INTRODUCTION: the management of psychiatric patients who have committed crimes represents one of the most complex challenges for mental health services, as it involves clinical, ethical, legal, and social aspects. In this context, the perception of nurses, who play a central role in care, is particularly important in the daily management of these patients, as they must balance the right to treatment with public safety and compliance with regulations (Badon et al., 2023). The aim of the research is to analyze nurses perceptions of the management of psychiatric patients who have committed crimes within SPDCs, with a focus on the planning of the Individualized Care Plan (ICP), the critical issues encountered, training needs and the perceived level of preparation. MATERIALS AND METHODS: the study was conducted through a multicenter cross-sectional observational survey, carried out between May 1 and September 30, 2025, at the AST in Ascoli Piceno. Data collection was carried out through the administration of an online questionnaire on Microsoft Forms divided into a socio-demographic section (9 items) and a standardized section based on the CENA Survey scale (24 items), adapted to the study (Sivakumar et al., 2011). The sample consisted of n.37 nurses working in hospitals, and prisons, belonging to the Mental Health Departments in the Marche region. RESULTS: the survey revealed significant results in three main areas: professional, training and safety. In particular, n.20 (54%) nurses stated that they knew how to adopt coping strategies and n.17 (46%) knew how to manage stress, but n.10 (27%) felt vulnerable to emotional distress. On a technical level, compared to the emotional level, only n.12 (32%) feel prepared in psychiatric assessment, with n.28 (76%) not using standardized tools, negatively affecting the perception of effectiveness and safety. Specific training is lacking, as n.31 (84%) professionals have never received dedicated courses and n. 33 (89%) have never participated in training events; despite this, n.19 (51%) and n.16 (43%) are aware of the importance of specific skills in the assessment, treatment and management of patients who are offenders. Furthermore, the degree of perceived safety is statistically correlated with the level of training, technical competence and work organization. ANALYSIS: the data collected using Microsoft Forms were exported in Microsoft Excel format and processed using descriptive statistics and graphical representations. The categorical variables were analyzed by constructing relative frequency (n) and percentage (%) tables to highlight the distribution of responses in the three areas investigated: agreement, safety and competence. In addition, two main statistical tests: t-test for independent samples and the Chi-square test which were used to investigate the presence of statistically significant associations between categorical variables. DISCUSSIONS: the survey revealed that nursing care for patients who have committed crimes is a complex phenomenon, characterized by a high emotional burden. Insufficient specific training and the lack of structured resources increase feelings of insecurity and stress, with consequences for nursing care. Therefore, the results, in line with the literature, suggest, on the one hand, the need to develop and adopt standardized tools and shared protocols to improve safety and organizational critical issues and on the other hand, to enhance the training and skills of professionals in order to optimize the quality of the therapeutic care pathway. KEYWORDS: “Therapeutic approach to the offender patient”, “Nurse”, “Forensic nursing”, “Ethics”, “Mental health psychiatric patient offender”, “Mental health”.
INTRODUZIONE: la gestione del paziente psichiatrico autore di reato rappresentata una delle sfide più complesse per i servizi di salute mentale, poiché coinvolge aspetti clinici, etici, legali e sociali. In questo contesto, assume particolare rilievo la percezione degli infermieri, figure centrali dell'assistenza, nella gestione quotidiana di tali pazienti che devono conciliare il diritto alla cura con la sicurezza pubblica e il rispetto delle normative (Badon et al., 2023). Lo scopo della ricerca è analizzare la percezione degli infermieri sulla gestione del paziente psichiatrico autore di reato all'interno degli SPDC, con attenzione alla pianificazione del Piano Assistenziale Individualizzato (PAI), alle criticità riscontrate, ai bisogni formativi e al livello di preparazione percepito. MATERIALI E METODI: lo studio è stato condotto mediante un'indagine osservazionale trasversale multicentrica, realizzata tra il 1 Maggio e il 30 Settembre 2025 presso l'AST di Ascoli Piceno. La raccolta dati è avvenuta tramite la somministrazione di un questionario online su Microsoft Forms articolato in una sezione socio-anagrafica (9 items) e una sezione standardizzata basata sulla scala CENA Survey (24 items), adattata allo studio (Sivakumar et al., 2011). Il campione è costituito da n. 37 infermieri operanti nelle strutture ospedaliere e penitenziarie, afferenti ai Dipartimenti di Salute Mentale della regione Marche. RISULTATI: l'indagine ha fatto emergere risultati rilevanti in tre ambiti principali: professionale, formativa e di sicurezza. In particolare, n. 20 (54%) infermieri dichiarano di saper adottare strategie di coping e n. 17 (46%) di saper gestire lo stress, ma emergono n. 10 (27%) che si sentono vulnerabili al disagio emotivo. Sul piano tecnico, rispetto a quello emotivo, solo n. 12 (32%) si sentono preparati nella valutazione psichiatrica con n. 28 (76%) che non utilizza strumenti standardizzati, influenzando negativamente la percezione di efficacia e sicurezza. La formazione specifica risulta carente in quanto n. 31 (84%) professionisti non hanno mai ricevuto corsi dedicati e n. 33 (89%) non hanno mai partecipato a eventi formativi; nonostante ciò, n. 19 (51%) e n. 16 (43%) conoscono l'importanza di competenze specifiche nella valutazione, trattamento e gestione del paziente autore di reato. Inoltre, il grado di sicurezza percepita risulta correlata statisticamente al livello di formazione, alla competenza tecnica e all'organizzazione lavorativa. ANALISI: i dati raccolti tramite Microsoft Forms sono stati esportati in formato Microsoft Excel ed elaborati mediante statistiche descrittive e rappresentazioni grafiche. Le variabili categoriali sono state analizzate attraverso la costruzione di tabelle di frequenza relativa (n) e percentuale (%) per evidenziare la distribuzione delle risposte delle tre aree indagate: accordo, sicurezza e competenza. Altresì, sono stati utilizzati due test statistici: t-test per campioni indipendenti e il test Chi-quadro impiegati per indagare la presenza di associazioni statisticamente significative tra le variabili categoriali. DISCUSSIONI: dall'indagine è emerso come l'assistenza infermieristica al paziente autore di reato rappresenti un fenomeno complesso, caratterizzato da un elevato carico emotivo. L'insufficiente formazione specifica e l'assenza di risorse strutturate aumentano il senso di insicurezza e di stress, con conseguenze sull'assistenza infermieristica. Pertanto, i risultati, in linea con la letteratura, suggeriscono da un lato la necessità di sviluppare e adottare strumenti standardizzati e protocolli condivisi per migliorare la sicurezza e le criticità organizzative, e dall'altro potenziare la formazione e le competenza dei professionisti al fine di ottimizzare la qualità del percorso terapeutico assistenziale. KEYWORDS: "Theraputic approach to the offender patient", "Nurse", "Forensic nursing", "Ethics", "Mental health psychiatric patient offender", "Mental health".
IL PAZIENTE PSICHIATRICO AUTORE DI REATO: SURVEY CROSS-SECTIONAL NELL’AST DI ASCOLI PICENO
ANTINI, GIUSI IDA
2024/2025
Abstract
INTRODUCTION: the management of psychiatric patients who have committed crimes represents one of the most complex challenges for mental health services, as it involves clinical, ethical, legal, and social aspects. In this context, the perception of nurses, who play a central role in care, is particularly important in the daily management of these patients, as they must balance the right to treatment with public safety and compliance with regulations (Badon et al., 2023). The aim of the research is to analyze nurses perceptions of the management of psychiatric patients who have committed crimes within SPDCs, with a focus on the planning of the Individualized Care Plan (ICP), the critical issues encountered, training needs and the perceived level of preparation. MATERIALS AND METHODS: the study was conducted through a multicenter cross-sectional observational survey, carried out between May 1 and September 30, 2025, at the AST in Ascoli Piceno. Data collection was carried out through the administration of an online questionnaire on Microsoft Forms divided into a socio-demographic section (9 items) and a standardized section based on the CENA Survey scale (24 items), adapted to the study (Sivakumar et al., 2011). The sample consisted of n.37 nurses working in hospitals, and prisons, belonging to the Mental Health Departments in the Marche region. RESULTS: the survey revealed significant results in three main areas: professional, training and safety. In particular, n.20 (54%) nurses stated that they knew how to adopt coping strategies and n.17 (46%) knew how to manage stress, but n.10 (27%) felt vulnerable to emotional distress. On a technical level, compared to the emotional level, only n.12 (32%) feel prepared in psychiatric assessment, with n.28 (76%) not using standardized tools, negatively affecting the perception of effectiveness and safety. Specific training is lacking, as n.31 (84%) professionals have never received dedicated courses and n. 33 (89%) have never participated in training events; despite this, n.19 (51%) and n.16 (43%) are aware of the importance of specific skills in the assessment, treatment and management of patients who are offenders. Furthermore, the degree of perceived safety is statistically correlated with the level of training, technical competence and work organization. ANALYSIS: the data collected using Microsoft Forms were exported in Microsoft Excel format and processed using descriptive statistics and graphical representations. The categorical variables were analyzed by constructing relative frequency (n) and percentage (%) tables to highlight the distribution of responses in the three areas investigated: agreement, safety and competence. In addition, two main statistical tests: t-test for independent samples and the Chi-square test which were used to investigate the presence of statistically significant associations between categorical variables. DISCUSSIONS: the survey revealed that nursing care for patients who have committed crimes is a complex phenomenon, characterized by a high emotional burden. Insufficient specific training and the lack of structured resources increase feelings of insecurity and stress, with consequences for nursing care. Therefore, the results, in line with the literature, suggest, on the one hand, the need to develop and adopt standardized tools and shared protocols to improve safety and organizational critical issues and on the other hand, to enhance the training and skills of professionals in order to optimize the quality of the therapeutic care pathway. KEYWORDS: “Therapeutic approach to the offender patient”, “Nurse”, “Forensic nursing”, “Ethics”, “Mental health psychiatric patient offender”, “Mental health”.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/24187