Impact of the concept of “Open Doors” on coercive measures - A pre-/post- comparison

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research Pub Date : 2025-03-24 DOI:10.1016/j.jpsychires.2025.03.039

Bianca Ueberberg, Niklas Lübbeling, Hans-Jörg Assion

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引用次数: 0

Abstract

Intro

With the intention of reducing restraints and increasing patient autonomy, the “Open Doors” policy (ODP) is an intensely discussed alternative to the tradition of closed wards. The aim of this study was to investigate the impact of the ODP on coercive measures, the need for staff presence and critical incidences among involuntarily admitted patients after implementation in a general psychiatric hospital.

Methods

Retrospectively, data were collected from involuntarily admitted patients before and after the implementation of the concept of “Open Doors” based on the electronic patient's medical records. Data comprised socio-demographic and clinical information with focus on coercive measures, staff presence and critical incidences.

Results

There was a moderate reduction in coercive measures after the introduction of the ODP. More specifically, recurrent mechanical restraints, combinations of different kinds of coercive measures as well as one-to-one supervision were applied less often. Regarding critical incidences, there were more abscondings, yet their duration was shorter and there were less suicide attempts recorded.

Conclusion

The results suggest that the ODP can be effective in reducing coercive measures applied among involuntarily admitted patients. However, it should be noted that this may not only be due to the opening of the ward doors, but may also be related, for example, to a change in the therapeutic relationship or a change in the ward climate. Thus, prospective and qualitative studies could give a more differentiated insight into the effect of the ODP.

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“门户开放”概念对强制措施的影响——前后比较

为了减少限制和增加病人的自主权，“门户开放”政策（ODP）是一个热烈讨论的替代传统的封闭病房。本研究的目的是调查ODP对强制措施的影响、工作人员在场的必要性以及在普通精神病医院实施后非自愿住院病人的危急发生率。方法回顾性分析实施“门户开放”理念前后非自愿住院患者的电子病历资料。数据包括社会人口和临床资料，重点是强制性措施、工作人员在场情况和危急情况。结果引入ODP后，强制措施有所减少。更具体地说，反复的机械约束、不同种类强制措施的组合以及一对一监督的应用频率较低。在严重事件方面，潜逃人数较多，但持续时间较短，自杀未遂人数较少。结论ODP可有效减少非自愿住院患者的强制措施。然而，应该注意的是，这可能不仅仅是由于病房门的打开，还可能与治疗关系的变化或病房气候的变化有关。因此，前瞻性和定性研究可以对ODP的影响提供更有区别的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of psychiatric research 医学-精神病学

CiteScore

7.30

自引率

2.10%

发文量

622

审稿时长

130 days

期刊介绍： Founded in 1961 to report on the latest work in psychiatry and cognate disciplines, the Journal of Psychiatric Research is dedicated to innovative and timely studies of four important areas of research: (1) clinical studies of all disciplines relating to psychiatric illness, as well as normal human behaviour, including biochemical, physiological, genetic, environmental, social, psychological and epidemiological factors; (2) basic studies pertaining to psychiatry in such fields as neuropsychopharmacology, neuroendocrinology, electrophysiology, genetics, experimental psychology and epidemiology; (3) the growing application of clinical laboratory techniques in psychiatry, including imagery and spectroscopy of the brain, molecular biology and computer sciences;