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["If certain tensions are present, it affects everyone": Multiple case study on processes of coercive measures.]
Livia Martinelli1, Sandra Siegrist-Dreier2, Nanja Schlup3
1Solothurner Spitäler AG, Schweiz.
Reducing coercive measures in psychiatric care requires understanding patient and staff interactions. Key findings highlight the importance of de-escalation, empathy, and respect during and after coercive events.
Area of Science:
- Psychiatry
- Nursing
- Mental Health Care
Context:
- Urgent need to reduce coercive measures in psychiatric settings.
- Interactions between patients, nursing staff, and medical professionals significantly impact coercive events.
- Coercive measures affect all parties involved, necessitating a holistic approach.
Purpose:
- Describe and compare patient, nurse, and medical professional perspectives on interactions before, during, and after coercive measures.
- Identify potential areas for prevention and quality improvement in psychiatric care.
- Analyze the processes and dynamics of coercive measures through a multiple case study.
Summary:
- Thematic analysis identified three key tension areas: tension/relaxation, humaneness/dehumanisation, and safety/autonomy.
- Pre-coercion stages involve complex tensions, emotions, and stress, often with communication gaps.
- Interaction quality during coercion and post-coercion impacts on individuals and relationships are critical.
Impact:
- De-escalation techniques, focusing on emotional and nonverbal aspects, are crucial for reducing coercion.
- Empathy and respect throughout the process are vital for prevention and quality of care.
- Routine debriefings after coercive measures are recommended for continuous improvement.
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