医护人员遭遇医院工作场所暴力情况及影响因素分析

目的 了解医护人员遭受医院工作场所暴力现状,分析影响医院工作场所暴力发生的因素,探寻易遭受医院工作场所暴力医护人员的特点。 方法 采用整群抽样方法选择研究对象,利用自行设计问卷对研究对象2013年6月至2014年6月遭受医院工作场所暴力情况进行调查,采用SAS9.3进行数据分析。结果 医院工作场所暴力事件的发生率为66.1%,急症科室、年龄31～40岁、已婚、中级职称、在院工作时间11～20年、与患者接触时间长与医院工作场所暴力事件的发生显著相关。结论 医护人员在医院工作场所遭受暴力的风险性高,对医护人员心理和职场行为均会产生不良影响。应从个体层面、医院层面及社会制度层面采取预防措施,构建和谐的医疗环境。     

公立医院工作场所患者暴力对护士职业倦怠的影响

目的 探讨公立医院工作场所患者暴力对护士职业倦怠的影响以及可能的机制。方法 采用横断面问卷调查法收集数据,采用多元阶层线性回归分析法进行数据统计分析。结果 公立医院工作场所暴力的发生频率由高到低的次序是语言侵犯、苛刻刁难、妨碍工作、诋毁声誉、威胁恐吓、躯体攻击、性骚扰类,样本护士的职业倦怠总体发生率为68.9%,遭受暴力对护士职业倦怠具有积极的预测作用（β=0.379,P＜0.01）。结论 大多数护士遭受到过不同类型的患者暴力,职业倦怠在护士群体中也较为普遍。减少患者暴力并构建和谐的护患关系将有利于缓解护士的身心疲惫状态,进而提高护理服务质量。     

医疗工作场所暴力流行特点与应对策略研究

通过对国内外相关文献进行梳理,归纳总结医疗工作场所暴力现状及流行特点,包括医疗工作场所暴力发生率、暴力场所、暴力时间、诱发因素及受害者应对方式、暴力不良影响等方面。最后,针对现状提出可供借鉴的策略。     

县级医院工作场所暴力现状及影响因素分析

目的 了解县级医院医生遭受医院工作场所暴力的流行特征并分析原因,提出相应的防范策略,降低医院工作场所暴力事件的发生。方法 使用自拟问卷对我国东、中、西部地区共90所县级医院进行问卷调查,其中有效问卷5842份,有效收回率为81.91%。结果 县级医院医生暴力总发生率为69.38%;logistic回归分析结果显示,医生的性别、年龄、教育程度、月平均收入、所在科室与工作年限是医院工作场所暴力的影响因素。结论 暴力的发生率偏高（主要特征）,建议相关部门加大对医院工作场所暴力的干预,维护医院正常秩序,为医生提供良好的工作环境。

     

河北省精神科护士应对精神科暴力技能培训的调查研究

目的 了解河北省精神科护士应对精神科暴力行为技能培训情况,为做好精神科护士防暴技能培训提供依据。方法 采用自制调查问卷,对河北省精神科护士防暴技能培训情况进行调查分析。结果 （1）48.1%的护士回答经常和常常经历精神病人的暴力行为,并且有93.8%的护士在处理暴力行为时受到过不同程度的伤害;（2）15.2%和33.7%的护士对自身的职业安全没有关注和很少关注,92.5%的护士认为各级管理者对护士的职业安全未引起足够的重视;（3）应对暴力专业技巧（脱身法、控制法）的培训情况,75.6%的护士回答没有或很少有;（4）96.5%的护士回答需求或非常需求精神科暴力行为的专业技巧培训。结论 河北省精神科临床暴力行为普遍存在,暴力行为对护士造成不同程度的伤害,但对精神科护士防暴专业知识和专业技能技巧培训非常欠缺,远远达不到护士的需求,所以要提高各级领导和护士自身对精神科护理职业安全的关注和重视,加大对精神科护士防暴知识和技巧的培训,减少精神科暴力行为的伤害。     

黄山机场鸟类调查与鸟击防范对策探讨

2006年4月至2007年11月对黄山机场及其周边地区的鸟类进行了调查,共记录鸟类111种,隶属14目36科,构成鸟击航空器隐患的主要种类有池鹭、赤腹鹰、家鸽、小云雀、家燕和麻雀6种,其次是白鹭、凤头麦鸡、黄斑苇、山斑鸠、豆雁、鸢、棕背伯劳等.对该区域鸟类的区系成份、居留特点和主要威胁鸟类的活动情况进行了分析,并提出了一些鸟击防范对策.     

老年精神科护理风险研究

目的:分析探讨精神科老年病人的护理安全风险因素及降低安全风险的对策。方法:选取我院精神科于2013年4月至2014年5月收治的老年精神病人100例进行回顾性的分析。结果:影响精神科老年病人的护理安全的因素主要有:饮食不当(噎食)、行动不当(跌倒)、皮肤损伤。结论:影响精神科老年病人的护理安全的因素对病人的生命安全造成了严重的影响,对此,精神科老年病人的护理要具有针对性与预见性,提高护理安全,减少护患矛盾。     

企业道德风险防范对策之我见

企业作为市场经济的风险承担者,在经营过程中必然面临着各种风险考验,其中由委托-代理关系产生的信息不对称引起的道德风险不仅损害企业集体的利益,助长投机的行为,还影响企业的长远发展。因此企业需要主动寻求有效的措施来防范道德风险。道德风险治理和财务治理作为公司治理的重要组成部分,在公司治理理论和实践上都起到重要的作用,但是单一方面的治理又有局限性,通过两种治理机制共同配合实施的方法来抑制企业的败德行为和利己主义行为能够很好的解决企业内部、外部的利益矛盾。     

影响儿科护理满意度的原因及防范对策

儿科因其对象特殊 ,牵涉范围较广 ,要求也高 ,与其他成人科室有很大不同。护理工作面对的不仅是患儿 ,还有他们的家长 ,往往因有些家长过于疼爱孩子 ,而给护理工作带来的难度更大 ,极易产生对护理工作的不满意 ,因此 ,认真分析其原因及探讨防范对策 ,对进一步加强儿科护理人员的自身建设及完善医疗护理服务等都是十分有益的。1　原因分析1 .1　护士综合素质有待提高　儿科护士不仅要具备一般医务人员的职业道德外 ,还需要具有儿科护士特殊的素质要求 ,而对社会经验不足、应变观察能力不足、服务不到位、与家属沟通缺乏技巧、对家属提出的问…     

精神科医疗告知存在的问题及改进措施

医疗告知已成为当前医疗活动中的重要内容。由于精神疾病患者的特殊性,导致精神科医疗告知还存在许多未解的难题。分析精神科医疗告知存在的问题,探讨规范告知的内容、方式、流程,提出对策和改进措施,对临床工作具有一定的指导意义。     

Descriptive Epidemiology and Underlying Psychiatric Disorders among Hospitalizations with Self-Directed Violence

Background

Suicide claims over one million lives worldwide each year. In the United States, 1 per 10,000 persons dies from suicide every year, and these rates have remained relatively constant over the last 20 years. There are nearly 25 suicide attempts for each suicide, and previous self-directed violence is a strong predictor of death from suicide. While many studies have focused on suicides, the epidemiology of non-fatal self-directed violence is not well-defined.

Objective

We used a nationally representative survey to examine demographics and underlying psychiatric disorders in United States (US) hospitalizations with non-fatal self-directed violence (SDV).

Method

International Classification of Disease, 9^th Revision (ICD-9) discharge diagnosis data from the National Hospital Discharge Survey (NHDS) were examined from 1997 to 2006 using frequency measures and adjusted logistic regression.

Results

The rate of discharges with SDV remained relatively stable over the study time period with 4.5 to 5.7 hospitalizations per 10,000 persons per year. Excess SDV was documented for females, adolescents, whites, and those from the Midwest or West. While females had a higher likelihood of self-poisoning, both genders had comparable proportions of hospitalizations with SDV resulting in injury. Over 86% of the records listing SDV also included psychiatric disorders, with the most frequent being affective (57.8%) and substance abuse (37.1%) disorders. The association between psychiatric disorders and self-injury was strongest for personality disorders for both males (OR = 2.1; 95% CI = 1.3–3.4) and females (OR = 3.8; 95% CI = 2.7–5.3).

Conclusion

The NHDS provides new insights into the demographics and psychiatric morbidity of those hospitalized with SDV. Classification of SDV as self-injury or self-poisoning provides an additional parameter useful to epidemiologic studies.     

Neuropsychological Impairment and Its Association with Violence Risk in Japanese Forensic Psychiatric Patients: A Case-Control Study

Background

In Japan, the legislation directing treatment of offenders with psychiatric disorders was enacted in 2005. Neuropsychological impairment is highly related to functional outcomes in patients with psychiatric disorders, and several studies have suggested an association between neuropsychological impairment and violent behaviors. However, there have been no studies of neuropsychological impairment in forensic patients covered by the Japanese legislation. This study is designed to examine the neuropsychological characteristics of forensic patients in comparison to healthy controls and to assess the relationship between neuropsychological impairment and violence risk.

Methods

Seventy-one forensic patients with psychiatric disorders and 54 healthy controls (matched by age, gender, and education) were enrolled. The CogState Battery (CSB) consisting of eight cognitive domains, the Iowa Gambling Task (IGT) to test emotion-based decision making, and psychological measures of violence risk including psychopathy were used.

Results

Forensic patients exhibited poorer performances on all CSB subtests and the IGT than controls. For each group, partial correlational analyses indicated that poor IGT performance was related to psychopathy, especially antisocial behavior. In forensic patients, the CSB composite score was associated with risk factors for future violent behavior, including stress and noncompliance with remediation attempts.

Conclusion

Forensic patients with psychiatric disorders exhibit a wide range of neuropsychological impairments, and these findings suggest that neuropsychological impairment may increase the risk of violent behavior. Therefore, the treatment of neuropsychological impairment in forensic patients with psychiatric disorders is necessary to improve functional outcomes as well as to prevent violence.     

Prevalence and Risk Factors of Violence by Psychiatric Acute Inpatients: A Systematic Review and Meta-Analysis

Background

Violence in acute psychiatric wards affects the safety of other patients and the effectiveness of treatment. However, there is a wide variation in reported rates of violence in acute psychiatric wards.

Objectives

To use meta-analysis to estimate the pooled rate of violence in published studies, and examine the characteristics of the participants, and aspects of the studies themselves that might explain the variation in the reported rates of violence (moderators).

Method

Systematic meta-analysis of studies published between January 1995 and December 2014, which reported rates of violence in acute psychiatric wards of general or psychiatric hospitals in high-income countries.

Results

Of the 23,972 inpatients described in 35 studies, the pooled proportion of patients who committed at least one act of violence was 17% (95% confidence interval (CI) 14–20%). Studies with higher proportions of male patients, involuntary patients, patients with schizophrenia and patients with alcohol use disorder reported higher rates of inpatient violence.

Conclusion

The findings of this study suggest that almost 1 in 5 patients admitted to acute psychiatric units may commit an act of violence. Factors associated with levels of violence in psychiatric units are similar to factors that are associated with violence among individual patients (male gender, diagnosis of schizophrenia, substance use and lifetime history of violence).     

Negotiating Dangerous Fields: Pragmatic Strategies for Fieldwork amid Violence and Terror

As anthropology turns toward the cultural issues of the 21 st century, more and more ethnographic fieldwork is and will continue to be conducted in regions fraught with conflict, instability, and terror. Despite a growing literature that seeks to develop new theories and perspectives for the study of violence, little mention is made of the practical matters of survival in perilous field sites and how the anthropologist's experience of violence in the field should be considered. What is needed is a pragmatic strategy for dealing with threats to the safety, security, and well-being of anthropologists and informants who work amid the menace of violence. Drawing on my own fieldwork in Haiti, I suggest the adoption of new tactics for ethnographic research and survival in dangerous fields—strategies that challenge the conventional ethics of the discipline, reconfigure the relationship between anthropologist and informant, and compel innovation in negotiating the exchange of data under hazardous circumstances. [Keywords: fieldwork, violence, methodology, ethics, Haiti]     

美国急诊科拥挤的应对策略及其对我国的启示

急诊科拥挤是现阶段影响我国医疗体系安全的重要因素。在对急诊科拥挤内涵作出科学界定的基础上,通过查阅、翻译美国急诊科拥挤的文献、网站等方法,介绍了美国急诊科拥挤先进的做法和经验。在对比分析中美急诊科拥挤成因的基础上,发现其共性原因,并在此基础上对其防范经验合理借鉴并本土化,提出了急诊科拥挤评估工具的引入、急诊科拥挤专业化团队的管理、急诊科拥挤专职人员的配备等完善对策,以期对我国亟需解决的急诊科拥挤提供有益参考。