20.500.12556/DKUM-82172 Učinkovitost verbalne in neverbalne deeskalacije na zmanjšanje agresivnega vedenja in uporabe posebnih varovalnih ukrepov Effectiveness of Verbal and Non-Verbal De-Escalation in Reducing Aggressive Behaviour and Coercion Izhodišča in namen raziskave: Večina smernic za obvladovanje agresivnega vedenja pri akutnih psihiatričnih pacientih opisuje uporabo deeskalacije kot metodo prve izbire, vendar so dokazi o njeni učinkovitosti nedosledni. Namen raziskave je bil oceniti učinek verbalne in neverbalne deeskalacije na pojavnost in resnost agresije ter uporabo fizičnih omejitev v akutnih psihiatričnih oddelkih. Metode: Izvedena je bila multicentrična randomizirana kontrolirana raziskava, ki je potekala v dveh fazah: izhodiščna faza je trajala pet zaporednih mesecev leta 2018, interventna faza pa enakih pet zaporednih mesecev leta 2019. Pred interventno fazo raziskave smo izvedli randomizacijo psihiatričnih bolnišnic v eksperimentalno in kontrolno skupino ter izobraževanje iz deeskalacije, namenjeno osebju v oddelkih eksperimentalne skupine. V izhodiščnem in interventnem obdobju raziskave smo ocenili incidenco in resnost agresivnega vedenja ter incidenco in trajanje epizod fizičnih omejitev. Rezultati: V izhodiščnem obdobju raziskave ni bilo statistično značilnih razlik v incidenci agresivnega vedenja in fizičnih omejitev med eksperimentalno in kontrolno skupino. Incidence agresivnih dogodkov, hudih agresivnih dogodkov in epizod fizičnih omejitev, izračunane na 100 hospitalnih dni, so se po učenju deeskalacije statistično značilno zmanjšale. Incidenčna stopnja za agresivni dogodek je bila v eksperimentalni skupini v interventnem obdobju raziskave 73 % manjša v primerjavi s kontrolo skupino (IRR = 0.268, 95 % IZ [0.221; 0.342]), incidenčna stopnja za hudi agresivni dogodek pa 86 % manjša (IRR = 0.142, 95 % IZ [0.107; 0.189]). Incidenčna stopnja epizod PVU, uvedenih zaradi agresivnega vedenja, se je v eksperimentalni skupini zmanjšala na 30 % incidenčne stopnje kontrolne skupine (IRR = 0.304, 95 % IZ [0.238; 0.386]), incidenčna stopnja epizod PVU, uvedenih iz drugih vzrokov, pa se ni zmanjšala. V eksperimentalni skupini se je statistično značilno zmanjšala tudi resnost agresivnih incidentov (p < 0.001), medtem ko se povprečno trajanje epizod fizične omejitve ni zmanjšalo. Zaključek: Rezultati raziskave kažejo, da je deeskalacija učinkovita pri zmanjševanju pojavnosti in resnosti agresije ter uporabe fizičnih omejitev. Introduction and aim of the study: Most guidelines for the management of aggressive behaviour in acute psychiatric patients describe the use of de-escalation as the first-choice method, but the evidence for its effectiveness is inconsistent. The aim of the study was to assess the effect of verbal and non-verbal de-escalation on the incidence and severity of aggression and the use of physical restraints in acute psychiatric wards. Methods: A multi-centre cluster randomized study was conducted in the acute wards of all psychiatric hospitals in Slovenia. The research was carried out in two phases, a baseline period of five consecutive months and an intervention period of the same five consecutive months in the following year. After the baseline period, randomization of psychiatric hospitals into experimental and control groups was performed, and de-escalation training for the staff on experimental wards was implemented. The incidence and severity of aggressive behaviour and the incidence and duration of episodes of physical restraint were assessed during both study periods Results: In the baseline study period, there were no significant differences in the incidence of aggressive behaviour and physical restraints between the experimental and control groups. The incidence rates of aggressive events, severe aggressive events, and physical restraints decreased significantly after de-escalation training. Compared to the control group, the incidence rate of aggressive events was 73 % lower in the experimental group (IRR = 0.268, 95 % CI [0.221; 0.342]), while the rate of severe events was 86 % lower (IRR = 0.142, 95 % CI [0.107; 0.189]). During the intervention period, the incidence rate of physical restraints due to aggression in the experimental group decreased to 30 % of the rate in the control group (IRR = 0.304, 95 % CI [0.238; 0.386]. No reduction in the incidence of restraint used for reasons unrelated to aggression was observed. After the intervention, a statistically significant decrease in the severity of aggressive incidents was observed in the experimental group (p < 0.001), while the average duration of restraint episodes did not decrease. Conclusion: The results of our study show that de-escalation is effective in reducing aggression and the use of physical restraints. agresija posebni varovalni ukrepi omejitev s pasovi deeskalacija akutni psihiatrični oddelek aggression coercive measures physical restraint de-escalation acute psychiatric ward true true false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2022-07-25 16:07:11 2023-05-11 08:42:12 2023-05-12 03:06:52 0000-00-00 00:00:00 2023 0 Maribor 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 151660547 DOK_Celofiga_Andreja_2023.pdf DOK_Celofiga_Andreja_2023.pdf 1 B289B5782503D34A3063BEF3EE85A070 a6b7b7eca1e0ed30078fde51d111f90b1bfe8055ec65f44ec6cb97bf644f653f cbb9bca8-c7f0-11ed-b823-00155d000105 https://dk.um.si/Dokument.php?lang=slv&id=166215 Medicinska fakulteta 0 0 0