Nurses' experience with using force in institutional care of psychiatric patients

Abstract

Involuntary psychiatric care has a long tradition and is approved of even in contemporary legislation. To illustrate the experiences of nurses who participate in compulsory treatment, narrative interviews were conducted with a nursing staff (seven registered nurses and seven enrolled nurses). All narrated one to five stories from their personal experience in which force was used against a patient, apart from one who only spoke in general terms about the use of force against patients. The commonest type of situation described was providing coercion in connection with giving a compulsory injection to a patient (n = 11). None of the interviewees wanted to use force against patients, and when situations requiring its use occurred, they wished they did not have to participate. In spite of this they seemed to accept the use of force as a part of their work as psychiatric nurses. The interviewees explained and justified the use of force with examples of weak paternalism: they are the patients' helpers when they are not able to take care of themselves. Although the interviewees had many clear reasons why the use of force is necessary in psychiatric care; nevertheless, its use incurred many feelings of discomfort. They emphasized the importance of the method used when forcing patients and tried to choose a way that avoided violence and struggle. The study points to 1) the need to find alternatives to the use of force and 2) the need for communication between physicians and nursing staff about the use of force.

Key Words:

• Compulsory psychiatric treatment
• Experiences
• Force
• Narrative method
• Nursing staff