Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice

Abstract

The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self‐harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re‐centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re‐evaluating the risk management culture that gives rise to and legitimizes harmful practices.

Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals, service users and carers

“…Organizational processes reported in the current study focussed on paternalistic, formulaic approaches to risk, serving organizational accountability agendas related to the origination of care planning as a result of concerns about safety and fragmented community care . The findings support the recent literature demonstrating that actuarial risk assessments can be used by professionals to manage uncertainty in a manner that distances service users from potential solutions . To better integrate care plans with people's everyday lives, risk management should be separated from holistic needs elicitation.…”

Factors influencing work engagement among psychiatric nurses in Japan

“…Psychiatric hospitals face many tasks, including inpatient discharge promotion (Okumura, Sugiyama, Noda, & Tachimori, ), treatment of elderly patients with mental disorders (World Health Organization, ) and risk management during psychiatric patient care (Slemon, Jenkins, & Bungay, ), all of which necessitate better performance by mental health care providers in their work environment. Psychiatric nurses often experience stressful events due to psychiatric patients' mental symptoms and maladaptive behaviours, such as disturbed and unpredictable behaviour (Hasan & Tumah, ), unpleasant attitude towards nurses (Yada et al, ) and aggression (Fujimoto, Hirota, Kodama, Greiner, & Hashimoto, ).…”

Undergraduate students' perspectives on pursuing a career in mental health nursing following practicum experience

“…Not only does this impact student experiences of their practicums and recruitment into the mental health field, but also suggests the need for a fundamental shift in the way mental health care is conceptualised and enacted. Literature demonstrates that nurses in these settings are caught in tension between desiring to engage in therapeutic relationships with patients, but perceiving practices that contain and control patients as necessary for safety and treatment (Slemon, Jenkins, & Bungay, ; Larsen & Terkelsen, ; Muir‐Cochrane, O'Kane, & Oster, ). Change initiatives are needed that shift the practices of care towards prioritising the therapeutic relationship and empowering patients, while also acknowledging the need for safety for all individuals in the inpatient mental health setting.…”