Adult Patients’ Experience of Coercion in Intensive Care: A Scoping Review

Abstract

Background The use of coercion, which can be understood in a clinical context as imposing a measure against a patient’s opposition or declared will, can occur in various forms in intensive care units (ICU). One prime example of a coercive measure in the ICU is the use of restraints, which are applied for patients` own safety and for the protection of caregivers. A scoping review was conducted to explore the empirical data available on the experiences of ICU patients with coercive measures.Main text For this scoping review, clinical databases (PubMED, EMBASE, PsychINFO, Web of Science Core Collection, CINAHL, Scopus and Cochrane Library) were searched for qualitative studies. Using the CASP criteria for qualitative studies, the review focused on empirical research that captured how ICU patients themselves experienced restraints or other forms of coercion and excluded research related to staff experiences. A total of nine studies could be retrieved that fulfilled the inclusion criteria.The review describes common themes emerging from the scarce studies on patient experiences, including communication issues, delirium, memory, and emotional reactions. In spite of their serious clinical condition and fluctuating states of consciousness, a part of the patients did have memories of their ICU stay. Statements from patients revealed feelings of compromised autonomy and dignity that came with a loss of control. Physical restraints were only one concrete manifestation of coercion as perceived by patients in the ICU setting. Conclusion To date, there are few qualitative studies focusing on patient experiences of coercive measures in the ICU. In addition to the experience of restricted physical movement, the perception of loss of control, loss of dignity and loss of autonomy suggests that restraining measures are just one element in a setting that may be perceived as coercive. Health professionals may underestimate how deeply patients are affected by the perception of coercion. Good communication that clearly explains unavoidable measures to patients can reduce the negative impacts of coercive measures. More research on patient experiences is needed in order to reach a more comprehensive understanding of how patients perceive their ICU stay and to identify opportunities for further improvement of intensive care.