Measuring Staff Attitudes to Coercion in Poland

Abstract

Introduction: Coercion can be defined as the use of force to limit a person's choices. In Poland, coercive measures may tend to be overused. However, there is limited information regarding the attitudes of nurses toward coercion in psychiatric settings and the factors influencing any decisions to use coercion.Aims: To validate the Staff Attitudes to Coercion Scale (SACS) for a group of psychiatric nurses and psychiatrists, to compare the said with the original Norwegian SACS version, and to compare nurses' attitudes with those displayed by psychiatrists. A second aim was to understand the relationship between self-efficacy and attitudes to coercion.Method: We surveyed 351 psychiatric nurses and psychiatrists rating SACS and GSES (General Self Efficacy Scale). We validated the SACS factor structure using confirmatory principal component factor analysis, calculated the internal consistency of subscales, and analyzed the test-retest reliability and face validity of the subscales themselves. Further, we analyzed the differences in attitudes toward coercion between nurses and psychiatrists, as well as whether there was an association between GSES and the SACS subscales. We compared the means on the SACS items between three countries—Germany, Norway, and Poland.Results: The confirmatory factor analysis of the Polish version of SACS found the same factor structure with three factors as was displayed in the original Norwegian SACS, except that one item was loaded on another factor. Internal consistency was acceptable for the factors on coercion as security and the coercion as offending, and unacceptable for the factor on coercion as treatment. Test-retest reliability was excellent for all the three subscales. Face validity was high for the factor coercion as security, partly present for coercion as offending, and not present for coercion as treatment. The subscale Coercion as Treatment was rated significantly higher by nurses than by psychiatrists, but there was no difference for the two other subscales. There was no significant association between the General Self-Efficacy Scale and any of the SACS subscales. The biggest differences in attitudes toward forms of coercion was noted between Poland and Germany.Discussion: The three-factor structure of SACS was the best solution for the Polish nurses and psychiatrists. The attitudes toward coercion differed between the two groups, but a low correlation was computed for the SACS subscales and self-efficacy. There is a cultural diversity visible amongst the three countries examined. Reduction in the use of coercion is a priority worldwide. More knowledge about the process involved in using coercive measures may contribute to this. The use of coercive interventions may harm patients and threaten patients' rights. Thus, education is needed for pre-service and in-service nurses alike.

Development of the Japanese version of Staff Attitude to Coercion Scale

“…As for item 4, “Use of coercion is a declaration of failure on the part of the mental health services,” it did not load on any factors in our EFA. It seemed to suggest a common problem observed in previous studies that developed the Polish version of SACS, which reported almost the same factor structure with the original version, except for item 4 ( 18 , 19 ). The term “a declaration of failure” might be confusing or evoke different images among respondents.…”

“…It was thought that a hope of decreasing the use of coercion was derived from the undesirableness of its use. Concerning the results of factor analyses conducted in the other language versions of the SACS, the original three-factor structure was almost replicated in the Polish version ( 18 , 19 ), but not in the German version, which offered a one-factor structure ranging from rejecting to approving the use of coercion ( 20 ). Studies on the factor structure of the SACS is limited ( 17 ) and further studies are needed.…”

Systematic literature review of the use of Staff Attitudes to Coercion Scale (SACS)

“…Two studies analyzed the single items, and not the three subscales (28,47). Three studies confirmed the original three-factor model (25,27,28), and one study found that a one-factor model was better suited (26).…”

“…One study used a yes/no response instead of the original five-point Likert scale (30), and one study had used a four-point scale (36). Five of the studies had only translation and validation as its purpose (24)(25)(26)(27)(28). Two studies analyzed the single items, and not the three subscales (28,47).…”

“…The "Staff Attitude to Coercion Scale" (SACS) was developed and published in 2008 as a valid and feasible instrument to measure staff attitudes to coercion (24). Since then, the questionnaire has been used in several countries (25)(26)(27)(28). In addition to the original Norwegian and English translation, the SACS questionnaire has been translated into Farsi, German, Polish, and Chinese (25,26,28,29).…”