Perception of coercion in psychiatric and nonpsychiatric (medical and surgical) inpatients

Implications of Involuntary Psychiatric Admission: Health, Social, and Clinical Effects on Patients

Involuntary psychiatric admission is an increasing, widespread practice adopted throughout the world; however, its legal regulation and practice are still under debate, and it is subject to criticism from the human rights point of view. Only a few studies have strictly focused on the outcomes and subsequent treatment implications of this practice. To perform a scoping review of the literature on involuntary psychiatric admission and systematize and summarize its outcomes and implications for adult psychiatric inpatients.Four overarching issues emerged from the studies: a) symptomatological repercussions, b) impacts on treatment before discharge, c) impacts on treatment after discharge, and d) implications on patients' attitudes, behavior, and functioning. The overall evidence suggested correlations between involuntary psychiatric admission and several implications: length of stay, aggressive behavior, occurrence of psychopathologies, uses of coercive measures, psychiatric service activations after discharge, emotive reactions, and quality of life. The proposal presented here is the major involvement of the patient and of all the other actors involved during the entire treatment process to promote a shift from a delegation perspective to a negotiation perspective in the management of involuntary psychiatric admission.

Health professionals' perceptions about the decision-making process in the care of pediatric patients

OBJECTIVE

To evaluate the perceptions of physicians, nurses and nursing technicians of their participation in the decision-making process surrounding life support limitation in terminally ill pediatric patients, with comparisons by professional category.

METHODS

A cross-sectional study was conducted in the pediatric intensive care unit of a tertiary public university hospital with the participation of physicians, nurses and nursing technicians. The MacArthur Admission Experience Survey Voice Scale was used to assess and quantify the perceptions of professionals who assisted 17 pediatric patients with life support limitation within 24 hours after the outcome of each patient was determined. All professionals working in the unit (n = 117) who were potentially eligible for the study received a free and informed consent form prior to the occurrence of the cases studied.

RESULTS

Study participants included 25/40 (62.5%) physicians, 10/17 (58.8%) nurses and 41/60 (68.3%) nursing technicians, representing 65% of the eligible professionals identified. The questionnaire return rate was higher for physicians than technicians (p = 0.0258). A perceived lack of voice was reported in all three professional categories at varying rates that were lower for physicians than for nurses and nursing technicians (p < 0.00001); there was no difference between the latter (p = 0.7016). In the three professional categories studied, three subscale items were reported. For two of the three statements, there were significant differences between physicians and nurses (p = 0.004) and between physicians and nursing technicians (p = 0.001). For one of the statements, there was no difference among the three professional categories.

CONCLUSION

Respondents perceived a lack of voice in the decision-making process at varying rates across the three categories of studied professionals who assisted terminally ill pediatric patients with life support limitation, with physicians expressing lowered rates of perceived coercion.

French lay people's and health professionals' views regarding the acceptability of involuntary treatment of nursing home residents

OBJECTIVES

We examined the views of lay people and health professionals in France about involuntary treatment of residents in nursing homes.

METHOD

Participants (101 lay people, 20 nurses, 20 psychologists, and 10 physicians) were presented with a series of stories created by varying the levels of five factors: type of behavioral problem encountered (e.g., night-wandering), associated signs of dementia, physician's effort to explain the reason for treatment, resident's attitude (e.g., lasting reluctance), and physician's decision to prescribe psychotropic drugs or not. Participants were asked to judge the acceptability of the decision in each concrete case.

RESULTS

Three qualitatively different positions were found. The largest group (40% of the participants) viewed treatment of residents' behavioral problems as the most important objective. They felt it also important to respect residents' wishes and, therefore, to spend much time in talking with them about treatment. An almost equally large group (39%)--which included 60% of physicians--viewed respect for residents' autonomy as the most important consideration. A smaller group (21%)--including 40% of the psychologists--focused on the importance of taking time to talk with the residents. They also thought that treating patients against their will was unacceptable. Thus they took autonomy one step further than the preceding group.

CONCLUSION

It is important to reduce as much as possible the conflict between the principles of patient autonomy and perceived beneficence when caring for nursing home patients with behavior problems. This can be done by promoting their decision making abilities.

The effectiveness of technology-based patient education on self-reported deprivation of liberty among people with severe mental illness: a randomized controlled trial

Deprivation of liberty (DL) in psychiatric inpatient care is common worldwide. As liberty is a central element of patients' rights, there is a need to develop most effective methods supporting patients' personal liberty. The article presents initial results from a study to determine the effectiveness of an information technology (IT)-based patient education programme on patients' experiences of being deprived of their liberty during their in-hospital stay. An overall sample of 311 patients with schizophrenia spectrum psychosis was randomized into three groups: an intervention group with needs-based computerized patient education, a patient education group with conventional education and a control group with standard care. Data on the general experience of DL were collected at baseline and during the patient discharge process. In general, all patients experienced less DL at the time of their discharge. The change in patients' experiences of their DL did not differ statistically between the three groups. Male patients in the standard care group were significantly more likely to drop out of the study than female patients. Although technology-based patient education was not found to be superior to other approaches, we did not find any reason to inhibit its utilization in patient care among persons with severe mental health problems. From the healthcare organizations' perspective, a cost-effectiveness analysis is needed, as the IT education was slightly more time-consuming.