This work was done with the aim of evaluating, through a review of the literature, the need and the possible effectiveness of a protocol for the prevention of aggressive behavior in the Marche region. Working on prevention is essential in order to reduce and/or avoid, by health professionals, the use of coercive practices, gray areas and ethically questionable for the implications on mental and physical health that they have on patients. According to available sources, it appears that restraint following aggressive behavior or psychomotor agitation reaches 10.4% in hospital facilities and 2.5% in RSA. These data date back to 2012 but seem to be confirmed also in more recent literature reviews Gatti M et al., (2019). From the articles examined it seems that, in order to avoid the practice of restraint as much as possible, it is useful to work on the prevention of aggressive behavior with: the use of validated scales for the early identification of aggression, the use of personalized treatment plans, the involvement of family members, de-escalation techniques, training of staff and their availability and reachability, environmental and structural changes and alternatives to restraint. Materials and methods: to carry out this literature review it was essential first of all to inform readers about the meaning of coercion in ethical terms, to talk about the consequences from a physical and psychological point of view that this practice brings with it and to provide knowledge on the size of the phenomenon in Italy. It was then essential to work on the research question. In this regard, the question investigated is the following: Can the drafting of a protocol in the SPDC (psychiatric diagnosis and treatment service) for the prevention of aggressive acts for the Marche region help to reduce the frequency with which mechanical restraint is implemented? The keywords identified: - “no- restraint” - “psichiatry” - “Physical Restraint” - “de-escalation” - “Alternative” - “Mental Healthcare Act 2017” - “coercion in mental health care” - “general hospital psychiatric units” - “prevalence”. The strategy chosen to identify eligible studies included consulting the PubMed database, FNOPI (National Federation of Nursing Professional Orders), ISTAT (National Institute of Statistics), Criminal Code, MSD manuals and other websites. The searches were carried out both through the use of search strings and through the use of free words.
Questo lavoro è stato fatto con lo scopo di valutare, attraverso la revisione della letteratura, la necessità e l’eventuale efficacia di un protocollo per la prevenzione degli agiti aggressivi nella regione Marche. Lavorare sulla prevenzione è indispensabile al fine di ridurre e/o evitare, da parte dei professionisti sanitari, il ricorso alle pratiche coercitive, zone grigie e deontologicamente discutibili per le implicazioni sulla salute mentale e fisica che comportano sugli assistiti. Secondo le fonti disponibili, risulta che la contenzione a seguito di comportamento aggressivo o agitazione psicomotoria raggiunga, nelle strutture ospedaliere, il 10,4 % e nelle RSA il 2,5%. Questi dati risalgono al 2012 ma sembrano trovare conferma anche in revisioni della letteratura più recenti Gatti M et al., (2019). Dagli articoli esaminati sembra che, al fine di evitare quanto più possibile la pratica della contenzione, sia utile lavorare sulla prevenzione del comportamento aggressivo con: l’utilizzo di scale validate per la precoce individuazione dell’aggressività, l’utilizzo di piani di cura personalizzati, il coinvolgimento dei famigliari, le tecniche di de-escalation, la formazione del personale e la sua disponibilità e reperibilità, le modifiche ambientali e strutturali e sulle alternative alla contenzione. Materiali e metodi: per realizzare questa revisione della letteratura è stato indispensabile innanzitutto informare i lettori sul significato in termini etici della coercizione, Parlare delle conseguenze da un punto di vista fisico e psicologico che questa pratica porta con sé e fornire una conoscenza sulla dimensione del fenomeno in Italia. È stato poi essenziale lavorare sul quesito di ricerca. A tal proposito il quesito indagato è il seguente: La stesura di un protocollo nelle SPDC (servizio psichiatrico di diagnosi e cura) per la prevenzione degli agiti aggressivi per la regione Marche può aiutare a ridurre la frequenza con cui si attua la contenzione meccanica? Le parole chiave individuate: - “no- restraint” - “psichiatry” - “Physical Restraint” - “de-escalation” - “Alternative” - “Mental Healthcare Act 2017” - “coercion in mental health care” - “general hospital psychiatric units” - “prevalenza”. La strategia scelta per identificare gli studi eleggibili ha incluso la consultazione della banca dati di PubMed, della FNOPI (federazione nazionale ordini professionali infermieristiche), ISTAT (istituto nazionale di statistica), Codice penale, MSD manuals ed altri siti internet. Le ricerche sono state svolte sia attraverso l’uso di stringhe di ricerca, sia attraverso l’uso di parole libere.
Necessità di un protocollo per la prevenzione del comportamento aggressivo nella regione Marche
SANTILLI, SARA
2023/2024
Abstract
This work was done with the aim of evaluating, through a review of the literature, the need and the possible effectiveness of a protocol for the prevention of aggressive behavior in the Marche region. Working on prevention is essential in order to reduce and/or avoid, by health professionals, the use of coercive practices, gray areas and ethically questionable for the implications on mental and physical health that they have on patients. According to available sources, it appears that restraint following aggressive behavior or psychomotor agitation reaches 10.4% in hospital facilities and 2.5% in RSA. These data date back to 2012 but seem to be confirmed also in more recent literature reviews Gatti M et al., (2019). From the articles examined it seems that, in order to avoid the practice of restraint as much as possible, it is useful to work on the prevention of aggressive behavior with: the use of validated scales for the early identification of aggression, the use of personalized treatment plans, the involvement of family members, de-escalation techniques, training of staff and their availability and reachability, environmental and structural changes and alternatives to restraint. Materials and methods: to carry out this literature review it was essential first of all to inform readers about the meaning of coercion in ethical terms, to talk about the consequences from a physical and psychological point of view that this practice brings with it and to provide knowledge on the size of the phenomenon in Italy. It was then essential to work on the research question. In this regard, the question investigated is the following: Can the drafting of a protocol in the SPDC (psychiatric diagnosis and treatment service) for the prevention of aggressive acts for the Marche region help to reduce the frequency with which mechanical restraint is implemented? The keywords identified: - “no- restraint” - “psichiatry” - “Physical Restraint” - “de-escalation” - “Alternative” - “Mental Healthcare Act 2017” - “coercion in mental health care” - “general hospital psychiatric units” - “prevalence”. The strategy chosen to identify eligible studies included consulting the PubMed database, FNOPI (National Federation of Nursing Professional Orders), ISTAT (National Institute of Statistics), Criminal Code, MSD manuals and other websites. The searches were carried out both through the use of search strings and through the use of free words.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/19806