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[Use of coercion in nursing homes after new legislation].

BACKGROUND
The use of coercion in nursing homes is common as well as challenging, but was not regulated by law until 2009. Two key conditions are that the patient must be without mental competence and that the coercive measures are in the patient's best interest. Inspection reports have revealed insufficient application of the law, and this is of concern to patients as well as healthcare staff. With the aid of a qualitative study, we wished to identify the challenges encountered and the experiences gained by doctors and other nursing-home personnel from the new provisions regarding the use of coercion.


MATERIAL AND METHOD
A total of 65 nursing-home employees were interviewed in focus groups. The interview guide included questions on, for example, when coercion is being used and how the new chapter of the Act is being applied. In the qualitative analysis, the content of the statements was categorised and condensed.


RESULTS
All focus-group interviews described coercion as frequently occurring, but also that few formal decisions are being made. Involvement of the doctors and inter-disciplinary cooperation were assessed as crucial for ensuring appropriate application of the new regulations, in addition to time, staffing and competence. The participants were uncertain as to how the new regulations should be applied, and regarded the requirements for a formal decision as unrealistic. Some of the coercive measures described are illegal. The absence of legal authority in cases where coercion is regarded as the lesser evil was described as challenging.


INTERPRETATION
The new legal basis for the use of coercion is likely to raise awareness of the issue, but has a large potential for erroneous interpretation and causing reluctance to make formal decisions. In some areas, the law is out of step with the realities in nursing homes and the employees' values.