Implementing a re-structured response to behavioural disturbance in the emergency Department – A mixed methods evaluation

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing Pub Date : 2025-03-26 DOI:10.1016/j.ienj.2025.101600

Jennifer Davids , Nicole Bohlken , Martin Brown , Margaret Murphy

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引用次数: 0

Abstract

Background

The increasing prevalence of violence in Emergency Departments (EDs) globally emphasises that the early detection of behavioural disturbance, the skilful application of de-escalation techniques and as a last resort, patient restraint, are vital to the safety and wellbeing of staff and patients.

The findings from our previous research led four EDs across three sites to form a working party consisting of clinicians, educators, IT specialists, researchers, and security officers to design and implement a restructured approach to managing behavioural emergencies.

Methods

This mixed methods study used surveys and interviews and the Theoretical Domains Framework (TDF) to evaluate the barriers and facilitators to implementing an intervention designed to manage behavioural emergencies. We collected 61 surveys and conducted 12 interviews with nurses, physicians and security staff.

Results

The qualitative and quantitative data collected using the TDF pinpointed six facilitators and nine barriers for the implementation of the Code Black intervention. We were able to identify environmental, systemic and cultural factors that inhibited its implementation. Staff felt confident in their ability to apply the Code Black knowledge and skills and appreciative of efforts being made to improve safety. However, some remain unconvinced that behavioural change of staff will lead to safer outcomes.

Conclusion

The restructured approach is an effective containment of escalating aggression which ensures greater safety of patients and staff. However, the implementation of interventions in emergency care settings is complex. EDs have unique characteristics that influence sustainability and that need to be explored further to ensure the ongoing uptake of new practices. This paper demonstrates how to identify facilitators and barriers to change and provide evidence that may be used to drive implementation in the emergency care setting.

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在急诊科实施对行为障碍的重组反应——混合方法评估

背景：全球急诊科暴力事件日益普遍，这突出表明，及早发现行为障碍、熟练应用降级技术以及在最后手段时对患者进行克制，对工作人员和患者的安全和福祉至关重要。我们之前的研究结果促使三个站点的四名ed组成了一个由临床医生、教育工作者、IT专家、研究人员和安全官员组成的工作组，以设计和实施一种重组的方法来管理行为紧急情况。方法这项混合方法研究使用调查和访谈以及理论领域框架（TDF）来评估实施旨在管理行为紧急情况的干预措施的障碍和促进因素。我们收集了61份调查问卷，对护士、医生和保安人员进行了12次访谈。结果使用TDF收集的定性和定量数据确定了实施黑色代码干预的6个促进因素和9个障碍。我们能够确定环境、系统和文化因素抑制其实施。员工对自己运用黑色代码知识和技能的能力充满信心，并赞赏为改善安全所做的努力。然而，一些人仍然不相信员工行为的改变会带来更安全的结果。结论重组后的方法有效遏制了攻击升级，确保了患者和工作人员的安全。然而，在紧急护理环境中实施干预措施是复杂的。生态环境具有影响可持续性的独特特点，需要进一步探索，以确保不断采用新的做法。本文演示了如何识别变革的促进因素和障碍，并提供可能用于推动急诊护理环境实施的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Emergency Nursing NURSING-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： International Emergency Nursing is a peer-reviewed journal devoted to nurses and other professionals involved in emergency care. It aims to promote excellence through dissemination of high quality research findings, specialist knowledge and discussion of professional issues that reflect the diversity of this field. With an international readership and authorship, it provides a platform for practitioners worldwide to communicate and enhance the evidence-base of emergency care. The journal publishes a broad range of papers, from personal reflection to primary research findings, created by first-time through to reputable authors from a number of disciplines. It brings together research from practice, education, theory, and operational management, relevant to all levels of staff working in emergency care settings worldwide.