目的 了解精神科医师对于《中华人民共和国精神卫生法》第四十条使用约束隔离措施时的限制条件,即"扰乱医疗秩序的行为"以及"没有可替代措施"这两项的理解与态度,为完善精神卫生法以及相关配套文件提供依据.方法 在上海市6家精神卫生专科机构中对精神专科医师发放自行编制的问卷,共回收393份有效问卷.结果 超过50%的精神科医师认为"冲动打人、毁物、试图外跑、喧哗吵闹,影响其他患者休养、反复纠缠医生或护士、拒绝服药、拒绝检查"属于"扰乱医疗秩序的行为".对于何为"没有其他可替代措施",超过50%支持率的4种情况分别是:药物或其他治疗效果不明显(93.9%)、经工作人员言语劝阻无效(88.8%)、病房工作人员人手有限(58.0%)和时间紧迫而无法采用其他手段(83.7%).不同性别、学历水平、职称高低对各情形的理解分别在"拒绝参加康复活动"、"喧哗吵闹、影响其他患者修养"和"经工作人员劝阻无效"、"试图外跑"和"病房工作人员人手有限"呈现分歧.结论 精神科医师对于精神卫生法规定的约束隔离的理解存在差异,有必要进一步完善《精神卫生法》,出台更具可操作性的精神科约束隔离使用指南,规范精神科医务人员的临床行为.%Objective To investigate psychiatrists' perspectives towards conditions of using restraints, which is "act of disturbing medical order" and "no available alternatives", according to Article 40 of the Mental Health Law of the People's Republic of China, in order to provide basis for the improvement of related law and documents. Methods Psychiatrists from 6 psychiatric hospitals in Shanghai were surveyed by self-designed questionnaire. And 393 questionnaires were withdrawn. Results "Attack others impulsively, destructing things, trying to run out of wards, pandemonium brake out, influencing other patients' rest, entangling doctors and nurses repeatedly, refusing to take medicine and refusing examinations" were considered as "act of disturbing medical order" in more than 50% psychiatrists. Effects of medical treatment or other treatments being not obvious(93.9%), invalid verbal dissuasion by medical staff (88.8%), limited manpower in wards (58.0%)and failing to take other measures owing to the urgent time (83.7%)were defined as "no available alternatives" by over 50% psychiatrists. Psychiatrists of different genders, educational background and titles showed significant differences on comprehension in "refusing rehabilitation activities", "influencing other patients' rest" and"invalid verbal dissuasion by medical staff", and "trying to run out of wards" and "limited manpower in wards". Conclusions Psychiatrists' understanding on the conditions of using restraints is different. Thus it's important to perfect the Mental Health Law and promulgate detailed legal articles to regulate psychiatrists' behavior.
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