Organizational risk management of resistance to care episodes in health facilities

摘要

Aims. This article reports a study of organizational risk management approaches to resistance to care episodes in specific clinical areas: prevention measures, provision of subsequent support and follow-up by management and resultant organizational change. Background. Resistance to care describes a patient's unwillingness to be assisted by healthcare staff and is manifested in defensive behaviours ranging from minor non-compliance/dissent to aggression. It has previously been studied in aged care settings and focused on patient behaviours and appropriate responses. Methods. This was a cross-sectional survey of a representative sample of nurses (n=5044) who were members of the New South Wales Nurses' Association in Australia, in 2008-2009. Results. Of 1132 participants, 80% reported being involved in resistance to care episodes during the previous month and this was higher in some settings. Episodes were not routinely reported internally, and often did not lead to organizational change. Nurses reported that talking with other staff was the most effective action in dealing with the consequences of these episodes. Half of the respondents considered that they were provided with sufficient support and follow-up after a resistance to care episode. Prevention measures and follow-up strategies adopted by employers varied across clinical settings. Conclusion. Resistance to care is not confined to aged care settings, and risk management of resistance to care can increase safety in the workplace. Preventive strategies such as increased staff, training and security should be focused on high risk clinical areas; and appropriate support, follow-up and organizational change instituted in response to these episodes.