Influencing the critically ill patient? A qualitative study with teams in German intensive care

Susanne Joebges ¹ Anna-Henrikje Seidlein ^2*

• ¹ Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany
• ² Universitätsmedizin Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany

Nurses and physicians can influence the patients will in various ways during intensive care treatment, whereby certain strategies fall into the realm of formal and informal coercion. Understanding and addressing these dynamics is crucial for humanized intensive care which promotes patient autonomy, minimizes coercion and fosters positive support strategies. To investigate which possibilities and forms of (un)intentional influencing and overriding of the patient's will between "formal" (physical restraint, sedation) and "informal" (psychological measures such as deception and threats) coercion are used in the ICU.In this qualitative study, semi-structured interviews were conducted with 30 nurses and physicians working in different German ICUs between September 2022 and February 2023. Participants were selected using a purposive random sampling technique to support the heterogeneity of the sample. Interviews were analysed using thematic analysis. Data analysis took place between February 2023 and January 2024.Five different forms of influence aiming at motivation, convincement (argumentative or manipulative), subordination and control were identified, along with different communicative practices (e.g. information, deception, lie, persuasion, threat) and other strategies (e.g. physical restraint) to reach the corresponding goal. The different forms are used simultaneously or alternately, i.e. they cannot be categorized in terms of an escalation hierarchy. The boundaries between support, informal and formal coercion are blurred, sometimes subtly.Discussion: In the ICU nurses and physicians influence the patient's will using many strategies; some despite moral and legal concerns. Further research is needed to determine the frequency of informal coercion in larger samples and different intercultural contexts. Please see also graphical abstract attached.Trial registration: Not applicable. No intervention was carried out on humans.