心理健康专业人员对隔离的看法和态度：安全与治疗考虑之间的矛盾关系。

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry Pub Date : 2024-10-18 DOI:10.1016/j.ijlp.2024.102033

Grégory Yersin , Benedetta Silva , Philippe Golay , Stéphane Morandi

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引用次数: 0

摘要

背景：世界各地的急诊精神病科使用隔离的频率差异很大。在瑞士，隔离是在严格条件下授权使用的。然而，并非瑞士的每家精神病院都采取了这种强制措施。强制手段的使用与患者的一些特征以及组织、环境和专业人员等方面有关。然而，这些因素在不同研究中的作用仍不一致，而且不同的强制措施往往被放在一起研究。因此，本研究旨在根据精神卫生专业人员使用隔离措施的经验及其个人和专业背景，评估他们对隔离措施的看法和态度：方法：邀请在瑞士沃州和瓦莱州成人和老年急症精神病院工作的护士和医生参与在线调查，了解他们的社会人口特征、专业背景、当前职位和活动，以及他们对隔离的看法和态度。然后使用探索性结构方程模型（ESEM）来确定参与者对隔离的看法和态度的结构，以确定社会人口学和专业人员的哪些方面可以预测其基本层面：116 名精神卫生专业人员同意参与研究。大多数人认为隔离具有治疗作用，同时也认为隔离可能会产生负面影响或对病人造成危险。大多数人还认为，隔离会增加一般的安全感。最后，相当一部分人认为瑞士关于隔离的法律框架不够明确。精神卫生专业人员对隔离治疗的看法和态度可以从四个方面来描述："消极后果"、"安全"、"隔离的合法性/法律方面 "和 "组织方面"。分析表明，随着隔离使用的增加，有将其正常化的趋势：隔离给精神卫生专业人员带来了复杂的挑战。因此，主管当局应提供细致的指导，帮助他们在使用这种强制措施时保持高水平的护理质量。

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Mental health professionals' perceptions and attitudes towards seclusion: The ambivalent relationship between safety and therapeutic considerations

Background

Frequency of seclusion in acute psychiatric units varies greatly worldwide. In Switzerland, its use is authorised under strict conditions. However, this coercive measure is not implemented in every psychiatric hospital in the country. The use of coercion is associated with a number of patient characteristics as well as organisational, contextual and professional's aspects. Nevertheless, the role of these factors remain inconsistent across studies and different coercive measures are often studied together. Hence, the aim of this study was to assess mental health professionals' perceptions and attitudes towards seclusion according to their experience with this type of measure and their personal and professional background.

Method

Nurses and physicians working in acute adult and geriatric psychiatric units in the Swiss Cantons of Vaud and Valais were invited to participate to an online survey exploring their socio-demographic characteristics, professional background, current position and activity, as well as their perceptions and attitudes towards seclusion. Exploratory Structural Equation Modelling (ESEM) was then used to determine the structure of the participants perceptions and attitudes towards seclusion to identify which socio-demographic and professionals' aspects could predict their underlying dimensions.

Results

116 mental health professionals agreed to participate in the study. A majority considered that seclusion had a therapeutic impact, while believing that it could also have negative effects or be dangerous for the patient. The majority also thought that seclusion increased the general feeling of safety. Lastly, a substantial proportion felt that the Swiss legal framework regulating seclusion was not sufficiently clear. Mental health professionals' perceptions and attitudes towards seclusion could be described by four dimensions: “Negative consequences”, “Safety”, “Legitimacy/legal aspect of seclusion” and “Organisational aspects”. Analyses revealed a tendency to normalize seclusion as its use increases.

Conclusion

Seclusion poses complex challenges for mental health professionals. The competent authorities should therefore provide careful guidance to help them maintain a high level of quality of care in the use of this coercive measure.

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来源期刊

International Journal of Law and Psychiatry Multiple-

CiteScore

4.70

自引率

8.70%

发文量

审稿时长

41 days

期刊介绍： The International Journal of Law and Psychiatry is intended to provide a multi-disciplinary forum for the exchange of ideas and information among professionals concerned with the interface of law and psychiatry. There is a growing awareness of the need for exploring the fundamental goals of both the legal and psychiatric systems and the social implications of their interaction. The journal seeks to enhance understanding and cooperation in the field through the varied approaches represented, not only by law and psychiatry, but also by the social sciences and related disciplines.