Staff\u2019s normative attitudes towards coercion: the role of moral doubt and professional context\u2014a cross-sectional survey study

Bert Molewijk,Almar Kok,Tonje Husum,Olaf Aasland,Reidar Pedersen

doi:10.1186/s12910-017-0190-0

Abstract

BackgroundThe use of coercion is morally problematic and requires an ongoing critical reflection. We wondered if not knowing or being uncertain whether coercion is morally right or justified (i.e. experiencing moral doubt) is related to professionals’ normative attitudes regarding the use of coercion.MethodsThis paper describes an explorative statistical analysis based on a cross-sectional survey across seven wards in three Norwegian mental health care institutions.ResultsDescriptive analyses showed that in general the 379 respondents a) were not so sure whether coercion should be seen as offending, b) agreed with the viewpoint that coercion is needed for care and security, and c) slightly disagreed that coercion could be seen as treatment. Staff did not report high rates of moral doubt related to the use of coercion, although most of them agreed there will never be a single answer to the question ‘What is the right thing to do?’.Bivariate analyses showed that the more they experienced general moral doubt and relative doubt, the more one thought that coercion is offending. Especially psychologists were critical towards coercion. We found significant differences among ward types. Respondents with decisional responsibility for coercion and leadership responsibility saw coercion less as treatment. Frequent experience with coercion was related to seeing coercion more as care and security.ConclusionsThis study showed that experiencing moral doubt is related to some one’s normative attitude towards coercion. Future research could investigate whether moral case deliberation increases professionals’ experience of moral doubt and whether this will evoke more critical thinking and increase staff’s curiosity for alternatives to coercion.

Highlights

The use of coercion is morally problematic and requires an ongoing critical reflection
Instrument For the results described within this paper we used the following questionnaires: Staff Attitude to Coercion Scale (SACS) Staff ’s normative attitude regarding the use of coercion was measured with SACS [31]
The remaining associations found in the multivariate model were not statistically significant. In this explorative cross-sectional survey study across seven wards in three Norwegian hospitals for mental health care, we studied the relationship between three kinds of doubt (‘moral doubt in general’, ‘moral doubt related to coercion’, and ‘relative doubt’) and the staff ’s normative attitude towards the use of coercive measures, controlled for professional background and contextual features

Summary

Introduction

The use of coercion is morally problematic and requires an ongoing critical reflection. It is generally understood that the use of coercion is morally problematic and that health care professionals needs to critically reflect upon and morally justify the use of coercion. Being uncertain whether the use of coercion is morally justified (i.e. moral doubt) is often a starting point for critical reflection and changing cultures and attitudes towards coercion. Within this study we wanted to find out whether experiencing moral doubt is related to the normative attitudes of health care professionals towards coercion. A better understanding of the possible role of moral doubt in stimulating critical reflection and changing cultures might inform us whether stimulating moral doubt, for example by means of moral case deliberation, can play a role in reducing and improving the use of coercion. We think the role of moral doubt and critical reflection in improving practices needs further attention in both clinical practice and research

Results

Discussion

Conclusion