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Abstract: Objective: Most guidelines for the management of aggressive behavior in acute psychiatric patients describe the use of de-escalation as the first-choice method, but the evidence for its effectiveness is inconsistent. The aim of the study was to assess the effect of verbal and non-verbal de-escalation on the incidence and severity of aggression and the use of physical restraints in acute psychiatric wards. Methods: A multi-center cluster randomized study was conducted in the acute wards of all psychiatric hospitals in Slovenia. The research was carried out in two phases, a baseline period of five consecutive months and an intervention period of the same five consecutive months in the following year. The intervention was implemented after the baseline period and included training in verbal and non-verbal de-escalation techniques for the staff teams on experimental wards. Results: In the baseline study period, there were no significant differences in the incidence of aggressive behavior and physical restraints between the experimental and control groups. The incidence rates of aggressive events, severe aggressive events, and physical restraints per 100 treatment days decreased significantly after the intervention. Compared to the control group, the incidence rate of aggressive events was 73% lower in the experimental group (IRR = 0.268, 95% CI [0.221; 0.342]), while the rate of severe events was 86% lower (IRR = 0.142, 95% CI [0.107; 0.189]). During the intervention period, the incidence rate of physical restraints due to aggression in the experimental group decreased to 30% of the rate in the control group (IRR = 0.304, 95% CI [0.238; 0.386]). No reduction in the incidence of restraint used for reasons unrelated to aggression was observed. After the intervention, a statistically significant decrease in the severity of aggressive incidents (p < 0.001) was observed, while the average duration of restraint episodes did not decrease. Conclusion: De-escalation training is effective in reducing the incidence and severity of aggression and the use of physical restraints in acute psychiatric units.
Keywords: aggression, restraint, de-escalation training, incidence, psychiatry, acute ward
Published in DKUM: 23.08.2023; Views: 409; Downloads: 14
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Abstract: The theme of this master’s project is research on the significance and influence of the architecture of psychiatric facilities on the process of treatment of people with mental disorders. The capital of Montenegro, Podgorica, has been struggling with a lack of adequate facilities for its Psychiatric Clinic, which has not had the capacity to hospitalise, or provide treatment and rehabilitation services to mentally ill persons for years. With the aim of gaining an understanding of the best practices that could be transferred to the new Psychiatric Clinic, this paper delves into the historic development of psychiatry, treatment and types of hospitals, as well as the position of patients in the society. The great revolution or milestone in psychiatry, the deinstitutionalisation process, caused the closing-down of many psychiatric clinics around the world. Mental health centres that do not force long-term hospitalisation on patients, but offer a wide range of therapeutic, rehabilitation and recreational activities, started to emerge as an alternative. The main goal of this project is to create a clinic in Podgorica that would use a modern architectural language and concept to break environmental prejudices, while providing patients with all the necessary contents for a pleasant and safe stay. The project aims to create a clinic that would respect the function and dynamics of the site, while maintaining its own irreplaceability and uniqueness within that environment.
Keywords: psychiatry, arhitecture, psyhiatric hospital, deinstitucionalization, stigmatization, clinic centre Montenegro
Published in DKUM: 05.02.2019; Views: 1601; Downloads: 332
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