Table 1 Overview of the first two steps of the analysis

Patients who refuse healthcare

Assessment of patients competence to consent

Experience with using coercion (stories)

• Removing razor blades or knives

• The physician does not come to the patient, the patient is taken by force to be assessed by a physician

• To secure patients that physically act out during transportation

• Sedate patients without consent because of necessity or safety

• Principle of necessity suspecting the patient is intoxicated, has hypoglycemia, an infection, a psychiatric condition or other

• Principle of necessity

• Legal duty to care

Situations where coercion was used

• Involuntary admission

• Suicide risk

• Patients who can`t fend for themselves

• The physician does not come to the patient, the patients need to be assessed by a physician

• Securing the patient during transport

• The patient does not realize the seriousness in the situation

Forms of coercion

• The patient is not given a choice

• Leading the patient by the arm

• Aid the police in restraining and securing the patient

• Hold an arm, sit on the patient

• Wrap a blanket around the patients’ arms with the security belt tightly fastened around the patient

• Pragmatic coercion

• Securing the patient during transport

• Pharmacological coercion

• Physical coercion

Guidelines versus the rules and regulations

Factors affecting the use of coercion

• Insecurity about how to apply the legislation to real life situations

• Interpretation of the guidelines-all patients should be assessed by a physician

• When a medical physician does not respond to the AP* call, they feel forced to bring the patient to the Emergency Medical Scenter

• A perceived lack of support from the management

• Increased fear of making mistakes

• Systemic factors

- Legislation

• Organizational factors

- Guidelines

- Culture of fear

- Insecurity

Concern for consequences