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3.
Nervenarzt ; 90(7): 690-694, 2019 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-31073672

RESUMEN

BACKGROUND: Mental health professionals use various strategies to prevent involuntarily committed persons from absconding under an open door policy. OBJECTIVE: To provide an ethical framework for the evaluation of the replacement of locked ward doors by formal coercion or treatment pressures. METHODS: Empirically informed conceptual and ethical analysis. RESULTS: The replacement of locked ward doors by formal coercive measures applied to individual persons, such as mechanical restraint or seclusion, is ethically problematic. The use of treatment pressures, for example in the context of intensified observational measures, requires a differentiated ethical evaluation and does not necessarily constitute the milder means in comparison to locked ward doors. CONCLUSION: Unexplored conceptual, empirical and ethical issues surrounding open door policies and treatment pressures should be clarified by means of psychiatric and ethical research. In clinical practice, the choice of the least burdensome and least restrictive measures for involuntarily committed persons should be facilitated by appropriate ethical support services.


Asunto(s)
Coerción , Trastornos Mentales/terapia , Procesos Psicoterapéuticos , Aislamiento de Pacientes/ética , Aislamiento de Pacientes/legislación & jurisprudencia , Psiquiatría/ética , Psiquiatría/normas
4.
Clin Microbiol Infect ; 21S: e1-e5, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24750421

RESUMEN

Highly infectious diseases (HIDs) are defined as being transmissible from person to person, causing life-threatening illnesses and presenting a serious public health hazard. In most European Union member states specialized isolation facilities are responsible for the management of such cases. Ground ambulances are often affiliated with those facilities because rapid relocation of patients is most desirable. To date, no pooled data on the accessibility, technical specifications and operational procedures for such transport capacities are available. During 2009, the 'European Network for HIDs' conducted a cross-sectional analysis of hospitals responsible for HID patients in Europe including an assessment of (a) legal aspects; (b) technical and infrastructure aspects; and (c) operational procedures for ground ambulances used for HID transport. Overall, 48 isolation facilities in 16 European countries were evaluated and feedback rates ranged from 78% to 100% (n = 37 to n = 48 centres). Only 46.8% (22/47) of all centres have both national and local guidelines regulating HID patient transport. If recommended, specific equipment is found in 90% of centres (9/10), but standard ambulances in only 6/13 centres (46%). Exclusive entrances (32/45; 71%) and pathways (30/44; 68.2%) for patient admission, as well as protocols for disinfection of ambulances (34/47; 72.3%) and equipment (30/43; 69.8%) exist in most centres. In conclusion, the availability and technical specifications of ambulances broadly differ, reflecting different preparedness levels within the European Union. Hence, regulations for technical specifications and operational procedures should be harmonized to promote patient and healthcare worker safety.


Asunto(s)
Enfermedades Transmisibles/terapia , Hospitales de Aislamiento/estadística & datos numéricos , Control de Infecciones/normas , Aislamiento de Pacientes/normas , Transporte de Pacientes/estadística & datos numéricos , Ambulancias/normas , Ambulancias/provisión & distribución , Estudios Transversales , Desinfección , Europa (Continente) , Encuestas de Atención de la Salud , Hospitales de Aislamiento/legislación & jurisprudencia , Hospitales de Aislamiento/normas , Humanos , Control de Infecciones/legislación & jurisprudencia , Control de Infecciones/organización & administración , Aislamiento de Pacientes/instrumentación , Aislamiento de Pacientes/legislación & jurisprudencia , Transporte de Pacientes/legislación & jurisprudencia , Transporte de Pacientes/normas
6.
Ned Tijdschr Geneeskd ; 1622018 Aug 03.
Artículo en Holandés | MEDLINE | ID: mdl-30182628

RESUMEN

We discuss two patients with infectious tuberculosis who underwent compulsory isolation and treatment without their consent. We describe the threat to the patient's rights, i.e. the right of freedom, the right of autonomy and the right of protection of the integrity of the body. We describe the application of the relevant laws and of the differing safeguards, and discuss the unlimited length of the Dutch Public Health Act orders. We refer to a Dutch statement and the WHO ethics guidelines on the implementation of their End TB Strategy. Forced isolation may be the last resort to protect society from patients with infectious diseases who do not comply with isolation measures, but compulsory treatment for tuberculosis patients is considered unacceptable. We suggest an amendment of the Dutch Public Health Act to enable better protection of the rights of tuberculosis patients.


Asunto(s)
Hospitalización/legislación & jurisprudencia , Programas Obligatorios/legislación & jurisprudencia , Competencia Mental , Aislamiento de Pacientes/legislación & jurisprudencia , Tuberculosis/terapia , Humanos , Países Bajos , Autonomía Personal
7.
Soins Psychiatr ; 39(317): 10-15, 2018.
Artículo en Francés | MEDLINE | ID: mdl-30047451

RESUMEN

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.


Asunto(s)
Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Trastornos Mentales/enfermería , Servicio de Psiquiatría en Hospital/legislación & jurisprudencia , Violencia/prevención & control , Redes Comunitarias/ética , Redes Comunitarias/legislación & jurisprudencia , Consenso , Ética Médica , Francia , Adhesión a Directriz , Humanos , Trastornos Mentales/psicología , Defensa del Paciente/legislación & jurisprudencia , Aislamiento de Pacientes/legislación & jurisprudencia , Aislamiento de Pacientes/psicología , Servicio de Psiquiatría en Hospital/ética , Enfermería Psiquiátrica/legislación & jurisprudencia , Restricción Física/legislación & jurisprudencia , Restricción Física/psicología , Medición de Riesgo/legislación & jurisprudencia , Esquizofrenia/diagnóstico , Esquizofrenia/enfermería , Psicología del Esquizofrénico , Violencia/ética
8.
Soins Psychiatr ; 39(317): 16-19, 2018.
Artículo en Francés | MEDLINE | ID: mdl-30047452

RESUMEN

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.


Asunto(s)
Adhesión a Directriz , Trastornos Mentales/enfermería , Aislamiento de Pacientes/legislación & jurisprudencia , Servicio de Psiquiatría en Hospital/legislación & jurisprudencia , Restricción Física/legislación & jurisprudencia , Medición de Riesgo/legislación & jurisprudencia , Francia , Adhesión a Directriz/legislación & jurisprudencia , Humanos , Trastornos Mentales/psicología , Programas Nacionales de Salud/legislación & jurisprudencia , Grupo de Atención al Paciente/legislación & jurisprudencia , Aislamiento de Pacientes/psicología , Enfermería Psiquiátrica/legislación & jurisprudencia , Restricción Física/psicología , Evaluación de Síntomas/enfermería , Evaluación de Síntomas/psicología
10.
Int J Ment Health Nurs ; 26(5): 513-524, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28960738

RESUMEN

In Finland, the Mental Health Act determines the legal basis for seclusion and restraint. Restrictive measures are implemented to manage challenging situations and should be used as a last resort in psychiatric inpatient care. In the present study, we examined the reasons for seclusion and restraint, as well as whether any de-escalation techniques were used to help patients calm down. Seclusion and restraint files from a 4-year period (1 June 2009-31 May 2013) were retrospectively investigated and analysed by content analysis. Descriptive statistics were calculated. A total of 144 episodes of seclusion and restraint were included to analyse the reasons for seclusion and restraint, and 113 episodes were analysed to examine unsuccessful de-escalation techniques. The most commonly-used techniques were one-to-one interaction with a patient (n = 74, 65.5% of n = 113) and administration of extra medication (n = 37, 32.7% of n = 113). The reasons for seclusion and restraint were threatening harmful behaviour (n = 51, 35.4% of n = 144), direct harmful behaviour (n = 43, 29.9%), indirect harmful behaviour (n = 42, 29.1%), and other behaviours (n = 8, 5.6%). In general, the same de-escalation techniques were used with most patients. Most episodes of seclusion or restraint were due to threats of violence or direct violence. Individual means of self-regulation and patient guidance on these techniques are needed. Additionally, staff should be educated on a diverse range of de-escalation techniques. Future studies should focus on examining de-escalation techniques for the prevention of seclusion.


Asunto(s)
Psiquiatría Forense/métodos , Hospitales Psiquiátricos , Aislamiento de Pacientes , Restricción Física , Adulto , Estudios Transversales , Femenino , Finlandia , Humanos , Masculino , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Aislamiento de Pacientes/legislación & jurisprudencia , Aislamiento de Pacientes/métodos , Restricción Física/legislación & jurisprudencia , Restricción Física/métodos , Estudios Retrospectivos , Violencia/prevención & control , Violencia/psicología
11.
J Public Health Policy ; 38(4): 482-492, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28710493

RESUMEN

As far back as the late 1700s, peoples in the United States were developing ways to control infectious disease without infringing on Constitutional rights. Despite acknowledgement that an infected person has certain civil liberties, the history of public health law shows that, in many instances, infectious disease isolation and quarantine proved to be scientifically questionable at best. I examine an historical example of such questionable relationship between public health and civil liberties: the locked ward at Firland Sanatorium in Seattle, Washington. Mandatory quarantine at Firland began in the late 1940s and lasted until the facility closed in the early 1970s. Can examining this history enhance understanding of the relationship between "the greater good" and an individual's civil liberties?


Asunto(s)
Derechos Civiles/historia , Cuarentena/historia , Tuberculosis Pulmonar/prevención & control , Derechos Civiles/legislación & jurisprudencia , Epidemias/prevención & control , Historia del Siglo XX , Humanos , Tratamiento Involuntario/historia , Tratamiento Involuntario/legislación & jurisprudencia , Aislamiento de Pacientes/historia , Aislamiento de Pacientes/legislación & jurisprudencia , Salud Pública/historia , Salud Pública/legislación & jurisprudencia , Cuarentena/legislación & jurisprudencia , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/historia , Estados Unidos , Washingtón/epidemiología
12.
Soins Psychiatr ; 38(310): 12-16, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28476249

RESUMEN

From confinement to the philosophy of care in the community, the history of psychiatry testifies to the evolution of practices in the matter of the restriction of freedom. The French National Health Authority still too often recommends practices based on restraint. Caregivers, in relation to the clinical aspect of the patients, need clearly identified therapeutic projects. While training can be vital for them, risk management policies can prove to be a hindrance to patients' freedom.


Asunto(s)
Trastornos Mentales/enfermería , Trastornos Mentales/psicología , Aislamiento de Pacientes/psicología , Aislamiento de Pacientes/tendencias , Restricción Física/psicología , Gestión de Riesgos/tendencias , Predicción , Francia , Necesidades y Demandas de Servicios de Salud/legislación & jurisprudencia , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Relaciones Enfermero-Paciente , Aislamiento de Pacientes/legislación & jurisprudencia , Autonomía Personal , Filosofía en Enfermería , Restricción Física/legislación & jurisprudencia , Restricción Física/estadística & datos numéricos , Gestión de Riesgos/legislación & jurisprudencia
13.
Soins Psychiatr ; 38(310): 17-20, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28476250

RESUMEN

Freedom of movement is recognised by national and supranational law. It falls within the scope of the definition of freedom set out in the Declaration of the Rights of Man and of the Citizen, in 1789. It is also legally formulated and recognised as a basic right in two European texts: the Universal Declaration of Human Rights of 10th December 1948 and the European Convention for the Protection of Human Rights and Fundamental Freedoms of 4th November 1950. How can it be respected in psychiatry, in view of the obligation to provide care and safety?


Asunto(s)
Trastornos Mentales/enfermería , Trastornos Mentales/psicología , Relaciones Enfermero-Paciente , Aislamiento de Pacientes/legislación & jurisprudencia , Derechos del Paciente/legislación & jurisprudencia , Autonomía Personal , Restricción Física/legislación & jurisprudencia , Negativa del Paciente al Tratamiento/psicología , Conducta Peligrosa , Francia , Humanos , Cooperación del Paciente/psicología , Pacientes Desistentes del Tratamiento/psicología , Negativa del Paciente al Tratamiento/legislación & jurisprudencia
14.
Soins Psychiatr ; 38(310): 21-22, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28476251

RESUMEN

The first organisation to bring together the users of care in the history of the speciality, the French National Federation of Patient Associations in Psychiatry has always campaigned for the respect of users' freedom of movement. Despite the progress made in terms of legislation, the federation presents a mixed picture. For Claude Filkenstein, its president, there remains a long way to go, notably in the field of the culture of psychiatric care. In her opinion, training should be a major advantage.


Asunto(s)
Trastornos Mentales/enfermería , Trastornos Mentales/psicología , Relaciones Enfermero-Paciente , Aislamiento de Pacientes/legislación & jurisprudencia , Aislamiento de Pacientes/psicología , Derechos del Paciente/legislación & jurisprudencia , Autonomía Personal , Restricción Física/legislación & jurisprudencia , Restricción Física/psicología , Organizaciones del Consumidor/legislación & jurisprudencia , Curriculum/tendencias , Predicción , Francia , Humanos , Enfermería Psiquiátrica/educación , Enfermería Psiquiátrica/legislación & jurisprudencia
15.
Soins Psychiatr ; 38(310): 23-25, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28476252

RESUMEN

Some institutions do not have an isolation room. Agitation is managed otherwise, with the idea that restraint or isolation can only be a terrible experience. The care pathway is therefore designed to favour autonomy and to limit restrictions of freedom. In this context, professionals are in constant contact with the user. Example of a unit which advocates this concept of rehabilitation.


Asunto(s)
Convalecencia/psicología , Trastornos Mentales/enfermería , Trastornos Mentales/rehabilitación , Defensa del Paciente/legislación & jurisprudencia , Defensa del Paciente/psicología , Aislamiento de Pacientes/legislación & jurisprudencia , Aislamiento de Pacientes/psicología , Autonomía Personal , Restricción Física/legislación & jurisprudencia , Restricción Física/psicología , Francia , Accesibilidad a los Servicios de Salud , Hospitales Psiquiátricos , Humanos , Trastornos Mentales/psicología , Curación Mental , Relaciones Enfermero-Paciente
16.
Soins Psychiatr ; 38(310): 29-31, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28476254

RESUMEN

Freedom of movement is at the centre of contradictory challenges for the different people working in psychiatry, faced with a society demanding social regulation and safety, and the desire of institutions to provide high quality care. This freedom, and more globally the respect of patients' civil rights, are an indicator of the expected quality of care. Taking these rights into consideration does not mean neglecting safety, but attempts to put it into perspective. This article presents the clinical case of a patient.


Asunto(s)
Trastornos Mentales/enfermería , Trastornos Mentales/rehabilitación , Defensa del Paciente/legislación & jurisprudencia , Aislamiento de Pacientes/legislación & jurisprudencia , Aislamiento de Pacientes/psicología , Indicadores de Calidad de la Atención de Salud/legislación & jurisprudencia , Restricción Física/legislación & jurisprudencia , Restricción Física/psicología , Anciano de 80 o más Años , Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Deluciones/enfermería , Deluciones/psicología , Ética en Enfermería , Resultado Fatal , Femenino , Francia , Hospitales Psiquiátricos/ética , Hospitales Psiquiátricos/legislación & jurisprudencia , Humanos , Competencia Mental/legislación & jurisprudencia , Competencia Mental/psicología , Defensa del Paciente/ética , Aislamiento de Pacientes/ética , Trastornos Psicóticos/enfermería , Trastornos Psicóticos/psicología , Indicadores de Calidad de la Atención de Salud/ética , Restricción Física/ética , Comunidad Terapéutica , Negativa del Paciente al Tratamiento/ética , Negativa del Paciente al Tratamiento/legislación & jurisprudencia , Negativa del Paciente al Tratamiento/psicología
17.
Soins Psychiatr ; 38(310): 32-39, 2017.
Artículo en Francés | MEDLINE | ID: mdl-28476255

RESUMEN

With the reforms of 2011 and 2013 relating to psychiatric hospitalisation, raises the question of the suitability of modern psychiatric practice with regard to a person's recognised principles and basic rights. Achieving a balance is difficult and the Constitutional Council has joined the debate, bringing to an end any idea of compromise between safety and freedom. A decision which was made as a result of a clarification of certain regulations which have proved controversial from the point of view of individual liberties.


Asunto(s)
Vías Clínicas/legislación & jurisprudencia , Trastornos Mentales/enfermería , Relaciones Enfermero-Paciente , Defensa del Paciente/legislación & jurisprudencia , Aislamiento de Pacientes/legislación & jurisprudencia , Autonomía Personal , Enfermería Psiquiátrica/legislación & jurisprudencia , Restricción Física/legislación & jurisprudencia , Conducta Peligrosa , Francia , Humanos , Trastornos Mentales/psicología , Terapia Ambiental/legislación & jurisprudencia , Terapia Ambiental/organización & administración , Grupo de Enfermería/legislación & jurisprudencia , Grupo de Enfermería/organización & administración , Aislamiento de Pacientes/psicología , Seguridad del Paciente/legislación & jurisprudencia , Restricción Física/psicología
18.
Fed Regist ; 82(12): 6890-978, 2017 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-28106359

RESUMEN

The Centers for Disease Control and Prevention (CDC), within the Department of Health and Human Services (HHS), is issuing this final rule (FR) to amend its regulations governing its domestic (interstate) and foreign quarantine regulations to best protect the public health of the United States. These amendments have been made to aid public health responses to outbreaks of new or re-emerging communicable diseases and to accord due process to individuals subject to Federal public health orders. In response to public comment received, the updated provisions in this final rule clarify various safeguards to prevent the importation and spread of communicable diseases affecting human health into the United States and interstate.


Asunto(s)
Control de Enfermedades Transmisibles/legislación & jurisprudencia , Brotes de Enfermedades/legislación & jurisprudencia , Aislamiento de Pacientes/legislación & jurisprudencia , Cuarentena/legislación & jurisprudencia , Viaje/legislación & jurisprudencia , Aeronaves/legislación & jurisprudencia , Control de Enfermedades Transmisibles/métodos , Brotes de Enfermedades/prevención & control , Humanos , Notificación Obligatoria , Examen Físico , Salud Pública/legislación & jurisprudencia , Estados Unidos
19.
Psychiatr Prax ; 44(6): 316-322, 2017 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-27399593

RESUMEN

Objective This study explores patients' preferences and measures of prevention of coercive methods in psychiatric treatment. Methods Structured interviews of 90 patients with psychotic disorders were undertaken, most of whom had previously experienced coercive methods. Results Participants saw preventive potential in a wider availability of individual non-pharmacological therapy, improvement of staff professional competence and communication skills, high staff-to-patient ratios and retreat facilities. The majority of participants preferred forced medication and manual restraint in case of self-endangerment, and forced medication and mechanical restraint in the event of endangerment of others. Conclusion Patients' suggestions relating to prevention of coercion are in line with most expert's opinions. In case coercive methods are required, manual restraint and application of forced medication is accepted as the treatment of choice according to most patients in case of self-endangerment.


Asunto(s)
Coerción , Adhesión a Directriz/legislación & jurisprudencia , Trastornos Mentales/terapia , Programas Nacionales de Salud/legislación & jurisprudencia , Prioridad del Paciente/legislación & jurisprudencia , Psicotrópicos/administración & dosificación , Restricción Física/legislación & jurisprudencia , Alemania , Hospitales Psiquiátricos/legislación & jurisprudencia , Humanos , Trastornos Mentales/psicología , Aislamiento de Pacientes/legislación & jurisprudencia , Aislamiento de Pacientes/psicología , Prioridad del Paciente/psicología , Psicotrópicos/efectos adversos , Restricción Física/efectos adversos , Restricción Física/psicología
20.
J Public Health Manag Pract ; 23(2): e25-e31, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-26523801

RESUMEN

The recent Ebola epidemic has put the words "isolation and quarantine" in the spotlight. Isolation and quarantine are tools that are often utilized by public health officials around the United States to address various types of infectious disease, including tuberculosis. While voluntary compliance is preferred, it can be difficult to achieve. In cases where an individual chooses not to voluntarily comply with an isolation or quarantine request, public health officials require assistance from the judiciary and law enforcement to effectuate the order. This article compares 2 recent court cases with different outcomes where public health officials sought assistance from the courts to enforce an isolation or quarantine order.


Asunto(s)
Brotes de Enfermedades/prevención & control , Aislamiento de Pacientes/legislación & jurisprudencia , Cuarentena/legislación & jurisprudencia , Brotes de Enfermedades/legislación & jurisprudencia , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Aislamiento de Pacientes/normas , Salud Pública/legislación & jurisprudencia , Cuarentena/normas , Tuberculosis/epidemiología , Tuberculosis/prevención & control , Estados Unidos/epidemiología
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