| ObjectiveWorkplace violence in Health Care sector is defined as violent acts which occurred in all kinds of hospital, it encompasses a spectrum of events ranging from verbal harassment and bullying to physical assault and commit a crime among health workers, or damaging to the hospital property.Workplace violence in Health Care sector is a global phenomenon.It is a serious problem either in developing countries or developed countries.This familiar events happened in the developed Western countries, nursing managers experienced the high proportion of violence in hospitals.There is more and more researcher pay attention to workplace violence.The issues covered definition of workplace,the template of prevention programe and assessment of violence which includes result,effect and progress.The research group will based on the results of workplace violence in health care sector which reported by other researchers.In China,because many hospital are surpported by government,the occurrence of workplace violence will threat to staff health and safety, disrupting the normal environment on health care sector. The news reports even be effected by the concequense of workplace violence.The threat of violence will lead to the same or similar public crisis,it burdens social with mass destruction; thus undermining the social stability and harmony.So far,there is insufficient reports related to workplace violence in health care sector,prevention programe is rare especially. The research group refer to literature reports and results of research which conclued by ourselves. At last,the research group concluded some effective measures about prevetion programe,precaution and procedure are suit to China.In summary, the research group analized the causes of workplace violence and set up prevention programe with multiple perspectives.Finally, the initial framework for prevention programe is established..The purpose of prevention programe is to end violence at beginning. The programe should be applied to different hospitals, then the administrators can understand and implement guidelines to prevent workplace violence..Furthermore, the administrators can improved the prevention programe,The prevention programe is based on theory and practice.It is designed reasonable and operated convenient.It is suit to health care sector. It should be spread to all over the country.MethodsA pilot study was conducted using a two-round Delphi inquiries.According to experts advice, the research group selected risk factors for workplace violence and strategies and tools of aura, guidelines in workplace violence prevention programe. Based on results of the consultation,the research group rearrange the administration regulations,to develop prevention programe for workplace violence.There are 21 experts work as registered nurses,doctor,nursing manager, staff who major in medical dispute manage and lawyer. All of them from acute hospitals and law firms.There are 14 senior adminstrator (66.67%),6 senior staff(28.57%),1 junior staff(4.76%); their work experience of 5-10 years in 1 person (4.76%),11-for 15 years in 6 people (28.57%), more than 15 years were 14 (66.67%). Based on the literature review, theoretical analysis and preliminary qualitative research, the research group to explore the basis for the prevention of workplace violence, specific measures and the basic framework, initially to build the workplace violence prevention programe.Self-designed questionnair was used by the pre-survey, combined with feedback from experts, and finally forming a formal survey for Delphi method. In two subsequent rounds, research group statistics and analysis, combining expert opinion and screen out the risk factors to wokplace violence in Health Care, determining if the components of workplace violence prevention programe are effective. Synthtical evaluation was used to calculate the weights of indicators; the importance of index is determined by indicators mean. The research group designed two questionaires according to results of Delphi inquire,one of questionnaire about client's recognization to antecdent of workplace violence and another questionnaire is related to the views of clinical medical personnel about antecdent of workplace violence and the prevention programe.At last,comparing the results of investigation on two sides.In the study,describing statitistics was used to analyze demographic constitution of experts.Mean and coefficient of variance was used to describe the experts'opinion of the importance of the item;and the coefficient of Kendall's W,percentage of questionaire received and authority degree of experts were used to examine the reliability and representation of consultation.The data were analyzed with statistical package of social sciences(SPSS)13.0 and Excel 2003.Statistical methods included descriptive statistics analysis,K related sample nonparametric test. The statistical significance was set at a level ofα=0.01.Two independent samples tests, statistical significance defined as P<0.05 (bilateral).Results1. The prediction accuracy results of the consultation. According to the demographic factors, the experts are proficiency on this field,since they are experienced.In the project, authority degree of experts is analyzed which based on the experts self-assessment.Assessment include the extent of experts familiar with the programe and influence of the determine factor.In two-round consultation, the expert authority of the coefficient of 0.8 or more accounted for 95%, the overall authority of the coefficient of 0.8547, the reliability of the contents of the consultation is ensured.The questionnaire return rate of 91.3% and 100% respectively, which met the statistical requirements.In the same time,it shows the enthusiasm and support of the experts.In two-round consultation of high risk factors of workplace violence on health care, coefficients were 0.202 and 0.400, chi-square values were 173.695 and 344.773 (P<0.01) respectively,which provides sufficient evidence of high consistency among experts opinions.2. Screening of risk factors of workplace violence in Health Care and establishing the weight of each index.Using Likert 5-scale method to describe the experts'opinion of the impotance of the item, and the mean beyond 3.5 and the coefficient of variance less than 0.3 were used to screen indexes. The second round of consultation results showed that:the importance of assigning the minimal mean score was "medical staff chased client for cost for hospitalization (3.2381)" the maximal coefficient of variation is the "client think the procedure for medical treatment was too cumbersome (0.1697)".The maximal mean score of the entry was "poor communication skills of health woker (4.7619)", the minimal coefficient of variation was "suffering from alcoholism or drug history side (0.0539) "; the weight of evaluation index based on indicators to determine the average scores and expert level of authority to calculate the weighted average scores for each indicator, after normalized to determine the weight of each index. After the second round of inquire, index weight of 42 indicators ranged 0.0184 to 0.0269,the maximal weight indicator was "poor communication skills of health woker (0.0269) ", the minimum weight indicator was "medical staff chased client for cost of hospitalization (0.0184) "After the members of research group concluded experts opinion and discussison,the final nine major sign of high risk factors were selected.3. Establishment of prevention programe for workplace violence in Health Care.The consequence of prevention programe for workplace violence in Health Care after two rounds consultantion indicated:1) the minimal mean score was the entry that is the " Operation manual for risk factors of workplace violence.Assessment Form (3.8571)" the maximal mean score was the entry that is " reporting to the administration timely when you find risk factors of workplace violence (4.8571)" 2) The coefficient of variation of the minimum entry is "report, certification signatures (0.0539)" the coefficient of variation of the maximal entry is "policy for workplace violence prevention programe (0.1136)."After second round of inquire, the weights of 51 entries ranged from 0.0175 to 0.0221. After the team discussion and finally selected 50 entries as the establishment of prevention programe for workplace violence in Health Care. The results showed: the maximum weight entry was " reporting to the administration timely when you find risk factors of workplace violence (0.0221)" the minimum weight entry was" Operation manual for risk factors of workplace violence Assessment Form (0.0175)"According to expert opinions, and finally identified three levels of prevention at all levels of the first three measures in order to facilitate staff at all levels to master and operateConclusionsAfter consultation 21 senior experts, the research group established the initial framework of prevention programe for workplace violence in Health Care. By investigation and analysis, research focuses on the high-risk factors of antecedent of workplace violence in Health Care and develop a three-level warning system, establishing a specific and feasible measures correspondingly.1. To establish a template of prevention programe for workplace violence in Health Care. The template includes four parts and 50 entries, the specific plans as follows:1.1 Strategies in prevention programe for workplace violence on health care.There are eleven entries include:guideline for initial prevention programe, different class of the prevention system, personnel training, management strategies and tools, appointment for staff in different department, documentation of medical record.1.2 Immediate Response towards Violence at Workplace.There are three entries include:victim, clinical staff and staff supervisior, hospital management, how to response to Violence at Workplace.1.3 Workplace violence preventive protocols.There are twenty-nine entries include:a standard response plan for violent situation, teamwork approach and communication procedures.1.4 Signs of confrontation and reporting guidance notes.There are seven entries include:the patient's condition, admission reason, risk factors, the reason of reporting,at last calculating the weight of each entry2.The research focus on antecedents of workplace violence in Health Care in order to prevention workplace violence early.At first,the research group investigated risk factors for workplace violence in Health Care,then,applying Delphi method and synthetical evaluation to identify effective preventive measures according to the characteristics of risk factors. Selected indicators covered all aspects of workplace violence,.It could be provide a proof for the further development of prevention programe guidelines and protocols. 2.1 The causes of violence relate to health worker:subjective fault of health worker (poor communication skills, indifference attitudes, did not explain the illness or prognosis); objective fault of health worker (error of working protocol, such as: Patient education is not enough so as to delay checks or treatment,.Health worker failed to inform patient the high price of drugs, side effects before medication administration, etc.).2.2 The antecedent of violence relate to client:client misunderstood the treatment effect(costs are too high on treatment, unreasonable medication, client was unsatisfied in effect of treatment, complications, etc.); client was dissatisfaction with the medical staff's attitude(client thought there is short of respect for the patient,health worker is unresponsible); client's characterise relate to antecedent of violence (changing the normal tone, irritate, loud, showing offensive hostile posture or attitude); client had history of damaging or offensive behavior.2.3 The external environment factors:the patient in critical condition, the situation is complex; the patient died; ganster were disturbing workplace, negative media reports about health worker.3.Investigation of clients and hospital staff which focus on the possibility of aggression, support the establishment of prevention programe is scientific and practical.The research focus on combination of practise and theorey,which base on antecedents of workplace violence and establishment of prevention programe for workplace violence.According to client's personality, the research group analized of data from investigation and demonstrated prevention programe for workplace violence is practical and scientific.
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