Hospitals and psychiatric institutions Patients plausibly claimed in interviews with the commissions that they were threatened with restraint if they questioned their medication or did not comply with the prescribed therapy. They were also urged to take their medication in a very aggressive manner (“If you do not take the medicine, then…”). One patient reported that she was threatened with the cancellation of her forthcoming discharge from the facility if she did not clear away the trays. Threat and restraint The interviewed patients, some of whom have been admitted to a psychiatric ward several times, find such treatment degrading and frightening. The NPM is insistent that the nursing staff should be sensitized in general about the use of such verbal pressure. Pertinent information from the NPM is taken very seriously by the hospitals and is the basis for meeting with staff in order to underline the significance of an appreciative approach when dealing with patients. Ultimately, violence to patients can be accounted for in treatment methods that are difficult to see objectively. An unfriendly look, roughness when assisting with personal hygiene or apparent impatience during care treatments can thus be perceived by the patients as intimidating or degrading. The NPM also observed that the prescription of so-called PRN medication often fails to comply with the regulations: amount, dose, channel and time of administration must be recorded in the patient documentation by the doctors authorised to write prescriptions. Whilst the administration of medication is a medical activity, it can be delegated to qualified nursing staff within the framework of a multi-professional area of competence. Precise prescription of PRN medication necessary Prescriptions that do not include a specified time plan are only permissible if the criteria for assessing the time and the dose of the medication to be administered are clear, unequivocal and transparent according to medical standards. It must be possible to preclude an inadmissible diagnostic or therapeutic activity by the nursing staff. However, the documentation viewed contained some vague information (such as “additionally for severe agitation” or “for agitation”). The consequence of such unspecific prescription of a PRN medication is naturally that the nursing staff have a relatively large amount of leeway. It cannot be ruled out that medication is used hastily to sedate patients without first trying milder measures. This kind of approach can also allow hidden violence to occur which patients can perceive as a “sanction” in extreme cases. 47