The Preservation of Order: The Use of Common Approach Among Staff Toward Clients in Long-Term Psychiatric Care

Abstract

The authors performed this grounded theory study to gain a deeper understanding of the kinds of social processes that lead to a need among psychiatric nursing staff to reach a common approach on how to act toward individual clients in long-term psychiatric care. They present a theory about the development of such common approaches among staff. The main findings were that in psychiatric group dwellings, when the internal order is perceived as having been disturbed, the staff preserve or restore the internal order by formulating and reaching a common approach . The staff negotiated with each other to achieve an agreement on how to act and behave toward the individual client. The authors isolate and describe different types of order-disturbing incidents and the common approaches taken by the staff in dealing with them. However, their data also show that staff often had difficulties in maintaining a common approach over time.

To do good might hurt bad: Exploring nurses' understanding and approach to suffering in forensic psychiatric settings

“…The structural analysis contributed a more explanatory view by highlighting that differences were manifested not only in different opinions but also in different ways of relating to the suffering person. Therefore, literature focusing on a common staff approach (Enarsson et al 2007(Enarsson et al , 2008, different forms of presence (Fredriksson 1999) and caring conversations as a means to alleviate suffering (Fredriksson & Eriksson 2001 provides the theoretical basis for critical reflection.…”

“…Furthermore, they can side with their peers, avoiding both being alienated from them and becoming overwhelmed by patients' suffering. As a consequence, patients are met with different strategies aiming at fostering an acceptable behaviour that fits the cultural demands of the unit (Enarsson et al 2007). By overlooking suffering rather than approaching and alleviating it, nurses can avoid becoming personally involved in and touched by patients' suffering.…”

“Being good or evil”: Applying a common staff approach when caring for patients with psychiatric disease

“…However, reality is not always comparable with the ideal. Sometimes patients do not wish to receive the care offered by nurses; nurses can handle such situations in different ways, for example through using a common staff approach (Enarsson et al, 2007).…”

“…We have previously performed a grounded theory study, (Enarsson, Sandman & Hellzén, 2007) with the aim of gaining a deeper understanding of the kinds of social processes that lead psychiatric nursing staff to formulate a common approach on how to act towards individual patients in long-term psychiatric care. The study showed how an order-disturbing incident that could not be dealt with within existing routines, and for which no similar previous experiences were available to base solutions on, led the staff to restore order by assuming certain attitudes and/or acting in certain ways towards a patient.…”

“…This is demonstrated when they schedule a patient's day and follow this schedule strictly, regardless of which carer the patient is being looked after by (Hellzén, 2000). We have previously described the social processes that create the desire in psychiatric nursing staff to reach a common approach on how to act towards individual clients in long-term psychiatric care (Enarsson et al, 2007). We now wish to understand how carers experience the common staff approach in caring.…”