[The latest best practice guidelines relating to seclusion and restraint]. / Les dernières recommandations de bonnes pratiques sur l'isolement et la contention.

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.

A Enfermagem Psiquiátrica, a ABEn e o Departamento Científico de Enfermagem Psiquiátrica e Saúde Mental: avanços e desafios / The Psychiatric Nursing, ABEn and the Scientific Department of Psychiatric and Mental Health Nursing: progress and challenges / La Enfermería Psiquiátrica, ABEn y el Departamento Científico de Enfermería Psiquiátrica y de Salud Mental: avances y desafíos

Este estudo contextualiza a Enfermagem Psiquiátrica e a Saúde Mental no Brasil, considerando os principais marcos históricos, políticos e sociais que influenciam o cuidado de enfermagem nessa área. As reflexões apontam para mudanças no paradigma da atenção psicossocial considerando os aspectos legais que regulamentam as ações, os avanços e desafios vivenciados na prática da Enfermagem Psiquiátrica no contexto assistencial assim como na formação do enfermeiro. É fundamental formar profissionais capazes de atuar na gestão e assistência na perspectiva interdisciplinar e em rede. As conquistas almejadas para esta especialidade perpassam por uma comunidade científica crítica e organizada politicamente que conheça e atenda a realidade dos profissionais. Neste panorama, o Departamento Científico de Enfermagem Psiquiátrica e Saúde Mental, criado pela Associação Brasileira de Enfermagem se instala como uma estratégia para congregar e consolidar o trabalho dos especialistas, visando a excelência da Atenção Especializada em Psiquiatria e Saúde Mental.

This study contextualizes the Psychiatric Nursing and Mental Health in Brazil, considering the major historic, political and social factors that influence nursing care in this area. Reflections pointed to changes in the paradigm of psychosocial care considering the legal aspects that regulate the actions, progress and challenges experienced in the practice of Psychiatric Nursing in healthcare settings as well as in nursing education. It is essential to train professionals to work in management and assistance in perspective and interdisciplinary care network. The achievements for this specialty rush on a scientific critical and organized politically and who knows answer the reality of professionals. In this view, the Scientific Department of Psychiatric Nursing and Mental Health, created by the Brazilian Association of Nursing was installed as a strategy to bring together and consolidate the work of experts, aiming to achieve the excellence of the Specialized Care in Psychiatry and Mental Health.

Este estudio contextualiza la Enfermería Psiquiátrica y de Salud Mental en Brasil, teniendo en cuenta los principales factores históricos, políticos y sociales que influyen en la atención de enfermería en esta área. Reflexiones señalaron a los cambios en el paradigma de la atención psicosocial, considerando los aspectos legales que rigen las acciones, avances y desafíos experimentados en la práctica de la enfermería psiquiátrica en los centros de salud, así como en la formación de enfermería. Es fundamental la formación de profesionales que trabajen en la gestión y la asistencia en la creación de redes y la perspectiva interdisciplinaria. Los logros almejados para esta especialidad pasan por una comunidad científica crítica y organizada políticamente, que conozca y atienda la realidad de los profesionales. En este escenario, el Departamento Científico de Enfermería Psiquiátrica y de Salud Mental, creado por la Asociación Brasileña de Enfermería, se instala como una estrategia para reunir y consolidar el trabajo de los expertos, visando la excelencia de la Atención Especializada en Psiquiatría y Salud Mental.

[Legal aspects of delegation and reorganisation of medical services in the psychiatric field]. / Rechtliche Aspekte von Delegation und Neuorganisation ärztlicher Tätigkeiten im psychiatrischen Fachgebiet.

Current psychiatric-psychotherapeutic in-patient care takes place in an area of tension between increasing treatment requirements and the persistent lack of qualified staff. The optimisation of the diagnostic-therapeutic procedures in a clinic helps to reduce existing care deficits or to generate resources for future developments. The subject of delegation and substitution of medical services is considered in this context. Inadequate knowledge of the legal situation on the part of the decision makers impairs the indispensable trustful cooperation among the professions and adds to the uncertainty of all those concerned. The present paper outlines the legal, organisational and health policy aspects of delegation and the reorganisation of medical activities in the field of psychiatry.

[Definition of the core area of medical services in the psychiatric-psychotherapeutic field--the prerequisite for any delegation]. / Definition des Kernbereichs ärztlicher Tätigkeit im psychiatrisch-psychotherapeutischen Fachgebiet--Voraussetzung für jede Delegation.

Based on legal jurisdiction, knowledge of the psychiatric-psychotherapeutic field and insight into the necessity of a new allocation of responsibilities in the overall therapeutic service of a clinic, the core areas of medical activities are defined for the first time, innovative organisational approaches to the reorganisation of therapeutic service are presented and discussed against the background of qualified staff deficit, introduction of an OPS coding for inpatient psychiatry and economic constraints.

Prescriptive authority for nurses: the Canadian perspective.

PURPOSE: This study aims to describe the role of prescriptive authority for nurses within Canada. CONCLUSIONS: Prescriptive authority for Canadian nurses is linked to the development of advanced practice nursing generally and nurse practitioners specifically. Recent legislative changes allow nurse practitioners to function more independently regardless of the availability of medical practitioners. The smaller population results in less legislative variety for specific nurse practitioner specialty areas. Facilitators and barriers to implementing effective prescriptive authority remain as challenges and mirror findings from other literature. PRACTICE IMPLICATIONS: Role clarity, strength in nursing focus, and support from administrators and legislation are required for prescriptive authority to be fully enacted.

The effects of a non-smoking policy on nursing staff smoking behaviour and attitudes in a psychiatric hospital.

The UK Department of Health required that by April 2001, all NHS bodies would have implemented a smoking policy. It has been suggested that the best demonstration a hospital can make of its commitment to health is to ban smoking on its premises. This paper reports on an evaluation of the effectiveness of a non-smoking policy in a newly opened NHS psychiatric hospital. Questionnaires were sent to all 156 nursing staff in a psychiatric hospital to assess the effectiveness of the policy in terms of staff smoking behaviour, attitudes to the restriction and compliance with the policy. Of the 156 questionnaires distributed, 92 (58%) were returned; smokers, former smokers and those who have never smoked were quite evenly represented at 34.78%, 34.78% and 30.43%, respectively. Of eight critical success factors for the policy, only one, staff not smoking in Trust public areas, had been achieved. A non-smoking policy was generally accepted as necessary by nursing staff working in a mental health setting. Staff felt that the policy was not effective in motivating smoking nurses to stop and that insufficient support was given to these nurses. The study highlights the importance of introducing staff support systems as an integral part of smoking policies and the role of counterintuitive behaviour in the effectiveness of smoking policy introduction in healthcare settings.

Suicide and self-harm in in-patient psychiatric units: a study of nursing issues in 31 cases.

A significant number of incidents of suicide and self-harm occur whilst patients are in receipt of care as in-patients. This audit comprises 31 cases which were referred to the first author for expert opinion, each case being the subject of legal action brought by patients and/or their families. The cases were referred from 31 different NHS trusts across England. All concerned suicide/serious self-harm in people in receipt of in-patient care. The aims of this audit were to carry out a detailed assessment of the 31 individual cases, so as to provide a nursing dimension to already established enquiries in this area and also to examine whether specific issues might be the subject of more systematic research. Further, this paper aims to provide some insights in the area of litigation, where nurses are becoming increasingly involved. The same broad approach to information-gathering and analysis was used, comprising a systematic review of case records, trust policies, expert reports and, where appropriate, inquest transcriptions. The sample comprised 12 suicides and 19 cases of serious self-harm. Factors associated with these events include: being male, having a dual diagnosis of mental illness and drug/alcohol abuse, and age between 21 and 30 years. Of the 12 deaths, five occurred in hospital, four by hanging and one by drowning. The audit highlighted environmental factors associated with these events which, arguably, could be simply addressed. There was a considerable variation in the content and quality of observation policy and practice. The results of this audit point to the need for further research but, above all, provide evidence requiring urgent action by the Department of Health regarding the setting of national standards.

O ensino de enfermagem psiquiátrica e a lei do exercício profissional da enfermagem / Psychiatric nursing teaching process and the legislation affecting nursing practice

O presente trabalho trata dos questionamentos surgidos durante discussões sobre a lei do exercício profissional da Enfermagem e como ela tem sido contemplada no desenvolvimento do ensino teórico-prático da disciplina Enfermagem Psiquiátrica I, da Escola de Enfermagem da Universidade São Paulo.

This paper presents some questions about the legislation that affects nursing practice. Authors analyzed how the principles of this legislation have been used in the psychiatric, nursing teaching process.

Este estudio trata de algunos asuntos acerca de la legislación de la práctica de la Enfermería Psiquiátrica. Fue analizado cómo los principios de la legislación han sido abordados en el proceso de la enseñanza de Enfermería Psiquiátrica.

Neuroleptic malignant syndrome: liability in nursing practice.

In the summer of 1991, the malpractice case Reyes v Houston International Hospital et al was settled for an amount in excess of $600,000. The case involved the psychiatric treatment received by Marjorie Reyes, a 27-year-old Latin-American mother of three, who was admitted to a psychiatric unit in late October 1986 with a diagnosis of atypical psychosis. Malpractice was charged because her treatment failed to meet any reasonably expected outcome for atypical psychosis. In fact, Reyes developed neuroleptic malignant syndrome (NMS) as a direct result of the antipsychotic medications she was administered. Her treatment outcome was nearly fatal and caused permanent, serious neurological disabilities. The litigation implicated the nursing care delivered in a psychiatric setting. This unfortunate situation illustrates general principles of legal liability in nursing practice as well as offers a unique opportunity to review NMS and to examine the specific implications for the assessment and evaluation of the side effects of antipsychotic medications. Additionally, methods of behavioral control, specifically as they relate to concepts concerning the use of medications, the importance of documentation, and the manner in which nurses plan care, were also addressed in the case. It is important for professionals to be familiar with general legal concepts and liabilities, the potential of the development of this serious side effect, and how clinical decisions regarding the administration of both routine and as-needed medications may incur legal accountability.