Emergency-related inpatient admissions in child and adolescent psychiatry: comparison of clinical characteristics of involuntary and voluntary admissions from a survey in Bavaria, Germany.

Emergency inpatient admissions of children and adolescents are more difficult if the patient is admitted involuntarily and/or the caregivers or custodians of institutional care are absent. The present study aimed to clinically characterize involuntary versus voluntary admissions by examining the reasons for presentation and associated factors. We retrospectively analyzed patients who presented to the emergency department of a hospital for child and adolescent psychiatry in Bavaria, Germany, and were admitted as inpatients for crisis intervention in the 4th quarter of 2014-2018. Reasons for presentation, clinical and sociodemographic characteristics, and type of admission (voluntary versus involuntary) were analyzed for 431 emergency inpatient admissions. A total of 106 (24.6%) patients were involuntarily admitted. In a binominal logistic regression, presentation due to alcohol consumption, deviant social behavior, and psychosocial burden was positively associated, whereas difficulties at school and depression were negatively associated, with the likelihood of involuntary admission. 58.5% of the 123 unaccompanied patients were admitted involuntarily. Reasons for the presentation of unaccompanied and voluntary inpatient admissions were suicidal thoughts, psychosocial burden, and externalized aggression. A substantial number of child and adolescent psychiatric admissions represent emergency admissions. Involuntarily admitted patients and unaccompanied children/adolescents represent a non-negligible proportion of clinical routine and the clinical and legal background factors need to be further clarified in future studies. This study is registered in the German Clinical Trials Register (24 September 2019, DRKS00017689).

Who accompanies patients to the chronic pain clinic?

BACKGROUND: Patients may be accompanied to the pain clinic consultation and these accompanying persons are relevant in the communication process. AIMS: We sought to characterize if patients were accompanied and by whom to the pain clinic. We also wished to determine the accompanying persons influence on the doctor-patient interaction. This has not been studied previously in this clinical setting. METHODS: Local ethics committee approval followed by written informed consent was obtained. Patients attending the pain clinic for the first time and review patients were included (n = 219). RESULTS: Twenty-one percent of patients (n = 46) were accompanied. Adult accompanied by spouse 19 (41.3 %) and adult child accompanied by parent 18 (39.1 %) were the most common dyads. The accompanying person's role was most frequently described by doctors as an advocate for the patient 30/46 (65.2 %) [for an adult accompanied by spouse (63.1 %)]. The influence of the main accompanying person on the patient doctor encounter was described as positive [adult accompanied by spouse (78.9 %)] [(adult accompanied by parent (94.4 %)]. CONCLUSIONS: Patients are accompanied to the pain clinic with a typically positive influence on doctor patient relationship and communication. Awareness of these issues is important in good communication in the pain clinic.

O brincar no contexto hospitalar na visão dos acompanhantes de crianças internadas / The act of playing within the hospital context in the vision of the accompanying persons of the hospitalised children

INTRODUÇÃO: a hospitalização infantil pode comprometer o desenvolvimento normal da criança, em decorrência da quebra de sua rotina e do processo de adaptação à nova realidade. São várias as iniciativas no sentido de promover espaços em hospitais que possibilitem à criança contato com atividades lúdicas. Muitas são as variáveis que influenciam a atitude da criança perante a possibilidade de realização de atividades lúdicas, dentre elas, a participação dos acompanhantes. Saber qual a interpretação dos mesmos sobre o brincar no contexto hospitalar e quais as características que associam a essa atividade é essencial para melhor planejamento das ações de atendimento OBJETIVO: esta pesquisa teve por objetivo analisar a opinião dos acompanhantes sobre a promoção do brincar no espaço de hospitalização da criança MÉTODO: para tanto, os acompanhantes responderam a questionários durante o período de internação. Os dados foram analisados através de estatística descritiva e análise de conteúdo. Participaram do estudo 65 mães de crianças internadas, sendo que a maioria acompanhava pacientes na faixa etária entre 2 a 6 anos RESULTADOS: todas avaliaram que a criança deve participar da brinquedoteca, pois auxilia na recuperação, propiciando alívio do sofrimento, acalmando a criança e aliviando as tensões CONCLUSÃO: conclui-se os acompanhantes consideram importante a brinquedoteca no contexto de hospitalização das crianças para amenizar efeitos da internação e auxiliar no desenvolvimento infantil.

INTRODUCTION: the infant hospitalisation may put at risk the normal development of the children due to the breaking of their routine and the adjustment to the new reality process. There are several initiatives to promote spaces in hospitals so that the children can have contact with recreational activities. There are many variables that may influence the children's attitude towards the possibility of playful activities, among them the involvement of the accompanying persons. It is essential to learn their interpretation of the playing activities in the hospital context and which characteristics are associated with this activity in order to reach better planning of the assistance OBJECTIVE: this study aimed to examine the opinion of the accompanying persons on promoting play during the children's hospitalisation METHODS: therefore, the accompanying persons answered questionnaires during that period of hospitalisation. Data were analysed using descriptive statistics and content analysis RESULTS: 65 mothers of hospitalised children, mostly accompanied patients aged from 2-6 years old. All of them confirmed that the children should attend the playroom since it helps in recovery, providing relief from suffering, calming them and thus relieving tensions CONCLUSION: as a conclusion, the accompanying persons highlight the importance of the playroom in the context of hospitalisation of children to soothe its effects of and help in the development of the children.

Accompanying persons education effectiveness and Ethical analysis in the department of Geriatrics / 中国医学伦理学

Objective:Explore the education content and method for the accompanying persons to enhance the capacity of taking care of patient .Methods:Life satisfaction index ( LSR-A) Scale and accompanying persons chaperone capability questionnaire are the tools of this research .This research trained the 45 accompanying persons care ability, and used before and after comparison .Results:Before the intervention , Most of the persons′life satis-faction levels was at a low level (41 persons′≤13), only 4 (8.9%) at a medium level.After the intervention, life satisfaction levels was improved (27 persons′≥14).Life sat!sfaction was improved (P<0.05).Chaperone capability situation was improved , for the P values in all the examination were <0 .05 .Conclusion:The manage-ment could strengthen the support for accompanying persons , could effectively improve their life satisfaction and im-prove their ability to accompany , thus improving the quality of patient care .The hospital should also consider the nursing ethical problems in accompanying persons education .

The act of playing within the hospital context in the vision of the accompanying persons of the hospitalised children / O brincar no contexto hospitalar na visão dos acompanhantes de crianças internadas

INTRODUCTION: the infant hospitalisation may put at risk the normal development of the children due to the breaking of their routine and the adjustment to the new reality process. There are several initiatives to promote spaces in hospitals so that the children can have contact with recreational activities. There are many variables that may influence the children's attitude towards the possibility of playful activities, among them the involvement of the accompanying persons. It is essential to learn their interpretation of the playing activities in the hospital context and which characteristics are associated with this activity in order to reach better planning of the assistance OBJECTIVE: this study aimed to examine the opinion of the accompanying persons on promoting play during the children's hospitalisation METHODS: therefore, the accompanying persons answered questionnaires during that period of hospitalisation. Data were analysed using descriptive statistics and content analysis RESULTS: 65 mothers of hospitalised children, mostly accompanied patients aged from 2-6 years old. All of them confirmed that the children should attend the playroom since it helps in recovery, providing relief from suffering, calming them and thus relieving tensions CONCLUSION: as a conclusion, the accompanying persons highlight the importance of the playroom in the context of hospitalisation of children to soothe its effects of and help in the development of the children.(AU)

INTRODUÇÃO: a hospitalização infantil pode comprometer o desenvolvimento normal da criança, em decorrência da quebra de sua rotina e do processo de adaptação à nova realidade. São várias as iniciativas no sentido de promover espaços em hospitais que possibilitem à criança contato com atividades lúdicas. Muitas são as variáveis que influenciam a atitude da criança perante a possibilidade de realização de atividades lúdicas, dentre elas, a participação dos acompanhantes. Saber qual a interpretação dos mesmos sobre o brincar no contexto hospitalar e quais as características que associam a essa atividade é essencial para melhor planejamento das ações de atendimento OBJETIVO: esta pesquisa teve por objetivo analisar a opinião dos acompanhantes sobre a promoção do brincar no espaço de hospitalização da criança MÉTODO: para tanto, os acompanhantes responderam a questionários durante o período de internação. Os dados foram analisados através de estatística descritiva e análise de conteúdo. Participaram do estudo 65 mães de crianças internadas, sendo que a maioria acompanhava pacientes na faixa etária entre 2 a 6 anos RESULTADOS: todas avaliaram que a criança deve participar da brinquedoteca, pois auxilia na recuperação, propiciando alívio do sofrimento, acalmando a criança e aliviando as tensões CONCLUSÃO: conclui-se os acompanhantes consideram importante a brinquedoteca no contexto de hospitalização das crianças para amenizar efeitos da internação e auxiliar no desenvolvimento infantil.(AU)

Vivências em serviço de urgências: o papel dos acompanhantes dos doentes / Emergency room: the role of the accompanying person

As pessoas que acompanham um utente no serviço de urgência (SU), familiares ou não, são parte integrante da unidade de cuidados. Em Portugal, a prática comum no acompanhamento a adultos é a permanência numa sala de espera exterior. Este estudo exploratório realizado em Portugal procura compreender melhor as vivências em SU dos diversos envolvidos, procurando clarificar o papel dos acompanhantes no serviço de urgência, para reflectir sobre formas de promover a sua participação em todo o processo. Adoptou-se a técnica dos incidentes críticos que foi aplicada por entrevista a 71 indivíduos que representam as diversas partes envolvidas: 2 administrativos (2,8 por cento); 7 médicos (9,9 por cento); 9 auxiliares de acção médica (12,7 por cento); 9 bombeiros (12,7 por cento); 9 utentes (12,7 por cento); 20 enfermeiros (28,2 por cento); 15 acompanhantes (21,1 por cento). Os principais resultados indicam que: i) os participantes relatam mais incidentes negativos que positivos (72,9 por cento), associados a comportamentos e atitudes emocionais (tais como, agressividade dos acompanhantes, distância e agressividade dos profissionais e acompanhantes que dificultam a prestação de cuidados); ii) os participantes raramente referem insatisfação ou ineficácia dos cuidados e tratamentos (constituem 4,3 por cento dos incidentes); ii) os incidentes positivos (17,1 por cento) referem-se a profissionais humanos e sensíveis (50 por cento) e eficazes (25 por cento). O serviço de urgência constitui uma zona de tempestade emocional e é necessário repensar a forma como o acompanhante dos doentes decorre.

Those who accompany a patient in the emergency service, either members of the family or others, are an integral part of the care unit. In Portugal, the usual practice in adults' accompaniment is the permanence in an exterior waiting room. This exploratory study aims at better understanding the emergency service experiences of all those involved, trying to clarify the role of the accompanying person, and reflecting on ways of promoting their participation in the entire process. The Critical Incidents Technique was adopted and administered by interview to 71 participants that represent the several involved parts: 2 administrative workers (2.8%); 7 doctors (9.9%); 9 medical assistants (12.7%); 9 fire-fighters (12.7%); 9 users (12.7%); 20 nurses (28.2%); 15 accompanying persons (21.1%). The main results suggest that: i) participants report more negative incidents (72.9%), related to emotional behaviours and attitudes (such as accompanying person's aggressiveness, professionals' distance and aggressiveness); ii) participants' reference to dissatisfaction or inefficacy of care is rare (4.3% of the incidents); iii) positive incidents are centred on sensitive professionals (50%) and efficacy (25%). The emergency service is an area of emotional storm and it is necessary to rethink the way users are being accompanied by their dear ones.