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Di Lorenzo R, Mucchi F, Magnani N, Starace F, Bonisoli J, Bottone C, Ragazzini I, Ferri P, Marrama D. Staff Attitude Towards Coercive Measures in Hospital and Community Psychiatric Settings. J Clin Med 2025; 14:2886. [PMID: 40363919 PMCID: PMC12073010 DOI: 10.3390/jcm14092886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2025] [Revised: 04/13/2025] [Accepted: 04/19/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: The use of coercive measures in psychiatry is an ethically controversial issue. Staff attitude towards coercive measures could explain the different application frequencies of coercive measures across psychiatric services. Methods: We analyzed the attitude towards coercion held by professionals working in a psychiatric department using the Staff Attitude to Coercion Scale (SACS). We statistically evaluated the correlation between the SACS score and the demographic and work characteristics of professionals. Results: The most represented category of participants was nurses (73.03%). Most professionals worked in a Mental Health Community Service (MHCS) (72.09%). We reported a score of 41.9 ± 8.8 SD in total SACS and high scores in two SACS factors: "Coercion as offending" and "Coercion as care and security". Professionals working in Service for Psychiatric Diagnosis and Care (SPDC) showed reduced scores in total SACS and the SACS dimension "Coercion as offending" score. Place of work, particularly "working in SPDC", was statistically significantly associated with total SACS in a positive way and with the "Coercion as offending" score in a negative way in our regression multivariate test. Conclusions: Our professionals showed a predominantly critical and pragmatic attitude towards coercive measures. The professionals who are more frequently exposed to violent and aggressive behavior, such as those who work in SPDC, showed a reduced critical attitude towards coercion in comparison with those working in MHCS, suggesting that exposure to violence can shape the response of professionals.
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Affiliation(s)
- Rosaria Di Lorenzo
- Department of Mental Health and Drug Abuse, AUSL-Modena, 41121 Modena, Italy;
| | - Francesca Mucchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (F.M.); (P.F.)
| | - Nadia Magnani
- Adult Mental Health Functional Unit, ASL Toscana Sud-Est, 58100 Grosseto, Italy;
| | - Fabrizio Starace
- Department of Mental Health and Drug Abuse, ASL TO5, 10024 Moncalieri, Italy;
| | - Jessica Bonisoli
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (J.B.); (C.B.); (I.R.)
| | - Carolina Bottone
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (J.B.); (C.B.); (I.R.)
| | - Ilaria Ragazzini
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (J.B.); (C.B.); (I.R.)
| | - Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (F.M.); (P.F.)
| | - Donatella Marrama
- Department of Mental Health and Drug Abuse, AUSL-Modena, 41121 Modena, Italy;
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Eder N, Nordenberg K, Långström N, Rozental A, Moell A. Moral distress among inpatient child and adolescent psychiatry staff: a mixed-methods study of experiences and associated factors. Child Adolesc Psychiatry Ment Health 2025; 19:16. [PMID: 40022125 PMCID: PMC11871634 DOI: 10.1186/s13034-025-00868-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 02/10/2025] [Indexed: 03/03/2025] Open
Abstract
BACKGROUND Moral distress among healthcare staff is associated with emotional strain and workforce attrition but remains insufficiently explored in child and adolescent psychiatry (CAP). We investigated the experiences and factors contributing to moral distress among staff in inpatient CAP. METHODS We conducted a 2023 nationwide mixed-methods survey with 106 staff members from CAP inpatient units in Sweden. Quantitative data on moral distress were collected using the Stress of Conscience Questionnaire, while open-ended questions provided qualitative data on perceptions of moral distress and the impact of working with coercive measures. Findings were integrated using triangulation. RESULTS Staff reported high levels of moral distress, with physicians experiencing the highest. Triangulation revealed converging findings with younger and less experienced staff experiencing more moral distress. Aligning with the qualitative theme "Providing care one does not believe in", moral distress was also strongly associated with quantitative data of a demanding work environment, low social support, and intention to resign from job. The theme "Ethical dilemmas about coercive measures" indicated how coercive measure use could contribute to moral distress, while a more positive attitude to coercive measures was associated with lower moral distress. CONCLUSIONS Moral distress among CAP inpatient staff in Sweden was pronounced, particularly among younger, less experienced professionals, and physicians. Addressing moral distress appears critical in supporting staff well-being, promoting workforce retention, and maintaining high-quality patient care.
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Affiliation(s)
- Nora Eder
- Stockholm Centre for Eating Disorders, Region Stockholm, Stockholm, Sweden
| | - Kristin Nordenberg
- Child and Adolescent Psychiatric Services, Region Stockholm, Stockholm, Sweden
| | - Niklas Långström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Astrid Moell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
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Varpula J, Ameel M, Lantta T. Attitudes of nurses and nurse managers towards violence risk assessment and management: A cross-sectional study in psychiatric inpatient settings. J Psychiatr Ment Health Nurs 2024; 31:1109-1119. [PMID: 38847609 DOI: 10.1111/jpm.13069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 04/02/2024] [Accepted: 05/29/2024] [Indexed: 11/06/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT Workplace violence is a significant challenge in psychiatric hospital care. Some existing practices of violence risk assessment and management are based on nurses' intuition and clinical experience instead of structured tools. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Nurses and nurse managers consider violence risk assessment and management their responsibility. Still, nurses and nurse managers have mixed attitudes towards the use of validated risk assessment tools. The attitudes towards service users' positive risk-taking in nurses and nurse managers vary, with some nurses and nurse managers supporting its importance. WHAT ARE THE IMPLICATIONS FOR PRACTICE Change in nurses' and nurse managers' attitudes towards risk assessment tools is required before their implementation into practice. More profound change in practices towards recovery-oriented care is required also in risk assessment. ABSTRACT INTRODUCTION: Workplace violence is a prevalent issue in psychiatric inpatient care. Prevention efforts require the identification of at-risk service users using validated violence risk assessment tools. The shift in violence prevention emphasises preventive measures and collaborative risk assessment together with service users. Nurses have a central role in this process. Therefore, their attitudes are crucial when implementing evidence-based methods. AIM To assess the attitudes of nurses and nurse managers towards violence risk assessment and management. METHOD A cross-sectional online survey in Finnish psychiatric inpatient care. Data analysis was conducted with statistical methods. The STROBE guideline was used in reporting. RESULTS Nurses (n = 142) valued risk assessment and felt that it was their responsibility. Attitudes towards service users' risk-taking as part of their recovery varied. Nurses had mixed attitudes regarding the effectiveness of risk assessment tools. Older participants and nurse managers had more positive attitudes towards risk assessment tools. DISCUSSION The study findings highlight a feeling of responsibility of nurses towards violence risk assessment and at the same time their preference towards their own clinical judgement. IMPLICATIONS FOR PRACTICE Understanding nurses' attitudes is crucial in training and implementation processes to address concerns, provide support and enhance positive attitudes.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maria Ameel
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia
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Aluh DO, Diaz-Milanes D, Pedrosa B, Silva M, Grigaitė U, Almeida CR, de Almeida Mousinho MF, Vieira M, Cardoso G, Caldas-de-Almeida JM. Coercion in psychiatry: psychometric validation of the Portuguese Staff Attitudes to Coercion Scale (SACS). DISCOVER MENTAL HEALTH 2024; 4:27. [PMID: 39141248 PMCID: PMC11324637 DOI: 10.1007/s44192-024-00083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND There is a growing recognition that staff attitudes toward coercion in mental health care may influence its application. This study presents the psychometric properties of the Portuguese version of the Staff Attitudes towards Coercion Scale (SACS) and describes mental health professionals' attitudes towards coercion in Portugal. METHODS Mental health professionals working in five Portuguese mental health services in urban and rural regions of Portugal were invited to complete a questionnaire comprising the SACS and a socio-demographic form. Psychometric analyses including construct validity and internal consistency were carried out using R software. RESULTS A total of 91 out of 119 questionnaires completed were valid for analysis. Fifty-seven (62.64%) respondents were female, with an age range of 24 to 69 years (M = 39.33; SD = 11.09). More than half of them were nurses (52.75%, n = 48), and a third were psychiatrists (36.26%, n = 33). A three-factor structure was confirmed and showed the best fit compared to previously proposed models with a cumulative explained variance of 59%. The Portuguese SACS exhibited adequate internal consistency for both the full-scale and subscales. The highest mean score was in the pragmatic attitude domain (20.60; SD = 3.37). A negative correlation was observed between the critical attitude domain and both age and years of experience (p < 0.05). CONCLUSION A three-factor structure was confirmed and showed the best fit compared to previously proposed models. The Portuguese SACS showed excellent psychometric properties and is acceptable for assessing staff attitudes towards coercion.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka, Nigeria.
| | - Diego Diaz-Milanes
- Department of Quantitative Methods, Universidad Loyola Andalusia, Seville, Spain
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Manuela Silva
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Carolina Rocha Almeida
- Serviço de Psiquiatria E Saúde Mental de Adultos, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | | | - Margarida Vieira
- Centro Hospitalar De Vila Nova De Gaia/Espinho, E.P.E.| V. N. Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Comprehensive Health Research Centre (Chrc), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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Efkemann SA, Lickiewicz J, Doedens P, Lantta T, Bali P, Husum TL. A Scoping Review on Staff Attitudes towards the Use of Coercion in Mental Healthcare. Healthcare (Basel) 2024; 12:1552. [PMID: 39201112 PMCID: PMC11354183 DOI: 10.3390/healthcare12161552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/02/2024] Open
Abstract
Attitudes of mental health professionals towards the use of coercion are highly relevant concerning its use coercion in mental healthcare, as mental health professionals have to weigh ethical arguments and decide within a legal frame in which situations to use coercion or not. Therefore, assessment of those attitudes is relevant for research in this field. A vital instrument to measure those attitudes towards the use of coercion is the Staff Attitude to Coercion Scale. This scoping review aims to provide a structured overview of the advantages and limitations in the assessment of attitudes toward coercion. We conducted a scoping review in Medline, PsycINFO, CINAHL, and Web of Science, based on the PRISMA-ScR. Inclusion criteria were empirical studies on the attitudes of mental health professionals. We included 80 studies and systematically mapped data about the main results and limitations in assessing attitudes toward coercion. The main results highlighted the relevance and increased interest in staff attitudes towards coercion in mental healthcare. Still, the majority of the included studies relied on a variety of different concepts and definitions concerning attitudes. The data further indicated difficulties in developing new and adapting existing assessment instruments because of the equivocal definitions of underlying concepts. To improve the research and knowledge in this area, future studies should be based on solid theoretical foundations. We identified the need for methodological changes and standardized procedures that take into account existing evidence from attitude research in social psychology, nursing science, and other relevant research fields. This would include an update of the Staff Attitude to Coercion Scale based on the limitations identified in this review.
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Affiliation(s)
- Simone Agnes Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, 44791 Bochum, Germany
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, 31-501 Krakow, Poland
| | - Paul Doedens
- Department of Psychiatry, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Urban Vitality—Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
| | - Tella Lantta
- Department of Nursing Science, University of Turku, 20014 Turku, Finland;
- Centre for Forensic Behavioural Sciences, Swinburne University of Technology, Melbourne 3122, Australia
| | - Panagiota Bali
- Second Department of Psychiatry, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Chaidari, Greece
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Wullschleger A, Chatton A, Kuenzi N, Baeriswyl R, Kaiser S, Bartolomei J. Experience of violence and attitudes of staff members towards coercion in psychiatric settings: observational study. BJPsych Open 2024; 10:e80. [PMID: 38616714 PMCID: PMC11060063 DOI: 10.1192/bjo.2024.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Among important dimensions related to the use of coercive measures, professionals' attitude towards coercion is of particular interest. Little is known about how experiences of violence in the workplace might influence these attitudes. AIMS The present study aimed to investigate potential correlates of attitudes towards coercion, especially experiences of violence in the workplace. METHOD Mental health professionals were contacted through an online survey to assess their attitudes towards coercion using the Staff Attitude to Coercion Scale (SACS). The three subscales of the SACS (critical, pragmatic and positive attitudes) were analysed in a multivariate multiple linear regression, using a set of covariates including experiences of violence in the workplace. We hypothesised that experience of violence in the workplace would correlate with less critical attitudes of staff members towards coercion. RESULTS A total of 423 professionals were included in the regression analysis. Age, professional category, feeling of insecurity, having witnessed or used coercion, and the emotional burden associated with coercive measures had a joint significant effect on the three SACS subscales. A feeling of insecurity, but not the experience of violence, was associated with a less critical, more positive appraisal of coercive measures. The emotional burden related to the use of coercion was associated with a more critical attitude. CONCLUSIONS The present results highlight the importance of considering staff members' training and well-being regarding their feelings of insecurity when addressing attitudes towards coercion. The experience of patients should be integrated into staff training and coercion reduction programmes.
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Affiliation(s)
| | - Anne Chatton
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Noémie Kuenzi
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rachel Baeriswyl
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Javier Bartolomei
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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