Using consentless practices on medical wards-A qualitative study

BackgroundIn contrast to legally mandated coercive care in psychiatry, there is a paucity of studies on the use of coercive practices within somatic healthcare.AimTo gain an in-depth understanding of the practices used by nurses and other staff to provide somatic healthcare interventions to ill patients in the absence of informed consent.Research designFocus-group interviews were held, and the collected data were analyzed qualitatively using Reflexive Thematic Analysis.Participants and research contextParticipants (n = 37, mainly nurses) from medical wards at two Swedish hospitals.Ethical considerationsAll participants were informed about the study's aims and voluntary nature, and provided oral consent before being interviewed. No sensitive personal information was recorded.FindingsThe qualitative analysis resulted in the identification of four main themes: Consentless practices are used all the time; "Good examples" of consentless practices are learned on the ward; Choosing and adopting consentless practices to suit the situation; and Professional experience influences the use of consentless practices.ConclusionsConsentless practices are frequently used on medical wards, and nurses and other staff are familiar with a wide array of such practices. Consentless practices are learned informally, mainly through observation. Staff with greater professional experience can deliver healthcare interventions without overt coercion, but may become habituated to using consentless practices. These findings raise a range of ethical concerns. Better opportunities for reflection and learning on this topic may improve the ethical climate on medical wards.