重症监护病房中针对医护人员的暴力行为：频率、风险因素、干预措施和预防措施的系统评价和荟萃分析。

Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures.

机构信息

Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.

Medical Faculty, University of Basel, Basel, Switzerland.

出版信息

Crit Care. 2024 Feb 26;28(1):61. doi: 10.1186/s13054-024-04844-z.

DOI:10.1186/s13054-024-04844-z

PMID:38409034

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10898135/

Abstract

BACKGROUND

To assess the frequency, risk factors, consequences, and prevention of violence against healthcare workers in intensive care units.

METHODS

PubMed, Scopus, Google Scholar, EMBASE, Cochrane, and Web of Science were searched for studies on violence against healthcare workers in adult intensive care units. Risk factors, patient characteristics, and implications for healthcare workers were collected. Study quality, bias, and level of evidence were assessed using established tools.

RESULTS

Seventy-five studies with 139,533 healthcare workers from 32 countries were included. The overall median frequency of violence was 51% (IQR 37-75%). Up to 97% of healthcare workers experienced verbal violence, and up to 82% were victims of physical violence. Meta-analysis of frequency revealed an average frequency of 31% (95% CI 22-41%) for physical violence, 57% for verbal violence (95% CI 48-66%), and 12% for sexual violence (95% CI 4-23%). Heterogeneity was high according to the I statistics. Patients were the most common perpetrators (median 56%), followed by visitors (median 22%). Twenty-two studies reported increased risk ratios of up to 2.3 or odds ratios of up to 22.9 for healthcare workers in the ICU compared to other healthcare workers. Risk factors for experiencing violence included young age, less work experience, and being a nurse. Patients who exhibited violent behavior were often male, older, and physically impaired by drugs. Violence was underreported in up to 80% of cases and associated with higher burnout rates, increased anxiety, and higher turnover intentions. Overall the level of evidence was low.

CONCLUSIONS

Workplace violence is frequent and underreported in intensive care units, with potential serious consequences for healthcare workers, calling for heightened awareness, screening, and preventive measures. The potential risk factors for violence should be further investigated.

SYSTEMATIC REVIEW REGISTRATION

The protocol for this review was registered with Prospero on January 15, 2023 (ID CRD42023388449).

摘要

背景

评估重症监护病房医护人员遭受暴力的频率、风险因素、后果和预防措施。

方法

在 PubMed、Scopus、Google Scholar、EMBASE、Cochrane 和 Web of Science 上检索了关于成人重症监护病房医护人员遭受暴力的研究。收集了与风险因素、患者特征以及对医护人员的影响有关的信息。使用既定工具评估了研究质量、偏倚和证据水平。

结果

纳入了来自 32 个国家的 75 项研究，共涉及 139533 名医护人员。总体暴力发生率中位数为 51%（IQR 37-75%）。高达 97%的医护人员遭受过言语暴力，高达 82%的医护人员遭受过身体暴力。对频率的荟萃分析显示，身体暴力的平均发生率为 31%（95%CI 22-41%），言语暴力为 57%（95%CI 48-66%），性暴力为 12%（95%CI 4-23%）。根据 I 统计量，异质性很高。患者是最常见的施暴者（中位数 56%），其次是访客（中位数 22%）。22 项研究报告称，与其他医护人员相比，重症监护病房的医护人员的风险比高达 2.3 或比值比高达 22.9。经历暴力的风险因素包括年龄较小、工作经验较少和护士身份。表现出暴力行为的患者通常为男性、年龄较大且因吸毒而身体受损。高达 80%的病例中暴力行为被漏报，与更高的倦怠率、更高的焦虑水平和更高的离职意向相关。总体而言，证据水平较低。