Molloy Luke, Beckett Paul, Chidarikire Sherphard, Cutler Natalie, Isobel Sophie, Murphy Gillian, Zugai Joel
University of Wollongong, Wollongong, Australia.
University of Sydney, Sydney, Australia.
Int J Ment Health Nurs. 2025 Jun;34(3):e70044. doi: 10.1111/inm.70044.
Mental health nursing practices within inpatient care aim to empower consumers to lead their treatment and recovery. However, involuntary care may be justified for safety reasons. This practice can be traumatising and harmful. Our review explores the enforcement of involuntary care by mental health nurses in inpatient settings utilising meta-ethnography. Searches of articles published over a 10-year period (2014-2024) were conducted in Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE. The searches aimed to identify rich qualitative data on this area of mental health nursing practice. Six articles were selected for inclusion and a reciprocal translation synthesis was undertaken. Three key metaphors emerged: 'a necessary evil', 'the dilemmas of enforcement' and 'perturbed practice'. These metaphors illustrate the complex and often conflicting emotions nurses experience when enforcing involuntary care. Nurses viewed the enforcement of involuntary care as a necessary but difficult practice, justified by the belief that it ultimately benefits the person's safety and well-being. Despite justifying involuntary care as necessary, nurses faced ethical dilemmas balancing patient autonomy, safety and dignity. Enforcing involuntary care caused significant emotional distress for nurses, who experienced discomfort, guilt and moral conflict, questioning their actions and the impact on their relationships with consumers. The findings highlight the importance of minimising restrictive practices and developing supportive frameworks that prioritise patient dignity and autonomy while ensuring safety.
住院护理中的心理健康护理实践旨在使患者能够主导自己的治疗和康复。然而，出于安全考虑，非自愿护理可能是合理的。这种做法可能会造成创伤和伤害。我们的综述利用元民族志探讨了住院环境中精神科护士实施非自愿护理的情况。在护理及相关健康文献累积索引（CINAHL）和医学期刊数据库（MEDLINE）中检索了过去10年（2014 - 2024年）发表的文章。检索旨在识别关于这一心理健康护理实践领域的丰富定性数据。选取了6篇文章纳入研究，并进行了双向翻译综合分析。出现了三个关键隐喻：“必要之恶”、“实施的困境”和“受干扰的实践”。这些隐喻说明了护士在实施非自愿护理时所经历的复杂且往往相互冲突的情绪。护士们将实施非自愿护理视为一种必要但困难的做法，理由是他们认为这最终有利于患者的安全和福祉。尽管认为非自愿护理是必要的，但护士们在平衡患者自主权、安全和尊严方面面临伦理困境。实施非自愿护理给护士带来了巨大的情绪困扰，他们感到不适、内疚和道德冲突，对自己的行为及其对与患者关系的影响产生质疑。研究结果强调了尽量减少限制性措施以及制定支持性框架的重要性，这些框架应在确保安全的同时优先考虑患者尊严和自主权。
