Sanky Charles
Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.
J Emerg Med. 2023 Feb;64(2):236-245. doi: 10.1016/j.jemermed.2022.11.002. Epub 2023 Feb 18.
Emergency department (ED) workplace violence has become increasingly prevalent in the United States, warranting the development of legislation, policy, and advocacy to protect health care workers. Solutions to address ED violence remain limited, and staff-oriented trainings often exist as short, one-time didactic sessions, which are not practical nor often applicable to the ED setting. There is a paucity of evidence-based interventions that incorporate behavioral-based training to adequately prepare staff for the complicated, multifactorial presentation of violence in the ED.
This pilot study sought to assess the feasibility of an improvisational theater-based, simulation intervention for health care professionals to address ED violence.
A longitudinal curriculum for ED violence was developed in collaboration with a committee of emergency medicine (EM) faculty, EM simulation experts, hospital security and police personnel, professional theater and improvisational performers, resident physicians, and medical students. This pilot intervention was tailored to new EM residents (n = 25) at a large, urban, academic medical center. Sessions were led by facilitators trained in group facilitation, simulation, and improvisation.
Participants felt the curriculum was helpful (82.6%), engaging (91.3%), applicable (73.9%), and enjoyable (82.6%). Participation primarily by residents identifying as female and people of color suggested the efficacy of creative expression and nontraditional modalities in engaging diverse learners. Ninety-five percent of participants expressed interest in future sessions.
A multidisciplinary workplace violence intervention leveraging principles of improvisational theater, health equity, organizational psychology, and EM simulation may prove useful in preparing health care professionals for violence in the ED.
在美国，急诊科工作场所暴力事件日益普遍，因此需要制定立法、政策并进行宣传，以保护医护人员。应对急诊科暴力的解决方案仍然有限，以员工为导向的培训通常是简短的一次性授课，既不实用，也往往不适用于急诊科环境。缺乏基于证据的干预措施，这些措施纳入基于行为的培训，以使工作人员充分应对急诊科暴力复杂的多因素表现。
本试点研究旨在评估一种基于即兴戏剧的模拟干预措施对医护人员应对急诊科暴力的可行性。
与急诊医学教员、急诊模拟专家、医院安保和警察人员、专业戏剧和即兴表演人员、住院医师和医学生组成的委员会合作，制定了针对急诊科暴力的纵向课程。该试点干预措施针对一家大型城市学术医疗中心的新急诊住院医师（n = 25）量身定制。课程由接受过团体促进、模拟和即兴表演培训的主持人主持。
参与者认为该课程有帮助（82.6%）、引人入胜（91.3%）、适用（73.9%）且有趣（82.6%）。主要由女性和有色人种住院医师参与表明，创造性表达和非传统方式在吸引不同学习者方面具有成效。95%的参与者表示对未来课程感兴趣。
利用即兴戏剧、健康公平、组织心理学和急诊模拟原则的多学科工作场所暴力干预措施，可能有助于医护人员应对急诊科的暴力事件。
