Cross-sectional study on nurses' attitudes regarding coercive measures: the importance of socio-demographic characteristics, job satisfaction, and strategies for coping with stress

"We just ignored them." Adaptation strategies used by emergency department personnel in the face of workplace violence: A qualitative study

BACKGROUND

Workplace violence (WPV) can have adverse psychological, physical, and emotional effects on emergency department (ED) personnel. Adaptive strategies can help them better adapt to WPV. The study aimed to explore ED personnel's experiences with adaptive strategies used in the face of WPV.

METHODS

In this qualitative study, 22 ED personnel (nurses, doctors, services patient care assistants, and security guards) were selected using purposive sampling from Urmia city hospitals. Deep semi-structured individual face-to-face interviews were used to collect data. After recording and implementing interviews, conventional content analysis was used to extract concepts.

RESULTS

Data analysis led to extracting an overarching theme of "mastering the situation and avoiding harm." Two categories that supported the main theme were: "effort to avoid violence" and "effort to escape suffering." The seven subcategories supported main categories included "managing patients and companions, "self-control," "seeking support, "emotional discharge," "thought diversion, "tendency to spirituality," and "seeking medical assistance."

CONCLUSION

Given the experiences of ED personnel regarding strategies used, health managers and policymakers are recommended to develop and implement comprehensive programs to reduce violence and empower nurses before and after dealing with violence. The following programs will help: developing and implementing guidelines such as zero-tolerance WPV policy, criminalizing violence against personnel and punishing perpetrators; holding classes related to communication skills, self-control skills, and deviant thinking skills for ED personnel; raising public awareness of the prevailing conditions in the emergency through mass media, and counseling and treating violent ED personnel.

A Scoping Review on Staff Attitudes towards the Use of Coercion in Mental Healthcare

Attitudes of mental health professionals towards the use of coercion are highly relevant concerning its use coercion in mental healthcare, as mental health professionals have to weigh ethical arguments and decide within a legal frame in which situations to use coercion or not. Therefore, assessment of those attitudes is relevant for research in this field. A vital instrument to measure those attitudes towards the use of coercion is the Staff Attitude to Coercion Scale. This scoping review aims to provide a structured overview of the advantages and limitations in the assessment of attitudes toward coercion. We conducted a scoping review in Medline, PsycINFO, CINAHL, and Web of Science, based on the PRISMA-ScR. Inclusion criteria were empirical studies on the attitudes of mental health professionals. We included 80 studies and systematically mapped data about the main results and limitations in assessing attitudes toward coercion. The main results highlighted the relevance and increased interest in staff attitudes towards coercion in mental healthcare. Still, the majority of the included studies relied on a variety of different concepts and definitions concerning attitudes. The data further indicated difficulties in developing new and adapting existing assessment instruments because of the equivocal definitions of underlying concepts. To improve the research and knowledge in this area, future studies should be based on solid theoretical foundations. We identified the need for methodological changes and standardized procedures that take into account existing evidence from attitude research in social psychology, nursing science, and other relevant research fields. This would include an update of the Staff Attitude to Coercion Scale based on the limitations identified in this review.

Variation in opinions on coercion use among mental healthcare professionals: a questionnaire study

INTRODUCTION

Even if coercive measures are widely applied in psychiatry and have numerous well-known drawbacks, there is limited known on the agreement among mental healthcare professionals' opinions on their use. In a questionnaire study using standardized scenarios, we investigated variation in staff opinions on coercion.

METHODS

In a web-based survey distributed to staff at three psychiatry hospitals, respondents were asked to consider if and what coercion to use by introducing two hypothetical scenarios involving involuntary psychiatric admission and in-hospital coercion.

RESULTS

One hundred thirty-two out of 601 invited staff members responded to the survey (Response Rate = 22%). There was large variation in participating staff members' opinions on how to best manage critical situations and what coercive measures were warranted. In the first scenario, 57% of respondents (n = 76) believed that the patient should be involuntarily admitted to hospital while the remaining respondents believed that the situation should be managed otherwise. Regarding the second scenario, 62% of respondents responded that some in-hospital coercion should be used. The majority of respondents believed that colleagues would behave similarly (60%) or with a tendency towards more coercion use (34%). Male gender, being nursing staff and having less coercion experience predicted being less inclined to choose involuntary hospital admission.

CONCLUSION

There is a high degree of variation in coercion use. This study suggests that this variation persists despite staff members being confronted with the same standardized situations. There is a need for evidence-based further guidance to minimize coercion in critical mental healthcare situations.

Compassion fatigue prevalence and risk factors among Saudi psychiatric nurses: A cross-sectional study

In recent times, compassion fatigue is increasingly being recognized as a damaging outcome associated with the stress experienced by psychiatric nurses. In addition to affecting their job performance work-related stress undermines nurses' physical and emotional well-being. However, there is a lack of research on compassion fatigue that specifically focuses on psychiatric nurses working in Saudi Arabia. This cross-sectional study investigated the prevalence and factors associated with compassion fatigue among Saudi psychiatric nurses. The study participants were asked to complete a demographic questionnaire and the Arabic form of the Professional Quality of Life Scale. Statistical analyses, including one-way ANOVA, t-tests, the Levene test, and multiple linear regression, were employed to assess variables related to compassion fatigue. The survey spanned 158 psychiatric nurses from the Mental Health Complex located in Riyadh City. The mean scores for compassion satisfaction, burnout, and secondary traumatic stress were 39.72 ± 6.881, 24.29 ± 5.386, and 26.94 ± 6.973, respectively. The analysis revealed that variables such as age range (36-55 years) and an associated degree or lower explained 5.2% of the variance in compassion satisfaction. Age range (18-25 years), exercise frequency, and years of nursing experience collectively accounted for 8.4% of the variables contributing to burnout. The age range (25 to 35 years) and working night shifts also explained 5% of the variance in secondary traumatic stress. The findings indicated that compassion satisfaction, burnout, and secondary traumatic stress among the population of psychiatric nurses working in Saudi Arabia were at a moderate level. A higher frequency of healthy lifestyle practices, such as regular exercise, and being in an older age range, were positively associated with compassion satisfaction and negatively associated with burnout and secondary traumatic stress.

Zero Tolerance for Coercion? Historical, Cultural and Organisational Contexts for Effective Implementation of Coercion-Free Mental Health Services around the World

Coercion of service users/patients when receiving care and treatment has been a serious dilemma for mental health services since at least the 18th century, and the debate about how best to minimise or even eradicate compulsion remains intense. Coercion is now, once again and rightly, at the top of the international policy agenda and the COST Action 'FOSTREN' is one example of a renewed commitment by service user advocates, practitioners and researchers to move forward in seriously addressing this problem. The focus of service improvement efforts has moved from pure innovation to practical implementation of effective interventions based on an understanding of the historical, cultural and political realities in which mental health services operate. These realities and their impact on the potential for change vary between countries across Europe and beyond. This article provides a novel overview by focusing on the historical, cultural and political contexts which relate to successful implementation primarily in Europe, North America and Australasia so that policy and practice in these and other regions can be adopted with an awareness of these potentially relevant factors. It also outlines some key aspects of current knowledge about the leading coercion-reduction interventions which might be considered when redesigning mental health services.

Influence of mental health professionals' attitudes and personality traits on decision-making around coercion: Results from an experimental quantitative survey using case vignettes

OBJECTIVE

Research on coercion in mental healthcare has recently shifted to the investigation of subjective aspects, both on the side of the people with mental disorders affected and the staff members involved. In this context, the role of personality traits and attitudes of staff members in decision-making around coercion is increasingly being assessed. This study aimed to examine the role of staff attitudes towards coercion and staff members' personality traits in decision-making around coercion in an experimental setting.

METHODS

We assessed the attitudes towards coercion and (general) personality traits of mental health professionals in psychiatric hospitals with a quantitative survey. Furthermore, we developed case vignettes representing cases in a 'grey zone' and included them in the survey to assess staff members' decisions about coercion in specific situations.

RESULTS

A general approving attitude towards coercion significantly influenced decisions around coercion in individual cases-resulting in a more likely approval of applying coercion in the cases described in the vignettes. Personality traits did not seem to be relevant in this regard.

CONCLUSION

Strategies to reduce coercion in mental healthcare institutions should focus more on the role of staff attitudes and encourage staff members to reflect on them critically.

Experience of mental health nurses regarding mechanical restraint in patients with psychomotor agitation: A qualitative study

AIM

To explore mental health nurses' experiences whilst managing a patient with psychomotor agitation, and the factors that influence the decision to use mechanical restraints.

BACKGROUND

Psychomotor agitation is considered a potentially violent psychiatric emergency. The management of disruptive behaviours includes mechanical restraints as the last resort although its use has consequences for patients, professionals and the therapeutic relationship.

DESIGN

A qualitative study design with a hermeneutical approach was developed.

METHODS

A total of 31 nurses were purposively sampled from six short- and medium-stay mental health inpatient units. Data were obtained from semi-structured interviews. A thematic content analysis following the seven steps of Colaizzi's method was performed. Three researchers independently conducted an inductive analysis within a perspective of a hermeneutic paradigm. The COREQ checklist was followed in carrying out this research.

RESULTS

Four themes emerged from the analysis: 1) Nurses' perceptions of restraint methods, 2) Factors influencing decision-making, 3) Consequences for professionals of the use of mechanical restraint and 4) Alternatives to mechanical restraint.

CONCLUSIONS

Aspects such as the importance of teamwork, the issue of cognitive dissonance, ethical conflict and barriers to effecting the withdrawal of these measures affect the mental health nurse's decision-making process. The understanding of these aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints.

RELEVANCE FOR CLINICAL PRACTICE

Knowing how nurses feel during the patient's episode of psychomotor agitation and which factors influence the decision on whether to apply coercive methods can guide us on the quality of care offered.

Measurement Properties of the Staff Attitude to Coercion Scale: A Systematic Review

OBJECTIVE

The Staff Attitude to Coercion Scale (SACS) was developed to assess mental health care staff's attitudes to the use of coercion in treatment. The staff's attitudes to the use of coercion may also influence their willingness to engage in professional development projects aimed at reducing use of coercion. This study systematically reviews the existing evidence related to the measurement properties of the SACS in papers published since the publication of SACS in 2008.

METHODS

Seven databases were searched for studies published until October 2021 assessing the measurement properties of SACS or using SACS. All original studies reporting data relevant for the assessment of measurement properties of the SACS were eligible for inclusion. The methodological quality of the studies was assessed and rated using the COnsensus-based Standard for the selection of health Measurement INstruments (COSMIN).

RESULTS

Of the 81 identified publications, 13 studies with a total of 2,675 respondents met the inclusion criteria. Most studies reported data on structural validity and internal consistency, with high methodological quality, but there were almost no data on any other measurement properties.

CONCLUSION

We found evidence for adequate structural validity and internal consistency of the SACS, while other important measurement properties were not addressed in any of the reviewed studies. Caution is needed when interpreting results of the SACS in terms of aspects such as reliability, criterion validity and measurement error. The relationship between staff attitudes to coercion and the actual use of coercion also remains unclear and needs to be further investigated.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier: CRD42021239284.

Attitudes of psychiatric nurses towards aggression: A polish study

WHAT IS KNOWN ABOUT THE SUBJECT?

(SCIENTIFIC RATIONALE)

Mental health care in Poland lags behind that of many other countries, and coercive measures are used on a regular basis. Scant research has been conducted in Poland regarding the treatment of psychiatric patients. The perspectives of Polish psychiatric nurses towards aggression remain unknown. WHAT DOES THIS PAPER ADD TO THE EXISTING KNOWLEDGE?: The translated and validated Attitude Towards Aggression Scale (ATAS) in Polish will serve as an instrument that gauges Polish nurses' attitudes towards aggression. The Polish nurses have unenlightened and negative attitude towards aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is now an instrument in Polish by which we can gauge the attitudes of mental health nurses, which must precede any educational efforts. Polish nurses showed more restrictive and antiquated attitudes about patient violence than nurses in some other parts of the world. With a shift to more positive attitudes, the use of coercion could be reduced, resulting in improved patient care.

INTRODUCTION

In Poland, the mode and site of patient treatment have changed little in the past 75 years, despite therapeutic advances worldwide. There is limited information regarding attitudes of nurses towards aggression in psychiatric settings in Poland, nor has there been an instrument in Polish to measure it.

AIM

To translate and validate the Attitudes Towards Aggression Scale (ATAS) for use in Poland, and to assess the attitudes of three groups of nursing personnel towards aggression.

METHOD

We surveyed 980 psychiatric and general nurses as well as nursing students. We translated the ATAS into Polish, and validated it using exploratory factor analysis.

RESULTS

The Polish version of the ATAS showed good psychometric properties. We found that Polish nurses perceived patient aggression extremely negatively.

DISCUSSION

Polish nurses perceive aggression as destructive, negative and not to be tolerated, leading to use of restraints. Among the three groups, psychiatric nurses showed the most negative attitude towards aggression. Thus, education is needed for preservice and inservice nurses alike to address this issue.

WHAT THIS STUDY ADDS TO EXISTING EVIDENCE

We now have a validated instrument to assess nurses' attitudes about aggression. We also know that Polish nurses have exceedingly negative attitudes towards aggression.

IMPLICATIONS FOR PRACTICE

The Polish version of ATAS was found valid and reliable. Therefore, we can now measure the attitudes of Polish nurses towards aggression, which was not possible previously. The baseline data provide a starting point from which to determine effects of educational efforts.

Coercion in psychiatry: A cross-sectional study on staff views and emotions

WHAT IS KNOWN ON THE SUBJECT?: Coercive interventions (CI) in emergency psychiatry face increasing criticism, as they can be an emotional, even traumatic event for all persons involved. They are thus considered the last resort. The use of coercive interventions differs widely with regard to type and frequency of measures across different countries and institutions. Individual staff characteristics, such as attitudes towards coercion, may play a vital role in the management of aggression. Little is known about the influence of emotions of staff members on CI, but they are likely to play an important role. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Most staff members surveyed had a rather critical view of coercion and considered it a "necessary evil." Staff members with the most work experience had a more critical view of coercion in comparison with less experienced staff. Nurses rated coercion more positively than did psychiatrists or psychologists. Emotions play an important role in decision-making processes. The current study systematically asked for accompanying emotions during the application of CI and looked for individual differences. A majority of the participants experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% stated that they felt a sense of power. Older staff members more often felt anger or guilt; women felt less power than men did. Nurses felt more desperation than other occupational groups. Staff members consider reflective interventions, such as team supervisions or post-seclusion/restraint debriefings with the patient, as important. Nevertheless, only half reported that these interventions are carried out routinely. Staff members believe that certain risk factors (including stress, low staffing, a fully occupied ward and the presence of particular staff members) enhance the probability of CI. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To reduce the use of coercive interventions, we recommend that psychiatric teams include highly experienced staff members as work experience has a positive effect on the attitudes towards coercive interventions. Structured post-seclusion/restraint debriefings and team supervisions are considered helpful by staff members and are relatively easy to implement on acute wards. Enhancing staff members' ability to reflect on their own attitudes, emotions and actions is likely to reduce coercive interventions. ABSTRACT: Introduction Little is known about staff attitudes towards coercive interventions (CI) and emotions accompanying these measures. Aim The current study assessed attitudes, views on reflective interventions and accompanying emotions of different occupational groups towards CI, as well as factors, that increase the probability of CI. Method Staff members (N = 138) of a large psychiatric hospital in Germany were assessed using the Staff Attitude to Coercion Scale (SACS) and newly developed items assessing staff members' emotions and views on coercion. Results Experienced staff members were most critical of coercion. Nurses rated coercion significantly more positively than other staff. A majority experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% felt a sense of power. Nurses felt the most desperation. Participants strongly desired reflective measures such as post-seclusion/restraint debriefings with patients. According to staff members, stress on the wards and low staffing increases the probability of CI. Discussion The study assessed accompanying emotions during the application of CI. Attitudes towards coercion and emotions are associated with individual staff characteristics (e.g. profession, work experience). Implications The presence of experienced staff members may help prevent CI. Staff consider reflective interventions helpful in reducing CI.

Coping with Criticism and Embracing Change—Further Reflexions on the Debate on a Mental Health Care System without Coercion

In August 2019, a manuscript was published in this journal that aimed at imagining a mental health care system that renounces the judicial control to better focus on the will and preferences of those who require support. Alternative scenarios for dealing with risk, inpatient care, and police custody were presented that elicited strong and emotionally laden reactions. This article adds further reflections to this debate, aiming at contributing explanations for this unsettlement. A productive notion of criticism is discussed, and ways to achieve change toward a more human rights-oriented psychiatric practice are outlined.

A Visual Dashboard to Monitor Restraint Use in Hospitalized Psychiatry Patients

BACKGROUND

Restraint events are tracked using a duration rate as part of a national psychiatry quality reporting program and tracked annually. Visual dashboards can help track metrics in near real time but are not routinely used in psychiatric settings.

METHODS

This observational study sought to characterize restraint events by extracting electronic medical record data on restraint episodes between January 1, 2017, and December 31, 2019, in five inpatient units in one academic medical center. The data were also used to build a visual dashboard and calculate restraint metrics (duration and frequency) across locations and time.

RESULTS

A total of 540 distinct restraint events occurred during the study period. Highest restraint episode counts occurred during evening shift (54.8%), compared to daytime (37.2%) and nighttime (8.0%) shifts. Highest episode duration rates occurred in an adult unit (61.3% of total hours spent in restraints across all units), while highest episode counts occurred in the adolescent unit (48.3% of all restraint episodes). A visual dashboard with two views (summary and detailed) was created. The summary view integrates patient volume data (total patient hours per month) with total duration and number of episodes per month. The detailed view displays event frequency by hour of day, nursing shift, weekday, and patient length of stay at the time of restraint.

CONCLUSIONS

Visual dashboards can provide timely and efficient access to granular data elements and metrics related to restraint events, beyond the reporting requirement of a national quality program. Visual dashboards can reveal variations in restraint use and yield important opportunities for clinical quality improvement.

Mental health professionals' feelings and attitudes towards coercion

BACKGROUND

Despite absence of clear evidence to assert that the use of coercion in psychiatry is practically and clinically helpful or effective, coercive measures are widely used. Current practices seem to be based on institutional cultures and decision-makers' attitudes towards coercion rather than led by recommendations issued from the scientific literature. Therefore, the main goal of our study was to describe mental health professionals' feelings and attitudes towards coercion and the professionals' characteristics associated with them.

METHOD

Mental health professionals working in the Department of Psychiatry of Lausanne University Hospital, Switzerland, were invited to participate to an online survey. A questionnaire explored participants' sociodemographic characteristics, professional background and current working context, and their feelings and attitudes towards coercion. Exploratory Structural Equation Modelling (ESEM) was used to determine the structure of mental health professionals' feelings and attitudes towards coercion and to estimate to which extent sociodemographic and professional characteristics could predict their underlying dimensions.

RESULTS

130 mental health professionals completed the survey. Even if a large number considered coercion a violation of fundamental rights, an important percentage of them agreed that coercion was nevertheless indispensable in psychiatry and beneficial to the patients. ESEM revealed that professionals' feelings and attitudes towards coercion could be described by four main dimensions labelled "Internal pressure", "Emotional impact", "External pressure" and "Relational involvement". The personal as well as the professional proximity with people suffering from mental disorders influences professionals' feeling and attitudes towards coercion.

CONCLUSIONS

As voices recommend the end of coercion in psychiatry and despite the lack of scientific evidence, many mental health professionals remain convinced that it is a requisite tool beneficial to the patients. Clinical approaches that enhance shared decision making and give the opportunity to patients and professionals to share their experience and feelings towards coercion and thus alleviate stress among them should be fostered and developed.

Influence of nursing staff attitudes and characteristics on the use of coercive measures in acute mental health services-A systematic review

WHAT IS KNOWN ON THE SUBJECT?: Aggressive behaviour is a major problem in clinical practice of mental health care and can result in the use of coercive measures. Coercive measures are dangerous for psychiatric patients and international mental healthcare works on the elimination of these interventions. There is no previous review that summarizes the attitude of nursing staff towards coercive measures and the influence of nursing staff characteristics on attitude towards and the use of coercive measures. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The attitude of nurses shifted from a therapeutic paradigm (coercive measures have positive effects on patients) to a safety paradigm (coercive measures are undesirable, but necessary for the wards' safety). Nurses express the need for less coercive interventions to prevent seclusion and restraint, but their perception of intrusiveness is influenced by how often they use specific coercive measures. The knowledge from scientific literature on the influence of nursing staff on coercive measures is highly inconclusive, although the feeling of safety of nurses might prove to be promising for further research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is need for increased attention specifically for the feeling of safety of nurses, to better equip nurses for their difficult work on acute mental health wards. ABSTRACT: Introduction The use of coercive measures generally has negative effects on patients. To help prevent its use, professionals need insight into what nurses believe about coercion and which staff determinants may influence its application. There is need for an integrated review on both attitude and influence of nurses on the use of coercion. Aim To summarize literature concerning attitude of nurses towards coercive measures and the influence of staff characteristics on the use of coercive measures. Method Systematic review. Results The attitude of nurses changed during the last two decades from a therapeutic to a safety paradigm. Nurses currently view coercive measures as undesirable, but necessary to deal with aggression. Nurses express the need for less intrusive interventions, although familiarity probably influences its perceived intrusiveness. Literature on the relation between staff characteristics and coercive measures is inconclusive. Discussion Nurses perceive coercive measures as unwanted but still necessary to maintain safety on psychiatric wards. Focussing on the determinants of perception of safety might be a promising direction for future research. Implications for practice Mental health care could improve the focus on the constructs of perceived safety and familiarity with alternative interventions to protect patients from unnecessary use of coercive interventions.

Correlates of psychiatric staff's attitude toward coercion and their sociodemographic characteristics

BACKGROUND

A deeper understanding of the nurses' characteristics that influence their positive attitudes toward coercion is necessary if coercive measures rates are to be effectively reduced.

AIM

To identify the difference in psychiatric staff attitudes toward coercive measures in relation to their sociodemographic characteristics.

SETTING

The study conducted at the National Center for Mental Health, which is regulated under the authority of the Jordanian Ministry of Health.

PARTICIPANTS

A total of 85 psychiatric staff recruited from the National Center for Mental Health.

METHODS

A cross-sectional, descriptive, correlational design was used. Data were collected using a self-administered questionnaire, which consisted of 15 items that focused on assessing a staff's attitude toward coercion.

RESULTS

The relationship between clinical unit and attitude toward coercion was significant (r = -.30; P = .006). Similarly, the correlations between gender-based units and attitudes toward coercion were significant (r = -.38; P = .002). Another significant correlation was revealed with different years of experience (r = .22; P = .04).

CONCLUSION

The more years of experience in the field of psychiatric nursing the more positive attitude toward coercion. Moreover, working with male psychiatric patients and in acute psychiatric units increase the risk of coercive measures use.

Propensity to decide on involuntary hospitalisation in primary medical care: Dispositional or situational determinants?

BACKGROUND

The incidence of involuntary hospitalisations varies widely among and within countries. One factor that could account for these variations is the local profile of medical doctors deciding on involuntary admissions. The first goal of this study was to test whether to decide on an involuntary hospitalisation was an individual or a situational disposition. The second goal was to explore doctors' characteristics associated with the use of coercion in specific situations.

METHOD

Medical doctors of four French-speaking Swiss cantons with the competence, according to cantonal laws, to decide on an involuntary hospitalisation were invited to take part in an online survey. Respondents were asked whether they would decide on an involuntary hospitalisation or not in seven clinical vignettes. Propensity to decide on involuntary hospitalisation was estimated with a two-parameter logistic item response model and latent class analysis. Univariate logistic regression models were used to test whether individual factors were associated with the use of coercion in each situation.

RESULTS

192 medical doctors completed the online questionnaire. There was near-zero correlation between vignettes: an involuntary hospitalisation decided on by a doctor in one situation was not related to the use of coercion in another. No subgroup was more prone to generally resort to coercion. However, some individual characteristics were related to the use of coercion in specific situations.

CONCLUSIONS

Medical doctors' propensity to use coercion for mental health problems was better accounted for by situational rather than dispositional factors. Thus, the use of coercion should be examined as a multidimensional concept.

A German Version of the Staff Attitude to Coercion Scale. Development and Empirical Validation

Background: Individual staff factors, such as personality traits and attitudes, are increasingly seen as an important factor in the reduction of coercion in mental health services. At the same time, only a few validated instruments exist to measure those factors and examine their influence on the use of coercion. Aim: The present study aimed to develop and validate a German version of the Staff Attitude to Coercion Scale (SACS). Methods: The original English version of the SACS published was translated into German. Subsequently, it was empirically validated on a sample of N = 209 mental health professionals by conducting an exploratory factor analysis. Results: The three-factor structure in the original version of the SACS, consisting of critical, pragmatic and positive attitudes toward the use of coercion, could not be replicated. Instead, the German version revealed one factor ranging from rejecting to approving the use of coercion. Conclusion: The SACS is one of the first instruments created to assess staff attitudes toward coercion in a validated way. The version of the instrument developed in this study allows for a validated assessment of those attitudes in German. Our results highlight the ethical importance of using validated measurements in studies on the role of staff factors in the reduction of coercion.

Prevalence, predictors, and patterns of mechanical restraint use for inpatients with dual diagnosis

PURPOSE

This study examined the prevalence, predictors, and patterns of mechanical restraint in an inpatient dual diagnosis population.

DESIGN AND METHODS

Data were longitudinally collected from patients affected by severe mental illness and comorbid substance abuse that were hospitalized in three large wards from 2006 to 2012.

FINDINGS

In a sample of 1698 hospitalizations, the use of mechanical restraint ranged between 1% and 4% per year. The diagnosis of schizophrenia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.29-5.40), the use of stimulant substances (OR, 5.68; 95% CI, 2.78-11.59) and male sex (OR, 3.22; 95% CI, 1.12-9.27) were associated with an increased risk of being exposed to mechanical restraint.

PRACTICE IMPLICATIONS

Specialized interventions targeting people at risk of mechanical restraint may further reduce the incidence of restraint and improve treatment outcomes.

Psychiatric staff attitudes toward coercive measures: An experimental design

PURPOSE

To evaluate the effectiveness of a training program on the attitudes of psychiatric nurses toward using coercive measures.

DESIGN AND METHODS

A repeated measures time-series design with two-equivalent groups was used. A convenience sample of 48 psychiatric nurses were recruited. Data collection was conducted using the Staff Attitude to Coercion Scale.

FINDINGS

Results showed the effectiveness of the training program in improving nurses' attitude toward coercive measures. After 4 weeks of the training, nurses in the intervention group demonstrated significant improvements in their attitude mean scores.

PRACTICE IMPLICATIONS

Equipping the psychiatric nurses with essential clinical knowledge and skills concerning the appropriate application of coercive measures policy were imperative issues that might help the nurses in dealing with these clinical complex situations effectively.