RESUMO
Background: The issue of restraint has long been considered a difficult political and social situation, affecting both healthcare wor-kers and facilities. The practice of restraint is still widespread in many public and private care settings, but there is a lack of systemic studies capable of monitoring the phenomenon. The framing of the question essentially concerns the right to personal freedom, guaranteed by the Italian Constitution. Materials and Methods: An anonymous questionnaire was developed containing questions on knowledge of the regulations on restraints, how, ways, and when they are implemented, and general information such as age, gender, educational qualification, qualification, O.Us. to which they belong. The collected data were statistically processed (Chi-square test) with the Epi Info 7.1.5 program (CDC-Atlanta- USA). A total of 1002 questionnaires were completed. The stratification of the sample by structure shows that 73.9% were public facilities. The indicative figure is represented by the 23.8% of respondents who say that "the restraint is not noted in the medical record". Conclusions: Restraint could be a real risk for the healthcare worker, encroaching on the issue of health liability. It is therefore important to raise awareness among healthcare professionals and top management of the need to structure, at company level, procedures that comply with the "Recommendations on physical restraint" to overcome the use of restraint through the improvement of care pathways in compliance with organizational and risk management standards.
Assuntos
Restrição Física , Restrição Física/ética , Restrição Física/legislação & jurisprudência , Restrição Física/estatística & dados numéricos , Humanos , Itália , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Hospitais , Responsabilidade LegalRESUMO
Due to restraints' consequences for personal liberty and dignity, the threshold to apply restraints is understandably high and heavily regulated. However, there can be clinical scenarios in which restraint use can facilitate a patient's freedom. This article considers such a case and examines conditions under which using restraints offers therapeutic benefit for patients with traumatic brain injuries.
Assuntos
Lesões Acidentais , Lesões Encefálicas Traumáticas , Liberdade , Restrição Física , Lesões Acidentais/terapia , Adulto , Lesões Encefálicas Traumáticas/terapia , Humanos , Masculino , Respeito , Restrição Física/ética , Restrição Física/legislação & jurisprudênciaRESUMO
Women of reproductive age may experience pregnancy and mothering in a correctional environment designed for men. Rates of incarceration for women in the United States are high by international standards, and they continue to rise. Mothers were often single mothers prior to incarceration, and they are often separated from their children for the first time upon entering prison. Pregnancy, delivery, lactation, and parenting each require special consideration. Outcomes of pregnancy in prison are better overall than for similarly disadvantaged women in the community. Breastfeeding, despite being recommended by medical groups, is problematic for most who are awaiting forced separation from their infant, due to a lack of mother-baby units in most U.S. states. Mother-baby units have crucial goals, including improved family relations and decreased recidivism. They should not discriminate against mothers with treated perinatal mental illness. Many barriers for visitation of incarcerated mothers exist, including that, because there are fewer women's prisons, there are greater distances between mothers and children. This article reviews data about pregnancy and motherhood in corrections, and it discusses the international state of mother-baby units, with implications for U.S. corrections.
Assuntos
Estabelecimentos Correcionais , Gestantes , Aleitamento Materno , Feminino , Humanos , Relações Mãe-Filho , Poder Familiar , Parto , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/normas , Restrição Física/legislação & jurisprudênciaRESUMO
BACKGROUND: The French legal framework in psychiatry for involuntary detention (ID) and seclusion measures was modified in 2011 and 2016, respectively. This study aimed to describe the evolution of ID and seclusion measures in the Centre-Val de Loire region (CVL France) between 2012 and 2017, using the psychiatric hospital discharge database. METHODS: A cross-sectional study was conducted, including adult patients (≥ 18 years old) from CVL hospitalized in psychiatry or included in a care program (outpatient care) between 2012 and 2017. Hospital stays for each patient were identified by an anonymized number. RESULTS: In 2017 in CVL, 13,942 patients were hospitalised for psychiatric reasons, with 2378 in ID (17%), a proportion that has remained stable since 2012. Among them, 3% were in care due to imminent danger (+ 54% since 2013, stabilisation since 2016), and 11% were hospitalized following a third party request (-13%). However, regarding location results varied from one department to the next. Seclusion measures involved 10% of full-time patients (stable), 27% of ID patients and 3% of those under voluntary care (stable). One quarter of the secluded patients were in voluntary care. Mean seclusion duration was 12 days, consecutive or not, and somewhat less for patients in voluntary care alone (10 days). CONCLUSION: The region wide ID rate and average duration of seclusion were lower than the nationwide rate (24% in full-time ID in 2015; 15 days of seclusion/patient), whereas the number of imminent danger procedures increased, as did the persistence of seclusion measures for patients in voluntary care (recommended only as a last resort and/or for ID patients). These results should lead to renewed assessment of care center practices. The French psychiatric hospital discharge database has several limitations, including lack of financial incentive and highly complex structuration. However, since 2018 new data regarding seclusion and restraint measures have been added to the existing registry, and they should facilitate more accurate analyses, particularly as concerns restraint.
Assuntos
Hospitais Psiquiátricos/estatística & dados numéricos , Internação Involuntária , Tratamento Psiquiátrico Involuntário/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Isolamento de Pacientes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , França/epidemiologia , História do Século XXI , Hospitalização/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Humanos , Internação Involuntária/legislação & jurisprudência , Tratamento Psiquiátrico Involuntário/legislação & jurisprudência , Tempo de Internação/estatística & dados numéricos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Isolamento de Pacientes/legislação & jurisprudência , Isolamento de Pacientes/psicologia , Restrição Física/legislação & jurisprudência , Restrição Física/psicologia , Restrição Física/estatística & dados numéricos , Adulto JovemRESUMO
Objective: The aim of this study was to explore parents' awareness and usage of CRS, incentives and challenges in CRS use, as well as their perception about potential CRS legislation in Malaysia.Methods: This was a cross-sectional study conducted in a public tertiary care center in Northern Malaysia. A self-developed researcher-assisted questionnaire was developed in English and translated into Malay language, to explore parents' awareness ad CRS usage, as well as the incentives and barriers in CRS use. Parents of a newborn were conveniently sampled, excluding parents with pre-term newborn or those without a car. Upon obtaining written informed consent, the parents were allowed to answer the questionnaire within 20 minutes, assisted by the researchers. Parents who were found not using CRS for their newborn were given a digital pamphlet with CRS-related information via mobile devices.Results: A total of 200 parents were approached and 193 of them consented to participate in this study. The majority of the parents (87.6%) were aware of CRS, but only half of them (57.0%) provided a CRS for their current newborn. From 100 CRS users, most of them used a CRS for "child's safety" purposes (84.5%). Among 83 CRS nonuser, nearly half of them (45.8%) perceived that it is adequate to carry their child during traveling without using a CRS. When exploring previous experience in using CRS among all parents (n = 193), more than half of them (63.9%) faced difficulty as their child refused to use the CRS. More than half (54.9%) of all parents were not aware about the possible CRS legislation in Malaysia. However, the majority of them (90.7%) agreed with the implementation of CRS law.Conclusions: Although majority of the parents were aware about CRS, but only half had a CRS for their current newborn. Most of the parents supported CRS legislation in Malaysia, but assistance will be required to help them through challenges related to CRS use.
Assuntos
Sistemas de Proteção para Crianças/estatística & dados numéricos , Pais/psicologia , Restrição Física/legislação & jurisprudência , Adulto , Conscientização , Estudos Transversais , Humanos , Recém-Nascido , Malásia , Percepção , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
Restraint and seclusion (R&S) measures in psychiatric settings are applied worldwide, despite poor scientific evidence to back up their effectiveness. The medical, ethical and medico-legal implications of coercive interventions are broad-ranging and multifaceted. The review aims to shed a light on the most relevant and meaningful standards that have been laid out by international treaties, supranational institutions (United Nations, Council of Europe, World Health Organization), scientific institutions (American Medical Association, Australian Department of Health), legislative bodies and courts of law. Several court cases are herein expounded upon, with a close focus on meaningful analysis, decisions and conclusions that have laid the groundwork for a different, more restrictive and more clearly defined approach towards R&S imposed upon psychiatric patients. It is reasonable to assume that changing norms, civil rights enforcement, court rulings and new therapeutic options have influenced the use of R&S to such an extent that such measures are among the most strictly regulated in psychiatric practice; health care providers should abide by a strict set of cautionary rules when making the decision to resort to R&S, which must never be put in place as a substitute for patient-centered therapeutic planning. Case law shows that R&S should only be weighed in terms of their effectiveness towards therapeutic goals. Being able to prove that R&S was employed as part of a therapeutic path rather than used to maintain order or to exact punishment may go a long way towards shielding operators against negligence lawsuits and litigation.
Assuntos
Coerção , Institucionalização/normas , Internacionalidade , Transtornos Mentais , Restrição Física/normas , Internação Compulsória de Doente Mental/ética , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Dinamarca , Alemanha , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Institucionalização/ética , Institucionalização/legislação & jurisprudência , Agências Internacionais/normas , Internacionalidade/legislação & jurisprudência , Itália , Responsabilidade Legal , Guias de Prática Clínica como Assunto , Psiquiatria/legislação & jurisprudência , Restrição Física/ética , Restrição Física/legislação & jurisprudência , Sociedades Médicas , Estados UnidosRESUMO
BACKGROUND: We report on the impact of two system-level policy interventions (the Long-Term Care Homes Act [LTCHA] and Public Reporting) on publicly reported physical restraint use and non-publicly reported potentially inappropriate use of antipsychotics in Ontario, Canada. METHODS: We used interrupted time series analysis to model changes in the risk-adjusted use of restraints and antipsychotics before and after implementation of the interventions. Separate analyses were completed for early ([a] volunteered 2010/2011) and late ([b] volunteered March 2012; [c] mandated September 2012) adopting groups of Public Reporting. Outcomes were measured using Resident Assessment Instrument Minimum Data Set (RAI-MDS) data from January 1, 2008 to December 31, 2014. RESULTS: For early adopters, enactment of the LTCHA in 2010 was not associated with changes in physical restraint use, while Public Reporting was associated with an increase in the rate (slope) of decline in physical restraint use. By contrast, for the late-adopters of Public Reporting, the LTCHA was associated with significant decreases in physical restraint use over time, but there was no significant increase in the rate of decline associated with Public Reporting. As the LTCHA was enacted, potentially inappropriate use of antipsychotics underwent a rapid short-term increase in the early volunteer group, but, over the longer term, their use decreased for all three groups of homes. CONCLUSIONS: Public Reporting had the largest impact on voluntary early adopters while legislation and regulations had a more substantive positive effect upon homes that delayed public reporting.
Assuntos
Antipsicóticos/uso terapêutico , Instituição de Longa Permanência para Idosos/legislação & jurisprudência , Assistência de Longa Duração/legislação & jurisprudência , Casas de Saúde/legislação & jurisprudência , Lista de Medicamentos Potencialmente Inapropriados/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Idoso , Antipsicóticos/efeitos adversos , Defesa do Consumidor/legislação & jurisprudência , Instituição de Longa Permanência para Idosos/normas , Humanos , Prescrição Inadequada/legislação & jurisprudência , Análise de Séries Temporais Interrompida , Assistência de Longa Duração/normas , Casas de Saúde/normas , Ontário , Lista de Medicamentos Potencialmente Inapropriados/normas , Registros Públicos de Dados de Cuidados de Saúde , Restrição Física/efeitos adversos , Restrição Física/estatística & dados numéricosRESUMO
We draw upon two recent reports from the Chief Ombudsman that describe the prison management of people assessed at risk of self-harm or suicide, as cruel, inhuman or degrading treatment or punishment. People were mechanically restrained on 'tie-down' beds by their legs, arms and chest or placed in waist restraints with their hands cuffed behind their backs over prolonged periods. These practices occurred at the direction of, or were approved by, health professionals. We highlight ethical issues for health professionals party to 'tie down' and examine the current guidance and regulatory framework for health professionals working in coercive environments. This article is timely in the context of current Government Inquiries into the criminal justice system and mental health and addictions, the review of the health and disability system, the Correction's Amendment Bill before parliament, and Government plans to expand Waikeria prison to include a 100-bed mental health facility. We call for the use of 'tie down' to be abolished in New Zealand prisons, and for all health professionals to refuse to participate in this practice. Government must make provision for sufficient forensic mental health capacity and capability in the health sector, and ensure timely, equitable access to high-quality, trauma-informed and culturally safe services.
Assuntos
Serviços de Saúde Mental/legislação & jurisprudência , Prisioneiros/legislação & jurisprudência , Prisões/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Internação Compulsória de Doente Mental/legislação & jurisprudência , Humanos , Avaliação das Necessidades/legislação & jurisprudência , Nova Zelândia , PuniçãoRESUMO
The Mastrogiovanni case was a revolutionary case in the field of Italian forensic psychiatry. A recent judgment of the Court of Cassation has defined what the legal limits of mechanical restraint should be. On the other hand, even today, there is a gap in the scientific community about the presence of guidelines governing mechanical restraint. It is probably time to create specific guidelines to protect the psychiatric patient and the mental health worker.
Assuntos
Psiquiatria Legal/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Humanos , ItáliaAssuntos
Defesa da Criança e do Adolescente/legislação & jurisprudência , Proteção da Criança/legislação & jurisprudência , Direito Penal/legislação & jurisprudência , Delinquência Juvenil/legislação & jurisprudência , Adolescente , Criança , Governo Federal , Humanos , Delinquência Juvenil/prevenção & controle , Prisões , Restrição Física/legislação & jurisprudência , Governo Estadual , Estados UnidosRESUMO
Psychiatric care has always included patients in crisis who are potentially dangerous or agitated. Faced with the many issues they may encounter, the therapeutic relationship has always been prioritized over all other considerations. However, the practice of seclusion and restraint has been steadily increasing in the past few decades. Their use is becoming customary rather than exceptional and consequently fosters less thought by the care teams. In the Healthcare System Modernization Act of January 26th, 2016, the lawmakers sought to underline the freedom-destroying nature of these practices and the necessity of their regulation. This law represents a fundamental change in the nature of seclusion and restraint. What was but a simple prescription becomes a conscious decision of depriving someone of her or his freedom and must only be considered as a last resort. The changes in the Law and the recent changes in the recommendations for clinical practice by the French National Institute of Health invite reflection. Many questions remain about the origins of violence, the reasons for the increasing use of seclusion and restraint measures, and the alternatives that have been developed. Many theories suggest that the less stressful and constrained an environment is, the more empowered the patient will be. He is an actor in his own care and is considered a full active participant. The Law is reconciled with caregivers initiating a reflection on the benefits of these measures regarding the violation of fundamental freedoms. Reflection on psychiatric care and the quality of its management must be the focus when caring for patients in crisis.
Assuntos
Tomada de Decisão Clínica , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Isolamento de Pacientes/psicologia , Psiquiatria/legislação & jurisprudência , Psiquiatria/tendências , Restrição Física/legislação & jurisprudência , Restrição Física/normas , Internação Compulsória de Doente Mental , França , HumanosAssuntos
Atenção à Saúde/organização & administração , Medicina Militar , Restrição Física , Liberdade , Capacitação em Serviço , Saúde Ocupacional , Segurança do Paciente , Restrição Física/legislação & jurisprudência , Restrição Física/normas , Estados Unidos , United States Department of Veterans AffairsRESUMO
AIM OF THE STUDY: The aim of the paper is analysis of the impact of immobilization treatment of "less severe" motor organ injuries affecting soft tissues on the position of medical experts and court decisions in crimes against health. We also analysed the attitude of courts to expert opinions and present a proposal for a model of judicial and medical opinion in such cases. MATERIAL AND METHODS: In the study, we analysed judgments of the criminal divisions of common courts, in which the use of medical immobilization of a given part of the body or lack thereof could have an impact on the degree of health impairment determined by the medical expert. RESULTS: Some experts consider medical immobilization to be tantamount to an impairment of the function of a body organ, and the courts rarely reject such opinions. For some experts, the key is not the actual function of the immobilized part of the musculoskeletal system after 7 days from injury, but the immobilization treatment itself, and not the time it takes. In addition, experts determine the severity of injuries when immobilization is/is not used. CONCLUSIONS: The degree of health impairment, as defined in the Penal Code, should be determined by a medical check-up carried out 7 days after the injury, with an assessment of its "biological" effects, and not by the use of immobilization treatment and the time for which it is maintained.
Assuntos
Prova Pericial/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Gestão da Segurança/legislação & jurisprudência , Medicina Baseada em Evidências/legislação & jurisprudência , Medicina Legal/legislação & jurisprudência , Humanos , Exame Físico/métodos , Polônia , Qualidade da Assistência à Saúde/legislação & jurisprudência , Violência/prevenção & controleRESUMO
Restraint in geriatric care is not a trivial act. It must be regulated, performed in accordance with best practice guidelines and respect patients' fundamental rights. It requires initial evaluation as well as daily re-evaluation. An alternative must always be considered by the whole team, which should be mindful of its responsibility and its sense of ethics.
Assuntos
Geriatria , Restrição Física , Idoso , França , Humanos , Direitos do Paciente/legislação & jurisprudência , Restrição Física/ética , Restrição Física/legislação & jurisprudênciaAssuntos
Psiquiatria do Adolescente/legislação & jurisprudência , Psiquiatria Infantil/legislação & jurisprudência , Psiquiatria Legal/legislação & jurisprudência , Hospitalização/legislação & jurisprudência , Isolamento de Pacientes/legislação & jurisprudência , Psicotrópicos/uso terapêutico , Restrição Física/legislação & jurisprudência , Adolescente , Criança , Alemanha , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudênciaRESUMO
Over recent years, the psychiatric sector has endeavoured to develop community-based care. Paradoxically, the number of compulsory hospitalisations is increasing. At the same time, the legal framework is evolving and measures relating to the deprivation of liberty in the context of psychiatric care have given rise to extensive guidelines. The work of the French National Health Authority represents, in this context, a certain continuity, with regard to the legal, ethical and social discussions around restriction of liberty practices within psychiatric units. The main focus is on the prevention and management of violent outbursts.
Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Transtornos Mentais/enfermagem , Unidade Hospitalar de Psiquiatria/legislação & jurisprudência , Violência/prevenção & controle , Redes Comunitárias/ética , Redes Comunitárias/legislação & jurisprudência , Consenso , Ética Médica , França , Fidelidade a Diretrizes , Humanos , Transtornos Mentais/psicologia , Defesa do Paciente/legislação & jurisprudência , Isolamento de Pacientes/legislação & jurisprudência , Isolamento de Pacientes/psicologia , Unidade Hospitalar de Psiquiatria/ética , Enfermagem Psiquiátrica/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Restrição Física/psicologia , Medição de Risco/legislação & jurisprudência , Esquizofrenia/diagnóstico , Esquizofrenia/enfermagem , Psicologia do Esquizofrênico , Violência/éticaRESUMO
Several measures relating to seclusion and restraint are included in the French public health code. The best practice guidelines of the French National Health Authority, published in 2017, define these two notions and advise on the behaviour to adopt with regard to their implementation and monitoring. Likewise, informing and supporting the patient when these measures are lifted are critical moments which the teams must also be able to manage correctly.
Assuntos
Fidelidade a Diretrizes , Transtornos Mentais/enfermagem , Isolamento de Pacientes/legislação & jurisprudência , Unidade Hospitalar de Psiquiatria/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Medição de Risco/legislação & jurisprudência , França , Fidelidade a Diretrizes/legislação & jurisprudência , Humanos , Transtornos Mentais/psicologia , Programas Nacionais de Saúde/legislação & jurisprudência , Equipe de Assistência ao Paciente/legislação & jurisprudência , Isolamento de Pacientes/psicologia , Enfermagem Psiquiátrica/legislação & jurisprudência , Restrição Física/psicologia , Avaliação de Sintomas/enfermagem , Avaliação de Sintomas/psicologiaAssuntos
Educação de Pessoa com Deficiência Intelectual/legislação & jurisprudência , Cuidados no Lar de Adoção/legislação & jurisprudência , Institucionalização/legislação & jurisprudência , Pessoas com Deficiência Mental/legislação & jurisprudência , Pessoas com Deficiência Mental/psicologia , Adolescente , Criança , Defesa da Criança e do Adolescente/legislação & jurisprudência , Defesa da Criança e do Adolescente/psicologia , Coerção , Cuidados no Lar de Adoção/psicologia , Alemanha , Humanos , Consentimento dos Pais/legislação & jurisprudência , Consentimento dos Pais/psicologia , Poder Familiar/psicologia , Isolamento de Pacientes/legislação & jurisprudência , Isolamento de Pacientes/psicologia , Psicotrópicos/administração & dosagem , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Restrição Física/psicologia , Estresse Psicológico/complicações , Estresse Psicológico/psicologiaRESUMO
Rates of involuntary admission are increasing in England. Personality disorder should be excluded as a criterion for involuntary admission; stronger restraint reduction programmes should be instigated; and involuntary care should be based on treating illness (something we can do) and not on predicting violence (something we cannot). Declaration of interest None.