The Impact of Coercive Measures on the Therapeutic Relationship Between Patients and Nurses in the Acute Psychiatric Care. An Integrative Review.

Abstract

Introduction: The reduction of coercion requires a stable therapeutic relationship. It is generally assumed that coercive measures have a negative effect on the therapeutic relationship, but little is known about the specific impact.

Question: What is the impact of coercive measures in acute psychiatric care on the therapeutic relationship between nurses and patients?

Method: An integrative review and a thematic analysis were undertaken.

Results: Theme 1, labelled 'Destructive effects', encompasses three subthemes: 'Loss of trust', 'Power imbalance' and 'Engagement reduction' and highlights the negative impact on the therapeutic relationship. Theme 2, entitled 'Nursing dilemma', with the subtheme 'Dehumanisation' discusses the inherent conflicts faced by mental health nurses. Theme 3, 'Reinforcement', suggests potential enhancements in therapeutic relationships.

Discussion: Key characteristics of the therapeutic relationship, such as providing support, meeting at eye level, empathy and trust, can suffer damage from coercive measures and diminish a fundamental aspect of psychiatric nursing. Moreover, the absence of a therapeutic relationship can foster behaviours that prompt additional coercive measures, creating a negative cycle with adverse effects for all involved.

Implications for practice: Nurses need to be aware of the effects of coercive measures on therapeutic relationships and use coercive measures as a last resort.