在精神卫生服务中,在国际边界上司空见惯的是,为了防止好斗的患者伤害自己,其他患者或工作人员,强制措施,最重要的是,需要采取暴力管理策略。没有协议,来自欧盟的建议或指示,在欧盟各国应采取哪些强制措施,没有一个整体的最佳实践方法。
这个项目是通过一个专家组构思的,欧洲精神病学研究小组(EViPRG)。该研究旨在纳入欧盟和多学科的回应,以确定17个欧洲国家的暴力管理做法以及相关的研究和教育优先事项。从EVIPRG成员,每个国家的一名成员同意担任其国家的国家项目协调员。鉴于受访者的国际传播,本研究设计和数据收集采用eDelphi调查方法。开发了一种调查仪器,通过EVIPRG成员同意和验证。
结果包括来自17个国家的2809名受访者,其中999名受访者自我选择参加第2轮eDelphi。大多数受访者从事急性精神病学工作,54%(n=1511);门诊部,10.5%(n=295);和法医,9.3%(n=262)。受访者的其他工作领域包括康复,初级保健和急诊。令人关切的是,19.5%的受访者没有接受过暴力管理培训。在暴力患者的管理中最常用的干预措施是身体约束,隐居和药物。教育和研究的最高优先事项包括:预防暴力;环境和工作人员对暴力程度的影响;管理暴力的最佳做法;风险评估以及暴力和侵略的病因和触发因素。
在许多欧洲国家,在精神卫生服务中与暴力管理有关的程序和政策问题上缺乏明确性。欧洲的暴力管理实践似乎支离破碎,没有明确的意识形态立场或合作教育和研究。在欧洲,语言差异是现实,可能会导致孤立的思维,然而,它绝不能被视为分享最佳实践的障碍。
In mental health services what is commonplace across international frontiers is that to prevent aggressive patients from harming themselves, other patients or staff, coercive measures and foremost, violence management strategies are required. There is no agreement, recommendations or direction from the EU on which measures of coercion should be practiced across EU countries, and there is no overall one best practice approach.
The project was conceived through an expert group, the European Violence in Psychiatry Research Group (EViPRG). The
study aimed to incorporate an EU and multidisciplinary response in the determination of violence management practices and related research and education priorities across 17 European countries. From the EVIPRG members, one member from each country agreed to act as the national project coordinator for their country. Given the international spread of respondents, an
eDelphi survey approach was selected for the
study design and data collection. A survey instrument was developed, agreed and validated through members of EVIPRG.
The results included a total of 2809 respondents from 17 countries with 999 respondents who self-selected for round 2
eDelphi. The majority of respondents worked in acute psychiatry, 54% (n = 1511); outpatient departments, 10.5% (n = 295); and Forensic, 9.3% (n = 262). Other work areas of respondents include Rehabilitation, Primary Care and Emergency. It is of concern that 19.5% of respondents had not received training on violence management. The most commonly used interventions in the management of violent patients were physical restraint, seclusion and medications. The top priorities for education and research included: preventing violence; the influence of environment and staff on levels of violence; best practice in managing violence; risk assessment and the aetiology and triggers for violence and aggression.
In many European countries there is an alarming lack of clarity on matters of procedure and policy pertaining to violence management in mental health services. Violence management practices in Europe appear to be fragmented with no identified ideological position or collaborative education and research. In Europe, language differences are a reality and may have contributed to insular thinking, however, it must not be seen as a barrier to sharing best practice.