Università degli Studi di Modena e Reggio Emilia
Corso di laurea in infermieristica - Sede di Modena
| Thesis Title | The evolution in managing aggressive episodes in an Italian acute psychiatric ward during the last 9 years |
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| Name | Barbieri Nicolò |
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| Supervisor(s) | Di Lorenzo Rosaria, Meli Salvatore, Mordenti Federico |
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| Academic Year | 2021/22 |
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| Thesis type | Research thesis |
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Abstract
Background: Violent and aggressive behaviors are frequent events in the psychiatric field with ethical, legal, psychological and physical consequences. Mechanical restraint (MR) is an extreme procedure for managing these episodes. International and local policies in recent years have implemented strategies for the progressive reduction of MR. Aims: To describe the frequency of application of MR in an acute psychiatric ward over the last 9 years and to analyze which variables may have significantly influenced the use of MR. Materials and methods: This retrospective analysis was conducted in an acute psychiatric ward (SPDC) of the AUSL of Modena. All hospitalized patients undergoing MR from 01/01/2013 to 31/12/2021 were enrolled. Demographic, clinical and organizational variables were collected and the data were statistically analyzed. Results: We highlighted a statistically significant association between MR reduction and the implementation of restrictive guidelines on MR use in 2015 (multivariate linear regression: coeff .: -15.68; p = 0.006; 95% CI: -24.91; -6.45) and a positive association with staff injuries number (coeff .: 1.5; p = 0.043; 95% CI: 0.061; 2.94). Concurrently, an increase in Incident Reports (IR) was recorded especially in 2015 and 2019 concerning staff injuries and assaults. Following, in 2020, a 12hrs' shift of hospital guards was implemented in SPDC, favoring the reduction of both IR and MR. Conclusions: Our results suggest that alternative procedures in the management of aggression can be applied after a profound cultural change, initially imposed by legal and guideline interventions and successively accepted by staff. Nevertheless, in our ward, only the presence of hospital guards supported staff in the aggressiveness management without using MR and at the same time avoiding IRs.
