The use of coercive measures in a high secure hospital: expressions of institutional and emotional work

Hui, Ada M.L. (2015) The use of coercive measures in a high secure hospital: expressions of institutional and emotional work. PhD thesis, University of Nottingham.

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This thesis examines the use and implications of using coercive measures within a high security hospital. High security hospitals are unique environments where challenges are often faced in balancing care with safety and security. The use of coercive measures, namely, restraint, seclusion, rapid tranquillisation and segregation, are considered unavoidable necessities in preventing and/or limiting harm. Yet coercive measures are deemed ethically, morally and professionally controversial.

This study explores patient, staff and environmental factors that influence variations in attitudes and experiences towards the use of coercive measures using a sequential mixed methods design. Stage one examines the rates, frequencies and demographic characteristics of patients experiencing coercive measures. . Stage two uses standardised questionnaires to elicit and analyse staff and patient attitudes towards aggression (ATAS), containment measures (ACMQ) and hospital environment (EssenCES). Stage three uses a constructivist grounded theory approach to conducting semi-structured interviews with staff using institutional and emotional work theories.

Findings revealed that younger, newly admitted females were those most likely to experience coercion. Aggression was viewed as being significantly more destructive on the pre-discharge ward, in comparison with the admission, ICU and treatment ward. Discrepancies were found between staff and patient perceptions of the least acceptable containment measures. Patients experienced the hospital environment as more supportive and cohesive than staff. Finally, findings from the staff interviews uncovered a complex interplay between personal and institutional expectations, values and actions.

Further research is required into examining i) the attitudes and implications regarding the least restrictive methods, ii) the internal dynamics within high secure hospitals warrant and what it means for staff to be working in an environment where patients feel more supported by being contained than staff do when containing them, and iii) what can be done to relieve the tensions of healthcare professionals expected to care, coerce and contain.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Middleton, H.C.
Vollm, B.
Keywords: Forensic psychiatry, sociology, mental health, coercive measures, restraint, seclusion, rapid tranquillisation, institutions, organisations, emotional work
Subjects: R Medicine > RC Internal medicine
Faculties/Schools: UK Campuses > Faculty of Social Sciences, Law and Education > School of Sociology and Social Policy
Item ID: 29557
Depositing User: Hui, Ada
Date Deposited: 23 Oct 2015 10:14
Last Modified: 15 Dec 2017 14:15

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