# “It’s really about something! I can save the patient a lot of suffering if I get him to do it”: between care and coercion in the use of non-invasive ventilation

## TL;DR

This paper explores the ethical challenges healthcare professionals face when using non-invasive ventilation, highlighting tensions between patient care and coercion.

## Contribution

The study identifies specific strategies and moral dilemmas in the use of non-invasive ventilation that have not been previously detailed.

## Key findings

- NIV is often a stressful and morally distressing situation for healthcare professionals.
- Three themes emerged: diverging professional perspectives, strategies for carrying out NIV, and being caught in a dilemma.
- Informal and formal coercion can occur if NIV is not handled sensitively.

## Abstract

Despite clear evidence that non-invasive ventilation (NIV) is important and effective, both staff and patients report challenges. Patients often perceive NIV as unpleasant, and their acceptance is poor. For healthcare professionals, the patient’s insufficient adherence is demanding and requires considerable expertise, personnel and time resources. Therefore, it is likely that actions are taken to influence the patient’s will in favour of NIV in order to apply it. However, it is not yet clear what these actions look like and what they mean for patients and team members.

Qualitative semi-structured online interviews with nurses and physicians practicing at German intensive care units have been conducted. Transcribed interviews were analysed using a thematic analysis.

The NIV was described as a frequent and, at the same time, stressful and morally distressing situation in which the patient’s will is deliberately influenced and/or overridden. Three themes were developed inductively from the data that relate to influencing the patient’s will regarding NIV: (1) Diverging professional perspectives on NIV, (2) strategies for carrying out NIV and (3) being caught in a dilemma.

While NIV is an important and evidence-based intervention, its application can lead to moral conflict and both informal and formal coercion if not handled with sensitivity. Promoting respectful treatment, shared decision-making and team training is essential to ensure NIV is experienced as supportive rather than coercive.

Not applicable.