Nurses' Experiences of Using Coercion in Forensic and Non-Forensic Settings: A Constant Comparative Analysis.

Abstract

Introduction: Coercive measures are increasingly used in psychiatric settings, especially in forensic settings. Coercive measures such as seclusion, restraints and involuntary care cause negative outcomes for both people living with mental illness and nurses.

Aim: The aim of this paper is to compare the perspectives of nurses who experience the use of coercive measures in forensic and general psychiatric care.

Method: Grounded theory was used as a qualitative methodology. We used the constant comparative method to analyse the data. Individual interviews were conducted with nurses from general psychiatry (n = 9) and forensic psychiatry (n = 9).

Results: Four categories were determined: (1) Towards a contextual understanding of coercion; (2) Justifications for the use of coercion; (3) Maintaining a relationship of trust; and (4) Influence of the culture of control.

Discussion: Nurses providing care in a coercive context-whether in general psychiatric or forensic settings-face important ethical dilemmas. Several factors can influence the application of coercion, including a paternalistic culture of risk management.

Implications for practice: A considerate and empathetic approach, grounded in a posture of advocacy, helps to prevent the use of coercion.

Relevance statement: This paper may raise awareness among mental health nurses working with patients who are involved in the justice system. Psychiatric nurses are particularly affected by the application of coercion in their clinical practice. The theoretical framework used in this article is well suited to an exploration of the dual roles imposed on psychiatric nurses (care and control). Last, this paper highlights the need to stimulate discussion and critical reflection among nurses regarding the duality of control and care and the ongoing application of coercion in clinical settings.