Journal Reviews
Journal Reviews
Feldhaus KM, Houry D, Kaminsky R. Lifetime sexual assault prevalence rates and reporting practices in an emergency department population. Ann Emerg Med 2000; 36:23-27.
The number of ED patients who have suffered sexual assaults at some point in their lives is high, but few victims report the assaults or receive medical care, according to this study from the Denver Health Medical Center and the University of Colorado Health Sciences Center, also in Denver. Verbal surveys were conducted with 360 female patients at an urban ED. Here are the key findings:
- The lifetime prevalence rate of sexual assault was 39%.
- Only 43% of patients who were sexually assaulted sought medical care after the incident.
- Of those who did seek medical care, an overwhelming majority — 78% — did so in an ED.
- Of the patients who sought ED care, 88% disclosed the sexual assault to the physician, but only 61% had medical evidence collected.
"Physicians should recognize the importance of the evidentiary examination, as this is often critical for the conviction of perpetrators, and they should encourage victims to request an evidentiary examination," recommend the researchers.
Survey results showed that victims of sexual assault who didn’t report the crime to police or seek medical care often were embarrassed and feared public disclosure. Also, the survey indicated that women assaulted by a partner were less likely to seek medical care.
Erickson L, Williams-Evans SA. Attitudes of emergency nurses regarding patient assaults. J Emerg Nurs 2000; 26:210-215.
There is still an alarming rate of patient assaults and underreporting of assaults on nursing staff in the ED, says this study. Here are the key findings:
- Of the nurses surveyed, 82% had been assaulted during their careers.
- Over half of nurses surveyed had been assaulted during the preceding year, and a third of those assaults were not reported.
- Of the 45 nurses who were victims of assault, only nine believed that reporting their assaults had been beneficial.
- Nurses who had previously taken an assault prevention class were less likely to be assaulted.
Two reasons nurses didn’t report assaults were the time-consuming nature of reporting mechanisms and a belief that no benefit would be gained by reporting. The researchers recommend the following steps:
- Restructuring incident reports;
- Creating specific forms for nurses to report patient assaults;
- Working cooperatively with nurses, administrators, law enforcement, and the legislature;
- incorporating risk assessment, assault prevention, and crisis intervention into basic nursing education programs.
Nurses need to become involved in their communities and in the political arena, argue the researchers. "Health care providers and their patients deserve protection from assaults and abuse," they say. "First and foremost, the myth that assaults are part of the job’ needs to be rebuked before any real changes can occur."
Mandelberg JH, Kuhn RE, Kohn MA. Epidemiologic analysis of an urban, public emergency department’s frequent users. Acad Emerg Med 2000; 7:637-646.
Patients who use the ED frequently are usually indigent, homeless, alcohol abusers, or chronically ill, and there is a smaller subset of patients within that group who remain frequent ED users for several years, says this five-year study from the University of California-San Francisco School of Medicine, San Francisco General Hospital, and Johns Hopkins University School of Medicine in Baltimore.
The study’s goal was to determine how frequent users of the ED differed from other patients. In this study, frequent users (patients who visited the ED five or more times during a one-year period) made up 3.9% of ED patients but accounted for 20.5% of ED visits.
About a third of frequent users for one year remained frequent users the next year. However, only about half of those who remained frequent users the second year were still frequent users the third year. Because frequent users reflect urban social problems such as poverty and homelessness, a subset of patients will continue to account for a disproportionate share of ED visits, the researchers state. However, the primary goal of ED managers should be to better meet the needs of this group of patients, rather than discouraging frequent users, they warn.
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