Ethical issues experienced by mental health nurses in the administration of antipsychotic depot and long‐acting intramuscular injections: A qualitative study

Smith, J. P.; Herber, Oliver Rudolf

doi:10.1111/inm.12105

Cited by 8 publications

(5 citation statements)

References 36 publications

(36 reference statements)

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“…The study shows that practitioners' face many practical, everyday problems in trying to determine what coercion is morally justified in daily practice, and that they use various strategies to make this determination and ensure best practices. It also confirms the need to provide staff opportunities to increase their awareness of their daily practices and to discuss the ethical challenges of their 'lived experiences' regarding coercion (Smith and Herber 2015;Happell and Harrow 2010). Hence, ethics could offer important support for professionals in their efforts to handle moral concerns regarding coercion in everyday practice.…”

Section: Methodological Considerationsmentioning

confidence: 71%

The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care

2016

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Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics (i.e., ethical theory, moral deliberation and clinical ethics support) in such initiatives. This study adds to this subject by exploring health professionals' descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed.

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Section: Methodological Considerationsmentioning

confidence: 71%

The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care

2016

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“…Participants’ focus on abstinence (rather than maintenance) may have been influenced by the current emphasis on ‘recovery’ in UK policy and practice [21–23]; therefore, this finding might not be replicated in other countries and policy contexts. Coerced treatment, patient choice, and mental capability in treatment decision-making are, meanwhile, sensitive issues that have been debated in relation to other long-acting medications such as contraception [24, 25] and antipsychotic medications [26, 27]. It is difficult to draw any firm conclusions from the findings we report here, but the relationship between medication duration, choice, mental capability, and human rights will almost certainly feature in future discussions about prolonged-release OAT.…”

Section: Discussionmentioning

confidence: 99%

Prolonged-release opioid agonist therapy: qualitative study exploring patients’ views of 1-week, 1-month, and 6-month buprenorphine formulations

2019

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Background Options for opioid agonist therapy (OAT) are expanding with the development of prolonged-release (also known as extended-release) 1-week, 1-month, and 6-month formulations of buprenorphine. There is an assumption that patients will welcome these new treatments and medication adherence will correspondingly increase. However, there has been little research exploring patients’ views of prolonged-release buprenorphine. This paper aims to understand which durations patients prefer and why, and to consider the findings with reference to the development of future OAT products. Methods Data were generated as part of a qualitative interview study. Fieldwork was conducted in London, UK, during 2018 (before any prolonged-release OAT formulations were licensed in Europe). Participants ( n = 36) were taking daily oral OAT (methadone or buprenorphine) or using heroin daily without OAT. They included 26 men and 10 women, aged 24–63 years. All were asked for their views on weekly, monthly, and six-monthly duration buprenorphine. Responses were audio-recorded, transcribed, and analyzed by Iterative Categorization. Results Participants generally stated that having buprenorphine of different prolonged durations was positive. They tended to believe that ‘longer’ prolonged-release formulations would be beneficial for patients who wanted to avoid thinking about drugs and drug-using associates, wished to evade the stigma of substance use, and desired ‘normality’ and ‘recovery.’ In contrast, participants favored ‘shorter’ prolonged-release formulations for patients who are new to OAT, worried about the safety and reliability/effectiveness of OAT, want a ‘break’ from street opioids, and need contact with services to monitor/support them. Participants indicated that transitioning between OAT medications of different duration would be a very individual process. Some also linked prolonged-release OAT duration to political, philosophical, and ethical issues, such as patient coercion and mental capability. Conclusions Medication duration is an important but complex feature of prolonged-release buprenorphine, with patients’ views and preferences likely to be influenced by a wide range of factors. We need further qualitative research to explore the experiences of people who have actually used prolonged-release OAT. Meanwhile, drug developers should continue to build flexibility and choice into OAT products to ensure that future treatment is acceptable to patients and able to accommodate their diverse individual needs.

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“…In terms of the justification for using direct coercion, ethical behaviour contributes to an increase in awareness of violations towards the patient, which in turn minimizes moral stress. The staff have the sense of being consistent when taking appropriate action with a code of ethics [36,37]. On the other hand, in Scandinavian countries, the USA, and the Netherlands, the subjects of discussion are issues related to the reduction of coercive practices and the improvement of their quality [38].…”

Section: Discussionmentioning

confidence: 99%

The use of direct coercion during the management of a patient with paranoid schizophrenia - case report

Fąfara¹,

Marć²,

Aebisher³

et al. 2022

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In a situation of increased aggression from a patient, which creates a danger and a threat to their own health and to other patients and staff, direct coercion is used. Such intervention is undertaken when it is necessary to protect the patient's life or health. The aim of this study is to show the specifics of care for a patient in whom an assessment of mental health during the period of intensification of symptoms of paranoid schizophrenia indicated the legitimacy of the use of direct coercion. The paper describes an individual case of a mechanically immobilized patient. To collect data about the patient, the following research techniques were used: interview, observation, measurement, and documentation analysis. The following research tools were also used in the work: interview questionnaire, a card for the application of direct coercion against a person staying in a psychiatric hospital or other medical institution or in an organizational unit of social assistance, the Modified Explicit Aggression Scale -MOAS, and the Courtauld Emotional Control Scale (CECS). Mechanical immobilization is unpleasant for both the patient and the staff. Nevertheless, it is indispensable in certain cases. Compliance with the law makes it impossible to commit abuses against a patient who has been mechanically immobilized. StreszczenieW sytuacji nasilonej agresji pacjenta, stwarzającej niebezpieczeństwo i zagrożenie dla własnego zdrowia, innych pacjentów i personelu, stosuje się przymus bezpośredni. Taką interwencję podejmuje się w razie konieczności ochrony życia lub zdrowia pacjenta i innych osób, kiedy inne interwencje nie zredukowały nasilenia zachowania agresywnego. Celem artykułu jest ukazanie specyfiki zarządzania opieką pielęgniarską nad pacjentką, u której ocena stanu zdrowia psychicznego w okresie nasilenia objawów schizofrenii paranoidalnej wskazała na zasadność zastosowania przymusu bezpośredniego. W pracy opisano przypadek pacjentki unieruchomionej mechanicznie. W celu zebrania danych o kobiecie posłużono się następującymi technikami badawczymi: wywiad, obserwacja, pomiar, analiza dokumentacji. Zastosowano również następujące narzędzia badawcze: kwestionariusz wywiadu, Karta zastosowania przymusu bezpośredniego wobec osoby przebywającej w szpitalu psychiatrycznym, innym zakładzie leczniczym albo w jednostce organizacyjnej pomocy społecznej, Zmodyfikowaną skalę jawnej agresji (MOAS), Skalę kontroli emocji (CECS). Procedura unieruchomienia mechanicznego jest nieprzyjemna zarówno dla pacjenta, jak i dla personelu. Pomimo to w określonych przypadkach okazuje się niezbędna. Przestrzeganie przepisów prawa uniemożliwia popełnienie nadużyć w stosunku do pacjenta, u którego zastosowano unieruchomienie mechaniczne.

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Ethical issues experienced by mental health nurses in the administration of antipsychotic depot and long‐acting intramuscular injections: A qualitative study

Cited by 8 publications

References 36 publications

The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care

The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care

Prolonged-release opioid agonist therapy: qualitative study exploring patients’ views of 1-week, 1-month, and 6-month buprenorphine formulations

The use of direct coercion during the management of a patient with paranoid schizophrenia - case report

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