Offene Türen in psychiatrischen Kliniken

Steinert, Tilman; Schreiber, Lisa; Metzger, Florian; Hirsch, Sophie

doi:10.1007/s00115-019-0738-y

Cited by 15 publications

(6 citation statements)

References 37 publications

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“…Indeed, all these justifications were described in a recent review by Chieze et al (2021). However, effects as a result (Steinert et al, 2019). Open doors were implemented in our MSMHU after data collection had begun, which allowed us to register early perceptions and opinions about the policy.…”

Section: Discussionmentioning

confidence: 99%

“…The definition of open doors ranges from vaguely defined policies to explicitly defined periods of time in which the unit is open. Different studies report reductions in the use of coercive measures as part of open‐door policies and no adverse effects as a result (Steinert et al, 2019). Open doors were implemented in our MSMHU after data collection had begun, which allowed us to register early perceptions and opinions about the policy.…”

Section: Discussionmentioning

confidence: 99%

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Experience of coercion among nursing professionals in a medium‐stay mental health unit: A qualitative study in Spain

Aragonés-Calleja¹,

Sánchez-Martínez

2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? Coercive measures represent an ethical conflict because they limit the person's freedom, compromising their personal autonomy, self‐determination and fundamental rights. The reduction of the use of coercive measures implies not only regulations and mental health systems, but also cultural aspects, such as societal beliefs, attitudes, and values. There is evidence about the professionals' views on coercion in acute mental health care units and community settings, but they remain unexplored in inpatient rehabilitation units. What the paper adds to existing knowledge? The knowledge about coercion varied from not knowing at all the meaning of the word, to a proper description of the phenomenon. Coercive measures are considered a necessary evil or normalized in mental health care and considered implicit to daily practice. What are the implications for practice? The perceptions and attitudes towards coercion might be influenced by the knowledge about the phenomenon. Training of mental health nursing staff in non‐coercive practice could help professionals to detect, be conscious towards, and question coercive measures, thus orienting them to the effective implementation of interventions or programmes with evidenced effectiveness to reduce them. AbstractIntroductionCreating a therapeutic and safe milieu with the minimum coercive measures requires knowing professionals' perceptions and attitudes towards coercion, but they remain unexplored in medium and long‐stay inpatient psychiatric rehabilitation units.AimTo explore the knowledge, perception and experience of coercion among nursing staff at a rehabilitation medium‐stay mental health unit (MSMHU) in Eastern Spain.MethodQualitative phenomenological study including 28 face‐to‐face, semi‐structured interviews based on a script. Data were analysed using content analysis.ResultsTwo main themes were found: (1) therapeutic relationship and treatment in the MSMHU, which included three subthemes: qualities of the professionals for building the therapeutic relationship; perceptions about the persons admitted to the MSMHU; views of the therapeutic relationship and treatment in the MSMHU; (2) Coercion at the MSMHU, comprising five subthemes: professional knowledge; general aspects; emotional impact of coercion; opinions; alternatives.DiscussionCoercive measures are often normalized in mental health care and considered implicit to daily practice. A proportion of participants who did not know what coercion is.Implications for PracticeKnowledge about coercion might influence attitudes towards coercion. Mental health nursing staff could benefit from formal training in non‐coercive practice, facilitating the operative implementation of effective interventions or programmes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Experience of coercion among nursing professionals in a medium‐stay mental health unit: A qualitative study in Spain

Aragonés-Calleja¹,

Sánchez-Martínez

2023

Psychiatric Ment Health Nurs

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“…Second, air conditioning means keeping windows and doors of terraces, patios and balconies closed, which would mean an end to our concept of open psychiatric wards. 12 ‘Open’ in this sense means more than entrance doors that are not locked; patients may feel locked in if they cannot open a window in their room or the door to a secured balcony. Thus, our recommendations for architectural planning are rather to keep the heat outside using smart building techniques such as optimal use of insulation materials, sensor-driven shutters or heat exchange systems under floors.…”

Section: Discussionmentioning

confidence: 99%

Aggressive incidents in psychiatric hospitals on heat days

et al. 2021

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This study explores the relationship between temperature and the number of aggressive incidents and coercive interventions in the years 2007–2019 in six psychiatric hospitals in the south of the Germany with a total of 1007 beds. The number of aggressive incidents among 164 435 admissions was significantly higher on ‘heat days’ (≥30°C). Furthermore, there was a dose–response relationship between the number of aggressive incidents and increasing temperature. In contrast, the number of coercive interventions was not related to temperature. Considering the background of global warming, rising temperature could result in more frequent aggressive behaviour during in-patient treatment of psychiatric patients.

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“…Several observational studies of open-door policy psychiatric wards suggest considerable potential for reductions in the use of coercive measures when compared with traditional, closed-door services 14–18. These results reflect the generally positive results from the only known randomised controlled trial (RCT) on the topic, conducted in China over 25 years ago 19.…”

Section: Introductionmentioning

confidence: 87%

Protocol for the Lovisenberg Open Acute Door Study (LOADS): a pragmatic randomised controlled trial to compare safety and coercion between open-door policy and usual-care services in acute psychiatric inpatients

2022

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IntroductionThe reduction of coercion in psychiatry is a high priority for both the WHO and many member countries. Open-door policy (ODP) is a service model for psychiatric ward treatment that prioritises collaborative and motivational measures to better achieve acute psychiatric safety - and treatment objectives. Keeping the ward main door open is one such measure. Evidence on the impact of ODP on coercion and violent events is mixed, and only one randomised controlled trial (RCT) has previously compared ODP to standard practice. The main objectives of the Lovisenberg Open Acute Door Study (LOADS) are to implement and evaluate a Nordic version of ODP for acute psychiatric inpatient services. The evaluation is designed as a pragmatic RCT with treatment-as-usual (TAU) control followed by a 4-year observational period.Methods and analysisIn this 12-month pragmatic randomised trial, all patients referred to acute ward care will be randomly allocated to either TAU or ODP wards. The primary outcome is the proportion of patient stays with one or more coercive measures. Secondary outcomes include adverse events involving patients and/or staff, substance use and users’ experiences of the treatment environment and of coercion. The main hypothesis is that ODP services will not be inferior to state-of-the art psychiatric treatment. ODP and TAU wards are determined via ward-level randomisation. Following conclusion of the RCT, a longitudinal observational phase begins designed to monitor any long-term effects of ODP.Ethics and disseminationThe trial has been approved by the Regional Committees for Medical and Health Research Ethics (REC) in Norway (REC South East #29238), who granted LOADS exemption from consent requirements for all eligible, admitted patients. Data are considered highly sensitive but can be made available on request. Results will be published in peer-reviewed journals and presented at scientific conferences and meetings.Trial registration numberISRCTN16876467.Protocol version1.4, 21 December 2021.

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Offene Türen in psychiatrischen Kliniken

Cited by 15 publications

References 37 publications

Experience of coercion among nursing professionals in a medium‐stay mental health unit: A qualitative study in Spain

Experience of coercion among nursing professionals in a medium‐stay mental health unit: A qualitative study in Spain

Aggressive incidents in psychiatric hospitals on heat days

Protocol for the Lovisenberg Open Acute Door Study (LOADS): a pragmatic randomised controlled trial to compare safety and coercion between open-door policy and usual-care services in acute psychiatric inpatients

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