| Research Purpose:objective under the background of doctor-patient conflict has become increasingly serious,this research has focused on the high-risk places,general hospital emergency department to prepare precursor patient-doctor violence behavior on the scientific method to identify evaluation,and according to the score graded warning,develop coping strategies,to achieve the standardized general hospital emergency department doctor-patient conflicts,the purpose of processing for medical and nursing at the same time,logistics and other related personnel training information,to improve the recognition rate of doctor-patient conflicts and warning rate,reduce the incidence of conflict,improving the patient’s medical experience and satisfaction,to strengthen the medical staff occupational identity and belonging,provide an empirical basis for the construction of a harmonious doctor-patient relationship.Research Method:This study adopts the methods of literature analysis,current situation investigation,brainstorming,structured interview,Delphi expert letter consultation and typical event analysis.1.Literature analysis: Through "emergency department,conflict,doctor-patient conflict,violent conflict,doctor-patient dispute,premonitory behavior,workplace violence,nurse-patient conflict" "Emergency Department,conflict,doctor-patient conflict,violent conflict,medical dispute,Aura,Workplace violence,conflict between nurses and patients" searched the relevant literature of Emergency doctor-patient conflict in nearly 10 years since 2009.Through the Chinese keywords "doctor-patient conflict,nurse-patient conflict,influencing factors,early warning,coping strategies,countermeasures progress",English keywords "Conflict of medical care,the Conflict of nurse and patient,influencing factors and countermeasures,and intervention measures and countermeasure progress" retrieval in recent years the doctor-patient conflicts early-warning and emergency response of the literature.2.The current situation survey method: Questionnaire survey was mainly used to understand the occurrence of doctor-patient violent conflicts in the hospital emergency work place in the past 1 year and the premonitory behaviors of patients or their families before the occurrence.3.Brainstorm: A total of 20 medical and managerial staff with more than 1 year of work experience in the emergency department were selected to conduct a brainstorming to analyze the premonitory behaviors of patients or their families before the occurrence of doctor-patient conflict,and all items were sorted out,integrated and summarized to form the preliminary items.4.Semi-structured interviews: A total of 10 people in the auxiliary department were selected for semi-structured interview to understand the identification and response of emergency auxiliary staff to the behavior premonitory of doctor-patient violent conflict.5.Delphi Expert Correspondence: To select senior and experienced experts to conduct two rounds of Delphi expert consultation,and to construct evaluation table and classification standard for emergency doctor-patient violence predictor behavior identification.6.Typical event analysis: The murder of Dr.Yang Wen in the emergency department of Beijing Civil Aviation General Hospital in January 2020 was mainly selected to analyze the premongering behavior of the patient or family members before the occurrence of doctor-patient conflict and the countermeasures taken for this event,so as to lay a foundation for the targeted development of doctor-patient conflict hierarchical response strategies.7.Statistical analysis:(1)Quantitative researchTwo persons input data into SPSS19.0 software for data analysis.Enumeration data in statistical description are described by frequency and percentage;Measurement data were described as "mean ± standard deviation".In the statistical analysis,two independent samples are used to test the measurement data in accordance with the normal distribution.Nonparametric statistical rank sum test was performed for measurement data that did not conform to normal distribution.Chi-square test or Fisher’s exact probability test are used for counting data.(2)Qualitative researchThe interview records were extracted according to the interview outline by manual analysis,and the data notes were checked to find out the common phenomena among the respondents.Results:1.Research the current situationThe frequency of emergency nurses reporting conflict in 1 year was: 55.8% of nurses experienced 1～3 conflicts in 1 year,13.9% of nurses experienced 10 conflicts in > in 1 year.The type of conflict experienced by emergency nurses was mainly verbal abuse,followed by the use of threatening language and actions.The occurrence place is mostly in infusion room,followed by triage desk,emergency room;Time of occurrence: 39.3% of violent conflicts occurred in the daytime,33.9% in the night shift,24.4% occurred at night and 2.4% occurred after work;The perpetrators are mainly family members(or friends)of the patients,and the gender is mainly male.The premonitory behaviors of the patients or their relatives before the occurrence of violent conflict were as follows: verbal abuse,emotional excitement and increased tone of voice;In terms of the differences of different demographic characteristics,the occurrence of violent conflicts was different due to the different educational level and working years of nurses,and the difference was statistically significant(P<0.05).The impact of conflict on emergency nurses: 86.2% of nurses felt wronged,75.5% showed a decline in work enthusiasm,and 60.1% thought of leaving.Coping style: 69.1% of nurses would seek help from security guards or superior leaders by taking more tolerant and evasive methods.2.Semi-structured interviewsThree themes were extracted from the staff of auxiliary medical department on the behaviors of foreboding before the occurrence of violent doctor-patient conflicts: the frequent occurrence of violent conflicts among security personnel was relatively bad in nature,and sometimes the phenomenon of direct hitting occurred;The frequency of doctor-patient violent conflicts in the toll office,pharmacy,inspection,imaging and other departments is relatively low,mainly verbal abuse;The majority of people involved in violent clashes at night emergency workplaces were drunk.3.Delphi expert consultationThere were two rounds.The first round had 14 experts participating in the study and the second round had 13 experts participating.The questionnaire recovery rate of the two rounds was 92.9% and 100% respectively.In the first round of consultation,the authority coefficient of experts was 0.89,the mean value of the importance of indicators at all levels was 3.71～4.79,and the coefficient of variation was 0～0.25.Ten experts put forward 19 opinions.In the second round of consultation,the authority coefficient of experts was 0.90,the importance value of indicators at all levels was 4.14～5.00,and the coefficient of variation was 0～0.14.Five experts put forward 7 opinions.The coordination coefficient of the first round of expert consultation(index I,II and III)is 0.256,0.256 and 0.404,respectively;The coordination coefficient of the second round of expert consultation(index I,II and III)is 0.431,0.200 and 0.505 respectively.The two rounds of expert consultation Kendall harmony coefficient significance test were P < 0.05 and P < 0.01 respectively,both of which were statistically significant.4.In the evaluation table of predictive behavior of emergency doctor-patient violence conflict,the final selected items are 4 first-level indicators,9 second-level indicators and 33 third-level indicators.The weight values of first-level indicators are 0.253,0.245,0.249 and 0.253,respectively;the weight values of second-level indicators range from 0.104-0.118,and the weight values of third-level indicators range from 0.025-0.034.5.Based on literature research,specific meetings were held to formulate hierarchical response strategies,including the formation of early warning and early control plans,implementation of hierarchical response strategies,formulation of specific plan procedures,and refining of integrated response models.Conclusion:1.The occurrence rate of violence conflict in emergency workplace is high,and the occurrence of violence conflict is different due to the different education level and working years of nurses.Therefore,training of nursing staff with low seniority should be strengthened to teach nursing staff to recognize the precursor behavior of violence conflict between doctors and patients,and master effective communication skills to reduce the occurrence of conflict.2.After two rounds of Delphi expert consultation,according to expert consultation opinions and revision,combined with the results of indicator screening,importance assigning,weight calculation,etc.the evaluation table of predictive behavior of emergency doctor-patient violence was constructed from the aspects of language,emotion,behavior and high-risk factors.3.According to the comparison degree of items in the second-level indicators in the doctor-patient behavior identification evaluation table,the risk level is determined according to the score,which is mainly divided into three risk levels: high,medium and low.4.The evaluation table of emergency doctor-patient violence threatening behaviors developed in this study has few items,fine contents,and is convenient and practical.After the training of emergency medical technicians,it can be quickly mastered,and the warning behaviors of doctor-patient violence in emergency workplace can be quickly identified in the clinical application process.5.The development of hierarchical warning and response strategies for emergency doctor-patient violent conflict behaviors,combined with the use of predictive behavior evaluation forms,reduced the incidence of doctor-patient violent conflict in the emergency workplace after initial clinical application,and higher satisfaction of nursing staff. |
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