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Psychiatric 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.
Cross-sectional study.
An 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.
A 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).
MHNs 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.
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.
To critically examine the policy logic of the EU-funded WHO Nursing Action Initiative and assess its capacity to address the structural drivers of Europe's nursing workforce instability, with a specific focus on retention governance as the missing determinant of sustainability.
Although Europe reports high aggregate numbers of nurses, persistent workforce shortages are driven not by insufficient supply but by systemic governance weaknesses that undermine retention. The Nursing Action Initiative provides the first coordinated, multi-country framework aligned with the WHO's 2023–2030 strategic priorities, yet several structural gaps, including the absence of binding retention metrics, enforceable safe staffing standards, harmonized advanced practice pathways, interoperable workforce intelligence, and mandatory accountability, limit its transformative potential. A shift from production-centric policies to a retention-driven governance architecture is therefore essential.
The Nursing Action Initiative represents an important step toward strengthening European nursing workforce policy, but its success will depend on Member States' willingness to implement structural reforms that ensure safe staffing, protect nurses' well-being, expand autonomous practice roles, and stabilize workforce distribution. Without a robust architecture of retention governance, neither the sustainability of Europe's nursing workforce nor the resilience of its health systems can be assured.
This commentary advances the policy debate by framing retention as the central determinant of workforce sustainability. It calls for urgent political commitment to move the Nursing Action Initiative beyond aspirational coordination and toward enforceable, system-level reform capable of delivering lasting improvements in workforce stability and quality of care across the European Union.
FreshRSS 