How patients and nurses experience the acute care psychiatric environment

Abstract

The concept of the therapeutic milieu was developed when patients' hospitalizations were long, medications were few, and one-to-one nurse-patient interactions were the norm. However, it is not clear how the notion of 'therapeutic milieu' is experienced in American acute psychiatric environments today. This phenomenological study explored the experience of patients and nurses in an acute care psychiatric unit in the USA, by asking them, 'What stands out to you about this psychiatric hospital environment?' Three figural themes emerged, contextualized by time, which was a source of stress to both groups: for patients there was boredom, and for nurses, pressure and chaos. Although they shared some themes, nurses and patients experienced them differently. For instance, nurses felt caged-in by the Plexiglas-enclosed nursing station, and patients felt caged-in by the locked doors of the unit. The findings from this US study do not support the existence of the therapeutic milieu as described in the literature. Furthermore, although the nurse-patient relationship was yearned for by nurses, it was nearly absent from patients' descriptions. The caring experienced by patients was mainly derived from interactions with other patients.

Metasynthesis of Research on the Role of Psychiatric Inpatient Nurses

“…To some extent, this lack of control arose from time-sapping nonnursing duties such as administrative concerns and excessive documentation (Cleary, 2003a;Fourie et al, 2005;Shattell et al, 2008). Poor staffing of the unit exacerbated the situation in subtle ways.…”

Patient Experience of Coercive Measures

“…Without professional guidance, this is a somewhat counterproductive constellation (Stenhouse 2011). Patients' experience of restrictive rules, inappropriate control or use of power and strength on the part of authoritarian staff can precipitate aggression and violence (Kontio et al 2010;Shattell et al 2008). This, in turn, launches a vicious circle of ever growing restrictions that are common, for example, in Finland (Raboch et al 2010).…”

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

“…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). Finally, the dynamics between places and intra-and inter-professional interactions and relationships (West and Barron, 2005;Barnes and Rudge, 2005;Oandasan et al, 2009;Kitto et al, 2013), and those between places and the nature and outcomes of care (including through place-based clinical interventions) (McKeever et al, 2002;Angus et al, 2003;Hodnett et al, 2005Hodnett et al, , 2009Marshall, 2008;Mesman, 2012) have been a focus of constructivist/humanist scholars.…”