提高综合性医院住院医师应对激越患者能力的探索

Exploration on Improving the Ability of Residents in General Hospitals to Cope With Patients With Agitation

目的了解并提高综合性医院住院医师面对激越患者的能力。方法对2020年10月—2021年9月在复旦大学附属中山医院参加规范化培训的住院医师进行激越相关的理论知识的培训。在培训前后均发放调查问卷,采用Likert 7级评分法,比较培训前后住院医师对激越患者心理舒适度以及激越相关知识的掌握情况。结果培训前,第1年、第2年、第3年的住院医师对激越患者的心理舒适度评分比较差异有统计学意义(P<0.001),不同科室的住院医师评分总体差异无统计学意义(P=0.400)。在有关激越的病因方面,第1年和第3年评分差异有统计学意义(P<0.05);对谵妄病因的了解方面,第1年和第2年、第3年住院医师评分比较差异均有统计学意义(P=0.037);有关药物治疗激越的知识和对口头及行为消减技术的熟悉度上方面,第1年、第2年、第3年住院医师评分两两比较差异均无统计学意义(P>0.05)。培训前有关谵妄的病因和口头及行为消减技术的熟悉度方面,不同科室的住院医生评分差异有统计学意义(P<0.05);在激越的病因和药物治疗知识方面,不同科室的评分差异无统计学意义(P>0.05)。培训后,住院医师心理舒适度评分,对激越病因知识的自我评分,对谵妄病因知识的评分,有关药物治疗知识的评分,对口头及行为消减技术熟悉度的评分均高于培训前,差异有统计学意义(P<0.001)。结论对住院医师进行激越相关的培训能够有效提高其应对激越患者的信心和能力,提高住院医师职业胜任力。

Objective To improve the ability of residents in the management of agitation.Methods The residents who participated in the standardized training in Zhongshan Hospital of Fudan University from October 2020 to September 2021 were trained on the theoretical knowledge of acute agitation.Survey questionnaires were distributed before and after the training,using the Likert 7-level scoring method to compare the resident physicians'mastery of psychological comfort and knowledge related to agitation in patients before and after the training.Results Before the training,there was a statistically significant difference(P<0.001)in the first,second,and third years,and the overall difference in the psychological comfort scores of residents from Before the training,there was a statistically significant difference in the psychological comfort scores of agitation patients among residents in the first,second,and third years(P<0.001),and there was no statistically significant difference in the overall scores of residents in different departments(P=0.400).In terms of the etiology of agitation,there was a statistically significant difference in scores between the first and third years(P<0.05).In terms of understanding the causes of delirium,there was a statistically significant difference in resident physician scores between the first year,the second year,and the third year(P=0.037).In terms of knowledge about drug therapy and familiarity with oral and behavioral reduction techniques,there was no statistically significant difference in resident physician scores between the first,second,and third years(P>0.05).There was a statistically significant difference in the scores of resident doctors in different departments regarding the etiology of delirium and familiarity with oral and behavioral reduction techniques before training(P<0.05).There were no statistically significant differences in scores among different departments regarding the causes of agitation and self-rating of drug treatment knowledge(P>0.05).After training,the resident physician's psychological comfort score,self-rating of knowledge about the causes of agitation,delirium,drug treatment knowledge,and familiarity with oral and behavioral reduction techniques were all higher than those before training,with statistically significant differences(P<0.001).Conclusion The training of residents with agitation can effectively improve their confidence and skills in dealing with agitation patients and improve their professional competence.