Nursing Perspectives: Reflecting History and Informal Coercion in De-escalation Strategies

Health professionals like nurses respond to aggression and violence with de-escalation techniques, and still often with coercive measures. Such measures applied by institutions are often rooted in historically grown traditions rather than evidence, reflection, or formation. In this article, we present de-escalation strategies integrating a high and critical awareness toward traditions and the practice of formal and informal coercion

Opening the Doors of a Substance Use Disorder Ward-Benefits and Challenges From a Consumer Perspective

Open doors in psychiatry have been a subject of controversy in recent years. While some studies postulate the clinical necessity of closed doors, others challenge the theoretical advantages of this setting, mention numerous drawbacks of closed wards, and focus on the advantages of open-door settings. With regard to patients diagnosed with substance use disorders (SUD), other standards may apply. Very little research has been done on this topic. Some studies adopted a consumer perspective (i.e. asking involved parties about their experience of the door status). To the authors' knowledge, no study has so far addressed the ideal setting for the treatment of SUD. With our data from the opening of a specialized SUD ward, we take one step to closing this knowledge gap. Applying a qualitative design, we asked patients and health care professionals (HCP) to report changes following the opening of the ward. The results are mainly in line with the literature on the general psychiatric population. The newly introduced open-door setting was mostly perceived as positive, but some disadvantages were mentioned (e.g. less protection of patients, less control over who enters/leaves the ward, the theoretically increased risk of patients absconding). Moreover, HCP (but not patients) mentioned potentially increased substance use on the ward as an additional disadvantage that could arise. Opening a previously closed ward was generally perceived as a positive and progressive decision. These findings support the trend towards an overall open-door policy in psychiatry

Somatische Pflege in psychiatrischen Einrichtungen: Quo vadis?

Menschen mit psychischen Erkrankungen haben im Vergleich zur Allgemeinbevölkerung eine deutlich schlechtere körperliche Gesundheit. Dennoch fehlt oft eine umfassende Diagnostik der somatischen Krankheiten und eine adäquate Behandlung. Verbesserungsbedarf besteht ausserdem im Monitoring diagnostizierter somatischer Erkrankungen und in der Verbesserung des Wissens und der Kompetenzen bezüglich einer adäquaten somatischen Behandlung und Pfl ege

Körperliche Gesundheit psychisch kranker Menschen

Die somatische Gesundheit psychisch kranker Menschen ist ein interdisziplinär relevantes Thema. Warum die Gesundheitslage dieser Patientengruppe derart schlecht ist und welche Möglichkeiten diskutiert werden, diese pflegerisch oder interdisziplinär zu verbessern, ist Thema dieses Artikels

Pilotstudie: Wahrnehmung ethischer Aspekte in der psychiatrischen Patientenversorgung

Die Wahrnehmung ethischer Aspekte von Mitarbeitenden der psychiatrischen Versorgung sowie ethische Unterstützung sind kaum erforscht. Explorative schriftliche Erhebung als Pilotstudie, qualitative und quantitative Auswertung. Brennpunkte betreffen Zwangsbehandlung, die Beziehung zwischen Patienten und Behandelnden, Personalknappheit, Zusammenarbeit zwischen Berufsgruppen und mit Angehörigen. Klinische Ethik in der Psychiatrie sollte neben psychiatriespezifischen klinischen Aspekten auch strukturelle Probleme, interprofessionelle Zusammenarbeit sowie den Umgang mit Angehörigen beachten. (englisch abstract) Research on staff perception of ethical aspects of psychiatric patient care are scarce; little is known about systematic supplies of ethics support in psychiatric institutions. The goal of this pilot study is to inform the implementation of Clinical Ethics Support Services in psychiatric institutions by assessing which topics of psychiatric practice are considered ethically challenging by the staff. Explorative survey as pilot study by questionnaire with clinical staff, quantitative (descriptive) and qualitative (coding) data-analysis. Involuntary treatment, the relationship between healthcare professionals and patients, staff shortage and the collaboration between the professions as well as dealing with patient relatives came up as ethical challenges. Clinical Ethics Support in psychiatric patient care should not only cover aspects that are specific for psychiatry, but also structural topics such as short resources, interprofessional collaboration and communication with relatives

Individuals With Opioid Dependence Using Polysubstances How Do They Experience Acute Hospital Care and What Are Their Needs? A Qualitative Study

Background: Opioid dependence accompanied by polysubstance use is a chronic illness with severe somatic, psychological and social consequences for those affected. International studies have shown that healthcare provision is inadequate for this population because of stigmatization and lack of expertise among medical professionals. It must be assumed that this is also the case in acute care settings of hospitals in German-speaking areas of Switzerland. To date, there are few studies addressing these patients' experiences that could provide data for targeted interventions. Aims: This qualitative study explored this patient population's perspective in terms of their experiences and needs regarding care provision in acute hospitals. The results should offer potential adaptations to care provision for this vulnerable group of individuals. Methods: Twelve individuals with opioid dependence using polysubstances were interviewed in two urban substitution centers. The data analysis of the material obtained was undertaken using qualitative content analysis according to Mayring. Results: As a whole, individuals with opioid dependence using polysubstances are not dissatisfied with care provided in acute hospitals as long as their relationship with health professionals is positive. Substitution medication is critically important to their treatment, but this group's experiences with its management during hospitalization continue to show widespread stigmatization along with inadequate knowledge and interprofessional collaboration and a failure to integrate these patients and their expertise into treatment and care. Conclusions and Future Directions: The treatment of individuals with substance-related disorders in acute hospitals requires staff with somatic and psychiatric training. In this regard, the principles of evidence-based models of reducing harm and multiprofessional treatment teams should be seen as particularly well suited and promising