Aggression towards nurses on psychiatry ward

Agresija je pojam koji podrazumijeva destruktivno ponašanje s ciljem nanosa štete osobama ili predmetima. Takav događaj u prijetećem ili već eskalirajućem stadiju često je prisutan na odjelima psihijatrije. Najčešće je upućen zdravstvenim djelatnicima, osobito medicinskim sestrama i medicinskim tehničarima koji su obično prvi u kontaktu s agresivnim bolesnikom, te pokreće slijed standardiziranih postupaka u prevenciji i redukciji istog. Ophođenje s takvim bolesnicima mijenjalo se tijekom povijesti. Primitivna plemena u počecima su postupala s agitiranim i agresivnim stanjima kao nečim nadnaravnim, dok su kasnije narodi zahvaljujući brojnim spoznajama i psihološkim teorijama uvidjeli uzroke takvog ponašanja. Danas se agresija u psihijatriji tretira kroz brojne terapijske metode u svrhu postizanja što bolje integracije i reintegracije u zajednici. Važno je prije svega prepoznati njen uzrok, čime se može utjecati na smanjenje rizika od eskalacije ponašanja. Osim toga, pažnja se pridaje stvaranju terapijskog okruženja koje se postiže adekvatnim prostornim uređenjem i uspostavom pozitivnog odnosa između medicinske sestre i pacijenta. Medicinska sestra autonoman je član psihijatrijskog zdravstvenog tima koji ima značajnu ulogu u prepoznavanju i procjeni rizika od eskalacije agresivnog ponašanja. Tehnikama deeskalacije pokušava se djelovati umirujuće na bolesnika. Ponekad, kada su se sve prethodne metode pokazale neuspješnima, javlja se potreba za primjenom mjera prisile koje obuhvaćaju humano sputavanje, farmakoterapiju i humanu sekluziju. To su složeni postupci koji zahtijevaju stručna znanja i vještine koji se postižu čestim uvježbavanjem, te kontinuiranom edukacijom zdravstvenog osoblja. Kako su medicinske sestre i tehničari posebno izloženi agresiji na psihijatrijskim odjelima, važno je obratiti pozornost na utjecaj uzastopnih agresivnih incidenata na njih. Osim fizičkih posljedica, moguća je pojava onih psiholoških, čime se, ukoliko izostanu određene intervencije, povećava vjerojatnost pojave profesionalnog izgaranja i posttraumatskog stresnog poremećaja. Osjećaji koji se javljaju obično budu vezani uz strah, što ima racionalnu podlogu rizika od ozljede. Nadalje, moguća je pojava negativnih osjećaja vezanih uz agresivni ispad poput ljutnje, protuagresije, gubitka povjerenja između medicinskih sestara i pacijenta, osjećaj krivnje i inkompetentnosti, što utječe na procjenu medicinske sestre, ponašanja i stajališta. Taj fenomen naziva se kontratransfer ili protuprijenos. Kako bi se osigurala najbolja moguća razina skrbi za bolesnika na psihijatrijskom odjelu, važno je educirati zdravstvene djelatnike o prepoznavanju negativnog kontratransfera, te razvoju svijesti o uporabi vlastitih mehanizama obrane.Aggression is a phenomenon that implies destructive behavior with the aim of causing damage to properties or objects. Such an event in a threatening or already escalating stage is often present in psychiatric wards. It is most commonly referred to healthcare professionals, especially nurses who are usually the first to come into contact with an aggressive patient, and initiates a sequence of standardized procedures in its prevention and reduction. The treatment of such patients has changed throughout history. Primitive tribes in the beginning treated agitated and aggressive conditions as supernatural, but later, thanks to numerous insights and psychological theories, people begin to see the causes of such behavior. Today, aggression in psychiatry is treated through a number of therapeutic methods in order to achieve the best possible integration and reintegration into the community. It is important, above all, to identify its cause, which can have the effect of reducing the risk of escalating behavior. In addition, attention is paid to creating a therapeutic environment that is achieved through adequate spatial planning and the establishment of a positive relationship between the nurse and the patient. Nurse is an autonomus member of the psychiatric health team who has a significant role in recognizing and assessing the risk of escalating aggressive behavior. Using deescalation techniques nurses try to have a calming effect on the patient. Sometimes, when all previous methods have proved unsuccessful, there is a need to apply coercive measures that include human restraint, pharmacotherapy, and human seclusion. These are complex procedures that require professional knowledge and skills that are achieved through frequent training and continuous education of health care staff. As nurses and technicians are particularly exposed to aggression in psychiatric wards, it is important to pay attention to the impact of successive aggressive incidents on them. Except physical consequences, the occurrence of psychological ones is possible, which, in the absence of certain interventions, increases the likelihood of occupational burnout and post-traumatic stress disorder. The feelings that occur are usually related to fear, which has a rational basis of the risk of injury. Furthermore, negative feelings related to aggressive outbursts such as anger, counter-aggression, loss of trust between nurses and patient, guilt and incompetence are possible, which affects the nurse’s assessment, behavior, and attitude. This phenomenon is called countertransference. In order to ensure the best possible level of care for patients in the psychiatric ward, it is important to educate health professionals about recognizing negative countertransference, and developing awareness of the use of their own defense mechanisms