Toward a Safer Working Environment on Psychiatric Wards: Service Users' Delayed Perspectives of Aggression and Violence-Related Situations and Development Ideas

Abstract

Delayed perceptions and proposals resembled the proximate ones. Perceptions may persist for years. Such perceptions and proposals, if taken into account from the beginning of treatment, may prevent negative long-term consequences of witnessed or experienced aggression/violence. Humane, interactive nursing models should be studied and disseminated.

Patient Experience of Coercive Measures

“…Patients have been found to feel alienated from the staff in in-patient settings, which makes communication more difficult and hinders or prevents sharing information between patients and staff (Jeffs et al 2012). Nurses' absence from the wards may result in feelings of loneliness (Duxbury 2002;Kontio et al 2014). In the absence of staff, patients tend to withdraw from situations and take a passive observer role with consequent or worsened suspiciousness.…”

“…It is of concern that even a long time after the event perceived as traumatic, salient perceptions, recollections and feelings of the service users may remain in their minds (Kontio et al 2014). For example, suicides witnessed on the ward many years ago still are experienced as extremely taxing memories and the same seems to be true for aggressive or violent incidents experienced or witnessed.…”

“…In a study by Kontio et al (2014), the service users' delayed (i.e. years after the event) perceptions of not having received sufficient attention brought to their mind feelings of loneliness, boredom, oppressive control and rules, fear and insecurity, as well as a lack of clarity about their current situation, their treatment plan and the reasons for seclusion or restraint.…”

“…Information on the reasons for seclusion and restraint helped patients to understand these restrictions (Meehan et al 2004;Chien et al 2005;Kontio et al 2012). In particular, the delayed descriptions-unlike most of those in the reports on immediate perceptions-were enriched with positive examples of professional and humane, readily available and attentive nurses able to create an atmosphere of safety (Kontio et al 2014).…”

“…In Finland, among other countries, the importance of patients' perspective and service user involvement in the development of inpatient aggression management programmes has been officially recognised (Ministry of Social Affairs and Health 2009). It is understood that patients' experiences and practical suggestions on the improvement of coercive measures, especially seclusion and restraint practices and their alternatives, are essential to ensure evidence-based patient-centred psychiatric services (Hyde et al 2009;Kuosmanen 2009;Keski-Valkama et al 2010a, b;Kontio et al 2012Kontio et al , 2014.…”