Owen C, Tarantello C, Jones M, Tennant C
Department of Psychological Medicine, University of Sydney and Canberra Hospital, Woden, New South Wales, Australia.
Psychiatr Serv. 1998 Nov;49(11):1452-7. doi: 10.1176/ps.49.11.1452.
To help predict aggressive and violent behaviors, the frequency and types of these behaviors in acute psychiatric inpatient settings were examined, and potential interactions between staffing and patient mix and rates of the behaviors were explored.
Data on violent incidents were gathered prospectively in three adult acute psychiatric units in a general hospital and two units in a primary psychiatric hospital in Sydney, Australia. Staff recorded violent and aggressive incidents, which were ranked on an 8-level scale. They also completed weekly reports of staffing levels and patient mix. Poisson regression analysis was used to calculate relative rates, 95 percent confidence intervals, and p values.
A total of 1,289 violent incidents were recorded over a seven-month period. Based on the scale, 58 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more nonnursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. In total these factors accounted for 62 percent of the variance in violence.
Violent incidents in psychiatric settings are a frequent and serious problem. Incidents appear to be underreported, and the seriousness of an incident does not guarantee it will be reported.
为了帮助预测攻击性行为和暴力行为，对急性精神科住院环境中这些行为的频率和类型进行了检查，并探讨了人员配备与患者构成之间的潜在相互作用以及这些行为的发生率。
前瞻性收集了澳大利亚悉尼一家综合医院的三个成人急性精神科病房以及一家初级精神病医院的两个病房中暴力事件的数据。工作人员记录暴力和攻击事件，并按照8级量表进行分级。他们还完成了每周的人员配备水平和患者构成报告。采用泊松回归分析来计算相对发生率、95%置信区间和p值。
在七个月的时间里共记录了1289起暴力事件。根据该量表，58%的事件较为严重。78%的事件针对护理人员。发现人员配备、患者构成与暴力之间存在复杂的关系。相对风险随着以下因素增加：更多的护理人员（无论男女）、更多计划休假的非护理人员、更多已知会煽动暴力的患者、更多迷失方向的患者、更多被强制拘留的患者以及更多使用隔离措施的情况。相对风险随着以下因素降低：更多年轻工作人员（30岁以下）、更多计划外缺勤的护理人员、更多入院患者以及更多有药物滥用或身体疾病的患者。这些因素总共解释了暴力行为中62%的差异。
精神科环境中的暴力事件是一个频繁且严重的问题。事件似乎报告不足，而且事件的严重性并不能保证其会被报告。
