Crawford M J, Turnbull G, Wessely S
Section of Epidemiology and General Practice, Institute of Psychiatry, London, UK.
J Accid Emerg Med. 1998 Jan;15(1):18-22. doi: 10.1136/emj.15.1.18.
To examine the impact of specific training for accident and emergency (A&E) staff on the quality of psychosocial assessment of deliberate self harm patients.
A non-randomised intervention study that compared the psychosocial assessment of deliberate self harm patients before and after a one hour teaching session for the A&E departments nursing and junior medical staff. Adequacy of psychosocial assessment was judged by examining A&E case notes. The records of the hospital's parasuicide team were examined to assess administrative changes. Staff attitude to and knowledge of deliberate self harm were also measured before and after the intervention.
45 of 52 nurses and all 15 junior medical staff attended the teaching session. Sixteen (13%) of 125 sets of records before and 58 (46%) of 127 sets of records after the intervention were judged to be adequate. In the postintervention period, notes were more likely to be judged adequate when a proforma was used as part of the assessment (52 of 66 with a proforma and six of 61 without a proforma, chi2 = 60, p < 0.01). Following the intervention, communication between A&E staff and the hospitals parasuicide team improved.
An intervention that provides teaching to A&E staff can lead to improvements in the quality of psychosocial assessment of patients with deliberate self harm.
探讨针对急症室（A&E）工作人员的专项培训对蓄意自伤患者心理社会评估质量的影响。
一项非随机干预研究，比较了为急症室护理人员和初级医务人员开展一小时教学课程前后，对蓄意自伤患者的心理社会评估情况。通过检查急症室病例记录来判断心理社会评估的充分性。查阅医院自杀未遂干预小组的记录以评估管理方面的变化。在干预前后还对工作人员对蓄意自伤的态度和知识进行了测量。
52名护士中的45名以及所有15名初级医务人员参加了教学课程。干预前125份记录中有16份（13%）被判定为充分，干预后127份记录中有58份（46%）被判定为充分。在干预后阶段，当评估中使用了表格时，记录更有可能被判定为充分（使用表格的66份中有52份，未使用表格的61份中有6份，卡方检验=60，p<0.01）。干预后，急症室工作人员与医院自杀未遂干预小组之间的沟通得到了改善。
为急症室工作人员提供教学的干预措施可提高对蓄意自伤患者心理社会评估的质量。
