| Abstract | Psihijatrija kao grana medicine uvelike se razlikuje od ostalih u tome što je jedina grana koja primjenjuje prisilne terapijske metode. Agresija je akt usmjeren prema drugome ili prema sebi, može biti verbalne, fizičke ili seksualne prirode. Agresivno ponašanje odnosi se na bilo koje prijeteće ponašanje bez obzira je li agresivnost izrečena verbalno, pokazana fizički i postoji li jasna agresivna namjera ili fizičko ponašanje koje aktualno ozljeđuje ili radi štetu osobi koja se agresivno ponaša, drugim osobama ili imovini.
Prema pacijentu čije je psihičko stanje praćeno izrazitom agitacijom i agresijom te svojim ponašanjem predstavlja opasnost za sebe i okolinu primjenjujemo protokolirane mjere susprezanja u obliku stezulja, sputavanje magnetnim remenima ili odvajanja u izolacijsku prostoriju. Uzevši u obzir da ne postoji znanstveno utemeljeni argument za odabir jedne prisilne metode kao kompetentniju od ostalih, njezin izbor ovisi o kulturološkom i tradicionalnom ustroju društva u kojem se primjenjuje. Upotreba fizičke sile kao intervencija u psihijatriji datira od samog početka, odnosno od začeća skrbi o psihički oboljelim osobama. Još uvijek je jedna od osnovnih metoda u radu. Svojim radom medicinska sestra/tehničar mora štititi sigurnost i interese pacijenata, ali i same sebe. Provođenjem mjera i izrađenih protokola sprječavaju se i neželjeni događaji i incidentne situacije koje bi mogle rezultirati narušavanjem zdravstvenog stanja, a ponekad i smrću. Mjere prisile treba koristiti samo kada deeskalacija nije bila uspješna odnosno kada je to jedini način da se spriječi agresivno ponašanja. Tijekom provođenja postupka medicinsko osoblje pazi na sigurnost i poštovanje prava bolesnika te primjenjuje silu tek onoliko koliko je potrebno za neutralizaciju prijetećeg ponašanja.
Nakon primjene mjere prisile potrebno je u standardnom postupku uz prisutnost voditelja odjela analizirati uzroke i rekonstruirati početak konflikta, rane znakove eskalacije, poduzete mjere, potencijalne pogreške i sve druge okolnosti. Odnos terapeut pacijent pokazao se kao faktor rizika i protektivni faktor u povećanju i smanjenju rizika. Kreiranje suportivne sredine na radnom mjestu može reducirati agresivnost i psihološku traumu, reducirati bolovanja i omogućiti radniku da se na poslu osjeća sigurno. |
| Abstract (english) | Psychiatry as a branch of medicine greatly differs from other branches regarding the fact that this is the only branch that applies forced therapeutic methods. Aggression is the act directed towards the other person or towards oneself and it can be verbal, physical or sexual. Aggressive behaviour is related to any kind of threatening behaviour, no matter whether the aggression was expressed verbally, shown physically or if there is a clear aggressive intention or physical behaviour which currently injures or harms the aggressive person, other persons or belongings.
Towards the patient whose psychological condition seems to be followed by extreme agitation and aggression and who, by his behaviour, causes danger for himself and the environment, we apply protocol measures of one’s control in the form of constraining bands, fixation by magnetic belts, or by separation into an isolation room. Taking into consideration that there is not a scientifically-based argument for choosing one forced method as more competent than the others, its choice depends on cultural and traditional constitution of the society in which it is applied. Usage of physical force as an intervention in psychiatry dates back from the very beginning, that is from the conception of care for the mentally ill persons. It is still one of basic methods in psychiatric work. By its work a nurse has to protect patients’ and their interests, as well as themselves. By conducting measures and elaborated protocols unwanted situations and incidents which could result in worsening health condition and sometimes even death, are being prevented. Forcing measures should be used only when de-escalation was not successful, apropos when it is the only way for preventing aggressive behaviour. During the period of conducting procedure, medical staff takes care about security and respecting the patients’ rights and uses force just enough that is necessary to neutralize threatening behaviour.
After applying forcing measures, in a standard procedure and with the presence of a department chief, it is necessary to analyse samples and to reconstruct the beginning of a conflict, early escalation signs, taken measures, potential errors and all the other circumstances. Therapist-patient relationship appeared to be a risk factor and protective factor in both increasing and decreasing risk. Creating supportive environment on a workplace can reduce aggression and psychological trauma, reduce sick leaves and enable worker to feel safe at work. |
