According to literature Safety, often defined as freedom from mental health and physical accident. The security of patient is definitely important concern in healthcare adjustments both in medical and mental healthcare settings. All patients are susceptible, but mentally sick patients are specifically more vulnerable to violence, maltreatment and neglect, and the impact of such unethical works on the physical and emotional health is often neglected. (Bhimani, 2010). As a health care provider it's important that people should ensure safe environment in which patients feel that these are being cared for their dignity, privateness and protection. Furthermore determine the patients specifically those who are at risky to harm themselves as well as others. The incidence should be reported and doc in occurrence form. As books also stated that the significance of Patient safety is the reduced amount of unsafe works within healthcare settings by using guidelines and sound knowledge to obtain optimal patient results (Brickell et al. , 2009). We can ensure patient security by aiding patients to re-establish personal control by including them in decisions, about their health care and restricting their actions only as necessary.
This paper will solve the patients' safety situations in psychiatric options their contributing factors, significance in mental health and ways of promote patients' security. Relating to( Bhimani, 2010) the review conducted in psychiatric hospital London documented that 33%female in-patients experienced unwanted sexual remarks and another review is carried out on 142 adult psychiatric patients where 31 % cases of physical assault, 8% sexual assault and 63%witnessed the distressing occasions within psychiatric adjustments were reported. In western world range of studies has acknowledged a high incidence of in-patient violence in psychiatric hospitals. But, in Pakistan such occurrences havent been reported. However the
stigma mounted on mentally sick patients, they are really teased, called brands, beaten, and humiliated in the communities, general population and private places but physical and erotic abuse are not common.
According to( Brickell et al. , 2009) the most frequent patient safety conditions that arise in the mental health adjustments are slips, falls, lacking patients, seclusion, restraint use, self-harming habit, aggression, assault, suicide, reduced convenience of self-advocacy and undesirable medication events(p, 324). Suicide is a significant problem and the key cause of loss of life in inpatient psychiatric configurations. The sources of suicide are factors related to the treatment environment, inability to evaluate patient behavioral characteristics, and personnel trust on no-suicide contracts. Approximately 30, 000 suicides that arise each year 5% to 6% occur on inpatient nursing homes (Lynch et al, 2008). In another study conducted by Brickell et al. , (2009) depressive and patients with drug abuse are at threat of aggression against staff, other patients, or do it yourself- harm and suicide. Further more in sociocultural context violence, hostility and suicidal habits weren't accepted and have serious results on contemporary society and psychiatric practice. These are often associated with the risk of damage or danger and also have immediately or indirectly influencing the quality of life of patients, their families, the city, and mental health employees. Therefore, mental state examination is important to recognize such risky behaviours.
"I experienced a 32 years old female patient, was admitted in psychiatric ward with complain of extreme aggression. History discovered that she possessed attempted self-harm, and use to put things occasionally. Attendant also said that she had threating behavior towards family members. She started slapping herself, she have knife in her hands demonstrating frequently to the personnel scheduled to which staff became intense towards the individual. "
So it is high risk that she may cause harm to self as well as others. As physician we have to identify and manage such risky behaviours also ensure the safety and staff package patient in a relaxed way however in the case circumstance staff became ambitious on patient.
According to (Rippon, 2000) three part model including interior, exterior and situational or interactional explains the sources of aggression. The inner model explains that aggression is due to mental health problems and aggravation of disease and external model includes all environmental factors like space and location and situational or interactional model areas aggression is because of negative staff frame of mind towards patient because of poor communication and intolerance. Therefore, the establishment of nurse-patient relationship is considered important in healthcare settings and social relationship is the primary of practice and making the restorative relationship is a simple element to enhance patient's safe practices.
However unsafe psychiatric settings donate to patient safety happenings and thoughts of insecure. To be able to prevent the basic safety happenings Aga khan university or college hospital is ensuring well-organized safe environment for patients as well as for personnel in psychiatric setting up. The safety measures and their relevance in campaign of mental health include washrooms are locked from outside the house to avoid suicidal attempts. Wall membrane fans to avoid hanging. Product medications are locked and are carefully administered at counter-top to prevent unfavorable medication events. Directly pressing call bells, plastic utensils are used to prevent harming self as well as others. Security staff is checking items and taking all probably harmful presents from guests before permitting them to meet clients. Doors are electronically manipulated in order to safeguard escaping of patients from ward. Suicidal, homicidal and violent patients are placed in observation room under close
supervision. Clients should play different activities under guidance of staff. So making a protected climate is the most effective measure to enhance the inpatient safe practices.
In addition Maslow's hierarchy address patients needs including patient safeness so after physiological needs the next thing is to guarantee the patients' safety and security. Being of unsafe hinders patient's restoration from mental disease. So, protected climate has a great effect on mental health. Patients' safety plays an important role to boost their self-esteem. In addition, most of psychiatric patients such as depressive patients feel hopelessness and helplessness. In safe psychiatric adjustments patients will feel secure and in the end it helps to improve up their self-esteem (Poston, 2009).
According to Stuart (2009) "The best nursing priority activity with suicidal and homicidal patients is to safeguard them yet others from further injury ". Therefore evaluation of risk factors is an important technique to prevent adverse basic safety incidents. During interview doctor should listen directly whether patients provides any background or discuss any considering any injury to self or others. And to enhance patient safety they are encouraged to play different video games in play area, seeing television and to do different activities in occupational remedy room under guidance of staff and really should be evaluated for hallucinations because hallucinations could order patients to harm self or others. Therapeutic marriage with patients will help to identify and take care of unsafe actions. Close monitoring of patients' action is important to ensure patient security. Sharp tools, such as cutlery, razors, scissors, and mirrors should be taken off the client possession and gain access to. Nurse should find out about the conversation of patient with his family and with other patients and plan consequently.
Except above mentioned interventions and strategies, further suggestions for promoting the patients' protection in mental health adjustments are that healthcare providers should give teachings on constructive coping strategies such as stress, anger management and plan group activities so that patients would verbalize their thoughts, share their experiences and constructing coping strategies with other patients. They should be respected rather than cared for as a stigma to the contemporary society.
In realization patient protection is preventing safety happenings which occur within an inpatient psychiatric setting up such as suicide and homicide, escaping of patients from units, disclosing of patients information to any irrelevant person and violation of patients' privileges and dignity. As professional medical providers we have to develop therapeutic romance with patients and do mental health assessment to identify the risk conducts and also take note about the safety issues to ensure our own safe practices and patients' security in mental health options.