Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain

Luis Nocete Navarro; Víctor  López de Loma Osorio; María Fe  Bravo Ortiz; Alberto Fernández Liria

doi:10.18294/sc.2021.3045

Salud mental y derechos humanos: La experiencia de los profesionales en formación en el uso de sujeciones mecánicas en Madrid, España

https://doi.org/10.18294/sc.2021.3045

Publicado 23 marzo 2021

Luis Nocete Navarro Psiquiatra. Unidad de Hospitalización Breve, Área de Gestión Clínica de Psiquiatría y Salud Mental, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España. , Víctor López de Loma Osorio Residente de Psiquiatría. Área de Gestión Clínica de Psiquiatría y Salud Mental, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España. , María Fe Bravo Ortiz Psiquiatra. Jefa de Servicio de Psiquiatría y Salud Mental, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España. , Alberto Fernández Liria Psiquiatra. Profesor Honorífico, Universidad de Alcalá, Alcalá de Henares, España.

PDF

PDF (English)

Vistas de resumen

2047

Cargando métricas ...

Palabras clave:

Salud Mental, Restricción Física, Inmovilización, Investigación Cualitativa, Derechos Humanos, Coerción, España

Resumen

La sujeción mecánica en psiquiatría es un procedimiento permitido en España que despierta importantes conflictos éticos. Diversos estudios sostienen que su uso depende de factores no clínicos, como las experiencias de los profesionales y las influencias del contexto, más que de factores clínicos (diagnósticos o síntomas). El objetivo del estudio es comprender las experiencias de profesionales de salud mental en formación en relación con el uso de sujeciones en la red de salud mental de Madrid. Es un estudio cualitativo de tipo fenomenológico mediante grupos focales, realizados en 2017. Las entrevistas fueron transcritas para su discusión y análisis temático mediante Atlas.ti. Los resultados descriptivos sugieren que estas medidas producen malestar y conflicto con relación al rol de cuidador y se observan estrategias de adaptación a los mismos. A partir de los hallazgos, se reflexiona acerca de aspectos de sus experiencias y del contexto que influyen en su uso, así como de las contradicciones del cuidado en la práctica clínica.

Referencias bibliográficas

1. Huertas García-Alejo R. Historia cultural de la psiquiatría. Madrid: La Catarata; 2012.

2. Kallert TW, Mezzich JE, Monahan J. Coercive treatment in psychiatry: Clinical, legal and ethical aspects. West Sussex: John Wiley & Sons; 2011.

3. Kirk SA, Gomory T, Cohen D. Mad Science: Psychiatric coercion, diagnosis, and drugs. New Brunswick: Transaction Publishers; 2013.

4. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. Means of restraint in psychiatric establishments for adults (Revised CPT standards) [Internet]. Estrasburgo; 2017 [citado 10 mar 2020]. Disponible en: https://rm.coe.int/16807001c3.

5. España, Jefatura del Estado. Ley 1/2000, de 7 de enero, de Enjuiciamiento Civil [Internet]. BOE-A-2000-323 [citado 10 mar 2020]. Disponible en: https://tinyurl.com/w7dywu9f.

6. Inchauspe Aróstegui JA, Valverde Eizaguirre M. La coerción en Salud Mental: conceptos, procesos y situación. En: Beviá B, Bono Á, editores. Coerción y salud mental: revisando las prácticas de coerción en la atención a las personas que utilizan los servicios de salud mental. Madrid: Asociación Española de Neuropsiquiatría; 2017. p. 13-89.

7. Kallert TW, Mezzich JE, Monahan J. Introduction. En: Kallert TW, Mezzich JE, Monahan J, editors. Coercive treatment in psychiatry: Clinical, legal and ethical aspects. West Sussex: John Wiley & Sons; 2011. p. xi–xxii.

8. Mayoral F, Torres F, Group Eunomia. Use of coercive measures in psychiatry. Actas Españolas de Psiquiatría. 2005;33(5):331-338.

9. Kallert TW, Glöckner M, Onchev G, Raboch J, Karastergiou A, Solomon Z, et al. The EUNOMIA project on coercion in psychiatry: study design and preliminary data. World Psychiatry. 2005;4(3):168-172.

10. Simpson SA, Joesch JM, West II, Pasic J. Risk for physical restraint or seclusion in the psychiatric emergency service (PES). General Hospital Psychiatry. 2014;36(1):113-118.

11. Raguan B, Wolfovitz E, Gil E. Use of physical restraints in a general hospital: a Cross-sectional observational study. Israel Medical Association Journal. 2015;17:633-638.

12. Krüger C, Mayer H, Haastert B, Meyer G. Use of physical restraints in acute hospitals in Germany : A multi-centre cross-sectional study. International Journal of Nursing Studies. 2013;50:1599-1606.

13. Foebel AD, Onder G, Finne-soveri H, Lukas A, Denkinger MD, Carfi A, et al. Physical restraint and antipsychotic medication use among nursing home residents with dementia. Journal of the American Medical Directors Association. 2016;17(2):184.e9-184.e14.

14. Hui A, Middleton H, Völlm B. The uses of coercive measures in forensic psychiatry: A literature review. In: Völlm B, Nedopil N, editors. The use of coercive measures in forensic psychiatric care: Legal, ethical and practical challenges. Switzerland: Springer; 2016. p. 151-184.

15. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. CPT/Inf (2017) 34, Section: 24/41, Date: 06/04/2017, B Prison establishments, 5 Means of restraint [Internet]. 2017 [10 mar 2020]. Disponible en: https://tinyurl.com/5h53bdym.

16. Steinert T, Lepping P. Legal provisions and practice in the management of violent patients: A case vignette study in 16 European countries. European Psychiatry. 2009;24(2):135-141.

17. Steinert T, Lepping P, Bernhardsgrütter R, Conca A, Hatling T, Janssen W, et al. Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends. Social Psychiatry and Psychiatric Epidemiology. 2010;45(9):889-897.

18. Sashidharan S, Mezzina R, Puras D. Reducing coercion in mental healthcare. Epidemiology and Psychiatric Sciences. 2019;28(6):605-612.

19. Pértega E. Health professionals’ decision making process about the use of physical restraints in inpatient pediatric psychiatric units in Madrid. New York University, Universidad Autónoma de Madrid; 2015.

20. Organización de las Naciones Unidas. Convención sobre los derechos de las personas con discapacidad [Internet]. Nueva York; 2006 [citado 10 mar 2020]. Disponible en: https://tinyurl.com/49f6p5bn.

21. Naciones Unidas, Asamblea General. Informe del Relator Especial sobre la tortura y otros tratos o penas crueles, inhumanos o degradantes [Internet]. Naciones Unidas; 2016 [citado 10 mar 2020]. Disponible en: https://tinyurl.com/dvw9t34e.

22. Consejo de Derechos Humanos. Informe del Relator Especial sobre el derecho de toda persona al disfrute del más alto nivel posible de salud física y mental [Internet]. 2017 [citado 10 mar 2020]. Disponible en: https://tinyurl.com/wcj85urf.

23. Szmukler G. Compulsion and “coercion” in mental health care. World Psychiatry. 2015;14(3):259-261.

24. Brodwin P. The ethics of ambivalence and the practice of constraint in US psychiatry. Culture, Medicine and Psychiatry. 2014;38(4):527-549.

25. Sweeney A, Filson B, Kennedy A, Collinson L, Gillard S. A paradigm shift: relationships in trauma-informed mental health services. BJPsych Advances. 2018;24(5):319-333.

26. Sailas E, Fenton M. Seclusion and restraint for people with serious mental illnesses. Cochrane Database Syst Rev. 2000;(1):CD001163.

27. Luciano M, Sampogna G, Vecchio V Del, Pingani L, Palumbo C, Rosa C De, et al. Use of coercive measures in mental health practice and its impact on outcome: a critical review. Expert Review of Neurotherapeutics. 2014;14(2):131-141.

28. Cusack P, Cusack FP, McAndrew S, McKeown M, Duxbury J. An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings. International Journal of Mental Health Nursirg. 2018;27(3):1162-1176.

29. Cusack P, Mcandrew S, Cusack F, Warne T. Reviewing evidence of the effects of restraint from the perspective of service users and mental health professionals in the United Kingdom (UK). International Journal of Law and Psychiatry. 2016;46:20-26.

30. Rose D, Evans J, Laker C, Wykes T. Life in acute mental health settings: experiences and perceptions of service users and nurses. Epidemiology of Psychiatric Sciences. 2015;24(1):90-96.

31. Duxbury JA. The Eileen Skellern Lecture 2014: physical restraint : in defence of the indefensible? Journal of Psychiatric and Mental Health Nursing. 2015;22(2):92-101.

32. Rakhmatullina M, Taub A, Jacob T. Morbidity and mortality associated with the utilization of restraints: A review of literature. The Psychiatric Quarterly. 2013;84(4):499-512.

33. Muskett C. Trauma-informed care in inpatient mental health settings : A review of the literature. International Journal of Mental Health Nursing. 2014;23(1):51-59.

34. Colectivo Locomún. #0 Contenciones [Internet]. 2018 [citado 25 sep 2019]. Disponible en: https://tinyurl.com/hmwpnzx6.

35. Gooding P, Mcsherry B, Roper C, Grey F. Alternatives to coercion in mental health settings : A literature review [Internet]. Melbourne: Melbourne Social Equity Institute, University of Melbourne; 2018 [citado 10 sep 2019]. Disponible en: https://tinyurl.com/3y7jf98y.

36. Comisión de Sanidad y Servicios Sociales. Proposición no de Ley presentada por el Grupo Parlamentario Ciudadanos, relativa a la eliminación de las sujeciones mecánicas en el ámbito asistencial: Aprobación con modificaciones así como enmiendas formuladas. Boletín Oficial de las Cortes Generales Madrid [Internet]. 2017 [citado 10 sep 2019]. Disponible en: https://tinyurl.com/pw4kvsww.

37. Hem MH, Gjerberg E, Husum TL, Pedersen R. Ethical challenges when using coercion in mental healthcare: A systematic literature review. Nursing Ethics. 2016;25(1):92–110.

38. Winship G. Further thoughts on the process of restraint. Psychiatric and Mental Health Nursing. 2006;13:55-60.

39. Beviá B, Girón M. Poder, estigma y coerción: Escenarios para una práctica no autoritaria en salud mental. Revista de la Asociación Española de Neuropsiquiatría. 2017;37(132):321-329.

40. Canvin K, Rugkåsa J, Sinclair J, Burns T. Leverage and other informal pressures in community psychiatry in England. International Journal of Law and Psychiatry. 2013;36(2):100-106.

41. Raboch J, Kališová L, Nawka A, Kitzlerová E, Onchev G, Karastergiou A, et al. Use of Coercive Measures During Involuntary Hospitalization: Findings From Ten European Countries. Psychiatr Services. 2010;61(10):1012-1017.

42. Duxbury J, Whittington R. Causes and management of patient aggression and violence: staff and patient perspectives. Journal of Advanced Nursing. 2005;50(5):469-478.

43. Petti TA, Mohr WK, Somers JW, Sims L. Perceptions of Seclusion and Restraint by Patients and Staff in an Intermediate-Term Care Facility. Journal of Child and Adolescent Psychiatric Nursing. 2001;14(3):115-127.

44. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. Means of restraint in a psychiatric hospital. Estrasburgo: CTP; 2006.

45. Marangos-Frost S, Wells D. Psychiatric nurses’ thoughts and feelings about restraint use: a decision dilemma. Journal of Advanced Nursing. 2000;31(2):362-369.

46. El-Badri S, Mellsop G. Patient and staff perspectives on the use of seclusion. Australasian Psychiatry. 2008;16(4):248-252.

47. Brophy LM, Roper CE, Hamilton BE, Tellez JJ, McSherry BM. Consumers and Carer perspectives on poor practice and the use of seclusion and restraint in mental health settings: Results from Australian focus groups. International Journal of Mental Health System. 2016;10(6).

48. Gudde CB, Olsø TM, Whittington R, Vatne S. Service users’ experiences and views of aggressive situations in mental health care: A systematic review and thematic synthesis of qualitative studies. Journal of Multidisciplinary Healthcare. 2015;8:449-462.

49. Cornaggia CM, Beghi M, Pavone F, Barale F. Aggression in psychiatry wards: A systematic review. Psychiatry Research. 2011;189(1):10-20.

50. Happell B, Harrow A. Nurses’ attitudes to the use of seclusion: A review of the literature. International Journal of Mental Health Nursing. 2010;19(3):162-168.

51. Van Der Merwe M, Muir-Cochrane E, Jones J, Tziggili M, Bowers L. Improving seclusion practice: Implications of a review of staff and patient views. Journal of Psychiatry Mental Health Nursing. 2013;20(3):203-215.

52. Cocho Santalla C, Nocete Navarro L, López Álvarez I, Carballeira Carrera L, Fernández Liria A. Experiencia y actitudes de los profesionales de salud mental en torno a las prácticas coercitivas directas: revisión bibliográfica de estudios cualitativos. Revista de la Asociación Española de Neuropsiquiatría. 2018;38(134):419-449.

53. Anderson S. Coercion. The Stanford Encyclopedia of Philosophy (Winter 2017) [Internet]. Edward NZ; 2017. Disponible en: https://tinyurl.com/8nrydmau.

54. Lovell A, Smith D, Johnson P. A qualitative investigation into nurses’ perceptions of factors influencing staff injuries sustained during physical interventions employed in response to service user violence within one secure learning disability service. Journal of Clinical Nursing. 2015;24(13–14):1926-1935.

55. Strout TD. Perspectives on the experience of being physically restrained: An integrative review of the qualitative literature. International Journal of Mental Health Nursing. 2010;19(6):416-427.

56. Moreno Pérez A, Fernández Liria A. La contención mecánica como acontecimiento centinela: propuesta para avanzar hacia su eliminación. Boletín la Asociación Madrileña de Salud Mental. 2020;46.

57. Knowles SF, Hearne J, Smith I. Physical restraint and the therapeutic relationship. The Journal of Forensic Psychiatry & Psychology. 2015;26(4):461-475.

58. Mohr WK, Petti TA, Mohr BD. Adverse effects associated with physical restraint. Canadian journal of psychiatry. 2003;48:330-337.

59. Real Academia Española. Experiencia [Internet]. Diccionario de la Lengua Española. 2017 [citado 6 feb 2017]. Disponible en: https://tinyurl.com/5zrrnzn4.

60. Nocete Navarro L, Carballeira Carrera L, López Álvarez I, Cocho Santalla C, Fernández Liria A. Percepciones y actitudes de los profesionales de salud mental en la contención mecánica. En: Coerción y salud mental: revisando las prácticas de coerción en la atención a las personas que utilizan los servicios de salud mental. Madrid: Asociación Española de Neuropsiquiatría; 2017. p. 109-168.

61. Berenguera A, Fernandez de Sanmamed MJ, Pons M, Pujol E, Rodríguez D, Saura S. Escuchar, observar y comprender: Recuperando la narrativa en las Ciencias de la Salud: Aportaciones de la investigación cualitativa [Internet]. Barcelona: Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP J. Gol); 2014. Disponible en: www.idiapjgol.org.

62. Onocko Campos RT, Furtado JP. Narrativas: utilização na pesquisa qualitativa em saúde. Revista de Saúde Publica. 2008;42(6):1090-1096.

63. Prieto Rodríguez MA, March Cerdá JC. Paso a paso en el diseño de un estudio mediante grupos focales. Atención Primaria. 2002;29(6):366-373.

64. Laza Vásquez C, Pulido Acuña GP, Castiblanco Montañez RA. La fenomenología para el estudio de la experiencia de la gestación de alto riesgo. Enfermería Global. 2012;11(4):295-305.

65. Eatough V, Smith J. I was like a wild wild person: Understanding feelings of anger using interpretative phenomenological analysis. British Journal of Psychology. 2006;(97):483-498.

66. Denzin NK, Lincoln YS. The SAGE Handbook of Qualitative Research. Newbury Park: SAGE Publications; 2011.

67. Husum TL, Bjørngaard JH, Finset A, Ruud T. Staff attitudes and thoughts about the use of coercion in acute psychiatric wards. Social Psychiatry and Psychiatric Epidemioly. 2011;46(9):893-901.

68. Wynn R, Kvalvik AM, Hynnekleiv T. Attitudes to coercion at two Norwegian psychiatric units. Nordic Journal of Psychiatry. 2011;65(2):133-137.

69. Thornberg R, Charmaz K. Grounded Theory and Theoretical Coding. En: Flick U, (ed). The SAGE Handbook of Qualitative Data Analysis. London: SAGE Publications; 2014. p. 153-169.

70. Tweed A, Charmaz K. Grounded Theory Methods for Mental Health Practitioners. En: Harper D, Thompson AR (eds). Qualitative Research Methods in Mental Health and Psychotherapy: A Guide for Students and Practitioners. West Sussex: John Wiley & Sons; 2012. p. 131-146.

71. Olofsson B, Gilje F, Jacobsson L, Norberg A. Nurses’ narratives about using coercion in psychiatric care. Journal of advanced nursing. 1998;28(1):45-53.

72. Corbin J, Holt NL. Grounded Theory. En: Somekh B, Lewin C (eds). Research Methods in the Social Sciences. London: SAGE Publications; 2005. p. 49–55.

73. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodoly. 2008;8(45).

74. Calderón C. Criterios de calidad en la investigación cualitativa en salud (ICS): apuntes para un debate necesario. Revista Española de Salud Pública. 2002;76(5):473-482.

75. Strauss A, Corbin J. Bases de la investigación cualitativa: técnicas y procedimientos para desarrollar la teoría fundamentada. Medellín: Editorial Universidad de Antioquia; 2002.

76. Emanuel EJ, Wendler D, Grady C. What Makes Clinical Research Ethical? Journal of the American Medical Association. 2000;283(20):2701-2711.

77. BOE. Ley Orgánica 15/1999, de 13 de diciembre, de Protección de Datos de Carácter Oficial. Boletín Of del Estado [Internet]. 1999;(298):43088-43099. Disponible en: https://tinyurl.com/vc48n29m.

78. Asociación Médica Mundial. Declaración de Helsinki de la Asociación Médica Mundial: Principios Éticos para las Investigaciones Médicas en Seres Humanos [Internet]. Asociación Médica Mundial Helsinki; 1964. Disponible en: https://tinyurl.com/5v6ypvd6.

79. Szmukler G, Appelbaum PS. Treatment pressures, leverage, coercion, and compulsion in mental health care. Journal of the American Medical Association. 2008;17(3):233-244.

80. Bentall R. Too much coercion in mental health services. The Guardian [Internet]. 2013. Disponible en: https://tinyurl.com/2588jjz9.

81. Martin JK, Pescosolido BA, Tuch SA. Of fear and loathing: The role of “disturbing behavior,” labels, and causal attributions in shaping public attitudes toward people with mental illness. Journal of Health and Social Behavior. 2000;41(2):208-223.

82. Malla A, Joober R, Garcia A. Mental illness is like any other medical illness: A critical examination of the statement and its impact on patient care and society. Journal of Psychiatry & Neuroscience. 2015;40(3):147-150.

83. Angermeyer medidas coercitivas, Holzinger A, Carta MG, Schomerus G. Biogenetic explanations and public acceptance of mental illness: Systematic review of population studies. The British Journal of Psychiatry: the Journal of Mental Science. 2011;199(5):367-372.

84. Read J, Haslam N, Magliano L. Prejudice, stigma and “schizophrenia’’: the role of the bio-genetic ideology.” En: Read J, Dillon J (eds). Models of Madness: Psychological, Social and Biological approaches to psychosis. 2nd ed. East Sussex: Routledge; 2013.

85. Perkins E, Prosser H, Riley D, Whittington R. Physical restraint in a therapeutic setting; a necessary evil? The International Journal of Law and Psychiatry. 2012;35:43-49.

86. Foster C, Bowers L, Nijman H. Aggressive behaviour on acute psychiatric wards. prevalence, severity and management. Journal of Advanced Nursing. 2007;58(2):140-149.

87. Peterson JK, Skeem J, Kennealy P, Bray B, Zvonkovic A. How often and how consistently do symptoms directly precede criminal behavior among offenders with mental illness? Law and Human Behavior. 2014;38(5):439-449.

88. Riahi S, Thomson G, Duxbury J. An integrative review exploring decision-making factors influencing mental health nurses in the use of restraint. Journal of Psychiatric and Mental Health Nursing. 2016;23:116-128.

89. Bigwood S, Crowe M. ‘It’s part of the job, but it spoils the job’: A phenomenological study of physical restraint: Feature Article. International Journal of Mental Health Nursing. 2008;17(3):215-222.

90. Sequeira H, Halstead S. The psychological effects on nursing staff of administering physical restraint in a secure psychiatric hohspital: When I go home, it’s then that I think about it. British Journal of Forensic Practice. 2004;6(1):3.

91. Bowers L. On conflict, containment and the relationship between them. Nursing Inquiry. 2006;13(3):172-180.

92. Saya A, Brugnoli C, Piazzi G, Liberato D, Ciaccia G Di, Niolu C, et al. Criteria, procedures, and future prospects of involuntary treatment in psychiatry around the world: A narrative review. Front Psychiatry. 2019;10.

93. Bowers L. Safewards: A new model of conflict and containment on psychiatric wards. Journal of Psychiatric and Mental Health Nursing. 2014;21(6):499-508.

94. Wynn R. Staff’s attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital. Nordic Journal of Psychiatry. 2003;57(6):453-459.

95. Laiho T, Kattainen E, Åstedt-Kurki P, Putkonen H, Lindberg N, Kylmä J. Clinical decision making involved in secluding and restraining an adult psychiatric patient: An integrative literature review. Journal of Psychiatric and Mental Health Nursing. 2013;20(9):830-839.

96. Bourdieu P. La distinción: Criterio y bases sociales del gusto. Madrid: Gruop Santillana de Ediciones; 1998.

97. Capdevielle J. El concepto de habitus: “con Bordieu y contra Bordieu.” Anduli: Revista Andaluza de Ciencias Sociales. 2011;(10):31-46.

98. Fisher WA. Restraint and Seclusion: A Review of the Literature. The American Journal of Psychiatry. 1994;151:1584-1591.

99. Jacob JD, Holmes D, Corneau P, Macphee C. Convergence and divergence : An analysis of mechanical restraints. Nursing Ethics. 2019;26(4):1009-1026.

100. Moylan LB, Cullinan M. Frequency of assault and severity of injury of psychiatric nurses in relation to the nurses’ decision to restrain. Journal of psychiatric and mental health nursing. 2011;18(6):526-534.

101. Khadivi AN, Patel RC, Atkinson AR, Levine JM. Association between seclusion and restraint and patient-related violence. Psychiatric Services. 2004;55(11):1311–1312.

102. Moore G, Pfaff JA. Assessment and emergency management of the acutely agitated or violent adult. En: Waltham MA; Robert S Hockberger (ed). Uptodate; 2020.

103. Kesselman H, Pavlovsky E, Frydlevsky L. Las escenas temidas del coordinador de grupos. Clínica y Análisis Grupal. 1976;1(1):1-9.

104. Dozza de Mendoça L. Escenas temidas en salud mental [Internet]. Madrid; 2016 [citado 10 dic 2019]. Disponible en: https://tinyurl.com/y9whfp44

105. Vedana KGG, da Silva DM, Ventura CAA, Giacon BCC, Zanetti ACG, Miasso AI, et al. Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff. Archives of Psychiatric Nursing. 2018;32(3):367-372.

106. Knight C. Trauma-Informed Social Work Practice: Practice Considerations and Challenges. Clinical Social Work Journal. 2015;43(1):25-37.

107. Bloom SL. Human service systems and organizational stress: Thinking & feeling our way out of existing organizational dilemmas [Internet]. Community Works; 2006 [citado 10 dic 2019]. Disponible en: https://tinyurl.com/w6ymrxs.

108. Meehan T, Bergen H, Fjeldsoe K. Staff and patient perceptions of seclusion: Has anything changed? Journal of Advanced Nursing. 2004;47(1):33-38.

109. Molewijk B, Kok A, Husum T, Pedersen R, Aasland O. Staff’s normative attitudes towards coercion: The role of moral doubt and professional context: A cross-sectional survey study. BMC Medical Ethics. 2017;18(1):1-14.

110. Krieger E, Moritz S, Lincoln TM, Fischer R, Nagel M. Coercion in psychiatry: A cross-sectional study on staff views and emotions. Journal of Psychiatric and Mental Health Nursing. 2020;1-14.

111. Jacobsen TB. Involuntary treatment in Europe: different countries, different practices. Current opinion in psychiatry. 2012;25(4):307-310.