ABSTRACT
Health care providers deal with disruptions from geriatric patients routinely. Despite the negative impact on provider efficiency, provider-patient relations, and patient well-being, there have been no systematic clinical studies of the impact of disruptive behaviors on geriatric inpatient care. This article presents a taxonomy for these behaviors, applying them to a study of disruptive behaviors and concomitant nursing interventions on a geriatric evaluation and management (GEM) unit. The sample, consisting of 23 nursing staff (16 RNs, 4 LPNs, and 3 nurse aides), was followed over 8 weeks (five shifts per week, distributed randomly over day, evening, and night shifts). An experienced pair of RN observers logged all disruptive behaviors and the associated interventions employed by the nursing providers. The taxonomy was validated on 97 disruptive events (113 disruptive behaviors) initiated by 87 patients. The major findings of the study were: (a) disruptive behaviors are common on a GEM unit; (b) behaviors that disrupt care are recognized only 50% of the time by nursing staff; (c) interventions, when used singly, were found successful 45% of the time; (d) multiple simultaneous interventions may be more successful than single interventions but were used in only 16% of cases; and (e) selection of interventions may be associated with staff education level.
Subject(s)
Geriatric Nursing/methods , Mental Disorders/prevention & control , Psychomotor Agitation/prevention & control , Aged , Geriatric Nursing/education , Health Knowledge, Attitudes, Practice , Hospital Units , Humans , Longitudinal Studies , Mental Disorders/classification , Mental Disorders/nursing , Mental Disorders/psychology , Nursing Methodology Research , Nursing Staff, Hospital/education , Nursing Staff, Hospital/psychology , Psychomotor Agitation/classification , Psychomotor Agitation/nursing , Psychomotor Agitation/psychologyABSTRACT
1. Using the nursing process, the occupational health nurse plays a key role in the health surveillance of workers at risk for exposure to chemical, biological, or physical hazards. 2. To implement and manage a successful occupational surveillance program, the occupational health nurse must be familiar with walk through procedures, test selection and interpretation issues, toxicology and epidemiology concepts and budgeting processes. 3. Employee education and program evaluation are integral and ongoing components of a comprehensive occupational health surveillance program. Anticipation of legal and ethical problems is also critical during the design, implementation, and evaluation of the program. 4. Quality data collection and management aid the occupational health nurse in decision making and accurate and timely record keeping.
