Nurses’ ethical perceptions about coercion

Abstract

In Finland, special attention has been paid to ethical questions related to the care of psychiatric patients and to the enhancement of patients' rights, yet the majority of the nurses participating in the survey did not perceive coercive measures as ethically problematic. More research on this issue as well as further education of the personnel and more extensive teaching of ethics in nursing schools are needed to support the ability of the psychiatric personnel to identify ethically problematic situations. In addition, it is important to consider new measures for generating genuine moral reflection among the personnel on the usage of coercive measures as well as on their effectiveness and legitimacy in the psychiatric care.

Coercion in a locked psychiatric ward

“…Lind, Kaltiala-Heino (19) found that only a few nurses working in a psychiatric acute ward felt that coercion was ethically problematic. How does it happen that in one study the therapists felt guilt and shame, while in another only a few had problematic feelings?…”

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

“…D'Orio et al [5], for example, report a 39% reduction in coercion following introduction of a package which included enhanced access to expertise during emergency situations. Involvement in the use of these measures or witnessing their use can be highly distressing for both service users and staff [6][7][8] and few are likely to remain neutral about them. Attitudes toward different types of coercive measure are likely to vary between and within service user and staff groups but little is known about the preferences of staff and service users when comparing different measures.…”

The feelings and thoughts of mental health nurses concerning the management of distressed and disturbed in-patients: A comparative qualitative European study

“…Although inpatient nurses use coercive interventions, for some it does not present ethical problems [51] as they appear oblivious to practice issues and hold paternalistic attitudes. For some patients seclusion maybe a positive experience as it enables them to have a "quiet" time away from the busy ward environment and an opportunity for reflection.…”

“…The implementation of restrictions includes the risk of misuse of power and perceived punishment, even if the expressed purpose is good [6,26]. Nurses may experience negative feelings towards the distressed and/or disturbed patients who have been involved in the use of coercion [6,18,27] and feelings of discomfort can be produced [28]. In acute environments, staff may not have the necessary clinical skills or time to be able to manage distressed and/or disturbed patients, consequently resorting to other methods of containment.…”