Coercive Measures in Patients Hospitalized in Psychiatric Wards: A Contextual Concept Analysis Using a Hybrid Model.

Abstract

Introduction: The use of coercive measures in psychiatric settings remains a contentious issue at the intersection of clinical necessity and ethical controversy. This study aimed to analyse the concept of coercive measures in inpatient psychiatric care.

Methods: A hybrid concept analysis was conducted. Initially, a comprehensive literature review was performed, encompassing 264 relevant studies. Subsequently, a qualitative phase was conducted in an Iranian psychiatric context, utilizing content analysis to examine 27 semi-structured interviews with patients, family members, and psychiatric staff. Methodological rigor was ensured through data triangulation, including 67 field notes from direct observations of coercive events in clinical practice.

Results: Coercive measures were defined as "explicit or implicit interventions restricting patients' freedom of choice, movement, and self-determination, primarily to control behavioural disturbances and prevent harm." Their use raises ethical dilemmas regarding autonomy, beneficence, nonmaleficence, and dignity, further complicated by a lack of clear guidelines. Findings highlighted the potential for significant physical and psychological harm to patients and staff, sometimes with long-term effects. Perspectives diverged: while staff often emphasized necessity, patients highlighted negative consequences; however, both agreed that many incidents might be preventable through early recognition and management of antecedents.

Conclusion: This conceptual analysis clarifies coercive measures in psychiatry as multifaceted interventions with ethical, clinical, and psychological implications. By systematically defining the concept and identifying its antecedents, the study provides a foundation for developing guidelines that balance patient autonomy and clinical safety. Reducing coercive practices requires addressing underlying triggers while upholding human rights in psychiatric care.