患者参与患者安全的国内外研究分析

患者是患者安全的主体和核心,保证患者安全,不仅是医护人员和医疗机构的责任,同时需要患者的参与。自1999年美国医学研究院发表了《孰能无错,构建更为安全的卫生保健体系》报告后,患者安全首次成为学术组织、公众媒体关注的焦点,其相关研究如雨后春笋般涌现,包括患者参与患者安全的研究。     

Safe and unsafe school spaces: Comparing elementary school student perceptions to common ecological interventions and operationalizations

There is a burgeoning literature on school safety in the United States. Often, researchers determine the problem and intervention. Few studies, however, examine how students understand school safety. In this study, elementary school students in the United States (n = 225) marked safe and unsafe school places; this was correlated with other commonly used school safety measures. Results indicate that children have different perceptions of safety based on school location. Additionally, for older children, unsafe places correlated with injury data, adult absence and low levels of territoriality. For younger children, unsafe places were associated with adult absence and referrals. Safe places were places that were more likely to have an adult. Results bring into question some common safety interventions. Implications include working with children to determine what is meant by ‘safe’ and interventions. Copyright © 2010 John Wiley & Sons, Ltd.     

Motivating signage prompts safety belt use among drivers exiting senior communities

Senior drivers are vulnerable to automobile crashes and subsequent injury and death. Safety belts reduce health risks associated with auto crashes. Therefore, it is important to encourage senior drivers to wear safety belts while driving. Using an AB design, replicated five times, we evaluated the short- and long-term effects of a sign with the message "BUCKLE UP, STAY SAFE" attached to a stop sign at the exits of five different senior communities. Safety belt use was stable during two pretreatment assessments averaged across the five sites and 250 drivers (72% and 68% usage), but significantly increased following installation of these signs (94% usage). Six months after installation of the signs, the effect persisted (88% usage). Use of such signs may be a cost-effective way of promoting safety belt use.     

Evaluation of behavioral skills training to prevent gun play in children

This study evaluated behavioral skills training (BST), in a multiple baseline across subjects design, for teaching firearm safety skills to 6 6- and 7-year-old children. Similar to previous research with 4- and 5-year-olds, half of the children acquired the safety skills following BST and half acquired the skills following BST plus in situ training.     

The effects of conducting behavioral observations on the behavior of the observer

Behavior-analytic approaches to occupational safety are often effective for improving safety in organizations, and have been successful in a wide variety of settings. The effects of these safety processes are thought to arise primarily from the behavioral observation process and the delivery of feedback. Typically, supervisors or employee observers involved in behavioral safety implementations conduct observations. The present study was an attempt to assess the effects of conducting observations on an observer's safety performance. An ABC multiple baseline counterbalanced across two sets of behaviors was conducted in a simulated office. The target behaviors involved knee and back positions during lifts; back, shoulder, and feet positions while sitting; neck and wrist positions while typing; and neck position during phone use. Substantial improvements in safety performance occurred after participants conducted observations on a videotape of a confederate's performance. The possible behavioral functions responsible for this change, and the implications of these findings for applied settings, are discussed.     

Teaching safety skills to children to prevent gun play: an evaluation of in situ training

This study evaluated behavioral skills training with added in situ training for teaching safety skills to prevent gun play. Following baseline, each child received two sessions of behavioral skills training and one in situ training session. Additional in situ training sessions were conducted until the child exhibited the safety skills (don't touch the gun, get away, and tell an adult). All children acquired and maintained the safety skills at a 3-month follow-up. In addition, of the 7 children assessed in a dyad situation, all exhibited the correct skills in the presence of another child.     

Intellectual Safety, Moral Atmosphere, and Epistemology in College Classrooms

Students report feeling safe to express and challenge their beliefs and assumptions in some classrooms and interactions but not in others. This paper proposes a definition of intellectual safety derived from student responses to their experience of safety or threat in college classrooms, and explores students' experience of intellectual safety in relation to epistemological development. Intellectual safety defined here has two components: epistemic fit or lack of fit between student and professor's epistemology, and moral climate. Students can be challenged in their world-views and feel either threatened, unsafe, and uncomfortable, or supported and safe despite possible discomfort. Experiencing an intellectually safe moral climate may create conditions and opportunities for epistemological reflection and change. Using concepts from moral theory, including moral type and moral perspectives of justice and care, I describe features of an intellectually safe moral climate during the cognitively and emotionally difficult time of epistemological development.     

Teaching self-protection to young children

Self-protective behaviors were taught to three preschool children in order to prevent the opportunity for abduction. An analogue measure of self-protection was developed in which confederate adults approached and verbally attempted to lure each child from the setting, before, during, and after training. A multiple baseline design across subjects was used. During baseline, all the children displayed susceptibility to the lures. Training procedures included modeling, behavior rehearsal, and social reinforcement. Within 1 week after training began, all children displayed appropriate responses to all of the lures both in the training setting and in the community.     

RESPONDING MAINTAINED UNDER INTERMITTENT SCHEDULES OF ELECTRIC-SHOCK PRESENTATION: “SAFETY” OR SCHEDULE EFFCTS?

Four experiments were conducted in which lever pressing by squirrel monkeys was maintained under multiple, mixed, or chained schedules of electric-shock presentation. In the first two experiments, a multiple schedule was employed in which a fixed-interval schedule of shock presentation alternated with a signaled two-minute component. Initially, no events were scheduled during the two-minute component (a safety period). In the first experiment, the safety period was “degraded” by introducing and systematically increasing the frequency of periodic shocks presented during that component. In the second experiment, the proportion of overall safe time to unsafe time was decreased by decreasing the value of the fixed-interval schedule while holding constant shock frequency during the two-minute component. In the third experiment, the overall arrangement was changed from a multiple to a mixed schedule in an attempt to determine whether fixed-interval responding would be maintained when a single exteroceptive stimulus was associated with both components. In the fourth experiment, the overall arrangement was changed from a multiple to a chained schedule in an effort to determine whether fixed-interval responding would be maintained when its consequence was presentation of a signaled “unsafe” period. Fixed-interval responding was well maintained under all experimental conditions; the varied relationships obtained lend more support to conceptualizations of shock-maintained behavior as exemplifying schedule-controlled behavior than to suggestions that such behavior may be readily accounted for by “safety theory.”     

EMPIRICALLY DERIVED INJURY PREVENTION RULES

This study describes a set of empirically derived safety rules that if followed, would have prevented the occurrence of minor injuries. Epidemiologists have criticized behavioral interventions as increasing “safe” behavior but failing to demonstrate a decrease in injury. The present study documents retrospectively the link between safe behavior and injury. It demonstrates that these empirically derived rules are very similar to rules for the prevention of serious injury. The study also shows that these rules are not widely accepted and implemented by parents. Suggestions for future research in this area are advanced.