{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,8,28]],"date-time":"2022-08-28T23:11:41Z","timestamp":1661728301009},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"17","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Was ist neu?<\/jats:title><jats:p>\n          In welchen Formen wird Zwang auf Intensivstationen wahrgenommen?\u2002Formeller und informeller Zwang sowie Zwangsbehandlung existieren auf Intensivstationen und werden sowohl von den Patienten als auch von dem Team wahrgenommen. Formeller Zwang umfasst Ma\u00dfnahmen wie Fixierungen, Sedierung und Umgebung. Informeller Zwang entsteht durch Beeinflussung, wie z.\u200aB. Manipulationen, unzureichende oder falsche Information, mangelnde Kommunikation und Drohung. L\u00e4ngerfristige, d.\u200ah. &gt;\u200a30 Minuten, freiheitsbeschr\u00e4nkende, -entziehende Ma\u00dfnahmen sowie Zwangsbehandlung sind genehmigungspflichtig.<\/jats:p><jats:p>\n          Begr\u00fcndung f\u00fcr die Anwendung von Zwang\u2002Die Anwendung von Zwang auf der Intensivstation bedeutet einen Spagat zwischen Patientenautonomie und dem Schutz des Patienten (F\u00fcrsorge).<\/jats:p><jats:p>\n          Situation mit Risiko f\u00fcr Zwang erkennen\u2002Auf Intensivstationen sind Phasen mit Agitation, Delir, aber auch Demenz oder depressive Phasen, Hypoaktivit\u00e4t bei Patienten, allt\u00e4glich. Zwangsma\u00dfnahmen in Notsituationen d\u00fcrfen nur nach entsprechender Pr\u00fcfung der juristischen und medizinethischen Kriterien eingesetzt werden und nur, wenn es keine Alternativen (Ultima Ratio) f\u00fcr deren Einsatz gibt. Die Anwendung von Zwang als Ultima Ratio umfasst die \u00dcberpr\u00fcfung der Entscheidungsf\u00e4higkeit und die Einsch\u00e4tzung\/Pr\u00fcfung der kritischen Situation.<\/jats:p><jats:p>\n          Zwang als Ultima Ratio\u2002Freiheitseinschr\u00e4nkende und freiheitsentziehende Ma\u00dfnahmen sowie Zwangsma\u00dfnahmen d\u00fcrfen nur in Ausnahmesituationen der Einwilligungsunf\u00e4higkeit und bei \u201edrohendem erheblichen Gesundheitsschaden\u201c angewendet werden.<\/jats:p><jats:p>\n          Prophylaxe und Konzepte zur Vermeidung von Zwang auf der Intensivstation\u2002Eine Behandlung auf der Intensivstation basiert auf einer aktuellen Indikation mit medizinischer Evidenz sowie den sich daraus ableitenden Standards und Prozess-Strukturen. Zur Vermeidung von formellem und informellem Zwang ist es entscheidend, ein Menschenbild im interprofessionellen Team zu etablieren, welches den Respekt vor dem Patienten und seiner Autonomie wahrt und dies in den Alltag und die Ausbildungskonzepte umsetzt. Konzepte, um die Anwendung von Zwang zu erkennen, zu benennen und um Zwang zu vermeiden, umfassen: Erkennen von Risikosituationen f\u00fcr Zwang, Standards zur Vermeidung von Zwang auf der Intensivstation, Aus- und Weiterbildung in Kommunikation.<\/jats:p>","DOI":"10.1055\/a-1664-7409","type":"journal-article","created":{"date-parts":[[2022,8,28]],"date-time":"2022-08-28T22:30:26Z","timestamp":1661725826000},"page":"1121-1127","source":"Crossref","is-referenced-by-count":0,"title":["Zwang in der Intensivmedizin: unzul\u00e4ssig, aber wir tun es"],"prefix":"10.1055","volume":"147","author":[{"given":"Susanne","family":"J\u00f6bges","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr An\u00e4sthesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Klinikum Dortmund, Klinikum der Universit\u00e4t Witten\/Herdecke"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,8,28]]},"reference":[{"key":"ref1","first-page":"3","volume-title":"Philosophische Betrachtungen zum Thema \u201eZwang\u201c \u2013 sprachphilosophische moralphilosophische und medizinethische Perspektiven","author":"W Kellerwessel","year":"2012"},{"key":"ref4","first-page":"A394","article-title":"Patientenverf\u00fcgungen bei Demenz: Der \u201enat\u00fcrliche Wille\u201c und seine ethische Einordnung","volume":"111","author":"R J Jox","year":"2014","journal-title":"Dtsch \u00c4rztebl"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s12910-022-00748-1","article-title":"What does coercion in intensive care mean for patients and their relatives? 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