Mental Health Nurses' Enforcement of Involuntary Care in Inpatient Settings: A Meta-Ethnography

Mental health nursing practices within inpatient care aim to empower consumers to lead their treatment and recovery. However, involuntary care may be justified for safety reasons. This practice can be traumatising and harmful. Our review explores the enforcement of involuntary care by mental health nurses in inpatient settings utilising meta-ethnography. Searches of articles published over a 10-year period (2014-2024) were conducted in Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE. The searches aimed to identify rich qualitative data on this area of mental health nursing practice. Six articles were selected for inclusion and a reciprocal translation synthesis was undertaken. Three key metaphors emerged: 'a necessary evil', 'the dilemmas of enforcement' and 'perturbed practice'. These metaphors illustrate the complex and often conflicting emotions nurses experience when enforcing involuntary care. Nurses viewed the enforcement of involuntary care as a necessary but difficult practice, justified by the belief that it ultimately benefits the person's safety and well-being. Despite justifying involuntary care as necessary, nurses faced ethical dilemmas balancing patient autonomy, safety and dignity. Enforcing involuntary care caused significant emotional distress for nurses, who experienced discomfort, guilt and moral conflict, questioning their actions and the impact on their relationships with consumers. The findings highlight the importance of minimising restrictive practices and developing supportive frameworks that prioritise patient dignity and autonomy while ensuring safety.