急诊科工作人员如何应对痴呆症患者表现出的具有挑战性的行为？一项混合方法研究。
How do emergency department staff respond to behaviour that challenges displayed by people living with dementia? A mixed-methods study.
机构信息
School of Health and Social Wellbeing, University of the West of England, Bristol, UK
School of Health and Social Wellbeing, University of the West of England, Bristol, UK.
出版信息
BMJ Open. 2023 Aug 4;13(8):e075022. doi: 10.1136/bmjopen-2023-075022.
OBJECTIVES
To investigate staff experiences of, and approaches to behaviour that challenges displayed by patients with dementia in the emergency department (ED). Behaviour that challenges is defined as 'actions that detract from the well-being of individuals due to the physical or psychological distress they cause within the settings they are performed', and can take many forms including aggressive physical actions, shouting and verbal aggression and non-aggressive behaviour including repetitive questioning, inappropriate exposure and resistance to care.
DESIGN
Mixed-methods study consisting of an online survey and semistructured telephone interviews. Quantitative data were analysed and presented using descriptive statistics. Qualitative data were analysed thematically.
SETTING
The EDs of three National Health Service (NHS) Hospital Trusts in Southwest England.
PARTICIPANTS
Multidisciplinary NHS staff working in the ED.
RESULTS
Fifty-two online survey responses and 13 telephone interviews were analysed. Most (24/36, 67%) survey respondents reported that they had received general training in relation to dementia in the last 2-5 years, however, less than a fifth (4/23, 17%) had received any ED-specific dementia training. All (48/48) felt that behaviour that challenges could potentially be prevented, though resource constraints and practice variation were identified. Four main themes emerged from the qualitative data: (1) the 'perfect storm' of the ED; (2) behaviour that challenges is preventable with the right resources; (3) improvisation and (4) requirement for approaches that are specific to the ED.
CONCLUSIONS
The findings of this study suggest that ED staff do not feel that they are prepared to respond effectively to behaviour that challenges displayed by people living with dementia. Future work could adapt or develop an intervention to support ED staff in responding to behaviour that challenges.
目的
调查工作人员在急诊科（ED）遇到痴呆患者具有挑战性的行为时的体验和应对方法。具有挑战性的行为被定义为“由于其在执行地点造成的身体或心理困扰而对个人的幸福产生不利影响的行为”，可以采取多种形式，包括攻击性的身体动作、大喊大叫和言语攻击以及非攻击性的行为，包括反复提问、不当暴露和抗拒护理。
设计
混合方法研究，包括在线调查和半结构化电话访谈。使用描述性统计对定量数据进行分析和呈现。定性数据进行主题分析。
设置
英格兰西南部三家国民保健服务（NHS）医院信托的急诊科。
参与者
在 ED 工作的 NHS 多学科工作人员。
结果
分析了 52 份在线调查回复和 13 次电话访谈。大多数（24/36，67%）调查受访者报告说，他们在过去 2-5 年内接受过一般的痴呆症培训，但不到五分之一（4/23，17%）接受过任何 ED 特定的痴呆症培训。所有（48/48）人都认为具有挑战性的行为是可以预防的，尽管存在资源限制和实践差异。定性数据中出现了四个主要主题：（1）ED 的“完美风暴”；（2）具有挑战性的行为是可以预防的，需要正确的资源；（3）即兴创作；（4）需要针对 ED 的特定方法。
结论
本研究的结果表明，ED 工作人员认为他们没有准备好有效应对患有痴呆症的人表现出的具有挑战性的行为。未来的工作可以改编或开发一项干预措施，以支持 ED 工作人员应对具有挑战性的行为。
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