L’efficacia di utilizzo delle tecniche di de-escalation nel paziente psichiatrico: revisione narrativa

Abstract

Introduction: Aggression and violence in the workplace represent an ever-increasing psychosocial phenomenon and this can cause possible important repercussions for the entire treatment process. Objective: to evaluate the effectiveness of using de-escalation techniques in the management the psychiatric patient’s aggressive actions. Methods: To conduct the following review, a research question was outlined using the PIO methodology. Subsequently, a narrative review of the literature was conducted, through the use of the PubMed and EMBASE databases. Results: From the review of the international literature, only three studies met our inclusion criteria Selected studies show that mental health workers react differently to violence. Some relate to patients by generating positive solutions, while others manage patients with coercive measures. The effectiveness of the use of de-escalation techniques in the management of aggressive actions and that both staff and patients aspire to achieve non-confrontational and social relationships while interacting in violent and threatening situations can be seen. Conclusions: De-escalation is the most effective technique only after careful knowledge of the patient, his pathologies and any prodromal signs and symptoms that may indicate the onset of aggressive behavior. Furthermore, it is more complicated with subjects having a previous history of aggression. However, the absence of adequate staff training emerges, which can guarantee the correct implementation of the intervention and which can make nurses safer in the management of aggressive action and of the violent patient.

Nursing attitudes and perceptions on restraint practices in Italian mental health settings

“…Summarizing, adequate staff training in the management of agitated psychiatric patients, with a preference for verbal deescalation techniques (techniques of self-control, negotiation, empathy, avoiding patient provocation and respecting his spaces) may lead to coercive event reduction and to promote safer and more appropriate treatments. A further method to reduce aggressive assaults could be the use of the open door in the wards (Cibis et al, 2017), the effectiveness of which emerged from a review of the literature (Calabrò et al, 2020). On the occasion of the recent online National Conference "Per una salute mentale di comunità" ("For community mental health") (June 25/26, 2021), the Italian Minister of Health explained the need to improve an alternative approach since binding psychiatric patients with mechanical restraints could only produce negative psychophysical outcomes and violated human rights.…”