement instruments in articles published in English from June 2008 to June 2018 was performed. Review criteria included use of instruments measuring patient-to-staff violence or aggression in acute, nonforensic, nongeriatric populations. Exclusion criteria included child or adolescent populations, staff-to-staff violence, and staff- or visitor-to-patient violence.
Overall, 74 studies were identified, of which 74% used structured instruments to measure aggression and violence on inpatient psychiatric units during the past 10 years. The instruments were primarily variants of the Observed Aggression Scale (OAS); 26% of the studies used unstructured clinical notes and researcher questionnaires. Major obstacles to implementing measurement instruments included time and workflow constraints and difficulties with use.
In the past 10 years, OAS variants with evidence of validity and reliability that define aggression and violence have been consistently used. The authors propose that adapting the Modified OAS to collect real-time clinical data could help overcome barriers to implementing standardized instruments to quantify violence against psychiatric staff.
患者对住院精神病病房工作人员的暴力行为很常见，造成了相当大的痛苦。尽管联合委员会要求 2018 年的行为健康组织使用标准化工具，但目前还没有确定的暴力和攻击的黄金标准衡量措施。因此，缺乏关于患者对工作人员暴力的频率的准确数据，无法指导制定更安全的机构临床政策，或评估旨在减少暴力的有针对性干预措施的影响。为了为制定标准化量表提供建议，作者回顾了最近研究中最常用于衡量暴力的评分工具。
对 2008 年 6 月至 2018 年 6 月期间以英文发表的文章中用于测量暴力的工具进行了全面的文献检索。审查标准包括使用测量急性、非法医、非老年人群中患者对工作人员暴力或攻击的工具。排除标准包括儿童或青少年人群、工作人员之间的暴力行为以及工作人员或访客对患者的暴力行为。
总的来说，确定了 74 项研究，其中 74%的研究在过去 10 年中使用了结构化工具来测量住院精神病病房的攻击性和暴力行为。这些工具主要是观察性攻击量表（OAS）的变体；26%的研究使用非结构化的临床记录和研究人员问卷。实施衡量工具的主要障碍包括时间和工作流程限制以及使用困难。
在过去的 10 年中，OAS 变体一直被一致地用于具有有效性和可靠性证据的攻击性和暴力行为的衡量。作者提出，采用改良 OAS 来收集实时临床数据可能有助于克服实施标准化工具以量化对精神科工作人员暴力行为的障碍。
