OSHA:醫療和社會服務工作者防止工作場所暴力指南NoticeTheseguidelinesarenotanewstandardorregulation.Theyareadvisoryinnature,informationalincontentandintendedtohelpemployersestablisheffectiveworkplaceviolencepreventionprogramsadaptedtotheirspecificworksites.Theguidelinesdonotaddressissuesrelatedtopatientcare.Theyareperformance-oriented,andhowemployersimplementthemwillvarybasedonthesite'shazardanalysis.本指南意在幫助雇主建立有效地工作環境，防止特定工作場所的暴力事件，不涉及與病人護理相關的問題。Workplaceviolenceaffectshealthcareandsocialserviceworkers.工作場所暴力影響醫療和社會服務工作者。TheNationalInstituteforOccupationalSafetyandHealth(NIOSH)definesworkplaceviolenceas"violentacts(includingphysicalassaultsandthreatsofassaults)directedtowardpersonsatworkoronduty."(4)ThisincludesterrorismasillustratedbytheterroristactsofSeptember11,2001thatresultedinthedeathsof2,886workersinNewYork,VirginiaandPennsylvania.Althoughtheseguidelinesdonotaddressterrorismspecifically,thistypeofviolenceremainsathreattoU.S.workplaces.關于工作場所暴力定義“針對在工作和執行任務者的暴力行為（包括身體的攻擊和威脅使用攻擊）”包括導致紐約、弗吉尼亞、賓夕法尼亞2886位工作人員死亡的恐怖行為誒。Formanyyears,healthcareandsocialserviceworkershavefacedasignificantriskofjob-relatedviolence.Assaultsrepresentaserioussafetyandhealthhazardwithintheseindustries.OSHA'sviolencepreventionguidelinesprovidetheagency'srecommendationsforreducingworkplaceviolence,developedfollowingacarefulreviewofworkplaceviolencestudies,publicandprivateviolencepreventionprogramsandinputfromstakeholders.OSHAencouragesemployerstoestablishviolencepreventionprogramsandtotracktheirprogressinreducingwork-relatedassaults.Althoughnoteveryincidentcanbeprevented,manycan,andtheseverityofinjuriessustainedbyemployeescanbereduced.Adoptingpracticalmeasuressuchasthoseoutlinedherecansignificantlyreducethisseriousthreattoworkersafety.OSHA鼓勵雇主建立暴力方法項目，并持續記錄減少工作相關攻擊方面的進展。盡管不是每個事件都可以被防止，但至少對雇員的傷害程度可以被降低。采用實踐措施能夠大幅降低對工作者安全傷害的嚴重程度。Theriskfactors危險因素Healthcareandsocialserviceworkersfaceanincreasedriskofwork-relatedassaultsstemmingfromseveralfactors.Theseinclude:醫療和社會服務工作者面臨日益增長的與工作相關的攻擊。主要因素如下：Theprevalenceofhandgunsandotherweaponsamongpatients,theirfamiliesorfriends;Theincreasinguseofhospitalsbypoliceandthecriminaljusticesystemforcriminalholdsandthecareofacutelydisturbed,violentindividuals;Theincreasingnumberofacuteandchronicmentallyillpatientsbeingreleasedfromhospitalswithoutfollow-upcare(thesepatientshavetherighttorefusemedicineandcannolongerbehospitalizedinvoluntarilyunlesstheyposeanimmediatethreattothemselvesorothers);Theavailabilityofdrugsormoneyathospitals,clinicsandpharmacies,makingthemlikelyrobberytargets;Factorssuchastheunrestrictedmovementofthepublicinclinicsandhospitalsandlongwaitsinemergencyorclinicareasthatleadtoclientfrustrationoveraninabilitytoobtainneededservicespromptly;Theincreasingpresenceofgangmembers,drugoralcoholabusers,traumapatientsordistraughtfamilymembers;Lowstaffinglevelsduringtimesofincreasedactivitysuchasmealtimes,visitingtimesandwhenstaffaretransportingpatients;Isolatedworkwithclientsduringexaminationsortreatment;Solowork,ofteninremotelocationswithnobackuporwaytogetassistance,suchascommunicationdevicesoralarmsystems(thisisparticularlytrueinhigh-crimesettings);Lackofstafftraininginrecognizingandmanagingescalatinghostileandassaultivebehavior;andPoorlylitparkingareas.ViolencePreventionPrograms暴力防止計劃Awrittenprogramforjobsafetyandsecurity,incorporatedintotheorganization'soverallsafetyandhealthprogram,offersaneffectiveapproachforlargerorganizations.Insmallerestablishments,theprogramdoesnotneedtobewrittenorheavilydocumentedtobesatisfactory.關于工作安全和保衛的計劃，結合組織的整體安全和健康。Ataminimum,workplaceviolencepreventionprogramsshould:Createanddisseminateaclearpolicyofzerotoleranceforworkplaceviolence,verbalandnonverbalthreatsandrelatedactions.Ensurethatmanagers,supervisors,coworkers,clients,patientsandvisitorsknowaboutthispolicy.不容忍工作場所暴力，無論口頭或非口頭威脅和相關行為。保證所有員工了解這項規定Ensurethatnoemployeewhoreportsorexperiencesworkplaceviolencefacesreprisals保證員工報告工作場所暴力不受到任何報復Encourageemployeestopromptlyreportincidentsandsuggestwaystoreduceoreliminaterisks.Requirerecordsofincidentstoassessriskandmeasureprogress.鼓勵員工及時報告事件和提出減少、消除風險的建議。記錄這項改進Outlineacomprehensiveplanformaintainingsecurityintheworkplace.Thisincludesestablishingaliaisonwithlawenforcementrepresentativesandotherswhocanhelpidentifywaystopreventandmitigateworkplaceviolence.保持工作場所安保的綜合計劃。Assignresponsibilityandauthorityfortheprogramtoindividualsorteamswithappropriatetrainingandskills.Ensurethatadequateresourcesareavailableforthiseffortandthattheteamorresponsibleindividualsdevelopexpertiseonworkplaceviolencepreventioninhealthcareandsocialservices.為個人或團隊提供必要的培訓。保證其防止工作場所暴力的專業能力Affirmmanagementcommitmenttoaworker-supportiveenvironmentthatplacesasmuchimportanceonemployeesafetyandhealthasonservingthepatientorclient.管理層重視員工安全和健康，與為患者或客戶服務同等重要Setupacompanybriefingaspartoftheinitialefforttoaddressissuessuchaspreservingsafety,supportingaffectedemployeesandfacilitatingrecovery.內部通報，作為保證安全、幫助受害員工和場所恢復的第一項努力Elementsofaneffectiveviolencepreventionprogram有效防止暴力的計劃Thefivemaincomponentsofanyeffectivesafetyandhealthprogramalsoapplytothepreventionofworkplaceviolence:Managementcommitmentandemployeeinvolvement;管理層的支持和員工參與Worksiteanalysis;工作場所分析Hazardpreventionandcontrol;危險防止和控制Safetyandhealthtraining;and安全和健康培訓Recordkeepingandprogramevaluation.記錄和項目評價ManagementCommitmentandEmployeeInvolvement管理層的支持和員工參與Managementcommitmentandemployeeinvolvementarecomplementaryandessentialelementsofaneffectivesafetyandhealthprogram.Toensureaneffectiveprogram,managementandfrontlineemployeesmustworktogether,perhapsthroughateamorcommitteeapproach.Ifemployersoptforthisstrategy,theymustbecarefultocomplywiththeapplicableprovisionsoftheNationalLaborRelationsAct.Managementcommitment,includingtheendorsementandvisibleinvolvementoftopmanagement,providesthemotivationandresourcestodealeffectivelywithworkplaceviolence.Thiscommitmentshouldinclude:Demonstratingorganizationalconcernforemployeeemotionalandphysicalsafetyandhealth;Exhibitingequalcommitmenttothesafetyandhealthofworkersandpatients/clients;Assigningresponsibilityforthevariousaspectsoftheworkplaceviolencepreventionprogramtoensurethatallmanagers,supervisorsandemployeesunderstandtheirobligations;Allocatingappropriateauthorityandresourcestoallresponsibleparties;Maintainingasystemofaccountabilityforinvolvedmanagers,supervisorsandemployees;Establishingacomprehensiveprogramofmedicalandpsychologicalcounselinganddebriefingforemployeesexperiencingorwitnessingassaultsandotherviolentincidents;andSupportingandimplementingappropriaterecommendationsfromsafetyandhealthcommittees.Employeeinvolvementandfeedbackenableworkerstodevelopandexpresstheirowncommitmenttosafetyandhealthandprovideusefulinformationtodesign,implementandevaluatetheprogram.Employeeinvolvementshouldinclude:Understandingandcomplyingwiththeworkplaceviolencepreventionprogramandothersafetyandsecuritymeasures;Participatinginemployeecomplaintorsuggestionprocedurescoveringsafetyandsecurityconcerns;Reportingviolentincidentspromptlyandaccurately;Participatinginsafetyandhealthcommitteesorteamsthatreceivereportsofviolentincidentsorsecurityproblems,makefacilityinspectionsandrespondwithrecommendationsforcorrectivestrategies;andTakingpartinacontinuingeducationprogramthatcoverstechniquestorecognizeescalatingagitation,assaultivebehaviororcriminalintentanddiscussesappropriateresponses.WorksiteAnalysis工作場所分析ValueofaworksiteanalysisAworksiteanalysisinvolvesastep-by-step,commonsenselookattheworkplacetofindexistingorpotentialhazardsforworkplaceviolence.Thisentailsreviewingspecificproceduresoroperationsthatcontributetohazardsandspecificareaswherehazardsmaydevelop.Athreatassessmentteam,patientassaultteam,similartaskforceorcoordinatormayassessthevulnerabilitytoworkplaceviolenceanddeterminetheappropriatepreventiveactionstobetaken.Thisgroupmayalsoberesponsibleforimplementingtheworkplaceviolencepreventionprogram.Theteamshouldincluderepresentativesfromseniormanagement,operations,employeeassistance,security,occupationalsafetyandhealth,legalandhumanresourcesstaff.Theteamorcoordinatorcanreviewinjuryandillnessrecordsandworkers'compensationclaimstoidentifypatternsofassaultsthatcouldbepreventedbyworkplaceadaptation,proceduralchangesoremployeetraining.Astheteamorcoordinatoridentifiesappropriatecontrols,theyshouldbeinstituted.Focusofaworksiteanalysis工作場所分析關注Therecommendedprogramforworksiteanalysisincludes,butisnotlimitedto:Analyzingandtrackingrecords分析和追蹤記錄；Screeningsurveys選擇性訪談；andAnalyzingworkplacesecurity工作場所安保分析；Recordsanalysisandtracking記錄分析和追蹤。Thisactivityshouldincludereviewingmedical,safety,workers'compensationandinsurancerecords—includingtheOSHALogofWork-RelatedInjuryandIllness(OSHAForm300),iftheemployerisrequiredtomaintainone—topinpointinstancesofworkplaceviolence.Scanunitlogsandemployeeandpolicereportsofincidentsornear-incidentsofassaultivebehaviortoidentifyandanalyzetrendsinassaultsrelativetoparticular:Departments；Units；Jobtitles;Unitactivities;Workstations;andTimeofday.Tabulatethesedatatotargetthefrequencyandseverityofincidentstoestablishabaselineformeasuringimprovement.Monitortrendsandanalyzeincidents.Contactingsimilarlocalbusinesses,tradeassociationsandcommunityandcivicgroupsisonewaytolearnabouttheirexperienceswithworkplaceviolenceandtohelpidentifytrends.Useseveralyearsofdata,ifpossible,totracetrendsofinjuriesandincidentsofactualorpotentialworkplaceviolence.Valueofscreeningsurveys篩選調查的價值Oneimportantscreeningtoolisanemployeequestionnaireorsurveytogetemployees'ideasonthepotentialforviolentincidentsandtoidentifyorconfirmtheneedforimprovedsecuritymeasures.Detailedbaselinescreeningsurveyscanhelppinpointtasksthatputemployeesatrisk.Periodicsurveys—conductedatleastannuallyorwheneveroperationschangeorincidentsofworkplaceviolenceoccur—helpidentifyneworpreviouslyunnoticedriskfactorsanddeficienciesorfailuresinworkpractices,proceduresorcontrols.Also,thesurveyshelpassesstheeffectsofchangesintheworkprocesses.Theperiodicreviewprocessshouldalsoincludefeedbackandfollow-up.Independentreviewers,suchassafetyandhealthprofessionals,lawenforcementorsecurityspecialistsandinsurancesafetyauditors,mayofferadvicetostrengthenprograms.Theseexpertscanalsoprovidefreshperspectivestoimproveaviolencepreventionprogram.Conductingaworkplacesecurityanalysis工作場所安保分析Theteamorcoordinatorshouldperiodicallyinspecttheworkplaceandevaluateemployeetaskstoidentifyhazards,conditions,operationsandsituationsthatcouldleadtoviolence.Tofindareasrequiringfurtherevaluation,theteamorcoordinatorshould:Analyzeincidents,includingthecharacteristicsofassailantsandvictims,anaccountofwhathappenedbeforeandduringtheincident,andtherelevantdetailsofthesituationanditsoutcome.Whenpossible,obtainpolicereportsandrecommendations.安全事件分析，包括攻擊者和受害人特征，事件發生前和發生過程以及相關環境的細節和結果。有可能，爭取拿到***報告并聽取建議。Identifyjobsorlocationswiththegreatestriskofviolenceaswellasprocessesandproceduresthatputemployeesatriskofassault,includinghowoftenandwhen.發現暴力風險高的崗位和場所。Notehigh-riskfactorssuchastypesofclientsorpatients(forexample,thosewithpsychiatricconditionsorwhoaredisorientedbydrugs,alcoholorstress);physicalriskfactorsrelatedtobuildinglayoutordesign;isolatedlocationsandjobactivities;lightingproblems;lackofphonesandothercommunicationdevices;areasofeasy,unsecuredaccess;andareaswithprevioussecurityproblems.注意高風險因素例如特殊患者或客戶；建筑場所的風險；隔離的地點和工作；照明問題；通訊工具；不安全的地方和有過安全問題的地點Evaluatetheeffectivenessofexistingsecuritymeasures,includingengineeringcontrols.Determineifriskfactorshavebeenreducedoreliminatedandtakeappropriateaction.評估現存的安防措施，包括工程控制。風險是否降低或解除。HazardPreventionandControl危險防止和控制Afterhazardsareidentifiedthroughthesystematicworksiteanalysis,thenextstepistodesignmeasuresthroughengineeringoradministrativeandworkpracticestopreventorcontrolthesehazards.Ifviolencedoesoccur,post-incidentresponsecanbeanimportanttoolinpreventingfutureincidents.EngineeringcontrolsandworkplaceadaptationstominimizeriskEngineeringcontrols工程控制和工作場所調整減少風險removethehazardfromtheworkplaceorcreateabarrierbetweentheworkerandthehazard.Thereareseveralmeasuresthatcaneffectivelypreventorcontrolworkplacehazards,suchasthosedescribedinthefollowingparagraphs.Theselectionofanymeasure,ofcourse,shouldbebasedonthehazardsidentifiedintheworkplacesecurityanalysisofeachfacility.工程控制減少工作場所危險或在工作人員與危險之間建立隔離。以下有效措施。選擇依據是基于對工作場所安全危險因素的了解。Amongotheroptions,employersmaychooseto:Assessanyplansfornewconstructionorphysicalchangestothefacilityorworkplacetoeliminateorreducesecurityhazards.評價新建或改建工作場所，減少安全威脅Installandregularlymaintainalarmsystemsandothersecuritydevices,panicbuttons,hand-heldalarmsornoisedevices,cellularphonesandprivatechannelradioswhereriskisapparentormaybeanticipated.Arrangeforareliableresponsesystemwhenanalarmistriggered.安裝和定期維護報警系統和其他安全設施，如報警鈕、手持報警器，移動通訊步話機等。建立報警的有效反應系統Providemetaldetectors—installedorhand-held,whereappropriate—todetectguns,knivesorotherweapons,accordingtotherecommendationsofsecurityconsultants.提供金屬探測器，安裝或手持，以發現***、刀具或其他武器。Useaclosed-circuitvideorecordingforhigh-riskareasona24-hourbasis.Publicsafetyisagreaterconcernthanprivacyinthesesituations.24小時使用內部監控。公共區域尤為重要Placecurvedmirrorsathallwayintersectionsorconcealedareas.在走廊交叉口設置凸鏡。Enclosenurses'stationsandinstalldeepservicecountersorbullet-resistant,shatter-proofglassinreception,triageandadmittingareasorclientservicerooms.護士站的安全Provideemployee"saferooms"foruseduringemergencies.緊急時員工“安全房間”Establish"time-out"orseclusionareaswithhighceilingswithoutgridsforpatientswho"actout"andestablishseparateroomsforcriminalpatients.Providecomfortableclientorpatientwaitingroomsdesignedtominimizestress.為病人提供舒適的等待區減少緊張Ensurethatcounselingorpatientcareroomshavetwoexits.保證患者的治療區有兩個出口Lockdoorstostaffcounselingroomsandtreatmentroomstolimitaccess.鎖上員工心理咨詢室，限制出入。Arrangefurnituretoprevententrapmentofstaff.調整家具，防止員工被困Useminimalfurnitureininterviewroomsorcrisistreatmentareasandensurethatitislightweight,withoutsharpcornersoredgesandaffixedtothefloor,ifpossible.Limitthenumberofpictures,vases,ashtraysorotheritemsthatcanbeusedasweapons.盡量減少危機處理區域的家具；保證是重量輕沒有尖銳角固定在地面；減少裝飾畫、花瓶、煙灰缸或其他可用作武器的物品Providelockableandsecurebathroomsforstaffmembersseparatefrompatient/clientandvisitorfacilities.提供可鎖的、安全的員工衛生間Lockallunuseddoorstolimitaccess,inaccordancewithlocalfirecodes.符合消防規定的情況下，鎖住所有未使用的門，限制出入，Installbright,effectivelighting,bothindoorsandoutdoors.室內外安裝明亮、有效的照明系統Replaceburned-outlightsandbrokenwindowsandlocks.更換不良的燈或破損的窗戶、鎖具Keepautomobileswellmaintainediftheyareusedinthefield.保持野外使用的車輛的完好Lockautomobilesatalltimes.記得隨時鎖車Administrativeandworkpracticecontrolstominimizerisk行者和工作實踐控制將危險最小化Administrativeandworkpracticecontrolsaffectthewaystaffperformjobsortasks.Changesinworkpracticesandadministrativeprocedurescanhelppreventviolentincidents.Someoptionsforemployersareto:Stateclearlytopatients,clientsandemployeesthatviolenceisnotpermittedortolerated.清晰地向患者、客戶和員工申明不允許或不容忍暴力Establishliaisonwithlocalpoliceandstateprosecutors.Reportallincidentsofviolence.Givepolicephysicallayoutsoffacilitiestoexpediteinvestigations.與當地警察局建立聯系。報告所有暴力事件。給***所有場所的平面圖，加快調查。Requireemployeestoreportallassaultsorthreatstoasupervisorormanager(forexample,throughaconfidentialinterview).Keeplogbooksandreportsofsuchincidentstohelpdetermineanynecessaryactionstopreventrecurrences.要求員工向其主管或經理包告所有攻擊或威脅（例如，通過保密的訪談）。記錄和登記事件有利于決定是否采取必要措施防止再發生。Adviseemployeesofcompanyproceduresforrequestingpoliceassistanceorfilingchargeswhenassaultedandhelpthemdoso,ifnecessary.敦告員工公司申請***幫助的步驟要求Providemanagementsupportduringemergencies.Respondpromptlytoallcomplaints.緊急時提供管理支持。對投訴及時回復。Setupatrainedresponseteamtorespondtoemergencies.建立受訓的緊急反應隊伍Useproperlytrainedsecurityofficerstodealwithaggressivebehavior.Followwrittensecurityprocedures.用良好受訓的安全官處理過分行為。遵守書面的安全步驟。Ensurethatadequateandproperlytrainedstaffareavailabletorestrainpatientsorclients,ifnecessary.保證有充足的良好受訓的員工必要時身體約束患者或客戶Providesensitiveandtimelyinformationtopeoplewaitinginlineorinwaitingrooms.Adoptmeasurestodecreasewaitingtime.有同情的、及時的向等待區、排隊的人群提供信息Ensurethatadequateandqualifiedstaffareavailableatalltimes.Thetimesofgreatestriskoccurduringpatienttransfers,emergencyresponses,mealtimesandatnight.Areaswiththegreatestriskincludeadmissionunitsandcrisisoracutecareunits.保證有充足、合格的員工。患者轉移、急診搶救、就餐和夜間是高風險時段。高風險區域包括住院部、搶救和重癥區。Instituteasign-inprocedurewithpassesforvisitors,especiallyinanewbornnurseryorpediatricdepartment.Enforcevisitorhoursandprocedures.設立訪客簽到和通行證制度，特別是新生兒或兒科。執行訪客時間限定和程序Establishalistof"restrictedvisitors"forpatientswithahistoryofviolenceorgangactivity.Makecopiesavailableatsecuritycheckpoints,nurses'stationsandvisitorsign-inareas.建立有暴力記錄的患者“限制訪客”名單，發放給安全巡查點、護士站和訪客簽到處。Reviewandrevisevisitorchecksystems,whennecessary.Limitinformationgiventooutsidersabouthospitalizedvictimsofviolence.必要時變更訪客檢查系統。Supervisethemovementofpsychiatricclientsandpatientsthroughoutthefacility.在機構內移動精神病客戶或患者時密切監督Controlaccesstofacilitiesotherthanwaitingrooms,particularlydrugstorageorpharmacyareas.控制等待區外的場所出入，尤其是藥品存儲區域Prohibitemployeesfromworkingaloneinemergencyareasorwalk-inclinics,particularlyatnightorwhenassistanceisunavailable.Donotallowemployeestoenterseclusionroomsalone.防止員工獨立在急診去工作，尤其是夜間。別讓員工獨立進入隱秘的房間。Establishpoliciesandproceduresforsecuredareasandemergencyevacuations.建立安全區域和緊急撤離區域制度和步驟Determinethebehavioralhistoryofnewandtransferredpatientstolearnaboutanypastviolentorassaultivebehaviors.了解患者的行為史是否有暴力或攻擊傾向Establishasystem—suchascharttags,logbooksorverbalcensusreports—toidentifypatientsandclientswithassaultivebehaviorproblems.Keepinmindpatientconfidentialityandworkersafetyissues.Updateasneeded.建立一個發現有攻擊性行為問題患者或客戶的系統，例如表格、登記本或口頭詢問。牢記患者隱私和工作人員安全問題。Treatandinterviewaggressiveoragitatedclientsinrelativelyopenareasthatstillmaintainprivacyandconfidentiality(suchasroomswithremovablepartitions).在相對開放同時保持私密性的地方治療或詢問有過激或被激怒的客戶，例如有可移動隔板的房間。Usecasemanagementconferenceswithcoworkersandsupervisorstodiscusswaystoeffectivelytreatpotentiallyviolentpatients.與同事或主管討論潛在暴力的客戶的案例管理Preparecontingencyplanstotreatclientswhoare"actingout"ormakingverbalorphysicalattacksorthreats.Considerusingcertifiedemployeeassistanceprofessionalsorin-housesocialserviceoroccupationalhealthservicestafftohelpdiffusepatientorclientanger.準備“意外事件應對方案，應對行為過激，有口頭或身體攻擊或危險的客戶。考慮使用受訓的專業人員幫助平息患者或客戶的怒氣。Transferassaultiveclientstoacutecareunits,criminalunitsorothermorerestrictivesettings.將有攻擊行為的客戶移到限制性區域。Ensurethatnursesandphysiciansarenotalonewhenperformingintimatephysicalexaminationsofpatients.保證護士或醫生不單獨對患者進行私密的身體檢查。Discourageemployeesfromwearingnecklacesorchainstohelppreventpossiblestrangulationinconfrontationalsituations.Urgecommunityworkerstocarryonlyrequiredidentificationandmoney.不鼓勵員工帶項鏈，防止沖突時可能被絞扼。Surveythefacilityperiodicallytoremovetoolsorpossessionsleftbyvisitorsormaintenancestaffthatcouldbeusedinappropriatelybypatients.定期巡查場所，去除可能被不當使用的工具或物品。Providestaffwithidentificationbadges,preferablywithoutlastnames,toreadilyverifyemployment.為員工準備工作卡，最好不是全名，但能確認其身份Discourageemployeesfromcarryingkeys,pensorotheritemsthatcouldbeusedasweapons.Providestaffmemberswithsecurityescortstoparkingareasineveningorlatehours.Ensurethatparkingareasarehighlyvisible,welllitandsafelyaccessibletothebuilding.為員工提供夜間安全護送到停車場。保證停車場顯眼、照明和安全。Usethe"buddysystem,"especiallywhenpersonalsafetymaybethreatened.Encouragehomehealthcareproviders,socialserviceworkersandotherstoavoidthreateningsituations.使用“陪伴系統”，尤其是個人安全受到威脅時。鼓勵家庭病床醫護人員、社會服務工作者避免被威脅。Advisestafftoexerciseextracareinelevators,stairwellsandunfamiliarresidences;leavethepremisesimmediatelyifthereisahazardoussituation;orrequestpoliceescortifneeded.告誡員工不要在電梯、樓梯間或不熟悉的地方過于停留。如有危險迅速離開。Developpoliciesandprocedurescoveringhomehealthcareproviders,suchascontractsonhowvisitswillbeconducted,thepresenceofothersinthehomeduringthevisitsandtherefusaltoprovideservicesinaclearlyhazardoussituation.建立保證家庭病床醫護人員安全的規定和措施。例如家庭訪視如何實行，訪視時他人在場和拒絕在危險環境提供服務的措施。Establishadailyworkplanforfieldstafftokeepadesignatedcontactpersoninformedabouttheirwhereaboutsthroughouttheworkday.Havethecontactpersonfollowupifanemployeedoesnotreportinasexpected.建立日常工作計劃，為野外工作員工提供指定聯系人，保證全天了解他們的情況。如果員工未按規定及時報告應迅速主動跟進。Employerresponsestoincidentsofviolence雇主對暴力事件的反應Post-incidentresponseandevaluationareessentialtoaneffectiveviolencepreventionprogram.Allworkplaceviolenceprogramsshouldprovidecomprehensivetreatmentforemployeeswhoarevictimizedpersonallyormaybetraumatizedbywitnessingaworkplaceviolenceincident.Injuredstaffshouldreceiveprompttreatmentandpsychologicalevaluationwheneveranassaulttakesplace,regardlessofitsseverity.Providetheinjuredtransportationtomedicalcareifitisnotavailableonsite.事件發生后的反應和評估是建立有效暴力防止計劃的核心。所有工作場所暴力計劃應該為收到傷害的個人或者工作暴力事件目擊者提供綜合的治療。受傷的員工應該及時得到質量和心理評估，無論攻擊的嚴重程度。Victimsofworkplaceviolencesufferavarietyofconsequencesinadditiontotheiractualphysicalinjuries.工作場所暴力受害者會在身體傷害之外很多其他后果Thesemayinclude:Short-andlong-termpsychologicaltrauma;長期和短期心理重創Fearofreturningtowork;害怕回到工作Changesinrelationshipswithcoworkersandfamily;與同事和家庭的關系的改變Feelingsofincompetence,guilt,powerlessness;and感到不稱職、有罪、沒有能力Fearofcriticismbysupervisorsormanagers.害怕主管或經理的批評Consequently,astrongfollow-upprogramfortheseemployeeswillnotonlyhelpthemtodealwiththeseproblemsbutalsohelppreparethemtoconfrontorpreventfutureincidentsofviolence.Severaltypesofassistancecanbeincorporatedintothepost-incidentresponse.Forexample,trauma-crisiscounseling,critical-incidentstressdebriefingoremployeeassistanceprogramsmaybeprovidedtoassistvictims.Certifiedemployeeassistanceprofessionals,psychologists,psychiatrists,clinicalnursespecialistsorsocialworkersmayprovidethiscounselingortheemployermayreferstaffvictimstoanoutsidespecialist.Inaddition,theemployermayestablishanemployeecounselingservice,peercounselingorsupportgroups.Counselorsshouldbewelltrainedandhaveagoodunderstandingoftheissuesandconsequencesofassaultsandotheraggressive,violentbehavior.Appropriateandpromptlyrenderedpost-incidentdebriefingsandcounselingreduceacutepsychologicaltraumaandgeneralstresslevelsamongvictimsandwitnesses.Inaddition,thistypeofcounselingeducatesstaffaboutworkplaceviolenceandpositivelyinfluencesworkplaceandorganizationalculturalnormstoreducetraumaassociatedwithfutureincidents.SafetyandHealthTraining安全和健康培訓Trainingandeducationensurethatallstaffareawareofpotentialsecurityhazardsandhowtoprotectthemselvesandtheircoworkersthroughestablishedpoliciesandprocedures.Trainingforallemployees為所有員工培訓Everyemployeeshouldunderstandtheconceptof"universalprecautionsforviolence"—thatis,thatviolenceshouldbeexpectedbutcanbeavoidedormitigatedthroughpreparation.Frequenttrainingalsocanreducethelikelihoodofbeingassaulted.每個員工理解“暴力防范通用法則”，即暴力時間無法預計被預計，但可以被避免或減緩。訓練可以減少被攻擊的發生。Employeeswhomayfacesafetyandsecurityhazardsshouldreceiveformalinstructiononthespecifichazardsassociatedwiththeunitorjobandfacility.Thisincludesinformationonthetypesofinjuriesorproblemsidentifiedinthefacilityandthemethodstocontrolthespecifichazards.Italsoincludesinstructionstolimitphysicalinterventionsinworkplacealtercationswheneverpossible,unlessenoughstafforemergencyresponseteamsandsecuritypersonnelareavailable.Inaddition,allemployeesshouldbetrainedtobehavecompassionatelytowardcoworkerswhenanincidentoccurs.面臨安全隱患的員工應該受到正式的指導。Thetrainingprogramshouldinvolveallemployees,includingsupervisorsandmanagers.培訓應該包括所有員工Newandreassignedemployeesshouldreceiveaninitia