‘They all said you could come and speak to us’: patients' expectations and experiences of help on an acute psychiatric inpatient ward

Abstract

Acute psychiatric inpatient care forms an integral part of mental health services. Few studies have focussed on the patient experience of acute care. Research into patient experience is increasingly important to policy and service development processes. Knowledge of patient experiences facilitates the development of nursing practice. The aim of the study was to gain insight into the experience of being a patient on an acute inpatient psychiatric ward. Thirteen participants were recruited from the acute ward. Unstructured interviews were used to gather narrative data of their experiences. Holistic analysis of the narratives was informed by Gee's socio-linguistic theories that meaning is linked to narrative structure. Reading of the holistic analyses yielded themes of help, safety and power running across the participants' experiences. The patient experience was characterized by dissonance between expectation and experience, the search for a nurse-patient relationship and the development of strategies to cope with being on the acute ward. This paper focuses on the theme of 'Help' where participants describe their expectation that they will receive help through the development of relationships with the nurses, and their experience of the barriers to this. In response, participants developed strategies to support each other.

Mental Health Hospital Admissions: a Teachable Moment and Window of Opportunity To Promote Change in Drug and Alcohol Misuse

“…These would need to include strategic decisions in the management, philosophy, and priorities of a ward for staff and inpatients to perceive therapeutic interventions as central to an inpatient admission. Such changes could herald a shift in the focus of treatment during a mental health admission from Bcontainment^and Bmanagement^to providing Bprotected time^where it is perceived as a Btherapeutic window of opportunity^and Bteachable moment^ (Stenhouse 2011;Thomson and Hamilton 2012;Butler et al 2014).…”

Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts

“…Similarly, these findings are supported by Stenhouse (2010Stenhouse ( , 2011, who interviewed service users in inpatient settings, and her aptly titled paper 'They all said you could come and speak to us' detailed service users' expectations, which she reported were not met as participants perceived nurses were too busy with non-nursing tasks. A study by Nolan et al (2016) Delaney and Johnson (2014) identified that whilst the therapeutic relationship with users was viewed as a foundational role, this was actually difficult to achieve:…”

“…Since the advent of recovery oriented approaches, which focuses workers' attention on service users' priorities, the value of service user involvement has been increasingly recognised as good practice (Beresford, 2008;Borg, Karlssen & Kim, 2009). However, whilst this may be heralded as a practice imperative, it is suggested that nurses may struggle to carry out such work (Patton, 2013;Stenhouse, 2011).…”

“…Interpersonal aspects of care are highly valued by service users (Simpson et al, 2016a;Valente, 2017), as it is time with staff that is most requested. (Barker, 2000;Stenhouse, 2011;Street, 2004). In a study where protected time for staff to spend time with service users was implemented, little positive effect was reported by service users .…”

“…Concerns may feature as background expectancies that service users have about mental health nurses and the nature of care relationships with those nurses. Expectations will be specific to individuals, as some service users may expect time to talk with nursing staff (Stenhouse, 2011), whilst others' expectations may relate to staff having power and control (Baker, Lovell, Easton & Harris, 2006). Expectations of this type may influence how service users engage with mental health nurses.…”