Facteurs li¡§|s aux?¡§|pisodes violents dans?les?soins: R¡§|sultats de l'enqu¡§ote europ¡§|enne Presst-Next

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• 作者：Madeleine Estryn-Behar¹ ; ^{madeleine.estryn-behar@sap.ap-hop-paris.fr} ; Nathalie Duville² ; Marie-Laurè ; ne Menini³ ; Donatella Camerino⁴ ; Serge Le Foll⁵ ; Olivier le Né ; zet⁶ ; Rachel Bocher⁷ ; Beatrice Van Der Heijden⁸ ; Paul Maurice Conway⁹ ; Hans-Martin Hasselhorn¹⁰ ; le Next-Study group
• 刊名：La Presse M¡§|dicale
• 出版年：2007
• 出版时间：January 2007
• 年：2007
• 卷：36
• 期：1_part_P1
• 页码：21-35
• 全文大小：426 K

文摘

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Summary

Introduction

The respective roles of medical specialties and work organization on violent events against healthcare workers (HCW) in different countries was examined.

Methods

Using the results of the Presst-Next study, we analyzed data from 27 134 HCW in 7 European countries. Multivariate logistic analyses were conducted with SPSS 12 software.

Results

After adjustment for age, gender and other occupational risk factors, the factors indicating insufficient team work were highly associated with an increased risk of violent events. Dissatisfaction with shift change (OR=1.35; 95 % CI 1.23-1.47), uncertainty about treatment (OR=1.57; 95 % CI 1?.44-1.71), and frequent interruptions (OR=2.04; 95 % CI 1.81-2.31) were linked to violent events, up to twice the number among HCW reporting better team work. Contradictory orders, dissatisfaction with psychological support, and harassment by superiors were all significantly associated with increased reporting of frequent violent events. We observed a positive gradient between violent events and job demand (time pressure) (OR=1.25 for an intermediate score and OR=1.55 for a high score, compared with a low score). Loneliness at work, certain work schedules, and physical load increased the risk. Nurses' aides were exposed to violent events more often (OR=1.57; 95 % CI 1.38-1.79) than head nurses. Older HCW and those with more experience were less exposed. The highest risks were associated with working in psychiatric (OR=4.89; 95 % CI 3.82-6.25) and emergency (OR=2.68; 95 % CI 2.10-3.44) departments, compared with home care and day care. The excess risk was an additional 30 % in geriatrics and long-stay departments. Significantly less risk was observed in pediatrics, obstetrics and gynecology departments (OR=0.70; 95 % CI 0.56-0.88).

Conclusion

Team building requires time, and shift change is a key period. This time is far from nonproductive. Rather, its effective use reduces treatment errors, enhances quality of care, and reduces the frequency of violent events. It is crucial in every department.