动态暴力风险评估量表在新入院精神障碍患者中的应用研究
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摘要
目的:探讨动态暴力风险评估量表(DASA)在新入院精神障碍患者中的应用,为住院精神障碍患者的暴力风险评估提供理论依据。方法:选取2018年4-11月笔者所在医院具有暴力攻击行为的新入院精神障碍患者360例。按照随机数字表法将其分为研究组和对照组,各180例。研究组采用DASA量表,对照组使用暴力历史、临床、风险评估量表(HCR-20),比较两组24 h的预测结果、量表完成程度、护士满意度。结果:24 h内,两组有攻击行为者DASA评分均高于无攻击行为者(P<0.05);DASA评分的AUC高于HCR-20评分,但差异无统计学意义(P>0.05);DASA量表完成率、满意度均高于HCR-20量表(P<0.05)。结论:对于暴力攻击行为的新入院的精神患者,DASA与HCR-20量表的预测结果相当,护理人员对DASA量表的临床完成度高、满意度高。
Objective:To explore the application of dynamic appraisal of situational aggression(DASA in newly admitted patients with mental disorders,and to provide theoretical basis for the risk assessment of violence in hospitalized patients with mental disorders.Method:A total of 360 newly admitted psychiatric patients with violent aggression in our hospital from April to November 2018 were selected.According to the random number table method,they were divided into study group and control group,180 cases in each group.The DASA scale was used in study group and historical,clinical,risk management-20(HCR-20)was used in control group.The 24 h predictive results,scale completion and nurses' satisfaction between two groups were compared.Result:Within 24 h,the DASA scores of aggressors in two groups were higher than those of non-aggressors(P<0.05).The AUC of DASA score was higher than that of HCR-20 score,but there was no significant difference(P>0.05).The completion rate and satisfaction rate of DASA were higher than those of HCR-20(P<0.05).Conclusion:For newly admitted psychiatric patients with violent aggression,the predicted results of DASA and HCR-20 scale were similar,nurses were highly satisfied with the clinical completion of DASA scale.
Objective:To explore the application of dynamic appraisal of situational aggression(DASA in newly admitted patients with mental disorders,and to provide theoretical basis for the risk assessment of violence in hospitalized patients with mental disorders.Method:A total of 360 newly admitted psychiatric patients with violent aggression in our hospital from April to November 2018 were selected.According to the random number table method,they were divided into study group and control group,180 cases in each group.The DASA scale was used in study group and historical,clinical,risk management-20(HCR-20)was used in control group.The 24 h predictive results,scale completion and nurses' satisfaction between two groups were compared.Result:Within 24 h,the DASA scores of aggressors in two groups were higher than those of non-aggressors(P<0.05).The AUC of DASA score was higher than that of HCR-20 score,but there was no significant difference(P>0.05).The completion rate and satisfaction rate of DASA were higher than those of HCR-20(P<0.05).Conclusion:For newly admitted psychiatric patients with violent aggression,the predicted results of DASA and HCR-20 scale were similar,nurses were highly satisfied with the clinical completion of DASA scale.
引文
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[22]邹海欧,姚秀钰,李峥,等.HCR-20量表在社区精神分裂症患者中的初步测评[J].中国护理管理,2016,16(7):909-913.
[23]肖茜,李纯,王小平,等.暴力危险性评估-20对精神分裂症暴力危险性评估的信效度研究[J].医学临床研究,2010,27(3):405-408.
[24]Mühlbauer E,Bauer M,Ebner-Priemer U,et al.Effectiveness of smartphone-based ambulatory assessment(SBAA-BD)including a predicting system for upcoming episodes in the longterm treatment of patients with bipolar disorders:study protocol for a randomized controlled single-blind trial[J].BMC Psychiatry,2018,18(1):349.
[2]Olashore A A,Akanni O O,Ogundipe R M.Physical violence against health staff by mentally ill patients at a psychiatric hospital in Botswana[J].BMC Health Serv Res,2018,18(1):362.
[3]Masna B,Giezek M,Ciechowicz J,et al.The analysis of the phenomenon of violence in psychiatric patients[J].Psychiatr Pol,2018,52(1):103-113.
[4]d'Ettorre G,Pellicani V.Workplace Violence Toward Mental Healthcare Workers Employed in Psychiatric Wards[J].Saf Health Work,2017,8(4):337-342.
[5]Magaard J L,Liebherz S,Melchior H,et al.Collaborative mental health care program versus a general practitioner program and usual care for treatment of patients with mental or neurological disorders in Germany:protocol of a multiperspective evaluation study[J].BMC Psychiatry,2018,18(1):347.
[6]Haines A,Brown A,Javaid S F,et al.Assessing Protective Factors for Violence Risk in U.K.General Mental Health Services Using the Structured Assessment of Protective Factors[J].Int JOffender Ther Comp Criminol,2018,62(12):3965-3983.
[7]Cowman S,Bj?rkdahl A,Clarke E,et al.A descriptive survey study of violence management and priorities among psychiatric staff in mental health services,across seventeen european countries[J].BMC Health Serv Res,2017,17(1):59.
[8]Kaunom?ki J,Jokela M,Kontio R.Interventions following a high violence risk assessment score:a naturalistic study on a Finnish psychiatric admission ward[J].BMC Health Serv Res,2017,17(1):26.
[9]Loveland-Jones C,Ferrer L,Charles S,et al.A prospective randomizedstudy of the efficacy of“Turning Point,”an inpatient violence intervention program[J].J Trauma Acute Care Surg,2016,81(5):834-842.
[10]Langeveld J,Bj?rkly S,Evensen J,et al.A 10-year follow-up study of violent victimization in first episode psychosis:Risk and protective factors[J].Psychiatry Res,2018,259:545-549.
[11]施忠英,张菊英,许德君,等.中文版暴力风险量表在住院精神疾病病人中的应用[J].护理研究,2014,28(23):2833-2835.
[12]Rotter M,Rosenfeld B.Implementing a Violence Risk Screening Protocol in a Civil Psychiatric Setting:Preliminary Results and Clinical Policy Implications[J].Community Ment Health J,2018,54(3):245-251.
[13]张帮峰,朱要国,张太栋,等.精神科暴力行为风险管理的研究进展[J].护理研究,2018,32(10):1516-1521.
[14]Le D V,Montgomery J,Kirkby K C,et al.Risk prediction using natural language processing of electronic mental health records in an inpatient forensic psychiatry setting[J].J Biomed Inform,2018,86(18):49-58.
[15]苏蕊,任丽丽,郭永秋.风险评估干预对预防癫痫性精神障碍患者暴力冲突行为的影响[J].齐齐哈尔医学院学报,2015,36(31):4795-4797.
[16]刘俐芬,马莹,王向林,等.香港暴力风险评估表和防暴力技能对暴力事件发生和护士自我效能的影响[J].国际护理学杂志,2017,36(24):3317-3320.
[17]杨明丽,杨婷.住院精神病人自杀风险评估量表的初步编制[J].临床心身疾病杂志,2015,21(5):62-66.
[18]马莹,耿云龙,步翔宇,等.暴力风险评估表在住院精神疾病患者中的应用研究[J].中华护理教育,2017,14(10):758-760.
[19]Al-Azzam M,Al-Sagarat A Y,Tawalbeh L,et al.Mental health nurses'perspective of workplace violence in Jordanian mental health hospitals[J].Perspect Psychiatr Care,2018,54(4):477-487.
[20]沈晓华.精神科患者暴力行为的预防及护理干预[J].中国校医,2018,32(6):478-479.
[21]周慧兰.住院精神病患者暴力行为原因分析及护理对策[J].中国现代医生,2017,55(36):158-160.
[22]邹海欧,姚秀钰,李峥,等.HCR-20量表在社区精神分裂症患者中的初步测评[J].中国护理管理,2016,16(7):909-913.
[23]肖茜,李纯,王小平,等.暴力危险性评估-20对精神分裂症暴力危险性评估的信效度研究[J].医学临床研究,2010,27(3):405-408.
[24]Mühlbauer E,Bauer M,Ebner-Priemer U,et al.Effectiveness of smartphone-based ambulatory assessment(SBAA-BD)including a predicting system for upcoming episodes in the longterm treatment of patients with bipolar disorders:study protocol for a randomized controlled single-blind trial[J].BMC Psychiatry,2018,18(1):349.