鱼骨图法分析精神科住院患者暴力攻击原因

Fishbone diagram analysis on the causes of violent attacks of psychiatric inpatients

目的：探讨运用鱼骨图分析精神科住院患者暴力攻击的原因。方法通过查阅不良事件讨论登记表、病历等分析327例发生暴力攻击行为的精神科住院患者的相关资料，查找暴力攻击的原因，绘制鱼骨图。结果精神科住院患者暴力攻击的原因可概括为患者因素、家属因素、工作人员因素、环境因素和管理因素，其中患者因素中最高的是既往暴力攻击史，占64．5％；家属因素中最高的是家属对患者的态度生硬、冷漠，占19．6％；工作人员因素中最高的是服务态度不好、说话太生硬，占30．0％；护理管理因素中最高的是封闭式管理，占61．8％；环境因素中最高的是病房拥挤嘈杂，占30．9％。结论鱼骨图用于精神科住院患者暴力攻击原因的分析简单实用，为防范精神科住院患者暴力攻击提供了对策依据，为进一步实现护理安全的持续质量改进提供了有力保证。

Objective To investigate the use of fishbone diagram analysis on the causes of violent attacks among psychiatric inpatients .Methods Totals of 327 cases of violent attacks psychiatric inpatients were analyzed in order to find the reasons for violent attacks using the fishbone diagram .Results The causes of violent attacks could be summarized as patient factors , family factors, staff factors, environmental factors and management factors . Patient factors according to the previous history of violent attacks were the highest , accounting for 64 .5%.Then the family factors due to blunt attitude of family members accounted for 19 .6%. The highest reason of staff factors was bad service attitude , accounting for 30.0%.The highest nursing management factor was closed-end management, accounting for 61.8%.The highest environment factor was because the wards were too crowded and noisy , accounting for 30.9%.Conclusions Fishbone diagram, used for analysis the causes violent attacks of psychiatric inpatients , is simple and practical .It provides a basis and a strong guarantee for the further implementation of continuous quality improvement in nursing safety .