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Práticas coercivas em pessoas internadas numa unidade de psiquiatria de agudos: Um estudo retrospetivo
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Advisor(s)
Abstract(s)
Introdução: As medidas coercivas são uma preocupação a nível mundial, a definição de
coerção é complexa pelo fato de várias intervenções estarem associadas à mesma. Pode-se
referenciar como aplicação de força ou ameaça de forma a persuadir a pessoa para fazer
algo, e na a aplicação de medidas que recorrem ao uso da força, exclusão e restrição, das
quais se destaca a contensão mecânica e isolamento ambiental.
Objetivo Geral: Identificar a prática de medidas coercivas, especificamente a contenção
mecânica e o isolamento ambiental, numa unidade de psiquiatria de agudos para adultos.
Metodologia: Estudo retrospetivo realizado numa unidade de psiquiatria de agudos
masculina em Portugal. Os dados colhidos correspondem ao período de 1 de janeiro de
2023 a 31 de dezembro de 2023, tendo sido obtidos a partir dos registos dos utentes que
foram submetidos a intervenções de contenção mecânica e/ou isolamento ambiental
durante esse período. Os dados analisados incluíram idade, diagnóstico psiquiátrico, estado
civil, escolaridade, nacionalidade, condição de admissão no internamento, tipo de medida
coerciva (contenção mecânica, isolamento), número e duração dos episódios coercivos,
motivos da coerção, hora do evento, registos dos diferentes profissionais de saúde. Este
estudo obteve o parecer favorável da Comissão de Ética da Instituição onde foi realizado o
estudo.
Resultados: Durante este período, registaram-se 563 internamentos na unidade do estudo,
sendo que 171 indivíduos (30,37%) foram submetidos a 407 contenções mecânicas e/ou
isolamentos. Destas medidas, 140 correspondem à contenção mecânica (34,4%), e 269
correspondem ao isolamento (66,2%). Cerca de 46,78% dos utentes submetidos a alguma
das medidas tinha idade compreendida entre 18 e 39 anos, e 34,49% tinha como
diagnóstico médico transtorno mental e comportamental devido ao uso de substâncias
psicoativas/ álcool. Durante esse período, os pacientes foram submetidos à contenção
mecânica por uma média de 4,63 (+3,05) turnos e ao isolamento por uma média de 9,00
(+14,12) turnos. Os principais motivos para a aplicação dessas medidas foram o
comportamento desorganizado (26,78%) e o risco de fuga (14,99%). Em nenhuma das 407
medidas foi registado o uso de briefing.
Conclusão: O estudo evidenciou a utilização da contenção mecânica e do isolamento,
sendo mais predominante em jovens adultos com transtornos relacionados ao uso de
substâncias. A duração das medidas e ausência de briefing registado sugere a necessidade
de aprimorar protocolos de intervenção. Esses resultados podem contribuir para melhorar a
qualidade dos cuidados de enfermagem prestados a utentes nos serviços de psiquiatria de
agudos.
Introduction: Coercive measures are a worldwide concern. The definition of coercion is complex due to the fact that various interventions are associated with it. It can be referred to as the application of force or threat in order to persuade a person to do something, and in the application of measures that resort to the use of force, exclusion and restriction, of which mechanical restraint and environmental isolation stand out. General objective: To identify the practice of coercive measures, specifically mechanical restraint and environmental isolation, in an acute psychiatric unit for adults. Methodology: One-year retrospective study carried out in a male acute psychiatric unit in Portugal. Data from 1 January 2023 to 31 December 2023 were obtained from the records of patients who underwent mechanical restraint and/or environmental isolation interventions during that period. The data analysed included age, psychiatric diagnosis, marital status, schooling, nationality, condition of admission to hospital, type of coercive measure (mechanical restraint, isolation), number and duration of coercive episodes, reasons for coercion, time of event, records of the different health professionals. This study obtained the favourable opinion of the Ethics Committee of the institution where the study was carried out. Results: During this period, there were 563 admissions to the study unit, of which 171 individuals (30.37%) were subjected to 407 mechanical restraints and/or isolations. Of these measures, 140 corresponded to mechanical restraint (34.4%), and 269 corresponded to isolation (66.2%). Around 46.78% of the patients subjected to one of the measures were aged between 18 and 39, and 34.49% had a medical diagnosis of mental and behavioural disorder due to the use of psychoactive substances/alcohol. During this period, the patients were subjected to mechanical restraint for an average of 4.63 (+3.05) shifts and isolation for an average of 9.00 (+14.12) shifts. The main reasons for applying these measures were disorganised behaviour (26.78%) and the risk of escape (14.99%). No briefing was recorded in any of the 407 measures. Conclusion: The study showed that the use of mechanical restraint and isolation was more prevalent in young adults with substance use disorders. The duration of the measures and the absence of a recorded briefing suggest the need to improve intervention protocols. These results may contribute to improving the quality of nursing care provided to users in acute psychiatric services.
Introduction: Coercive measures are a worldwide concern. The definition of coercion is complex due to the fact that various interventions are associated with it. It can be referred to as the application of force or threat in order to persuade a person to do something, and in the application of measures that resort to the use of force, exclusion and restriction, of which mechanical restraint and environmental isolation stand out. General objective: To identify the practice of coercive measures, specifically mechanical restraint and environmental isolation, in an acute psychiatric unit for adults. Methodology: One-year retrospective study carried out in a male acute psychiatric unit in Portugal. Data from 1 January 2023 to 31 December 2023 were obtained from the records of patients who underwent mechanical restraint and/or environmental isolation interventions during that period. The data analysed included age, psychiatric diagnosis, marital status, schooling, nationality, condition of admission to hospital, type of coercive measure (mechanical restraint, isolation), number and duration of coercive episodes, reasons for coercion, time of event, records of the different health professionals. This study obtained the favourable opinion of the Ethics Committee of the institution where the study was carried out. Results: During this period, there were 563 admissions to the study unit, of which 171 individuals (30.37%) were subjected to 407 mechanical restraints and/or isolations. Of these measures, 140 corresponded to mechanical restraint (34.4%), and 269 corresponded to isolation (66.2%). Around 46.78% of the patients subjected to one of the measures were aged between 18 and 39, and 34.49% had a medical diagnosis of mental and behavioural disorder due to the use of psychoactive substances/alcohol. During this period, the patients were subjected to mechanical restraint for an average of 4.63 (+3.05) shifts and isolation for an average of 9.00 (+14.12) shifts. The main reasons for applying these measures were disorganised behaviour (26.78%) and the risk of escape (14.99%). No briefing was recorded in any of the 407 measures. Conclusion: The study showed that the use of mechanical restraint and isolation was more prevalent in young adults with substance use disorders. The duration of the measures and the absence of a recorded briefing suggest the need to improve intervention protocols. These results may contribute to improving the quality of nursing care provided to users in acute psychiatric services.
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Keywords
Coerção Saúde Mental Psiquiatria Enfermagem Estudos retrospetivos
Pedagogical Context
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