Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care

BMC Medical Ethics

Reidar Pedersen¹  Bert Molewijk²  Marit Helene Hem¹ 

[1] Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, Oslo NO-0318, Norway;VU Medical Centre, Department Metamedica, EMGO+, Amsterdam, Netherlands

关键词: Mental health care;    Focus group interview;    Ethical challenges;    Coercion;   

Others  :  1089971
DOI  :  10.1186/1472-6939-15-82

 received in 2014-06-26, accepted in 2014-11-21,  发布年份 2014

【 摘 要 】

Background

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

Methods

We conducted seven focus group interviews in three mental health care institutions involving 65 multidisciplinary participants from different clinical fields. The interviews were recorded and transcribed verbatim. We analysed the material applying a ‘bricolage’ approach. Basic ethical principles for research ethics were followed. We received permission from the hospitals’ administrations and all health care professionals who participated in the focus group interviews.

Results

Health care practitioners describe ethical dilemmas they face concerning formal, informal and perceived coercion. They provide a complex picture. They have to handle various ethical challenges, not seldom concerning questions of life and death. In every situation, the dignity of the patient is at stake when coercion is considered as morally right, as well as when coercion is not the preferred intervention. The work of the mental health professional is a complicated “moral enterprise”.

The ethical challenges deserve to be identified and handled in a systematic way. This is important for developing the quality of health care, and it is relevant to the current focus on reducing the use of coercion and increasing patient participation. Precise knowledge about ethical challenges is necessary for those who want to develop ethics support in mental health care. Better communication skills among health care professionals and improved therapeutic relationships seem to be vital.

Conclusions

A systematic focus on ethical challenges when dealing with coercion is an important step forward in order to improve health care in the mental health field.

【 授权许可】

   
2014 Hem et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Gilburt H, Rose D, Slade M: The importance of relationships in mental health care: a qualitative study of service users’ experiences of psychiatric hospital admission in the UK. BMC Health Serv Res 2008, 8:92. doi:10.1186/1472-6963-8-92 BioMed Central Full Text
• [2]Landeweer E, Abma T, Widdershoven G: Moral margins concerning the use of coercion in psychiatry. Nurs Ethics 2011, 18(3):304-316.
• [3]Austin W, Kagan L, Rankel M, Bergum V: The balancing act: psychiatrists’ experience of moral distress. Med Health Care Phil 2008, 11:89-97.
• [4]Bigwood S, Crowe M: ’It’s part of the job, but it spoils the job’: a phenomenological study of physical restraint. Int J Ment Health Nurs 2008, 17:215-222.
• [5]Vatne S, Fagermoen MS: To correct and to acknowledge: two simultaneous and conflicting perspectives of limit-setting in mental health nursing. J Psychiatr Ment Health Nurs 2007, 14:41-48.
• [6]Vatne S, Hoem E: Acknowledging communication: a milieu-therapeutic approach in mental health care. J Adv Nurs 2007, 61(6):690-698.
• [7]Vatne S, Bjornerem H, Hoem E: Development of professional knowledge in action: experiences from an action science design focusing on acknowledging communication in mental health. Scand J Caring Sci 2008, 23:84-92.
• [8]Lind M, Kaltiala-Heino R, Suominen T, Leino-Kilpi H, Välimäki M: Nurses’ ethical perceptions about coercion. J Psychiatr Ment Health Nurs 2004, 11(4):379-385.
• [9]Vuckovich P-K, Artinian B-M: Justifying coercion. Nurs Ethics 2005, 12(4):370-380.
• [10]Frey JH, Fontana A: The group interview in social research. Soc Sci J 1991, 28(2):175-187.
• [11]Morgan DL: Focus Groups as Qualitative Research. 2nd edition. Thousand Oaks: SAGE Publications; 1997.
• [12]Giacomini MK, Cook DJ: Users’ guides to the medical literature. XXIII. Qualitative research in health care. A. Are the results of the study valid? JAMA 2000, 284(3):357-362.
• [13]Madriz E: Focus groups in feminist research. In Handbook of Qualitative Research. 2nd edition. Edited by Denzin NK, Lincoln YS. London: Sage Publications; 2000:835-850.
• [14]Kidd PS: Getting the focus and the group: enhancing analytical rigor in focus group research. Qual Health Res 2000, 10:293-308.
• [15]Litosseliti L: Using Focus Groups in Research. Continuum: London, New York; 2003.
• [16]Stewart DW, Shamdasani PN, Rook DW: Focus Groups. Theory and Practice. 2nd edition. Thousand Oaks: Sage; 2007.
• [17]Krueger RA, Casey MA: Focus Groups. A Practical Guide for Applied Research. 4th edition. Los Angeles: Sage; 2009.
• [18]Declaration of Helsinki. 2013. Downloaded 1/10/2014: [http://www.wma.net/en/30publications/10policies/b3/ webcite]
• [19]Kvale S, Brinkmann S: InterViews. Learning the Craft of Qualitative Research Interviewing. 2nd edition. Los Angeles: Sage; 2009.
• [20]Tanggaard L, Brinkmann S: Intervjuet. Samtalen som forskningsmetode. In The Interview. The Dialogue as Research Method. Edited by Brinkmann S, Tanggaard L. Copenhagen: Hans Reitzels Forlag; 2010:29-54. [Kvalitative metoder – en grundbog. (Qualitative methods – an introduction)] in Danish
• [21]Whittemore R, Chase SK, Mandle CL: Validity in qualitative research. Qual Health Res 2001, 11:522-537.
• [22]Brinkmann S: Qualitative Interviewing. Understanding Qualitative Research. Oxford: Oxford University Press; 2013.
• [23]Norwegian Social Science Data Services: Downloaded 10/10/2014http://www.nsd.uib.no/personvern/en/index.html webcite
• [24]Regional Committee for Medical and Health Research Ethics: Downloaded 10/10/2014https://helseforskning.etikkom.no/ikbViewer/page/komiteerogmoter/alle?p_dim=34677&_ikbLanguageCode=us webcite
• [25]ACT 2008-06-20 no. 44: Act on Medical and Health research (the Health Research Act): Downloaded 10/10/2014. http://www.ub.uio.no/ujur/ulovdata/lov-20080620-044-eng.pdf webcite
• [26]Sjöström S: Invocation of coercion context in compliance communication – power dynamics in psychiatric care. Int J Law Psychol 2006, 29:36-47.
• [27]Hem MH: Mature care? An empirical study of interaction between psychotic patients and psychiatric nurses. In PhD Thesis. Oslo: University of Oslo; 2008.
• [28]Priebe S, McCabe R: Therapeutic relationships in psychiatry: the basis of therapy or therapy itself? Int Rev Psychol 2008, 20:521-526.
• [29]Theodoridou A, Schlatter F, Ajdacic V, Rössler W, Jäger M: Therapeutic relationship in the context of perceived coercion in a psychiatric population. Psychiatr Res 2012, 200:939-944.
• [30]Kjellin L, Westrin C-G, Eriksson K, Axelsson-Östmann M, Candefjord I-L, Ekblom B, Machl M, Ängfors G, Östman O: Coercion in psychiatric care: problems of medical ethics in a comprehensive empirical study. Behav Sci Law 1993, 11(3):323-334.
• [31]Kjellin K, Andersson K, Candefjord I-L, Palmstierna T, Wallsten T: Ethical benefits and costs of coercion in short-term inpatient psychiatric care. Psychiatr Serv 1997, 48(12):1567-1570.
• [32]Johansson IM, Lundman B: Patients’ experience of involuntary psychiatric care: good opportunities and great losses. J Psychol Ment Health Nurs 2002, 9(6):639-647.
• [33]Johansson IM, Skärsäter I, Danielson E: The meaning of care on a locked acute psychiatric ward. Nord J Psychol 2009, 63:501-507.
• [34]Bennett NS, Lidz CW, Monahan J, Mulwy EP, Hoge SK, Roth LH, Gardner W: Inclusion, motivation and good faith: The morality of coercion in mental health hospital admission. Behav Sci Law 1993, 11(3):295-306.
• [35]Van den Hooff S, Goossensen A: How to increase quality of care during coercive admission? A review of literature. Scand J Caring Sci 2013. doi:10.1111/scs.12070
• [36]Radden J, Sadler JZ: The Virtuous Psychiatrist. Character Ethics in Psychiatric Practice. Oxford/New York: Oxford University Press; 2010.
• [37]Lillemoen L, Pedersen R: Ethical challenges and how to develop ethics support in primary health care. Nurs Ethics 2013, 20(1):96-108.
• [38]Landeweer E, Abma T, Widdershoven G: The essence of psychiatric nursing. Redefining nurses’ identity through moral dialogue about reducing the use of coercion and restraint. Adv Nurs Sci 2010, 33(4):E31-E42.
• [39]Reiter-Teil S, Mertz M, Schürmann J, Giles NS, Meyer-Zehnder B: Evidence-competence-discourse: The theoretical framework of the multi-centre clinical ethics support project METAP. Bioethics 2011, 25(7):403-412.
• [40]Widdershoven G, Molewijk B, Abma T: Improving care and ethics: a plea for interactive empircal ethics. Am J Bioethics 2009, 9(6–7):99-101.