Medical personnel’s opinions on difficulties in applying measures of coercion – a research report (part 2)

Iwona Radlińska, Marta Kożybska, Marcin Kolwitz, Artur Kotwas, Beata Karakiewicz

Abstract


Introduction: The objective of this research was to identify legal and practical challenges in the application of means of coercion based on the opinions of medical staff.
Materials and methods: A cross-sectional study was conducted using an original survey questionnaire among 205 medical staff (nurses and doctors) from 3 hospitals in Poland in 2019–2020.
Results: The vast majority of survey participants found the use of coercion in their workplace to be challenging (38% always difficult, 51% sometimes difficult). Immobilization was identified as the most difficult measure to apply (45.86%). The majority of respondents rated the preparation for the use of coercion in their workplace as “poor,” “very poor,” or nonexistent in terms of procedures, personnel numbers, training, and equipment (with ratings ranging from 60–90%). Most respondents expressed a desire for more frequent cooperation with external institutions. Among the socio-demographic variables analyzed, only age was significantly associated with difficulty in using coercive measures, with older participants (M = 50.00 years) reporting more difficulty.
Conclusions: The respondents generally applied coercion in accordance with Polish legislation, though several difficulties were noted in practice. These challenges may be due to shortcomings in workplace preparation for the use of coercion or inadequate cooperation with external institutions. Consequently, medical staff may resort to coercive measures that are not ideally suited to the patient but are feasible to apply. The greater difficulty reported by older respondents may reflect a higher awareness of practical issues in applying coercion. There is an urgent need to align legal requirements with practical realities, ensuring adequate funding for services.

Keywords


coercion; movement restraint; seclusion; compulsory medication; behaviour control; aggression

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References


Ustawa z dnia 19 sierpnia 1994 r. o ochronie zdrowia psychicznego. Dz.U. z 2020 r., poz. 685 ze zm.

Flaga-Gieruszyńska K, Radlińska I, editors. Przymus bezpośredni stosowany wobec osób z zaburzeniami psychicznymi. Szczecin: Wydawnictwo Pomorskiego Uniwersytetu Medycznego w Szczecinie; 2021.

Radlińska I, Kożybska M, Kolwitz M, Kotwas A, Karakiewicz B. Application of direct coercive measures. Report of medical staff’s opinions (Part 1). Pomeranian J Life Sci 2023;69(3):69-75. doi: 10.21164/pomjlifesci.920.

Doedens P, Vermeulen J, Boyette LL, Latour C, de Haan L. Influence of nursing staff attitudes and characteristics on the use of coercive measures in acute mental health services – A systematic review. J Psychiatr Ment Health Nurs 2020;27(4):446-59.

Krieger E, Moritz S, Weil R, Nagel M. Patients’ attitudes towards and acceptance of coercion in psychiatry. Psychiatry Res 2018;260:478-85.

Gowda GS, Lepping P, Noorthoorn EO, Ali SF, Kumar CN, Raveesh BN, et al. Restraint prevalence and perceived coercion among psychiatric inpatients from South India: A prospective study. Asian J Psychiatr 2018;36:10-6. doi: 10.1016/j.ajp.2018.05.024.

Vollema MG, Hollants SJ, Severs CJ, Hondius AJK. Determinants of seclusion in a psychiatric institution: A naturalistic and exploratory study. Tijdschr Psychiatr 2012;54(3):211-21.

Goulet MH, Larue C. A case study: Seclusion and restraint in psychiatric care. Clin Nurs Res 2018;27(7):853-70.

Riahi S, Thomson G, Duxbury J. An integrative review exploring decision-making factors influencing mental health nurses in the use of restraint. J Psychiatr Ment Health Nurs 2016;23(2):116-28.

Laukkanen E, Vehviläinen-Julkunen K, Louheranta O, Kuosmanen L. Psychiatric nursing staffs’ attitudes towards the use of containment methods in psychiatric inpatient care: An integrative review. Int J Ment Health Nurs 2019;28(2):390-406.

Convertino K, Pinto RP, Fiester AR. Use of inpatient seclusion at a community mental health center. Hosp Community Psychiatry 1980;31(12):848-50.

De Cangas JP. Nursing staff and unit characteristics: Do they affect the use of seclusion? Perspect Psychiatr Care 1993;29(3):15-22.

Morrison P, Lehane M. Staffing levels and seclusion use. J Adv Nurs 1995;22(6):1193-202.

Janssen W, Noorthoorn E, Linge R, Lendemeijer B. The influence of staffing levels on the use of seclusion. Int J Law Psychiatry 2007;30(2):118-26.

Bowers L, Van Der Merwe M, Nijman H, Hamilton B, Noorthorn E, Stewart D, et al. The practice of seclusion and time-out on English acute psychiatric wards: The City-128 study. Arch Psychiatr Nurs 2010;24(4):275-86.

Wynn R. Staff’s attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital. Nord J Psychiatry 2003;57(6):453-9.

Gandhi S, Poreddi V, Nagarajaiah, Palaniappan M, Reddy SSN, BadaMath S. Indian nurses’ knowledge, attitude and practice towards use of physical restraints in psychiatric patients. Invest Educ En Enferm 2018;36(1):e10.

De Benedictis L, Dumais A, Sieu N, Mailhot MP, Létourneau G, Tran MA, et al. Staff perceptions and organizational factors as predictors of seclusion and restraint on psychiatric wards. Psychiatr Serv 2011;62(5):484-91.

Doedens P, Maaskant JM, Latour CH, Meijel BKGV, Koeter MW, Storosum JG, et al. Nursing staff factors contributing to seclusion in acute mental health care – an explorative cohort study. Issues Ment Health Nurs 2017;38(7):584-9.

Khalil AI, Al Ghamdi MAM, Al Malki SA. Nurses’ knowledge, attitudes, and practices toward physical restraint and seclusion in an inpatients’ psychiatric ward. Int J Cult Ment Health 2017;10(4):447-67.

Bowers L, Crowder M. Nursing staff numbers and their relationship to conflict and containment rates on psychiatric wards – a cross sectional time series poisson regression study. Int J Nurs Stud 2012;49(1):15-20.

Miodownik C, Friger MD, Orev E, Gansburg Y, Reis N. Clinical and demographic characteristics of secluded and mechanically restrained mentally ill patients: A retrospective study. Isr J Health Policy Res 2019;8(1):9.

Kodal JS, Kjær JN, Larsen ER. Mechanical restraint and characteristics of patient, staff and shifts in a psychiatric ward. Nord J Psychiatry 2018;72(2):103-8.

Happell B, Koehn S. Attitudes to the use of seclusion: Has contemporary mental health policy made a difference? J Clin Nurs 2010;19(21-22):3208-17.

Korkeila H, Koivisto AM, Paavilainen E, Kylmä J. Psychiatric nurses’ emotional and ethical experiences regarding seclusion and restraint. Issues Ment Health Nurs 2016;37(7):464-75.

Bregar B, Skela-Savič B, Kores Plesničar B. Cross-sectional study on nurses’ attitudes regarding coercive measures: the importance of socio-demographic characteristics, job satisfaction, and strategies for coping with stress. BMC Psychiatry 2018;18(1):171.

Mann-Poll PS, Smit A, Koekkoek B, Hutschemaekers G. Seclusion as a necessary vs. an appropriate intervention: A vignette study among mental health nurses. J Psychiatr Ment Health Nurs 2015;22(4):226-33.




DOI: https://doi.org/10.21164/pomjlifesci.1115

Copyright (c) 2024 Iwona Radlińska, Marta Kożybska, Marcin Kolwitz, Artur Kotwas, Beata Karakiewicz

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