Abstract
BackgroundCoercive measures are containment methods used in psychiatry to curb patients’ disruptive and aggressive behaviours towards themselves, others or objects. The prevalence of the practice of coercive measures in psychiatry is directly related to the attitudes of the staff. When discussing these attitudes, nurses are often particularly singled out. The purpose of the study is to research the impact of individual factors on nurses’ attitudes in the decision-making process for the use of coercive measures.MethodsA cross-sectional study among all psychiatric nursing staff in Slovenia (n = 367, 79%) was conducted over the years 2013/2014. Standardized questionnaires were used, including a survey of nurses’ attitudes to the use of seclusion, the Job Descriptive Index, and the Folkman-Lazarus test.ResultsNurses’ attitudes towards special coercive measures are predominantly negative ( overline{x} = 11.312, SD = 2.641). The factors that explain a positive attitude are as follows: female gender (β = − 0.236, p < 0.001), fewer years of service (β = − 0.149, p = 0.023), emotion-focused strategies of coping with stress (β = 0.139, p = 0.020), and less-threatening patient behaviour (β = 0.157, p = 0.012).ConclusionsThe effects of some known factors did not prove important in the model. Newly recognized factors are “less-threatening patient behaviour” and “emotion-focused strategies of coping with stress”. Therefore, attitudes towards special coercive measures in psychiatry must be regarded as contextualized, interactive, and multidimensional phenomena that cannot be explained merely through a defined set of factors.
Highlights
Coercive measures are containment methods used in psychiatry to curb patients’ disruptive and aggressive behaviours towards themselves, others or objects
Survey of nurses’ attitudes to seclusion survey (SNASS) – Reasons for coercive measures (CM) The descriptive analysis of the first SNASS set, which combined 13 statements into two factors explaining the reasons to implement CM, showed that respondents tended to decide in favour of CM more often in cases of less-threatening patient behaviour (x= 12.782, SD = 3.194)
SNASS – Employees’ feelings related to CM The scale of 12 statements addressing the question “What do you usually feel after CM?” was combined into two factors using a factor analysis: 1) positive attitude towards CM and 2) negative attitude towards CM
Summary
Coercive measures are containment methods used in psychiatry to curb patients’ disruptive and aggressive behaviours towards themselves, others or objects. Coercive or containment measures in medicine, especially in psychiatry, are regarded as a serious violation of an individual’s rights to self-determination and to personal freedom [1] These measures impinge upon the freedom, autonomy and/or movement of hospitalized patients. Many studies in the past 10–15 years have identified a series of factors that influence the application of coercive measures by staff [11,12,13,14,15,16] The most common such factors are the following: the staff’s gender, having a non-stimulative therapeutic relationship with the patient, the staff’s experiences and skills, therapeutic (non-) communication, the relationship between the staff and the patient, the presence of staff among the patients, the personal characteristics of the staff, and other factors [11, 12, 17, 18]. The influence of individual socio-demographic factors on CM is quite complex, preventing the possibility of a consensus among practitioners and researchers
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