Coercive Measures in Patients Hospitalized in Psychiatric Wards: A Contextual Concept Analysis Using a Hybrid Model

The use of coercive measures in psychiatric settings remains a contentious issue at the intersection of clinical necessity and ethical controversy. This study aimed to analyse the concept of coercive measures in inpatient psychiatric care.

A hybrid concept analysis was conducted. Initially, a comprehensive literature review was performed, encompassing 264 relevant studies. Subsequently, a qualitative phase was conducted in an Iranian psychiatric context, utilizing content analysis to examine 27 semi-structured interviews with patients, family members, and psychiatric staff. Methodological rigor was ensured through data triangulation, including 67 field notes from direct observations of coercive events in clinical practice.

Coercive measures were defined as "explicit or implicit interventions restricting patients' freedom of choice, movement, and self-determination, primarily to control behavioural disturbances and prevent harm." Their use raises ethical dilemmas regarding autonomy, beneficence, nonmaleficence, and dignity, further complicated by a lack of clear guidelines. Findings highlighted the potential for significant physical and psychological harm to patients and staff, sometimes with long-term effects. Perspectives diverged: while staff often emphasized necessity, patients highlighted negative consequences; however, both agreed that many incidents might be preventable through early recognition and management of antecedents.

This conceptual analysis clarifies coercive measures in psychiatry as multifaceted interventions with ethical, clinical, and psychological implications. By systematically defining the concept and identifying its antecedents, the study provides a foundation for developing guidelines that balance patient autonomy and clinical safety. Reducing coercive practices requires addressing underlying triggers while upholding human rights in psychiatric care.