Clear role descriptions, well-defined expectations, team preparation, acknowledgement of vulnerabilities and institution-level support PSWs are important to safeguard both PSWs and service users by minimising the destabilisation risk. Future EX-IN training graduates can benefit from the establishment of remunerated PSW roles in psychiatric services.

BackgroundImplementing an open door policy is a complex intervention comprising changes in therapeutic stance, team processes, and a change from locked to open doors. Recent studies show that it can lead to a reduction of seclusion and forced medication, but the role of the physical change of door status is still unclear.AimsThe aims of this study is to examine the transition from closed to predominantly open doors on a psychiatric intensive care unit (PICU) and its associations with the frequency of seclusion and forced medication.MethodA PICU at the Department of Adult Psychiatry, University of Basel, Switzerland, implemented evidence-based strategies for operating an open door policy within the context of acute psychiatry and participated in a hospital-wide implementation of an open door policy before changing door status. 131 inpatient cases hospitalized on this PICU were examined regarding the frequency of seclusion and forced medication using explorative analyses over a time span of 32 weeks (16 weeks after implementation of the new treatment concept but before door opening, 16 weeks after door opening).ResultsFollowing door status change, the PICU was completely open on 51% of the days and partly open on 23% of the days. The mean number of open hours per day was 12.8 ± 3.9 h. The frequency of forced medication did not change, and the frequency of seclusion decreased significantly [χ2 (1, N = 131) = 4.73, p = 0.036].ConclusionThis pilot study underlines the potential of a change of door status to attain a reduction in safety measures in the first 4 months.

Objective: Substance use treatment is often performed inside locked wards. We investigate the effects of adopting a policy of open-door treatment for a substance use treatment and dual diagnosis ward. Methods: This is a prospective open-label study investigating 3-month study periods before opening (P1), immediately after (P2), and 1 year after the first period (P3). Data on committed patients, coercion (seclusion, forced medication, absconding events with subsequent police search), violence, and substance use was collected daily. We applied generalised estimating equation models. Results: The mean daily number of patients with ongoing commitment changed from 2.64 (P1) to 2.12 (P2) to 0.96 (P3), corresponding to a reduction of relative risk (RR) for having an ongoing commitment by 20% in P2 (RR 0.80; 95% CI 0.66-0.98) and 67% in P3 (RR 0.33; 95% CI 0.25-0.42). The mean daily number of coercive events was 0.29, 0.13, and 0.05, corresponding to a risk for undergoing coercive measures reduced by 56% (RR 0.44; 95% CI 0.22-0.90) and 85% (RR 0.15; 95% CI 0.05-0.45). Substance use, violence or ward atmosphere did not differ significantly. Conclusions: Our results support findings from general psychiatric wards of reduced coercion after adopting a primarily open-door policy. However, coercive events were rare during all periods. The widespread practice of restricting the freedom of inpatients with substance use disorders by locking ward doors is highly questionable.

Swiss hospitals are characterized by an increasing diversity, in the sense of personal and social differences such as including origin, gender language, skills, age, lifestyles and social status. Diversity is a challenge for hospitals. It is crucial to language barriers and migration and their clinical consequences. In spite of a trend towards interpreter services "going professional", interpreters are only reluctantly used. This is surprising. In this article we deal with three questions: What are clinical consequences of language barriers? How can language barriers be overcome? Should nurses act as interpreters? The literature available clearly shows that due to insufficient flow of information patients speaking a foreign language tend to receive inadequate care. Also, there is a consensus that patients' relatives acting as ad hoc interpreters are ill-equipped or unsuited to overcome language barriers. Conversely, professional interpreters improve most evidently the quality of care of patients speaking a foreign language. However in clinical everyday life the consistent use of interpreters is not always feasible. Thus, the setting-up of a pool of hospital-based ("internal"), trained bilingual health professionals appears to be an acceptable alternative.

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.

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.

BackgroundCannabis is the most widely used illicit substance. Various countries have legalized cannabis for recreational use. Evidence on the health effects of cannabis regulation remains unclear and is mainly based on observational studies. To date, there is no randomized controlled study evaluating the impact of cannabis regulation for recreational use compared to the illicit market on relevant health indicators. The present study (“Weed Care”) is the first to evaluate the impact of regulated cannabis access in pharmacies versus a waiting list control group representing the illicit market on problematic cannabis use as well as on mental and physical health.MethodsThe study is divided into two parts—a randomized controlled study of 6 months followed by an observational study of 2 years. Participants (N = 374) are randomly assigned to either the experimental group with access to legal cannabis in pharmacies or to the waiting list control group representing the current legal framework in Switzerland, namely the illicit market. After 6 months, all participants will have access to legal cannabis for the following 2 years (observational study). The primary outcome is problematic cannabis use as measured with the Cannabis Use Disorders Identification Test-Revised (CUDIT-R). Secondary outcomes are cannabis use patterns, mental disorders (e.g., depression, anxiety, and psychosis) and physical health (e.g., respiratory symptoms). Primary and secondary outcomes will be assessed online every 6 months. The study is approved by the responsible ethics committee as well as by the Swiss Federal Office of Public Health.DiscussionFindings from this study may provide a scientific basis for future discussions about addiction medicine and cannabis policy in Switzerland.Clinical Trial RegistrationClinicalTrials.gov (NCT05522205). https://clinicaltrials.gov/ct2/show/NCT05522205

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.