Abstract:There are multiple concerns regarding the practice of forced medication of clients with mental illness. Clients often report that side effects outweigh the benefits of psychotropic medication, while mental health clinicians often think the client may become dangerous without medication. Who should have the right to decide whether a client takes medication? Nursing plays an integral role in the decision making by considering alternative therapies and current research, addressing the diversity among our clients,… Show more
“…While IM medications are an important tool, they come with a complex set of risks, benefits, and implications. Administration of IM medications can increase scene safety in some respects, but--particularly when IM medication is given involuntarily--patients may experience a loss of autonomy, they may experience the intervention as unnecessarily invasive, and the experience may disrupt their relationships with healthcare providers (26,27). Administration of IMs may also temporarily escalate the situation and place the patient and staff members at increased risk of injury.…”
Objective: To evaluate the relationship between medications used to treat acute agitation (antipsychotics, mood stabilizers and benzodiazepines) and subsequent assault incidence in the psychiatric emergency room.
Methods: Medication orders and assault incident reports were obtained from electronic health records for 17,052 visits to an urban psychiatric emergency room from 2014-2019. Assault risk was modeled longitudinally using Poisson mixed-effect regression.
Results: Assaults were reported during 0.5% of visits. Intramuscular medications (IMs) were administered in 23.3% of visits overall, and predominately administered within the first 4-hours of a visit. IM administration was correlated with assault (IRR=24.2 [5.33, 110.0]), often because IM medication was administered immediately subsequent to reported assaults. Interacted with time, IMs were not significantly associated with reduction in future assaults (IRR=0.700 [0.467, 1.04]). Neither benzodiazepines nor mood stabilizers were associated with subsequent changes to the risk of reported assault. By contrast, antipsychotic medications were associated with decreased assault risk across time (IRR=0.583 [0.360, 0.942]).
Conclusions: IM order rates are high relative to overall assault incident risk. Of the three major categories of medications administered commonly in the psychiatric emergency setting, only antipsychotic medications were associated with measurable decreases in subsequent assault risk. Careful weighing of the risks and benefits of medications is encouraged; antipsychotic medication can have a significant side effect burden, and other medications (IMs, benzodiazepines, mood stabilizers) were not associated with subsequent reduction in assault risk in this analysis.
“…While IM medications are an important tool, they come with a complex set of risks, benefits, and implications. Administration of IM medications can increase scene safety in some respects, but--particularly when IM medication is given involuntarily--patients may experience a loss of autonomy, they may experience the intervention as unnecessarily invasive, and the experience may disrupt their relationships with healthcare providers (26,27). Administration of IMs may also temporarily escalate the situation and place the patient and staff members at increased risk of injury.…”
Objective: To evaluate the relationship between medications used to treat acute agitation (antipsychotics, mood stabilizers and benzodiazepines) and subsequent assault incidence in the psychiatric emergency room.
Methods: Medication orders and assault incident reports were obtained from electronic health records for 17,052 visits to an urban psychiatric emergency room from 2014-2019. Assault risk was modeled longitudinally using Poisson mixed-effect regression.
Results: Assaults were reported during 0.5% of visits. Intramuscular medications (IMs) were administered in 23.3% of visits overall, and predominately administered within the first 4-hours of a visit. IM administration was correlated with assault (IRR=24.2 [5.33, 110.0]), often because IM medication was administered immediately subsequent to reported assaults. Interacted with time, IMs were not significantly associated with reduction in future assaults (IRR=0.700 [0.467, 1.04]). Neither benzodiazepines nor mood stabilizers were associated with subsequent changes to the risk of reported assault. By contrast, antipsychotic medications were associated with decreased assault risk across time (IRR=0.583 [0.360, 0.942]).
Conclusions: IM order rates are high relative to overall assault incident risk. Of the three major categories of medications administered commonly in the psychiatric emergency setting, only antipsychotic medications were associated with measurable decreases in subsequent assault risk. Careful weighing of the risks and benefits of medications is encouraged; antipsychotic medication can have a significant side effect burden, and other medications (IMs, benzodiazepines, mood stabilizers) were not associated with subsequent reduction in assault risk in this analysis.
“…Um die dahingehende Entwicklung bei Pflegepersonen zu fördern, bieten sich die professionelle Selbstreflexion und Nachbesprechungen von herausfordernden Praxissituationen an. Mentoren können hier Coaches, die pflegerische Stationsleitung oder auch die anderen (erfahrenen) Pflegekollegen sein [10].…”
Section: Caring Als Moralische Normativitätunclassified
“…Um Hierarchiegefälle und paternalistische Versorgungsstrukturen aufzubrechen, werden Betreuungsansätze wie "Adherence", "Shared Decision Making" oder "Medication Concordance" empfohlen. Es handelt sich dabei um spezielle pflegerische Versorgungskonzepte und Haltungen von Pflegepersonen mit dem Ziel, dass die versorgten Kinder und Jugendlichen umfassend aufgeklärt werden, um im Betreuungsverhältnis notwendige Entscheidungen mitbestimmen beziehungsweise verstehen zu können [10]. Einschränkend muss hier aber festgestellt werden, dass eine solche Autonomieübertragung an Kinder und Jugendliche nur bedingt möglich ist.…”
Section: Caring Als Zwischenmenschliche Beziehungunclassified
Zwangsmedikation kann eine therapeutische Notwendigkeit auf Kinder- und Jugendpsychiatrien sein, um akut bedrohliches Geschehen zu deeskalieren. Oft bleiben die Patienten, aber auch das Personal nach einer solchen Maßnahme irritiert zurück. Dieser Umstand wirkt störend auf den pflegetherapeutischen Beziehungsaufbau. Eine caring-sensible Reflexion der Pflegepersonen adressiert diese Herausforderungen, fördert deren professionelle Entwicklung und trägt zur gelingenden Pflegepraxis bei.
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