Safety of the health treatment of a patient with mental disorder

Uvod: Med zdravstvenimi delavci so predvsem medicinske sestre tiste, ki izkusijo najvišjo stopnjo nasilja. V primeru nasilnega vedenja se od zdravstvenega osebja, zlasti pri pacientih z duševnimi motnjami, zahteva visoko strokovno znanje in izkušnje iz klinične prakse, s katerimi se deluje v smeri preprečitve nasilnega vedenja in njegovih posledic. Tveganje za nasilno vedenje narašča s številom diagnosticiranih psihiatričnih stanj. Z razvojem moderne družbe in novih trendov narašča tudi incidenca duševnih motenj. Varnost pacienta in kakovostna psihiatrična obravnava sta glavni prioriteti na vseh področjih zdravstvene nege. Namen: Namen diplomskega dela je predstaviti varnost zdravstvene obravnave pacienta z duševno motnjo. Metode dela: Uporabili smo deskriptivno metodo dela s sistematičnim pregledom domače in tuje literature, s časovnim okvirjem od leta 2006 do 2018. Vključeni so bili članki, ki so v celoti dostopni, recenzirani in objavljeni od leta 2006 naprej. Zaradi pomembnosti podatkov smo vključili tudi članek iz leta 1986. Iskanje je potekalo s pomočjo podatkovnih baz CINAHL in Medline. Pregledali smo tudi recenzirane zbornike in knjige iz Narodne univerzitetne knjižnice Ljubljana. V analizo smo vključili 33 člankov, en knjižni vir, Zakon o duševnem zdravju, Zakon o pacientovih pravicah in Kodeks etike v zdravstveni negi in oskrbi Slovenije, torej skupno 37 del. Razprava in zaključek: S pregledom literature smo ugotovili, da je nasilje na delovnem mestu pomembna težava, tako z vidika zdravja kot varnosti. Za medicinske sestre na področju psihiatrije je zelo pomembno poznavanje dejavnikov tveganja in okoliščin, ki povečujejo tveganje za pojav nasilnega vedenja. Izobraževanje medicinskih sester je pomembno za prepoznavanje znakov nasilnega vedenja in pa za ukrepanje ob njegovem pojavu. Na voljo so jim ocenjevalne lestvice in organizacijski modeli, s katerimi prepoznavajo možnosti za pojav nasilnega vedenja. Prednostna naloga na vseh ravneh zdravstvenega varstva je zagotovitev varne in kakovostne obravnave pacienta z duševno motnjo. Pri zaznavanju nasilja v zdravstveni negi je pomembno znanje. Kontinuirano izobraževanje iz teh strokovnih vsebin medicinsko sestro okrepi s spretnostmi prepoznave različnih vzorcev vedenja in poveča njeno občutljivost za določena ravnanja in dogodke, tako da nasilja ne obravnava več kot samoumevnega oz. kot »del svoje službe«.Introduction: Nurses in particular experience the highest levels of violence among health professionals. Health professionals are in case of violent behaviour, especially in patients with mental disorders, required to obtain a high level of expertise from clinical practice, which works in the direction of preventing violent behaviour and its consequences. The risk of violent behaviour increases with the number of diagnosed psychiatric conditions. With the development of modern society and new trends, also the incidence of mental disorders is increasing. Patient safety and quality psychiatric treatment are the main priorities in all areas of health care. Purpose: The purpose of the thesis is to present the safety of the treatment of a patient with mental disorder. Methods: A descriptive working method with a systematic review of domestic and foreign literature was used, with a time frame from 2006 to 2018. Articles that are fully accessible, reviewed and published since 2006 onwards were included. Due to the importance of the data we also included an article from 1986. The research was carried out using the CINAHL and Medina databases. We also analysed reviewed publications and books from the National University Library of Ljubljana. There are 33 articles, 1 book source, the Mental Health Act (ZDZdr), the Pacient Rights Act (ZPacP) and a Code of ethics in nursing and care of Slovenia, a total of 37 works included in the analysis. Discussion and conclusion: During the literature review, we came to the conclusion that violence at a workplace is an important issue, both in terms of health and safety. A better knowledge of risk factors and circumstances that increase the risk of violent behaviour is very important for the nurses in the field of psychiatry. It is important to educate nurses to identify signs of violent behaviour and to act upon the occurrence of it. They also have a number of rating scales and organizational models to identify the possibility of a violent behaviour. The priority at all levels of health care is to ensure safe and quality treatment of a patient with mental disorder. Knowledge is significant in the perception of violence in nursing. Continuous education from these professional contents provides the nurse with the skills to recognize different patterns of behaviour, increases her sensitivity to certain behaviours, events, and the nurse no longer treats them as self-evident or as a »part of her job«