Wostry Florian, Hahn Sabine, Schrems Berta
University of Vienna, Vienna, Austria.
School of Nursing, Bern University of Applied Sciences, Switzerland.
J Psychiatr Ment Health Nurs. 2025 Oct;32(5):1184-1196. doi: 10.1111/jpm.70012. Epub 2025 Jul 15.
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.
What is the impact of coercive measures in acute psychiatric care on the therapeutic relationship between nurses and patients?
An integrative review and a thematic analysis were undertaken.
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.
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.
Nurses need to be aware of the effects of coercive measures on therapeutic relationships and use coercive measures as a last resort.
减少强制手段需要稳定的治疗关系。人们普遍认为强制手段会对治疗关系产生负面影响，但具体影响却知之甚少。
急性精神科护理中的强制手段对护士与患者之间的治疗关系有何影响？
进行了综合综述和主题分析。
主题1标记为“破坏作用”，包含三个子主题：“信任丧失”、“权力失衡”和“参与度降低”，突出了对治疗关系的负面影响。主题2名为“护理困境”，子主题为“非人性化”，讨论了精神科护士面临的内在冲突。主题3“强化”提出了治疗关系中潜在的改善方面。
治疗关系的关键特征，如提供支持、平视交流、同理心和信任，可能会因强制手段而受损，并削弱精神科护理的一个基本方面。此外，缺乏治疗关系可能会助长引发更多强制手段的行为，形成一个对所有相关方都有不利影响的恶性循环。
护士需要意识到强制手段对治疗关系的影响，并将强制手段作为最后手段使用。
