Black K J, Compton W M, Wetzel M, Minchin S, Farber N B, Rastogi-Cruz D
Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110.
Hosp Community Psychiatry. 1994 Jul;45(7):706-10. doi: 10.1176/ps.45.7.706.
This study attempted to determine how often psychiatric residents are exposed to violence, the types of violence they encounter, and what institutional changes might increase their safety.
Safety conditions at two private general hospitals and one state hospital that served as training sites for a psychiatric residency program were assessed through a survey of psychiatric residents and site visits to the hospitals. The survey asked residents to quantify violent incidents occurring in the emergency rooms, wards, and clinics at each site. The site visits focused on safety issues related to staff training, physical layout, staffing patterns, current policies, and compliance with policies.
All 47 residents in the training program responded to the survey. None reported serious injury, although as many as 56 percent had been physically assaulted on the wards of one hospital, and 54 percent of residents had encountered a weapon in one emergency room. Almost all residents had been verbally threatened or had witnessed violence to others. A paradoxical finding of the survey was that the residents felt safest in the hospital that had the highest rate of violence. The site visits revealed that deficiencies in the safety procedures were allowing weapons to be brought into patient care areas.
Psychiatric residents are often exposed to dangerous situations, although serious injury is rare. Residents' beliefs about their level of safety seem to be influenced more by how competent they perceive the staff to be than by the frequency of violence. The findings from the site visits pointed to two steps to increase safety: creating a weapon-free environment by searching all patients and finding ways to improve compliance with existing safety measures.
本研究试图确定精神科住院医师遭受暴力的频率、他们所遭遇的暴力类型，以及哪些机构变革可能会提高他们的安全性。
通过对精神科住院医师进行调查以及对医院进行实地考察，评估了两家私立综合医院和一家州立医院的安全状况，这三家医院是一个精神科住院医师培训项目的培训地点。该调查要求住院医师对每个地点的急诊室、病房和诊所发生的暴力事件进行量化。实地考察重点关注与员工培训、物理布局、人员配置模式、现行政策以及政策合规性相关的安全问题。
培训项目中的47名住院医师全部回复了调查。虽然在一家医院的病房里有多达56%的住院医师遭到过身体攻击，在一个急诊室里有54%的住院医师遇到过武器，但无人报告受重伤。几乎所有住院医师都曾受到言语威胁或目睹过他人遭受暴力。该调查一个矛盾的发现是，住院医师在暴力发生率最高的医院里感觉最安全。实地考察发现安全程序存在缺陷，使得武器能够被带入患者护理区域。
精神科住院医师经常面临危险情况，不过重伤情况很少见。住院医师对自身安全水平的看法似乎更多地受到他们对工作人员能力的认知影响，而非暴力发生的频率。实地考察的结果指出了提高安全性的两个步骤：通过对所有患者进行搜查营造无武器环境，以及找到提高对现有安全措施遵守情况的方法。
