Dataset Information

The association between the admission to wards with open- vs. closed-door policy and the use of coercive measures.

ABSTRACT:

Introduction

Psychiatric treatment on a ward with open-door policy is associated with reduced numbers of coercive measures. The effect of the door policy of previous stays, however, has not been investigated.

Methods

The data set consisted of 22,172 stays by adult inpatients in a psychiatric university hospital between 2010 and 2019. Pairs of consecutive stays were built. The outcome variable was the occurrence of coercive measures during the second stay.

Results

Compared to treatments on wards with a closed-door policy at both stays, treatments on wards with an open-door policy at the second stay had smaller odds for coercive measures (OR ranging between 0.09 and 0.33, p < 0.01). In addition, coercive measures were more frequent in treatment histories where patients previously treated on a closed ward were admitted to a ward with an open-door policy and subsequently transferred to a ward with a closed-door policy at the second stay (OR=2.97, p = 0.046).

Discussion

Treatment under open-door policy is associated with fewer coercive measures, even in patients with previous experience of closed-door settings. The group of patients who were admitted to a ward with an open-door, then transmitted to a ward with a closed-door policy seem to be prone to experience coercive measures. Clinical strategies to keep these patients in treatment in an open-door setting could further reduce coercive measures.

SUBMITTER: Kruckl JS

PROVIDER: S-EPMC10634515 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

The association between the admission to wards with open- vs. closed-door policy and the use of coercive measures.

Krückl Jana S JS Moeller Julian J Imfeld Lukas L Schädelin Sabine S Hochstrasser Lisa L Lieb Roselind R Lang Undine E UE Huber Christian G CG

Frontiers in psychiatry 20231025

<h4>Introduction</h4>Psychiatric treatment on a ward with open-door policy is associated with reduced numbers of coercive measures. The effect of the door policy of previous stays, however, has not been investigated.<h4>Methods</h4>The data set consisted of 22,172 stays by adult inpatients in a psychiatric university hospital between 2010 and 2019. Pairs of consecutive stays were built. The outcome variable was the occurrence of coercive measures during the second stay.<h4>Results</h4>Compared t ...[more]

PMID: 37953938

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Project description:Many determinants leading to the use of different coercive measures in psychiatry have been widely studied and it seems that staff attitudes play a crucial role when it comes to the decision-making process about using coercion. However, research results about staff attitudes and their role in the use of coercive measures are inconsistent. This might be due to a focus on self-report studies asking for explicit answers, which involves the risk of bias. This study aimed to expand research on this topic by examining the impact of explicit and implicit staff attitudes on the use of coercive measures in clinical practice. In addition, the influence of gender, profession (nurses, psychiatrists), and years of professional experience as well as their influence on staff attitudes were examined. An adaption of the implicit association measure, the Go/No-Go Association Task (GNAT), with the target category coercion and distracter stimuli describing work load, as well as the explicit questionnaire Staff Attitudes to Coercion Scale (SACS) was completed by staff (N = 149) on 13 acute psychiatric units in 6 hospitals. Data on coercive measures as well as the total number of treated cases for each unit was collected. Results showed that there was no association between staff's implicit and explicit attitudes toward coercion, and neither measure was correlated with the local frequency of coercive measures. ANOVAs showed a significant difference of the GNAT result for the factor gender (F = 9.32, p = 0.003), demonstrating a higher tendency to justify coercion among female staff members (M = -0.23, SD = ±0.35) compared to their male colleagues (M = -0.41, SD = ±0.31). For the SACS, a significant difference was found for the factor profession (F = 7.58, p = 0.007), with nurses (M = 2.79, SD = ±1.40) showing a more positive attitude to the use of coercion than psychiatrists (M = 2.15, SD = ±1.11). No significant associations were found regarding the extent of professional experience. Results indicate a complex interaction between implicit and explicit decision-making processes dependent on specific contexts. We propose future research to include primers for more context-related outcomes. Furthermore, differences in gender suggest a need to direct attention toward occupational safety and possible feelings of anxiety in the workplace, especially for female staff members.

Project description:ObjectiveTo investigate the antecedents to episodes of aggression and the use of coercive measures in inpatient mental health settings, organize and explore their relationships and patterns through thematic analysis, identify gaps in the literature and provide insights for future research.IntroductionThe use of coercive measures in inpatient mental health settings remains controversial and ethically challenging. Despite an international consensus on the need to reduce their use, the antecedents to aggression and episodes involving coercive measures remain insufficiently explored. This review seeks to address this gap by systematically mapping the evidence of these antecedents and exploring their relationship, providing a foundation for future research.Inclusion criteriaStudies included were those published from 2014 to the present in the English language, focusing on either adult mental health inpatients or mental healthcare professionals aged 18 years or older involved in episodes of aggression or exposure to coercive measures in both acute and long-term inpatient mental health settings. Included studies must address antecedents to aggression or the use of coercive measures. Exclusions apply to studies focusing exclusively on behaviours unrelated to aggression or coercive measures, studies conducted in non-inpatient settings and those involving child, adolescent, geriatric or forensic populations.MethodsThe review will follow the Joanna Briggs Institute methodology for scoping reviews. The search strategy will cover key databases, including Ovid Medline, APA PsycINFO and Scopus, with reference list screening to ensure comprehensive coverage. Initial exploratory searches were conducted in June 2024, with the formal searches updated in January 2025. Studies will be screened against the inclusion criteria, and data will be extracted using a standardised form adapted to the review objectives. Grey literature will be excluded, focusing on peer-reviewed evidence. The analysis will include descriptive mapping of the antecedents to aggression and the use of coercive measures, supplemented by thematic analysis to organize and explore patterns and relationships between them. Results will be presented in a descriptive summary, supported by thematic analysis and descriptive statistics.Ethics and disseminationEthical approval is not required since this study uses existing published literature. The results will be disseminated through a peer-reviewed journal and presented at relevant international conferences.

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Project description:ObjectiveTying knots during suturing is one of the most challenging tasks in laparoscopic surgery. Therefore, measures aimed at ensuring both the ease and speed of knot tying not only benefit the surgeon but can also reduce operating time significantly. This study compared extracorporeal and intracorporeal knot tying techniques using a Szabo pelvic trainer model from the Gynaecological Endoscopic Surgical Education and Assessment program.DesignThe students tied intra- and extracorporeal knots using closed- and open-jaw knot pushers. Using an artificial tissue suturing pad in a certified Szabo pelvic trainer, students tied three knots using each technique according to block randomization. Task completion time, knot strength, knot-spread ability, and number of errors were recorded. The Wilcoxon test and mixed-effects models were used to analyze the results. After completing the exercises, participants answered a questionnaire concerning knot-tying techniques and their performance.SettingUniversity Hospital Basel, which provides tertiary-level clinical care.ParticipantsFifty-seven medical students with no experience in laparoscopy voluntarily signed up for this study.ResultsOpen and closed extracorporeal knot tying was significantly faster (p < 0.001, p < 0.001, respectively), more precise (p = 0.007, p = 0.003), and associated with reduced knot-spread ability (p < 0.001, p < 0.001) compared to intracorporeal knot tying. Open- and closed-jaw knot pushers were shown to be equal in terms of speed (p = 0.563), knot-spread ability (p = 0.49), and precision (p = 0.831). The study participants rated open (30 %) and closed (49 %) extracorporeal knot tying as more intuitive than intracorporeal (21 %) knot tying. Improved concentration was significantly correlated with tighter knots (p = 0.011).ConclusionsStudents achieved significantly better results using extracorporeal knot-tying techniques than intracorporeal ones, including greater speed, tighter knots, and optimized precision. These results suggest that beginners in the field of laparoscopy should be encouraged to practice extracorporeal knot-tying techniques.

Project description:WHAT IS KNOWN ON THE SUBJECT?: Aggressive behaviour is a major problem in clinical practice of mental health care and can result in the use of coercive measures. Coercive measures are dangerous for psychiatric patients and international mental healthcare works on the elimination of these interventions. There is no previous review that summarizes the attitude of nursing staff towards coercive measures and the influence of nursing staff characteristics on attitude towards and the use of coercive measures. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The attitude of nurses shifted from a therapeutic paradigm (coercive measures have positive effects on patients) to a safety paradigm (coercive measures are undesirable, but necessary for the wards' safety). Nurses express the need for less coercive interventions to prevent seclusion and restraint, but their perception of intrusiveness is influenced by how often they use specific coercive measures. The knowledge from scientific literature on the influence of nursing staff on coercive measures is highly inconclusive, although the feeling of safety of nurses might prove to be promising for further research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is need for increased attention specifically for the feeling of safety of nurses, to better equip nurses for their difficult work on acute mental health wards. ABSTRACT: Introduction The use of coercive measures generally has negative effects on patients. To help prevent its use, professionals need insight into what nurses believe about coercion and which staff determinants may influence its application. There is need for an integrated review on both attitude and influence of nurses on the use of coercion. Aim To summarize literature concerning attitude of nurses towards coercive measures and the influence of staff characteristics on the use of coercive measures. Method Systematic review. Results The attitude of nurses changed during the last two decades from a therapeutic to a safety paradigm. Nurses currently view coercive measures as undesirable, but necessary to deal with aggression. Nurses express the need for less intrusive interventions, although familiarity probably influences its perceived intrusiveness. Literature on the relation between staff characteristics and coercive measures is inconclusive. Discussion Nurses perceive coercive measures as unwanted but still necessary to maintain safety on psychiatric wards. Focussing on the determinants of perception of safety might be a promising direction for future research. Implications for practice Mental health care could improve the focus on the constructs of perceived safety and familiarity with alternative interventions to protect patients from unnecessary use of coercive interventions.

Dataset Information

The association between the admission to wards with open- vs. closed-door policy and the use of coercive measures.

Introduction

Methods

Results

Discussion

Publications

The association between the admission to wards with open- vs. closed-door policy and the use of coercive measures.

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