The use of coercion in psychiatric and mental health nursing is a major challenge, which can lead to negative consequences for nurses and patients, including rupture in the therapeutic relationship and risk of injury and trauma. The concept of coercion is complex to define and is used in different ways throughout the nursing literature. This concept is defined broadly, referring to both formal (seclusion, restraint, and forced hospitalization), informal (persuasion, threat, and inducement), and perceived coercion, without fully addressing its evolving conceptualizations and use in nursing practice. We conducted a concept analysis of coercion using Rodgers’ evolutionary method to identify its antecedents, attributes, and associated consequences. We identified five main attributes of the concept: different forms of coercion; the contexts in which coercion is exercised; nurses’ justification of its use; the ethical issues raised by the presence of coercion; and power dynamics. Our conceptual analysis shows the need for more nursing research in the field of coercion to achieve a better understanding of the power dynamics and ethical issues that arise in the presence of coercion.

Accessible summary• Support workers' attitudes towards the sexuality of people with intellectual disabilities are important. They can influence the support people with intellectual disabilities receive regarding their affective and sexual life.• Six support workers talked about their personal experiences. They talked about what they found easy and difficult when helping people with intellectual disabilities express their sexual life and needs.• They said that sexuality is a right, a health matter and an important need. They also said it was sometimes difficult to include sexuality in their work.• They also said they often feel insecure and uncertain about how to help because sexuality is a difficult subject to talk about. They wanted to help people make their own decisions, but also wanted to protect them if needed. AbstractBackground: In the last decade, the evolution of support workers' attitudes towards the affective and sexual lives of people with intellectual disabilities has been described as increasingly positive. However, restrictive attitudes targeting affective and sexual life are still documented. Material and methods:This study aimed to explore the ethical implications of support workers' experiences concerning sexuality in the context of intellectual disabilities in everyday practice. This inquiry was guided by the following research questions: (a) In the context of intellectual disabilities, what meanings do service users' sexuality have for support workers? (b) How are those meanings translated into practice? Inspired by critical phenomenology, in-depth individual interviews with support workers were conducted and analysed. Results: One superordinate theme (Negotiating Interventions) and three themes were identified: "Crossing Organizational Borders," "A Duty to Act Despite Uncertainty" and "Navigating Competing and Contradictory Discourses." Conclusion: Support workers' experiences related to sexuality in the context of intellectual disabilities are influenced by how they define their role in a clinical context. | 117 PARISEAU-LEGAULT ET AL.

Involuntary treatment orders (ITOs) represent coercive leverage for treatment adherence against the will of individuals incapable of providing consent. ITOs have failed to demonstrate benefits in quantitative studies, but little attention has been paid the growing body of qualitative evidence on ITOs. The current study is an interpretative meta-synthesis designed to integrate qualitative evidence and enhance our understanding of stakeholders' perspectives (service users, relatives, professionals, psychiatrists) of ITOs in the context of mental health care. Forty-four studies met the following inclusion criteria, peer-reviewed empirical qualitative studies, and focus on perspectives and experiences of ITOs in a mental health context. Themes resulting from the analysis are: an ITO as leverage to manage compliance and risk; legal concerns; learning to play the game; building a therapeutic relationship in a coercive context; positive and negative impacts of ITOs; family involvement; and discharge. Based on these themes, an exploratory model of ITOs is proposed.

Questions of sexuality and intellectual disability have now moved beyond the institutional era, and contemporary sexual health interventions have gradually been reconfigured in terms of social participation, partnership and normalising approaches. That being said, they also appear to be part of a complex negotiation process between support systems for individuals identified as having an intellectual disability. The aim of this study was to provide a better understanding of the experience of affective (sentimental and emotional) and sexual (identity and value-mediated) expression in the context of intellectual disability, as well as related factors of influence. Inspired by a critical theoretical framework and a phenomenological methodology, this research shows that these experiences are part of a negotiation process that is simultaneously systemic and intimate. It is systemic because it responds to knowledge systems specific to intellectual disability and sexuality, thus authorising a variety of interventions focused on normalising the individual. It is also intimate because these practices involve every axis of affective existence, from inhabiting restrictive spaces to reconfiguring people’s intimate relationships with themselves and others. Through these findings, nursing’s ability to recognise and advocate for this group’s sexual needs and rights is called into question.

Background: The World Health Organization describes the perpetuation of human rights violations against people with mental health problems as a global emergency. Despite this observation, recent studies suggest that coercive measures, such as seclusion, restraints, involuntary hospitalization, or involuntary treatment, are steadily or increasingly being used without proof of their effectiveness. In nursing, several literature reviews have focused on understanding nurses' perspectives on the use of seclusion and restraints. Although many studies describe the ethical dilemmas faced by nurses in this context, to this date, their perspectives on patient's rights when a broad variety of coercive measures are used are not well understood. The aim of this review is to produce a qualitative synthesis of how human rights are actually integrated into psychiatric and mental health nursing practice in the context of coercive work. Methods: Noblit and Hare's meta-ethnographic approach will be used to conduct this systematic review. The search will be conducted in CINAHL, Medline, PsycINFO, ERIC, and Scopus databases, using the PICo model (Population, phenomenon of Interest, Context) and a combination of keywords and descriptors. It will be complemented by a manual search of non-indexed articles, gray literature, and other applicable data sources, such as human rights related documents. Qualitative and mixed-method study designs will be included in this review. Empirical and peer-reviewed articles published between 2008 and 2019 will be selected. Articles will be evaluated independently by two reviewers to determine their inclusion against eligibility criteria. The quality of the selected papers will then be independently evaluated by two reviewers, using the Joanna Briggs Institute's Checklist for Qualitative Research. Data extraction and content analysis will focus on first-and second-order constructs, that is, the extraction of research participants' narratives and their interpretation. Discussion: This review will provide a synthesis of how psychiatric and mental health nurses integrate human rights principles into their practice, as well as it will identify research gaps in this area. The results of this review will then provide qualitative evidence to better understand how nurses can contribute to the recognition, protection, and advocate for human rights in a psychiatric context. Systematic review registration: PROSPERO, CRD42019116862