住院精神疾病患者攻击行为相关因素分析

目的 调查住院精神疾病患者攻击行为的发生情况,探讨其影响因素.方法 采用自行设计的问卷收集376例住院精神疾病患者的相关资料.如患者发生攻击行为,责任护士24h内进行记录,以护理记录中记录到的攻击行为发生情况为准.结果 376例患者入院1个月内攻击行为的发生率为28.7%.Logistic回归结果提示,攻击行为史、住院次数等是患者攻击行为发生的危险因素,年龄为保护因素.结论 精神科护士应高度关注反复入院、有攻击行为史、离异患者,其攻击行为发生风险高;年龄较大患者的攻击行为发生风险低.护士应通过评估,及时进行干预和控制,以减少和控制攻击行为的发生.     

精神科护士遭受患者攻击的危险因素分析与预防措施

目的探讨精神科护士遭受患者攻击的危险因素分析与预防措施。方法选择2017年10月至2018年10月于我院住院治疗的80例精神疾病患者为研究对象,调查其住院期间攻击护士情况,多因素logistic回归分析确定精神科护士遭受患者攻击危险因素并制定相应预防策略。结果 80例精神疾病患者中,38例对护士做出过攻击行为,攻击事件共44起,其中殴打29起,咬伤10起,其他5起。多因素logistic回归分析显示酒精性精神障碍、精神分裂症、男性、有攻击行为史是精神科护士遭受患者攻击的独立危险因素(P 0. 05)。结论精神科护士遭受患者攻击发生率较高,应制订相应预防措施及防范技巧教育培训,规范其日常行为,以降低遭受攻击行为发生率。     

精神科护士职业防护现状调查

目的了解精神科护理人员职业防护现状,为采取针对性防护措施提供科学依据。方法采用问卷调查法,对96名在职精神科护士职业损伤及职业防护的情况进行调查。结果56.3%的护士曾被针刺伤,67.7%的护士有被患者攻击致伤史,60.4%的护士能正确处理针刺伤后的伤口,70%的护士认为针刺伤是危害自身健康的主要因素。结论应加强对精神科护士特别是年轻护士的职业防护教育,规范处理流程,以降低护理人员的职业感染率。     

精神科护士遭受工作场所身体暴力事件的现况调查

目的 探讨精神科护士遭受工作场所暴力的形式及心理情况的现状,为临床护士及管理者提供研究依据.方法 采取整群抽样的调查方法,对该院一年内遭受工作场所身体暴力的精神科护士的遭受暴力形式和心理状态调查,采用χ2以及单因素方差分析进行统计分析.结果 仅有9.9%的精神科护士掌握暴力防范技巧.精神科女护士较精神科男护士更易遭受暴力行为在身体性袭击(χ2=9.611)、遭遇患者或家属打砸(χ2=4.085)、和被威胁(χ2=5.172)等三方面,差异均有统计学意义(均P<0.05).71.8%的人认同医院暴力事件越来越多;83.0%的人认为不信任家属,对家属感到恐惧;74.6%的人认为经常失眠、伴有焦虑,但男女比较,差异无统计学意义(P>0.05).结论 精神科护士缺乏掌握工作场所暴力攻击的知识,大部分护士遭受过工作场所暴力,并且出现不良的心理状态(尤其是女护士),为管理者提供一定依据,以制定相应对策,降低工作场所暴力.     

精神科新入院老年患者意外风险评估与护理对策

目的 比较男性和女性精神科新入院老年患者存在意外风险的差异,以便护士更好地掌握不同性别患者的意外风险和重点观察内容,防止或减少意外风险发生.方法 运用跌倒、噎食、攻击和自杀4个风险因素评估量表及护士用住院患者观察量表（NOSIE）,对2011年8月至2012年8月北京市某三级甲等精神病专科医院新入院的83例60岁以上的患者进行评估.结果 老年精神科新入院患者存在风险排序前3位为攻击（43.4％）、跌倒（37.3％）、自杀（31.3％）.男性患者33例,有攻击风险的20例,女性患者50例,有攻击风险的16例,男性与女性攻击风险比较差异有统计学意义（x2 =5.510,P＜0.05）.男性有跌倒、自杀、噎食、外走风险的分别有12,11,8,9例,女性分别有19,15,15,11例,男女比较差异均无统计学意义（x2值分别为0.023,0.103,0.329,0.302;P ＞0.05）.不同性别的老年患者NOSIE各因子分比较差异均无统计学意义（P＞0.05）.结论 为保证精神科老年新入院患者住院期间的安全,男性患者更应关注攻击风险因素的评估,女性患者更应关注跌倒风险因素的评估.     

精神科护士受患者攻击状况调查

精神病患者攻击行为在精神科临床较常见，由于攻击行为可能产生严重的后果，因而引起了护理同行的重视和研究的兴趣，而护士与精神病患者接触频率最高，但很少有人对护士受攻击的情况进行调查研究。为了解精神科护士受患者攻击的情况，探讨最大限度降低受攻击风险，保证护士人身安全的策略，用自制的调查问卷对124名精神科护士进行调查，现报道如下。     

精神科护士遭受暴力侵害状况调查分析及对策

目的 调查精神科护士遭受精神病人暴力侵害的发生情况,探讨其影响因素及对策.方法 采用自行设计调查问卷,调查175名精神科护士遭受暴力侵害事件的特点及发生率等情况.结果 精神科护士遭受暴力侵害的总发生率为86.5％;身高在165 cm以下、工作5年内的护士遭受侵害的发生率高;中夜班比白班更易发生暴力侵害;91.3％的患者发生暴力行为的年龄在20 ～ 50岁,女性患者以言语攻击为主,男性患者则以行为攻击为主.71.2％发生在病情的急性期,28.8％与护士对待患者的态度有关.精神科护士遭受暴力侵害后常出现不良的心理反应.结论 精神科护士遭受精神病人暴力侵害的发生率较高,影响精神科病人实施暴力侵害的因素有护士身高、工作年限、工作时段、精神病患者的症状特点、护士的态度等.医院对护士遭受的暴力侵害关注较少.应采取有效的防范措施,并建立针对专科护士的心理服务支持系统以减少暴力侵害的发生及影响.     

精神科护士遭受暴力攻击心理状况分析

精神科护士是"职业暴露"的高危人群,经常遭受患者的暴力攻击[1].冲动引发的暴力伤人,是精神疾病患者在受到幻觉、错觉等引起的冲动、伤人行为[2].精神疾病患者暴力攻击的时间、原因、危害性等很难预见,护士不可避免的会受到患者攻击.护士在暴力事件的发生时常处于被动状态[3].为了解精神科护士遭受冲动攻击后的心理状况,作者对2010年1月-12月我院遭受患者攻击的精神科护士进行了调查,现将结果报告如下.     

精神科护士对精神疾病态度及影响因素分析

目的了解精神科护士对精神疾病态度及其影响因素。方法采用方便抽样方法,选取160名精神科护士,对其进行一般情况问卷、精神卫生人员态度量表、特质应对方式问卷的调查。结果本组精神科护士中,96.9%认为评估患者躯体、精神疾病症状很重要,84.4%认为不会遵循上级要求其以不恭的方式对待患者的指令,53.8%认为只有在需要时才会学习精神病知识,56.3%认为有严重精神病的患者永远不可能恢复到良好的生活质量,69.4%认为精神科医护人员不像是真正的医护人员,75.6%会用“疯的”“疯子”“傻的”等词语描述其护理的精神病患者。影响护士对精神疾病态度的因素有学历、积极应对方式（B分别是-3.62、0.52,P<0.01）。结论绝大部分精神科护士工作责任感较强,能以积极态度评估和护理患者;部分护士会用歧视性语言称呼患者,且对学习专业知识的态度消极,对精神疾病转归的看法较悲观;学历、积极应对方式是其影响因素。提示提高护士的受教育水平,加强专业技能和心理培训,有助于改善其对精神疾病的消极态度。     

男性住院精神疾病患者攻击行为发生率及相关因素分析

目的调查男性住院精神疾病患者攻击行为的发生率,探讨发生的相关因素,为加强防范攻击事件提供临床参考。方法采用自行设计的一般资料调查表及护士用住院观察量表收集622例男性住院精神疾病患者的人口学信息和临床资料,以护理记录为依据判断患者在住院1月内是否发生攻击行为,对有无攻击行为的两组精神疾病患者的一般资料及临床资料进行单因素分析及多元logistic回归分析。结果住院男性精神疾病患者攻击行为发生率约27.2%,单因素分析显示攻击行为的发生与患者年龄、职业、婚姻、自知力、既往攻击行为史、病程、激动因子分等有明显的相关性,多元logistic回归分析提示结果显示既往攻击行为史、激动因子分是患者攻击行为发生的危险因素,年龄、病程、自知力是保护因素。结论年龄在30岁以下、病程短、有攻击行为史、缺乏自知力、情绪不稳易激动患者,其攻击行为发生风险较高,精神科医务人员应高度关注,应通过及时评估,实施相关对策预防和减少精神疾病患者暴力攻击行为的发生。     

An exploratory investigation into the nursing management of aggression in acute psychiatric settings

The management of aggression in inpatient psychiatric facilities is a major concern for nurses. Despite the prevalence of research on aggression within psychiatric settings, very few studies have tracked the clinical management of identified patients in a systematic manner. The overall aim of this study was to explore the clinical management of patients identified as potentially aggressive in psychiatric inpatient settings. A multimethod approach was used to collect the data. This included surveys, focus groups, and a file audit of patients identified from a random sample of completed aggression incident forms. The findings indicated that 88% of nurses who participated in the survey were assaulted and indicated the need for risk assessment; team management and review; and the importance of the first 5 days of admission as crucial for assessment and review. The development of support structures, formal preceptoring and supervisory arrangements and postincident supports were suggested as part of an overall strategy to support nurses working in acute inpatient settings.     

A coercive interactional style as an antecedent to aggression in psychiatric patients.

As with society at large, violence in psychiatric settings is a serious clinical problem. Despite a great deal of attention, however, very little is currently known about the underlying theory or interventions to reduce aggression and violence in hospital settings. In this study, some psychiatric patients were viewed as having a general, aggressive, interactional style, motivated by the traits of Intimidation and Interpersonal Control, which when combined were labeled Coercion. A causal model in which violence and aggression were hypothesized to be predicted by a coercive interpersonal style and negatively predicted by an accommodating interpersonal style was tested. These interpersonal styles were proposed to mediate antecedent variables, that is, history of violence, psychiatric diagnoses, and length of hospitalization. Data were collected in two hospitals on psychiatric patients (N = 156) and analyzed using multiple regression techniques. The results of theoretical model testing suggested that 60% of the variance in Aggression was explained by four model variables: (a) Intimidation and Interpersonal Control (Coercion) (beta = .44), (b) Length of Hospitalization (beta = .26), (c) History of Violence (beta = .27), and (d) Bipolar Affective Syndrome (beta = .21). The implications for clinical care are discussed.     

风险评估管理在老年精神科病房中的应用

目的探讨老年精神科病房开展风险评估管理后,护士对患者情况的掌握及有效防止意外事件发生的作用。方法选取2010年1—12月老年科某病房60岁以上的56名住院患者作为研究组,以2009年1—12月该区60岁以上的55名住院患者作为对照组。对照组给予常规护理,研究组在此基础上实施风险评估管理,主要包括：医生评估患者的病情变化、治疗方法、用药以及药物的副作用等,护士每周评估患者否具有摔伤、噎食、压疮的风险,并制定针对性的护理措施。分别于研究前后比较护士对两组患者情况的掌握及意外事件的发生情况。结果护士对对照组患者情况掌握的总得分为（77．36±1．26）分,对研究组患者情况掌握的总得分为（85．60±3．07）分,两组比较差异有统计学意义（t=11．690,P〈0．01）;对照组意外风险发生45例,对照组发生19例,两组比较差异具有统计学意义（X^2=13．87,P〈0．05）。结论开展网险牙篙管硼有利于护士对于患者病情掌握和意外风险的防范,从而提高护理质量。     

Nursing students' experiences in managing patient aggression

BACKGROUND: Nursing students are at high risk to become a victim of patient aggression. There is little evidence that training programmes developed for post-registered nurses or nurses in psychiatric or forensic settings can meet the needs of nursing students. To gain more insight into student nurses' educational outcomes in Germany the view of the target group was explored. METHODS: Twelve nursing students participated in semi-structured interviews. Data were evaluated by qualitative content analysis. RESULTS: Managing patient aggression is a general challenge for nursing students and is not confined to psychiatric settings. Specific problems of beginners became evident. Additionally, general issues were addressed on control of causes of aggression, interpretation aggressive situations, dealing with the aggressive patient, coping with stress, and organizational issues. CONCLUSION: Nursing students need preparation and training in handling patient aggression. They should acquire knowledge about aggression, awareness of contributing problems, self-confidence in dealing with aggressive patients, assertiveness and empathy in communication and the ability to cope in an appropriate manner. In addition the safety policy of hospital placements should be examined for appropriateness to support nursing students.     

中重度老年痴呆住院病人跌倒与噎食风险及病人特征的研究

[目的]对中重度老年痴呆病人的跌倒和噎食风险进行评定并探讨高风险病人的特征,为临床护士实施相应的安全防范措施提供依据.[方法]采用方便抽样方法选取北京市某精神病院中重度老年痴呆住院病人51例,使用噎食和跌倒风险评估表、Barthel指数评定量表进行评估.[结果]51例病人中,具有跌倒和噎食风险的病人分别占52.9％和90.2％;既往来发生过跌倒或噎食的病人亦具有跌倒或噎食的高风险;跌倒风险与噎食风险不具有一致性（x2＝1.17,P=0.28）;年龄越大,痴呆病人发生跌倒（t=-2.30,P=0.03）和噎食（t=2.37,P=0.02）的风险就越高;自理能力低的病人跌倒风险高（t=-2.30,P＝0.03）.[结论]中重度痴呆病人具有较高的跌倒风险与噎食风险;两种风险评估需要独自评定,不能相互取代;既往没有跌倒史或噎食史的中重度痴呆病人也需要重点预防跌倒或噎食的发生;高龄病人和自理能力差者为需要重点关注的人群.     

精神科护士对自身遭受患者攻击情况感知的调查研究

目的调查护士感知到的攻击行为发生情况,探讨其影响因素。方法采用攻击行为发生情况感知量表(POPAS)对北京安定医院病房及门诊的184名在岗护士进行调查。该问卷包括16种类型的攻击行为及2个问题。结果护士感到攻击行为特别是语言攻击及轻微身体攻击等的发生频率高;不同性别、工作时间及是否参加攻击行为控制培训的护士对攻击行为的感知不同(P0.05),多元逐步回归结果提示,性别、职称、是否接受过攻击行为控制培训是护士对攻击行为感知的影响因素,变异系数为13.9%。结论精神科护士经常遭受轻微攻击,男护士、护师及主管护师感知到的攻击行为发生率高,接受过攻击行为控制培训的护士感知到的攻击行为少于未培训护士。这提示应关注护士的身心健康并对护士进行相应培训,以协助护士识别、预防及控制攻击行为的发生。     

Risk assessment of violence to others: time for action

Possible expansion in the scope of practice of mental health nurses, together with the prevalence of nurses being assaulted by patients, accentuates the need for nurses to be more skilled in risk assessment. A literature search was undertaken on the topics of risk assessment, dangerousness, aggression, and violence in the data bases of CINAHL, MEDLINE and PSYCHLIT, in order to determine an evidence based approach to risk assessment of patient violence towards others. In the absence of reliable and valid nursing risk assessment measures, the approach suggested here focuses on the use of observation skills to detect behaviour antecedent to physical assault, and the ability to systematically assess evidence-based risk factors of violent action. Given this rudimentary framework, there is the need to adapt it to specific clinical settings. Failure to proceed rapidly with such developments may jeopardize the safety of both patients and staff.     

A study of psychiatric nurses' beliefs and attitudes about work safety and assaults in Turkey

In Turkey, the cultural structure effects the gender roles in the society, and women are subject to violence in an intense manner both inside the family and in their workplaces. In nursing, which is still defined as a woman's job in our country, it is possible to encounter many aggressive and threatening behaviours. Knowing no geographical borders, aggression leads to dissatisfaction and alienation with the profession for the nurses working at the psychiatric institutions in Turkey, thus aggression is a significant health risk in physical, psychological and social dimensions. The research was carried out with 162 randomly selected nurses working in the psychiatric institutions in Istanbul using the Attitudes Toward Patient Physical Assault Questionnaire. It has been determined that nurses' rate of exposure to verbal/physical assault by the patients and their relatives is high and that they experience an intense uncertainty and conflict, especially in legal issues, and that the duration of working in the psychiatry clinics effects attitudes toward the assaults. It is concluded that the nurses working at the psychiatry clinics in Turkey are under risk in regards to safety and they need protection and support, both in emotional and in legal terms.