The role of nurses at emergency medical aid in mandatory hospitalization

Uvod: Duševne motnje predstavljajo vedno večji in vedno bolj zaskrbljujoč zdravstveni problem, na kar kažejo tudi statistični podatki. Najpomembnejše je, da je pacient z duševno motnjo enakovreden drugim pacientom, ki duševne motnje nimajo, vendar jih družba še vedno stigmatizira in zapostavlja v primerjavi z drugimi pacienti, kljub ustavnim in zakonskim določbam, ki to strogo prepovedujejo. Najbolj pogost vzrok obiska urgence pri pacientu z duševno motnjo je poskus samomora. Hospitalizacija je za pacienta lahko zelo travmatična in stresna. Zakon o duševnem zdravju določa dve vrsti hospitalizacije s stališča soglasja pacienta, s privolitvijo in brez privolitve, za katero morajo biti izpolnjeni vsi pogoji določeni v 39. členu Zakona o duševnem zdravju. Namen: Želeli smo ugotoviti kakšna je obravnava pacienta z duševno motnjo v nujni medicinski pomoči, kakšne so njegove pravice in zakoni ob hospitalizaciji brez privolitve ter kakšne so kompetence in vloga medicinske sestre ob hospitalizaciji brez privolitve. Metode: Pri pisanju diplomskega dela smo uporabili deskriptivno metodo dela s pregledom literature. Literaturo smo iskali od novembra 2017 do sredine januarja 2018, s pomočjo podatkovnih baz CINAHL with full text, Cochrane Collaboration, Medline (Pubmed) ter COBISS.SI in z uporabo iskalnika Google učenjak. Razprava in sklep: Zakon o duševnem zdravju določa, da se hospitalizacija proti volji izvaja na dva načina. Prvi način je na podlagi sklepa sodišča s predlogom psihiatra, centra za socialno delo, koordinatorja nadzorovane obravnave, najbližje osebe ali državnega sodišča. Drugi način pa je v nujnih primerih pred izdajo sklepa sodišča. Narekuje tudi odsotnost vsakršne diskriminacije, stigmatizacije, razlikovanja in ločevanja oseb z duševno motnjo. Hospitalizacija brez privolitve je definitivno ena izmed etičnih dilem, saj je njen postopek vpet med dilemo posameznikove svobode in potrebe po zaščiti pacienta. Potrebno je poudariti, da je pred vsako prisilo nujno poskušati uporabiti druge tehnike, kot sta komunikacija in uporaba zdravil. Pomembni sta tako verbalna, kot neverbalna komunikacija. Obravnava pacienta s psihozo in nasilnim vedenjem je zelo stresna in predstavlja visoko tveganje za ogrožanje varnosti zdravstvenega osebja Pri obravnavi je potreben terapevtski odnos, katerega gradimo na podlagi strokovnega znanja, s terapevtsko komunikacijo in deeskalacijskimi tehnikami. Poleg tega ne smemo pozabiti na empatijo, ki ima v poklicu medicinske sestre zelo pomembno vlogo. S pomočjo empatije se medicinska sestra pacientu približa in pridobi ter ohrani njegovo zaupanje.Introduction: Statistical data prove that mental illnesses present an ever bigger and ever more worrying health problem. The most important fact is that mental patients are equal to patients without mental illnesses, although the society still stigmatizes and discriminates mental patients despite this being strictly prohibited in constitutional and legislative provisions. The most common cause of accident and emergency department visits in psychiatric patients is suicide attempt. Hospitalization could be very traumatic and stressful for the patient. The Mental Health Act makes provisions for two types of placement considering patient’s consent, voluntary and involuntary. For involuntary placement all requirements of Article 39 of the Mental Health Act must be met. Purpose: We wanted to find out how psychiatric patients are treated in emergency medical services, what their rights and laws regarding involuntary placement are, and describe the importance and roles of nurses in involuntary placement. Methods of work: A descriptive method of research with a literature search has been used in the writing of this diploma paper. The literature search was performed from November 2017 to mid-January 2018 with the aid of databases CINAHL with Full Text, Cochrane Collaboration, Medline (Pubmed) and COBISS.SI and by using Google Scholar browser. Discussion and conclusion: The Mental Health Act makes provisions for involuntary placement to be carried out in two possible ways. One is based on a court order with a psychiatrist’s recommendation or a recommendation from a social work centre, a supervised treatment coordinator, a close relative or a district court. The second is in emergencies before a court order. It also stipulates the absence of discrimination, stigmatization, differentiation and separation of mental patients. Involuntary placement is definitely one of the most prominent ethical dilemmas, because the process engages the dilemma of the individual’s freedom and the need for the patient’s protection. It should be noted that other methods, such as communication and the use of medication, should be used before using force. Both verbal and non-verbal communications are essential. The admission of an aggressive, psychotic patient could be very stressful and presents high risk for the safety of the medical staff. The admission requires a therapeutic attitude, which is built on expert knowledge by therapeutic communication and de-escalation techniques. We should also take into account empathy, which plays an important role in the nurses’ profession. By means of empathy the nurse can get close to the patient and get their trust