In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff. The study revealed that the nursing home staff usually spent a (...) lot of time trying a wide range of approaches to avoid the use of coercion. The most common strategies were deflecting and persuasive strategies, limiting choices by conscious use of language, different kinds of flexibility and one-to-one care. According to the staff, their opportunities to use alternative strategies effectively are greatly affected by the nursing home’s resources, by the organization of care and by the staff’s competence. (shrink)

The aim of the present study was to describe how registered nurses in nursing homes ensure legal security, good and safe nursing care and uphold the dignity of nursing home residents with severe dementia without violating residents’ integrity. Semi-structured interviews were conducted with 10 charge nurses in a county in central Sweden. The transcribed interviews were examined using manifest and latent content analyses. The manifest analysis identified actual local routines involving coercive treatment and registered nurses’ descriptions of complications and alternative (...) measures. The latent analysis resulted in three themes describing nursing strategies: one with coercive treatment, one with coercive treatment under specific circumstances and one to prevent coercive treatment. Interpretations of legal terms regarding coercive treatment and inadequate gerontological nursing training and understaffing seem to preserve the use of coercive treatment. (shrink)

Background: Studies have demonstrated the extensive use of coercion in Norwegian nursing homes, which represents ethical, professional as well as legal challenges to the staff. We have, however, limited knowledge of the experiences and views of nursing home patients and their relatives. Objectives: The aim of this study is to explore the perspectives of nursing home patients and next of kin on the use of coercion; are there situations where the use of coercion can be defended, and if so, under (...) which circumstances? Methods: The data are based on individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 60 relatives. Ethical considerations: Participation was based on written informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics. Results: More than half of the patients and the majority of the relatives accepted the use of coercion, trusting the staff to act in the patient’s best interest. However, the acceptance of coercion is strongly related to the patients’ lack of understanding, to prevent health risks and to preserve the patient’s dignity. Conclusion: The majority of nursing home patients and relatives accepted the use of coercion in specific situations, while at the same time they emphasised the need to try alternative strategies first. There is still a need for good qualitative research on the use of coercion in nursing homes, especially with a closer focus on the perspectives and experiences of nursing home patients. (shrink)

<b>Objectives:</b> To gather empirical data on how gender and educational level influence bioethical reasoning among medical students by analyzing their use of care versus justice arguments for reconciling a bioethical dilemma. <b>Setting:</b> University Departments of Medical Ethics, Social and Communication Psychology in Germany. Participants: First and fifth year medical students. Design and method: Multidisciplinary, empirical, 2-segment study of ethics in action: In intrapersonal Segment 1, the students were presented with a bioethical dilemma and then administered a 13-item questionnaire to survey (...) their individual preferences for care versus justice arguments in resolving the conflict. The survey questioned 6 justice, 6 care-related items and 1 socially critical item. Data were analysed by gender and year of medical school. In interpersonal Segment 2, the bioethical dilemma from Segment 1 was discussed in gender-mixed and gender-homogeneous groups. Coded transcripts were evaluated to identify prevalences in care versus justice reasoning. <b>Results:</b> Data on 462 medical students were evaluable (n=338 in Segment 1, n=168 in Segment 2, n=44 overlap). Gender and level of education had no effect on moral reasoning in intrapersonal Segment 1, but significantly affected reasoning in interpersonal Segment 2, where women significantly tended to use more care-orientated arguments. Justice arguments predominated the group discussions. <b>Conclusion:</b> Interpersonal contexts affect moral reasoning in medical students, probably by amplifying the socialisation relating to gender and educational level. Care orientation is associated with the female gender. Professional socialisation tends to reduce the diversity and richness of moral reasoning towards a more justice-weighted orientation. Medical ethics should teach both justice and care reasoning modes in order to broaden physicians' ability to reconcile bioethical dilemmas. (shrink)

Bewegungseinschränkende Maßnahmen werden in verschiedenen medizinischen Institutionen angewendet, um das Verhalten von Patienten durch physische bzw. mechanische oder chemische Eingriffe zu beeinflussen. Solche Maßnahmen stellen eine Art Freiheitsentziehung dar und bedürfen daher immer einer Rechtfertigung. Die Frage nach der Indikation für bewegungseinschränkende Maßnahmen ist abzuklären, da ein standardmäßiger Gebrauch nicht Ziel einer Behandlung sein sollte. Gesetze können als Richtschnur für behandelnde Ärzte und Pflegepersonal dienen. In der Schweiz ist am 1. Januar 2013 erstmals eine gesetzliche Regelung zu bewegungseinschränkenden Maßnahmen eingeführt (...) worden. Hauptziel dieser neuen Artikel im Schweizerischen Zivilgesetzbuch (Artikel 383 ff. ZGB) ist die Stärkung von Autonomie und persönlicher Freiheit von Patienten. Es ist wichtig, Vorschriften zu hinterfragen bzw. deren Auswirkungen für die betroffenen Personen zu analysieren und einen kritischen Dialog zu führen. Die vorliegende Publikation betrachtet bewegungseinschränkende Maßnahmen aus zwei verschiedenen Perspektiven: einerseits anhand einer medizinethischen Debatte, andererseits anhand einer Analyse der gesetzlichen Regelung in der Schweiz. Die neuen Artikel umfassen eine detaillierte Regelung zur „Einschränkung der Bewegungsfreiheit“. Dennoch schließen sie nicht alle bestehenden Regelungslücken. Die neue Schweizer Gesetzgebung kann daher nur als ein erster Schritt in die richtige Richtung betrachtet werden. Ausführungen zur praktischen Anwendung sind dringend nötig und sollten so schnell wie möglich ausgearbeitet werden. (shrink)