Mental Health Nurses' Perceived Appropriateness of Coercive Measures and Security Technologies in Psychiatric Settings: A National Cross-Sectional Study.

introductionPsychiatric settings are high-risk environments for violence. Coercive measures (CMs) and security technologies (STs) can be used to ensure safety. However, limited evidence exists on how Italian mental health nurses (MHNs) perceive the appropriateness of such practices and the influencing factors. This study aimed to fill this gap.

designCross-sectional study.

methodsAn online survey collected sociodemographic data and validated measures of depression, anxiety, stress, stigma toward mental illness, and humanization of care. The perceived appropriateness of various CMs and STs was rated on a 5-point Likert scale using a validated item set. Data were analyzed using descriptive statistics, bivariate tests, and multilevel mixed-effects linear regression.

resultsA total of 707 MHNs participated in the study. CMs were considered moderately appropriate (mean = 3.56 ± 0.92), with pharmacological restraint and locked-door policies rated as more appropriate than physical restraint. STs were evaluated better (mean = 3.74 ± 0.95), with alarms and closed-circuit television judged more appropriate than body-worn cameras and metal detectors. CMs were considered less appropriate by non-believers (p = 0.009), head nurses (p < 0.001), and those in non-acute settings (p = 0.004), and more appropriate by those in Central Italy (p = 0.036), on daytime shifts (p = 0.042), and with higher stigma (p = 0.012). STs were considered less appropriate by males (p = 0.004), head nurses (p = 0.040), and more experienced MHNs (p < 0.001), and more appropriate by those in Southern Italy (p < 0.001) and in non-acute settings (p < 0.001).

conclusionMHNs consider CMs and STs moderately appropriate. Perceptions are influenced by both individual and contextual factors. Targeted training, anti-stigma education, and inclusive policies are needed to ensure ethical and evidence-based safety practices in psychiatric care. CLINICAL RELEVANCE: Targeted education and training in mental health nursing, both continuing and post-graduate, are essential to support cultural change among MHNs and ensure the appropriate use of CMs and STs. Integrating anti-stigma initiatives and involving MHNs in policy development can strengthen clinical decision-making and foster safer, more ethical, and person-centred psychiatric care.