| Objective To retrospectively analyze the clinical data of suicide among inpatients in a class III hospital,to understand the relationship between inpatient suicide and environmental safety factors in the hospital,to identify potential risk factors in the hospital environment,and to discuss the prevention of suicide in hospitalized patients.It provides theoretical basis and empirical data for the study of suicide in China,and provides reference for prevention of in-hospital suicide and other suicide-related studies.Methods To collect the registration of hospitalized patients' suicide in the Patient Care Security Incident Registration(Report)Form from January 1,2008 to June 1,2017,and to apply to the Medical Records Division to view the medical records of hospitalized suicide patients.Combining the five previous records of post-suicidal communication seminars organized by the psychological group,detailed statistics were made on the age,gender,marital status,and cultural level of the inpatients committed suicide by jumping,using sharps,swallowing drugs,and self-defeating.Type of illness,length of hospital stay,diet,mental status,sleep status,suicide time,location of suicide,tools used to commit suicide,presence or absence of family members or attendants,financial difficulties,negative emotions,previous suicide history,detailed events,Incident analysis,improvement measures,handling opinions,etc.According to the results of data statistics,the classification of the suicidal environment of hospitalized patients in a class three grade A hospital was analyzed,and the characteristics of influencing factors of suicide safety in hospitalized patients in a class three grade A hospital were analyzed.According to the hospital environment,analyze the influencing factors of suicidal environment safety among inpatients in a tertiary hospital Patients environmental safety measures to commit suicide.Results 1.The basic situation found: In this group of 59 suicide patients,women(31 cases,52.54%)were more than men(28 cases,47.46%),and hospitalized patients committed suicide with a high age of suicide of 45-59 years old,accounting for 47.46%.The ?60-year age group accounts for 32.20%.The most common malignant tumors in suicide patients were 37 cases(62.72%),including 8 cases of gastrointestinal cancer(13.56%),8 cases of lung cancer(13.56%),5 cases of leukemia(13.51%),cervical cancer,pancreatic cancer,and liver cancer.There were 3 cases of lymphoma(8.11% each),1 case of breast cancer,vulvar cancer,otolaryngology and renal tumor,followed by benign digestive diseases in 6 cases(10.16%),including 5 cases of chronic liver disease(8.47%).Gastrointestinal hemorrhage in 1 case;cardiovascular disease in 4 cases 6.78%;skeletal joint disease in 3 cases in 5.08%;pulmonary infection,gallbladder surgery,uremia,renal insufficiency,herpes zoster neuralgia,systemic lupus erythematosus,placenta pre-bleeding with bleeding,esophageal foreign body and rickets in 1 case.This group of hospitalized patients committed suicide for the largest number of patients within one week(28 cases,47.46%).The time of hospitalized patients' suicidal behaviors was mainly concentrated in late nights.At 2:00-6:00 in the morning(20 cases,33.90%)was the period of high suicide.The most important way for hospitalized patients to commit suicide(29 cases,49.15%)was jumpers,followed by knives(16 cases,27.12%).The location of suicide mainly occurred in the window of the hospital ward or in the window sill of the corridor,accounting for 49.15%.In the suicide outcome,30 suicide deaths occurred,accounting for 50.85%.2.The hospital environment in which hospitalized patients commit suicide can be divided into physical and human environments.The physical environment refers to the hard environment.Factors influencing hospitalized patients' suicide can be divided into 1 factors that affect building-blocking suicide: roofs,ward windows,balconies,stairways,corridors,etc.;2 Sharp factors for suicide: cutters,glass,and others Sharp objects;3 drug suicide influencing factors: sedation,hypnotic drugs,analgesic drugs,and other drugs;4 self-inflicted influencing factors: bed sheets,restraint belts,shoelaces,wires,infusion tubes,exposed pipes,ward beams,ward toilets,Public toilets,showers,etc.;5 Other influencing factors: ponds,electric shocks,etc.The human environment refers to the soft environment.The influencing factors on inpatient suicide can be divided into 1 aspects of medical staff: management strategies of hospital administrators,knowledge of nursing staff psychology and suicide,communication skills of nursing staff,etc.;2 management systems: nursing staff The shift schedule system,the safety inspection system for security personnel,the safety notification system for the patients and their families by the medical staff,and 3 family support systems: the marital status,the relationship with family members,and other aspects of the family.3.The physical environment(hard environment)found that hospitalized patients committed suicide by jumping out of windows accounted for 49.15% of the suicide rate of patients in our hospital.In this study,hospitalized patients in general hospitals committed suicide via windows.The high-risk department for suicide was: Hematology 5 cases,accounting for 17.24%,followed by Gastroenterology 4 cases,accounting for 13.79%.The window of suicide via the window jumped from 22:00 at night to 6:00 at the next day,a total of 13 cases,accounting for 44.83%.The suicide building has the largest number of surgical buildings,a total of 9 cases,accounting for 31.03%.The surgical building is the highest floor in the hospital,with a total of 32 floors.After analysis,the suicide of the patient through the windows is not much related to the height of the floor.Instead,the floor is lower than the height of the floor.There are still more suicides.From 1st to 16 th floor,jumping committed suicide accounted for 72.41%.The suicide sites were mainly ward windows(16 cases),accounting for 55.17%,followed by stairway windows(6 cases),accounting for 20.69%.Most of the deaths were due to jumped suicide.The number of deaths was 21,accounting for 72.43%.The proportion of medical personnel who committed suicide by jumping out of the building was the highest,which was 48.28%.There were 5 cases of medical disputes,all of which belonged to patients who died of jumping.Twenty-five patients had increased costs due to multiple suicides resulting from suicide attempts.Sixteen inpatients who used sharps to commit suicide than females accounted for 62.50% of the suicides.The use of sharp instruments killed more elderly people,accounting for 50%.87.5% of the patients committed suicide through sharps on the bed,and 62.50% of patients committed suicide by cutting wrists.In addition,a small portion of them committed suicide by stabbing the head,chest,neck,and forearm.The suicide sharps were mainly fruit knives(62.5%),followed by razor blades(18.75%).In addition there are scissors,glass bottles and other sharps.Sixteen hospitalized patients committed suicide with a sharp instrument and 87.5% failed to commit suicide.Five inpatients were found to have had their own time since 18:00,and 3 cases were later in the morning.The tools used by inpatients include shoelaces,drainage tubes,and nylon ropes.The main location of inpatients is toilets,and there are beds and stairwells.The majority of suicide deaths died of suffocation,and all died in the toilet self-death outcome.All four hospitalized patients swallowed suicides,all of them were women.Four in-patients swallowed drugs to commit suicide at the bedside,and there were extrahospitals.The types of drugs swallowed include alprazolam,diazepam,and pain relief tablets.The number of drugs exceeds the doctor's orders,and most of the suicide attempts have been swallowed.4.Human environment(soft environment)discovery: Inpatient suicide is related to hospital administrators,medical personnel,security personnel,inspectors,and patient family members.Managers' improper management strategies for departments,lack of nursing staff psychology and suicidal knowledge,lack of communication skills for nursing staff,unreasonable schedules for nursing staff,lack of safety inspection system for security personnel,and safety for medical staff and their families Inadequate notification systems and inadequate family support systems can all be risk factors for suicide.Conclusion 1.Inpatient suicide,environmental factors have become an indispensable factor for suicide in patients' safety.The environment includes not only the public physical environment but also the humanistic institutional environment.Both of these environments have an impact on the suicide of inpatients.2.In the suicide of inpatients,from the perspective of the physical environment,suicide by jumping from buildings is the most serious and the fatality is the greatest.The most difficult to control is the suicide.Followed by the use of a sharp weapon to commit suicide,most of the suicides using sharp instruments are elderly or women.The relative death rate is relatively low,and the location is mostly in the ward,and is relatively easy to find.Since it is easy to draw materials,has a fast death time,and has a high success rate,the outcome is generally unrecoverable and often suffocates.The ward bathroom is a place often chosen by the self-seekers.Suicide is relatively low in suicide by swallowing drugs,and excess drugs are not readily available in hospitalization departments.3.In hospitalized patient suicide,from the perspective of the human environment,the medical care provider acts as a healer and caregiver who has direct contact with the patient every day.In the daily communication with the inpatients,communication skills are very important for discovering and preventing suicide in hospitalized patients.Suicidal knowledge and psychology knowledge are crucial for the timely detection and prevention of suicide in hospitalized patients.Whether the organization and management party's scheduling system is reasonable,whether the safety notification system is comprehensive,in place,and whether the security inspection system is effectively implemented,these systems can be used for timely detection.Timely prevention and timely prevention of suicide by hospitalized patients also play a crucial role.Disadjustment of family support system,rupture of marital status,poor relationship with family members,stimulation of negative family life events in other families,etc.will make patients feel suicidal in despair and sense of loss.4.The hospital can take various precautionary and management measures from the environment in which it commits suicide,such as paying full attention to the high-risk department suicide through the window-jumping suicide,strengthening the vigilance of window-jumping suicides during the high-risk period,and comprehensively improving the high-risk locations for suicide through the window-falling buildings.Using high-tech means to strengthen surveillance,improve the safety management system of hospital windows,strengthen the supervision of hazardous articles in the environment of departments and wards,strengthen the psychological training of nursing staff,improve various hospital management systems,give full play to family support systems and other measures for inpatients.Suicide control and prevention. |
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