The experience of working on a locked acute psychiatric ward

Abstract

This study's aim was to elucidate health-care staff experience of working on a locked acute psychiatric ward. In many countries changes in health care has contributed to fewer beds available in inpatient care, and a concentration of patients with severe psychiatric conditions. This implies a changing work environment in acute psychiatric care. Qualitative interviews with health-care staff (n= 10) were carried out on a ward for patients with affective disorder and eating disorder in a Swedish hospital. Qualitative content analysis was used. Four themes were identified from the data: 'undergoing changes in care delivery', 'feeling a need for security and control', 'managing the demands at work' and 'feeling a sense of responsibility'. This study adds to earlier research into how a sense of responsibility can place a significant burden on health-care staff working on a locked psychiatric ward and also contribute to increased control of patients. This study also shows that relationships and power structures among health-care staff need to be addressed when organizational changes are made in care delivery. Further research is needed to reach a comprehensive understanding of care on locked acute psychiatric wards, including a development of nursing and medicine as knowledge domains in one common context.

Advancing the Recovery Orientation of Hospital Care Through Staff Engagement With Former Clients of Inpatient Units

“…Despite its limitations, this study supports the use of a consumerengagement approach in psychiatric inpatient units, settings that so far have been largely overlooked in recoveryoriented care dialogues (11)(12)(13)(14). Furthermore, it provides evidence for the effectiveness of a rigorous and focused patient engagement strategy in psychiatric care.…”

“…It was developed to address the paucity of literature and service development tools that address efforts to advance the recovery-informed model of care in inpatient contexts (11,13,14).…”

“…First, delivering care driven by the agenda of a vulnerable, distressed patient who may be detained against his or her will may seem to run counter to ward practices that increasingly emphasize risk management and clinician-driven decision making in short-stay frameworks (9,11). Second, although recovery may be understood at a conceptual level, it is seldom applied because clinicians are not educated to develop the skills and perspectives necessary to support such an orientation (12)(13)(14).…”

Psychosocial Work Environment, Stress Factors and Individual Characteristics among Nursing Staff in Psychiatric In-Patient Care

“…Research characterising the work environment in psychiatric care has reported mixed findings. Among the negative sides are the psychiatric staff’s experiences of a demanding work environment with a heavy and intense work load [1,14] and the aggression and violence are commonly recognised problems [1,2,15,16]. The complex relationship with patients in psychiatric care has also been described as a source of stress [2,14,17].…”

“…Among the negative sides are the psychiatric staff’s experiences of a demanding work environment with a heavy and intense work load [1,14] and the aggression and violence are commonly recognised problems [1,2,15,16]. The complex relationship with patients in psychiatric care has also been described as a source of stress [2,14,17]. Several studies have highlighted the beneficial aspects of working in psychiatric care, such as good morale [6,18], low levels of moral distress [19], and meaningful and stimulating work [14].…”