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Attitudes to coercion at two Norwegian psychiatric units

Wynn R, Kvalvik AM, Hynnekleiv T.
Nord J Psychiatry. 2011 Apr;65(2):133-7.

BACKGROUND: Many countries allow for the use of restraint and seclusion in emergencies with psychiatric inpatients. Authors have suggested that the attitudes of staff are of importance to the use of restraint and seclusion.

AIM: To examine the attitudes to coercion at two Norwegian psychiatric units. In contrast to the idea that attitudes to coercion vary much within and between institutions, we hypothesized that staff's attitudes would be quite similar.

METHODS: We distributed a questionnaire to staff at two psychiatric units in two Norwegian counties. Eight wards were included. The questionnaire contained fictitious case histories with one patient that was violent and one patient that was self-harming, and staff were asked to describe how they would intervene in each emergency. Emergency strategies were sorted according to degree of restrictiveness, from the highly restrictive (restraint, seclusion) to the unrestrictive (talking, offering medication). Data were analysed with regression analyses.

RESULTS: There was only a limited degree of variance in how staff at the different units and various groups of staff responded. Staff were more likely to favour a highly restrictive intervention when the patients were physically violent. Male staff and unskilled staff were significantly more prone to choosing a highly restrictive intervention.

CONCLUSIONS: Our hypothesis was confirmed, as there was a limited degree of variance in staff's responses with respect to degree of restrictiveness. The study supported the idea that a range of different interventions are used in emergency situations.

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