No-Restraint Committed General Hospital Psychiatric Units (SPDCs) in Italy-A Descriptive Organizational Study.

This study describes and explores the application of no-restraint policies in General Hospital Psychiatric Units (GHPUs) in Italy, a country pioneering in deinstitutionalization and psychiatric reform. The research aims to assess the organizational characteristics and effectiveness of no-restraint practices, contributing to the global discourse on humane psychiatric care. Following a purposive sampling approach, a nationwide descriptive study was conducted involving a detailed online survey distributed to 24 GHPUs actively engaged in or aspiring toward no-restraint practices. The survey, comprising 60 items across seven sections, gathered comprehensive data on the structural, organizational, and operational dimensions of the units, along with the prevalence and management of restraint episodes. Results reveal a significant commitment to no-restraint policies, with 14 GHPUs reporting zero restraint incidents in 2022. Despite variations in infrastructure and staffing, a common thread was the implementation of systematic procedures and risk management training aimed at reducing coercive practices. The study identified a correlation between the use of exclusive garden spaces and an increased incidence of restraints, suggesting nuanced factors influencing restraint practices. The findings underscore the viability and ethical alignment of no-restraint practices within psychiatric care, highlighting the crucial role of organizational protocols and training. This research adds empirical weight to the advocacy for restraint-free environments in mental health settings, signaling a paradigm shift toward more humane and rights-respecting psychiatric care.

[Formative needs of the professional staff in psychiatric division. The project open doors]. / Bisogni formativi del personale nei reparti psichiatrici. Il progetto porte aperte.

INTRODUCTION: On national territory, the psychiatric divisions "open doors" that are using not restraint methods (not key closed) are still a minority. Most psychiatric divisions in Italy have their doors closed and use methods of physical restraint. To work in psychiatric divisions "open doors" the nursing staff needs advanced preparation levels. They have to use relational techniques to build an empathic relationship with the patient even in situations of acute crisis. AIM: In this study has been explored and analyzed formative needs of the professional staff in psychiatric division "open doors" with the aim to understand which skills are requested to work in these structures. MATERIALS AND METHODS: Were used a questionnaire and an interviews that have involved 78 nurses in psychiatric division. RESULTS: The subjects on which staff would be trained are: psychiatric nursing, aggressiveness management, legal risks in psychiatric divisions "open doors", cognitive-behavioural therapy, empowerment. CONCLUSIONS: Where are practiced the "no restraint methods" and the "open doors", physical aggressions are more rare and also escapes don't happen frequently. Working with the "open doors" means more humanity and a more relaxed atmosphere, less dangerous situations and less aggressive behaviour.