[Benzodiazepines and elderly : challenges of prescribing and deprescribing]. / Benzodiazépines et âge avancé : défis de la prescription et de la déprescription.

The elderly represent a group at risk of receiving problematic benzodiazepine (BZD) prescriptions in terms of duration or dose. The objective of this article is to investigate the difficulties related to the initial prescription, renewal, and withdrawal of BZDs in two university hospitals in French-speaking Switzerland. Specifically, we studied the actual use and perceived usefulness of clinical guidelines, the assignment of responsibilities among prescribers, and the assessment of public health risks. Eight semi-structured interviews were conducted with professionals from different specialties. A lack of usable clinical recommendations was noted, attributable to the lack of scientific knowledge and the complexity of geriatric cases. The introduction and renewal of prescriptions should be the result of systematic consultations between hospitals and ambulatory care.

Les personnes d'âge avancé représentent un groupe à risque de recevoir des prescriptions de benzodiazépines (BZD) problématiques en termes de durée ou de dose. L'objectif de cet article est d'investiguer les défis liés à la primo-prescription, la reconduction et le sevrage des BZD dans deux hôpitaux universitaires romands. Spécifiquement, nous avons étudié l'usage effectif et l'utilité perçue des recommandations cliniques, la répartition des responsabilités parmi les personnes qui prescrivent et l'appréciation des risques pour la santé publique. Huit entretiens semi-structurés ont été menés avec des professionnel-le-s de différentes spécialités hospitalières. Il est noté un manque de recommandations cliniques exploitables, s'expliquant par l'absence de connaissances scientifiques et par la complexité des cas gériatriques. L'introduction et la reconduction des prescriptions devraient faire l'objet de concertations systématiques entre les soins en hospitalier et en ambulatoire.

Is massage a legitimate part of nursing care? A qualitative study.

INTRODUCTION: The use of massage therapy has received increased attention in the treatment of chronic pain. However, barriers can hinder its use in nursing care. This study uses a qualitative methodology to explore professionals' experiences regarding touch massage (TM) and identify barriers and facilitators for the implementation of this intervention. MATERIALS AND METHODS: This study is part of a larger research program aimed at investigating the impact of TM on the experiences of patients with chronic pain hospitalized in two units of an internal medicine rehabilitation ward. Health care professionals (HCPs) were trained either to provide TM or to use of a massage-machine device according to their units. At the end of the trial, two focus groups were conducted with HCPs from each unit who took part in the training and agreed to discuss their experience: 10 caregivers from the TM group and 6 from the machine group. The focus group discussions were tape-recorded, transcribed and analyzed using thematic content analysis. RESULTS: Five themes emerged from thematic content analysis: perceived impact on patients, HCPs' affective and cognitive experiences, patient-professionals relationships, organizational tensions, and conceptual tensions. Overall, the HCPs reported better general outcomes with TM than with the machine. They described positive effects on patients, HCPs, and their relationships. Regarding interventions' implementation, the HCPs reported organizational barriers such as patients' case complexity, work overload, and lack of time. Conceptual barriers such as ambivalence around the legitimacy of TM in nursing care were reported. TM was often described as a pleasure care that was considered a complementary approach and was overlooked despite its perceived benefits. CONCLUSION: Despite the perceived benefits of TM reported by the HCPs, ambivalence arose around the legitimacy of this intervention. This result emphasizes the importance of changing HCPs' attitudes regarding a given intervention to facilitate its implementation.

Guidelines, Policies, and Recommendations Regarding the Sexuality of Individuals with Severe Mental Disorders in Psychiatric Units, Institutions, and Supported Housing Across Europe: A Systematic Review.

Sexual behavior of psychiatric inpatients is often inadequately addressed within psychiatric institutions. This systematic review aimed to identify existing policies, guidelines, and recommendations regarding inpatient sexual behavior in psychiatric units, institutions, and supported housing across Europe in existing literature. It also aimed to assess the attitudes held by mental health professionals (MHPs) and inpatients toward existing policies, guidelines, and recommendations. Nine databases were searched in seven languages for articles published between 2000 and 2020. Double-blind bias assessment was performed on 10 articles. Five thematic categories emerged from the selected studies: (1) types of policies and guidelines; (2) MHPs' and inpatients' attitudes toward inpatient sexual behavior; (3) impact and strategies related to inpatient sexual behavior; (4) barriers to inpatient sexual behavior; and (5) facilitators to inpatient sexual behavior. Most screened publications reported implicit norms addressing inpatient sexual behavior among the staff. Surveyed MHPs and inpatients typically showed opposing attitudes regarding inpatient sexual behavior, with MHPs generally deeming such behavior unsafe and inpatients emphasizing it as their human right. The aims of this systematic review were partially fulfilled as articles reported little or no policy documents and guidelines and, therefore, did not allow for the assessment of policy impact. MHPs' attitudes toward inpatient sexual behavior were addressed and trends in several countries outside of Europe addressing inpatient sexual behavior were discussed. Finally, capacity to consent with respect to inpatient sexual behavior is discussed in the context of human rights.