Montanari Vergallo Gianluca, Gulino Matteo
Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Rome, Italy.
Department of Clinical Sciences and Translational Medicine, TorVergata University of Rome, Rome, Italy.
Psychiatry Clin Psychopharmacol. 2021 Dec 1;31(4):468-473. doi: 10.5152/pcp.2021.21237. eCollection 2021 Dec.
International directives all recommend that using restraints on psychiatric patients should be avoided, yet scientific literature shows that such practices are still largely in use. This article aims to lay out strategies that could be put in place in order to gradually discard the use of restraints, particularly through a "restraint-free" approach, nursing, logistic-environmental pathways, and locally centered health care provision. All such tools have proven valuable for the purpose of safeguarding the health of psychiatric patients. Hence, the failure to put in place such measures may lead to litigation and lawsuits against physicians and particularly health care facilities. Undoubtedly, the ability to effectively implement such methods largely depends on the financial resources available, which in countries such as Italy are poorer than in others. Still, the risk of being sued and held professionally liable may constitute a factor in raising awareness among operators, facilities, and public health care management, leading to the implementation of policy changes aimed at minimizing the use of restraints.
国际指令都建议应避免对精神科患者使用约束措施，但科学文献表明这种做法仍在广泛使用。本文旨在阐述可以实施的策略，以便逐步摒弃约束措施的使用，特别是通过“无约束”方法、护理、后勤-环境途径以及以地方为中心的医疗保健服务。所有这些工具已被证明对于保障精神科患者的健康很有价值。因此，未能实施这些措施可能会导致针对医生尤其是医疗保健机构的诉讼。毫无疑问，有效实施这些方法的能力在很大程度上取决于可用的财政资源，在意大利等国家，这些资源比其他国家更为匮乏。尽管如此，被起诉并承担专业责任的风险可能会成为提高从业者、机构和公共卫生保健管理人员意识的一个因素，从而促使实施旨在尽量减少约束措施使用的政策变革。
