An Exploration of the Meanings of Space and Place in Acute Psychiatric Care

Abstract

Spatial human experiences such as confinement and freedom are important to acute psychiatric care. The physical space that inpatient psychiatric/mental health nurses and acute psychiatric patients share influences human relationships. The purpose of this paper is to explore the meanings of space and place in acute psychiatric settings, to discuss how these meanings affect human relationships, nurses' work environment and patients' perception of care, and to present how the design and use of nursing stations affects therapeutic relationships. We hope to encourage dialogue and research that will help clarify the meaning of space and place in acute care psychiatric units, and make for healthier work environments for nurses and healing care environments for patients.

Panoptic Power and Mental Health Nursing—Space and Surveillance in Relation to Staff, Patients, and Neutral Places

“…In accordance with our analysis of spaces in mental health institutions, Andes and Shattell (2006) emphasize that patients in acute psychiatric wards have little control over spaces and have no real privacy as staff may routinely enter for observations. Buchanan-Barker and Barker (2005) metaphorically refer to psychiatric nurses' panoptic observations and observation of patients as the "long arm of the soul doctor" (p. 541).…”

“…As shown by Haglund, von Knorring, and von Essen (2006), from a nurse's perspective, the spaces in mental health institutions create a specific caring environment within which locked doors create possibilities for extra contact with patients and emphasize structure and safety. Moreover, psychiatric wards often restrict patients to entering certain areas in the environment, sometimes by means of physical boundaries (e.g., locked doors and Plexiglas) and in other instances by marking the floor with colored tape (Andes & Shattell, 2006). Table 1 shows that inside mental health institutions most places are accessible to the staff, while most places are inaccessible to patients.…”

Edgar Allan Poe, “The Pit and the Pendulum,” and Ventricular Assist Devices

“…Furthermore, hospitalization creates a lack of privacy, loss of personal space, and even power imbalances between staff and patients. 42,44,45 Personal boundaries are altered because patients have little control over their own space, and the space they have is consistently being intruded on by staff and others. 45 In our study, use of restraints, feeling dependent on others, limited mobility, and the limited size of patients' rooms contributed to the sense of confinement.…”

Transfusing our lifeblood: Reframing research impact through inter-disciplinary collaboration between health geography and nurse education

“…A range of relationships have been described including how places are attributed symbolic identity by, and in relation to, nurses (Savage, 1997;Halford and Leonard, 2003;Cheek, 2004;Gilmour, 2006), and thus how places characterise and express particular professional nursing specialisms. Place has been positioned as crucial to the nature of mental health care (Montgomery, 2001;Andes and Shattell, 2006), community health (Bender et al, 2007), home care (Duke and Street, 2003), gerontology and geriatrics (Cheek, 2004) and midwifery (Lock and Gibb, 2003). Other studies have investigated the dynamics between places and nurse-patient decisions, ethics, interactions and relationships (Purkis, 1996;Malone, 2003;Bucknall, 2003;Peter and Liaschenko, 2004;Shattell et al, 2008;Seto-Nielsen et al, 2013).…”