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Thomson AE, Karpa J, Smith N. Psychiatric nurse and educator perspectives on professional boundaries in nursing education: An interpretive description study. J Prof Nurs 2024; 52:80-85. [PMID: 38777530 DOI: 10.1016/j.profnurs.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Psychiatric nurses are responsible for maintaining professional boundaries. However, professional boundaries are as described as unclear and psychiatric nursing students are at risk of crossing these boundaries. Educational instruction regarding professional boundaries within psychiatric nursing often lacks foundational structure placing students at risk of transgressions. PURPOSE The purpose of the study was to describe boundaries in psychiatric nursing practice, identify strategies effective in teaching professional boundaries, and inform curriculum development in psychiatric nursing education. METHOD Interpretive description was utilized to answer: How do psychiatric nurse educators interpret and explain professional boundaries in psychiatric nursing undergraduate education? Psychiatric nurse educators and psychiatric nurses were recruited from an academic institution in western Canada. Twenty participants engaged in semi-structured interviews. Eight of those participants also attended a focus group. RESULT Participants reported that 'textbook' definitions of boundaries were insufficient in illustrating the complexities of the construct. Rather, relational forms of learning such as educators sharing clinical stories, role play activities, clinical supervision, and clinical debriefing were described as helpful strategies. CONCLUSION Foundational knowledge regarding professional boundaries in psychiatric nursing practice appears to be incorporated in the formal curriculum. However, learning is enhanced through the informal and hidden curriculum.
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Venturini P, Bassi G, Salcuni S, Kotzalidis GD, Telesforo CL, Salustri E, Trevisi M, Roselli V, Tarsitani L, Infante V, Niolu C, Polselli G, Boldrini T. Psychometric properties of the Italian version of the staff attitude to coercion scale: an exploratory factor analysis. Front Psychiatry 2023; 14:1172803. [PMID: 37293405 PMCID: PMC10244557 DOI: 10.3389/fpsyt.2023.1172803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Aims The current study aimed to validate the Italian version of the Staff Attitude to Coercion Scale (SACS), which assesses mental health care staff's attitudes to the use of coercion in treatment. Methods The original English version of the SACS was translated into Italian, according to the back-translation procedure. Subsequently, it was empirically validated by performing an exploratory factor analysis on a sample of 217 mental health professionals (Mean = 43.40 years, SD = 11.06) recruited form Italian general hospital (acute) psychiatric wards (GHPWs), with at least 1 year of work experience (i.e., inclusion criteria). Results Results confirmed the three-factor solution of the original version for the Italian version of the SACS, though three items loaded on different factors, compared to the original. The three extracted factors, explained 41% of total variance, and were labeled similarly to the original scale and according to their respective item content, i.e., Factor 1 "Coercion as offending" (items: 3, 13, 14, and 15), Factor 2 "Coercion as care and security" (items: 1, 2, 4, 5, 7, 8, and 9), and Factor 3 "Coercion as treatment" (items: 6, 10, 11, and 12). The internal consistency of the three-factor model of the Italian version of the SACS was assessed through Cronbach's α and yielded acceptable indexes, ranging from 0.64 to 0.77. Conclusion The present findings suggest that the Italian version of the SACS is a valid and reliable tool that can be used to assess healthcare professionals' attitudes toward coercion.
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Affiliation(s)
| | - Giulia Bassi
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Georgios D. Kotzalidis
- Department of NESMOS, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy
| | | | | | | | - Valentina Roselli
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Vittorio Infante
- U.O.C. Psichiatria e Psicologia Clinica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- U.O.C. Psichiatria e Psicologia Clinica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | | | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
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Husum TL, Siqveland J, Ruud T, Lickiewicz J. Systematic literature review of the use of Staff Attitudes to Coercion Scale (SACS). Front Psychiatry 2023; 14:1063276. [PMID: 36824675 PMCID: PMC9941667 DOI: 10.3389/fpsyt.2023.1063276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE Staff's attitudes to the use of coercion may influence the number of coercive interventions employed and staff willingness to engage in professional development projects aimed at reducing the use of coercion itself. The Staff Attitude to Coercion Scale (SACS) was developed to assess the attitudes of mental healthcare staff to the use of coercion in 2008 and has been employed subsequently. This global study systematically reviews and summarizes the use of the scale in research. METHODS Seven databases were searched for studies using SACS in articles published in peer reviewed journals and gray literature. In addition, researchers who have asked for permission to use the scale since its development in 2008 were contacted and asked for their possible results. Extracting of data from the papers were performed in pairs of the authors. RESULTS Of the 82 identified publications, 26 papers with 5,838 respondents were selected for review. A review of the research questions used in the studies showed that the SACS questionnaire was mostly used in studies of interventions aimed at reducing coercion and further explain variation in the use of coercion. CONCLUSION SACS is, to our best of knowledge, the only questionnaire measuring staff's attitudes to the use of coercive interventions in mental health services. Its widespread use indicates that the questionnaire is perceived as feasible and useful as well as demonstrating the need for such a tool. However, further research is needed as the relationship between staff attitudes to coercion and the actual use of coercion remains unclear and needs to be further investigated. Staff attitudes to coercion may be a prerequisite for leaders and staff in mental healthcare to engage in service development and quality improvement projects.
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Affiliation(s)
- Tonje Lossius Husum
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Kraków, Poland
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Thomson AE, Smith N, Karpa J. Strategies Used to Teach Professional Boundaries Psychiatric Nursing Education. Issues Ment Health Nurs 2022; 43:895-902. [PMID: 35708994 DOI: 10.1080/01612840.2022.2083737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Issues in understanding professional boundaries have been reported amongst student psychiatric nurses. Nursing students are at risk of crossing and violating professional boundaries as they are inexperienced in maintaining therapeutic relationships. Despite these challenges, there was a lack of literature regarding boundary instruction in psychiatric nursing education. Interpretative description was applied as method to answer: What strategies do psychiatric nurse educators utilize to teach professional boundaries to undergraduate students? Eleven educators and nine psychiatric nurses were interviewed. Data was analyzed using an inductive approach. Eight participants also attended a focus group to help refine analysis. Boundary instruction strategies included sharing stories, reflective activities, discussion in clinical settings, role modeling, and role play. Boundary instruction should be incorporated into psychiatric nursing curriculum in a deliberate manner to ensure students are exposed to the topic in meaningful ways throughout their academic career.
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Affiliation(s)
- Andrea E Thomson
- Department of Psychiatric Nursing, Brandon University, Winnipeg, Canada
| | - Nadine Smith
- Department of Psychiatric Nursing, Brandon University, Brandon, Canada
| | - Jane Karpa
- Department of Psychiatric Nursing, Brandon University, Winnipeg, Canada
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Efkemann SA, Scholten M, Bottlender R, Juckel G, Gather J. Influence of mental health professionals' attitudes and personality traits on decision-making around coercion: Results from an experimental quantitative survey using case vignettes. Acta Psychiatr Scand 2022; 146:151-164. [PMID: 35322402 DOI: 10.1111/acps.13429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Simone Agnes Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University, Bochum, Germany
| | | | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University, Bochum, Germany
| | - Jakov Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University, Bochum, Germany.,Institute for Medical Ethics and History of Medicine, Ruhr University, Bochum, Germany
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Fukasawa M, Miyake M, Kikkawa T, Sueyasu T. Development of the Japanese version of Staff Attitude to Coercion Scale. Front Psychiatry 2022; 13:1026676. [PMID: 36325534 PMCID: PMC9618617 DOI: 10.3389/fpsyt.2022.1026676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND An important factor in proceeding the efforts to reduce coercion in psychiatry is the attitudes of clinical staff toward its use. We aimed to develop the Japanese version of the Staff Attitude to Coercion Scale (SACS) and clarify its psychometric properties. METHODS After the translation and back-translation of the SACS, which includes 15 items consisting of three subscales, we conducted an anonymous self-administered questionnaire survey of clinical staffs working in 17 wards in two psychiatric hospitals. We administered the second survey to some of the participants to confirm the test-retest reliability. Additionally, we obtained information regarding the 17 wards from the institutions. Internal consistency was assessed using Cronbach's alpha coefficients. Test-retest reliability was assessed using intraclass correlation coefficients (ICC). Structural validity was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). For construct validity, the correlation of the SACS score within wards and its association with the actual use of seclusion/restraints were explored using multilevel multivariate linear regression analyses. RESULTS We used 261 (67.1%) responses, 35 responses of which were also used to examine test-retest reliability. Cronbach's alpha coefficients (0.761) and ICC (0.738) indicated good reliability. The results of CFA based on the original three-dimensional structure did not indicate a good fit (CFA = 0.830, RMSEA = 0.088). EFA suggested a four-factor structure, two of which were almost consistent with the original two subscales. The correlation of the SACS score within wards was confirmed while a positive association with the actual use of seclusion/restraints was not identified. CONCLUSION While the original three-dimensional structure was not replicated, construct validity was partially confirmed. Reliability of the total scale was good. In Japan, although using the subscales was not recommended, using the total scale of SACS seemed acceptable.
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Affiliation(s)
- Maiko Fukasawa
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
| | - Michi Miyake
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takahiro Kikkawa
- Faculty of Nursing, Undergraduate School of Medicine, Tokai University, Isehara, Japan
| | - Tamio Sueyasu
- Department of Nursing, School of Health Sciences, Bukkyo University, Kyoto, Japan
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Husum TL, Ruud T, Lickiewicz J, Siqveland J. Measurement Properties of the Staff Attitude to Coercion Scale: A Systematic Review. Front Psychiatry 2022; 13:744661. [PMID: 35573326 PMCID: PMC9095955 DOI: 10.3389/fpsyt.2022.744661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/22/2022] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Tonje Lossius Husum
- Centre for Medical Ethics, University of Oslo, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Krakow, Poland
| | - Johan Siqveland
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Efkemann SA, Scholten M, Bottlender R, Juckel G, Gather J. A German Version of the Staff Attitude to Coercion Scale. Development and Empirical Validation. Front Psychiatry 2020; 11:573240. [PMID: 33536947 PMCID: PMC7847975 DOI: 10.3389/fpsyt.2020.573240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Simone A Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Ronald Bottlender
- Klinik für Psychiatrie und Psychotherapie, Klinikum Lüdenscheid, Märkische Klinken, Lüdenscheid, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jakov Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.,Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
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