Understanding how personhood impacts consumers’ feelings of safety in acute mental health units: a qualitative study

Cutler, Natalie Ann; Sim, Jenny; Halcomb, Elizabeth; Stephens, Moira; Moxham, Lorna

doi:10.1111/inm.12809

Cited by 11 publications

(20 citation statements)

References 34 publications

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“…Despite the existing evidence supporting the influence of staff, and specifically MHNs in preventing aggressive incidents (Bowers et al 2014), more work is needed to understand how this influence manifests in practice. MHNs can significantly influence how consumers experience safety within inpatient units (Cutler et al 2020) some of which rests on prioritizing engagement and recovery-oriented practice (Cutler et al 2021;Lim et al 2017). While it is a positive outcome that staff felt safer because of Safewards implementation (Fletcher et al 2019b), this still may perpetuate the idea that aggression is driven by consumers.…”

Section: Staff Acceptance and Engagementmentioning

confidence: 99%

“…Recovery-oriented practice is realized when MHNs are present and available for consumers (Cutler et al 2020;Pelto-Piri et al 2019), which enables trusting therapeutic relationships to be established (Cutler et al 2020;Henderson 2014). This also involves active listening, showing respect and facilitating consumer choice (Cutler et al 2020(Cutler et al , 2021 all of which are well aligned with the intent of Safewards and many of the interventions (Fletcher et al 2019b). These attributes are necessary for recovery-oriented practice (Lim et al 2019) and clearly stipulated within policy directives, and the broader literature as critical for contemporary service delivery (Isobel 2019;McKenna et al 2014;NSW Mental Health Commission 2014).…”

Section: Safewards Facilitating Recovery-oriented Practicementioning

confidence: 99%

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Safewards: An integrative review of the literature within inpatient and forensic mental health units

Mullen

Browne

Hamilton

et al. 2022

Int J Mental Health Nurs

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Mental health inpatient units are complex and challenging environments for care and treatment. Two imperatives in these settings are to minimize restrictive practices such as seclusion and restraint and to provide recovery‐oriented care. Safewards is a model and a set of ten interventions aiming to improve safety by understanding the relationship between conflict and containment as a means of reducing restrictive practices. To date, the research into Safewards has largely focused on its impact on measures of restrictive practices with limited exploration of consumer perspectives. There is a need to review the current knowledge and understanding around Safewards and its impact on consumer safety. This paper describes a mixed‐methods integrative literature review of Safewards within inpatient and forensic mental health units. The aim of this review was to synthesize the current knowledge and understanding about Safewards in terms of its implementation, acceptability, effectiveness and how it meets the needs of consumers. A systematic database search using Medline, CINAHL, Embase and PsychInfo databases was followed by screening and data extraction of findings from 19 articles. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of empirical articles, and the Johanna Brigg’s Institute (JBI’s) Narrative, Opinion, Text‐Assessment and Review Instrument (NOTARI) was used to undertake a critical appraisal of discussion articles. A constant comparative approach was taken to analysing the data and six key categories were identified: training, implementation strategy, staff acceptability, fidelity, effectiveness and consumer perspectives. The success of implementing Safewards was variously determined by a measured reduction of restrictive practices and conflict events, high fidelity and staff acceptability. The results highlighted that Safewards can be effective in reducing containment and conflict within inpatient mental health and forensic mental health units, although this outcome varied across the literature. This review also revealed the limitations of fidelity measures and the importance of involving staff in the implementation. A major gap in the literature to date is the lack of consumer perspectives on the Safewards model, with only two papers to date focusing on the consumers point of view. This is an important area that requires more research to align the Safewards model with the consumer experience and improved recovery orientation.

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Section: Staff Acceptance and Engagementmentioning

confidence: 99%

Section: Safewards Facilitating Recovery-oriented Practicementioning

confidence: 99%

Safewards: An integrative review of the literature within inpatient and forensic mental health units

Mullen

Browne

Hamilton

et al. 2022

Int J Mental Health Nurs

View full text Add to dashboard Cite

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“…The environment encompasses both the physical spaces of an acute unit and the social interactions and activities that occur within those physical spaces (Mollon, 2014). Other themes; Influence of Nurses (Cutler, Sim, Halcomb, Moxham, et al, 2020) and Being Seen as a Person (Cutler et al., 2020) are reported in separate papers due to the richness of the data.…”

Section: Introductionmentioning

confidence: 99%

How does the environment influence consumers' perceptions of safety in acute mental health units? A qualitative study

Cutler

Halcomb

Sim

et al. 2021

Journal of Clinical Nursing

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Aims and objectives To explore how the physical and social environment of acute mental health units influences consumers' perception and experience of safety. Background Acute mental health units are places in which consumers should feel safe. Not all consumers, however, feel safe in this environment. Little is known about what contributes to consumers' feelings of safety in this setting. Design The study used a qualitative descriptive design, influenced by naturalistic enquiry. Data were analysed using thematic analysis and are reported according to the COREQ checklist. Methods Fifteen people who had experienced admission to an acute mental health unit were individually interviewed. Results Having a supportive environment enhanced consumers' perception and experience of safety. A supportive environment was experienced when consumers had privacy, felt safe from other consumers and had meaningful activities to participate in within the acute mental health unit. In contrast, having their privacy breached by other consumers made participants feel unsafe. Many participants were fearful of other consumers, and felt unsafe and unable to protect themselves. Lack of meaningful activities led to boredom and contributed to consumers feeling unsafe. Conclusions Personal spaces should address consumers' privacy needs without compromising staff access. Staff presence enhances consumers' feelings of safety, but this need can be heightened when consumers are unable to alert staff when they feel unsafe. Meaningful activities link consumers to their lives outside of the hospital and can enhance recovery. Relevance to clinical practice Understanding how the acute unit environment is perceived by consumers can assist nurses and managers to promote feelings of safety among consumers. Feeling safe can, in turn, optimise recovery.

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“…Recognizing consumers as the experts they are in their illness experience, can be a way to invite a more recovery-oriented practice to the inpatient mental health unit and have an impact on the current power dynamics (Olasoji et al 2020a). More equality, by recognizing the worth and the dignity of a person can also increase the feeling of safety among consumers (Cutler et al 2021).…”

Section: Discussionmentioning

confidence: 99%

“…More equality, by recognizing the worth and the dignity of a person can also increase the feeling of safety among consumers (Cutler et al . 2021).…”

Section: Discussionmentioning

confidence: 99%

Nursing handover involving consumers on inpatient mental healthcare units: A qualitative exploration of the consumers’ perspective

Velde

Hecke

Cleemput³

et al. 2021

Int J Mental Health Nurs

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Handovers between nurses are a significant cause of communication problems and possible consumer safety issues. A potential solution for both problems is the nursing handover involving consumers, in which the consumer is present at the time of handover. This practice invites consumers to be more involved in their care process and supports a recovery‐oriented practice. Research into nursing handovers involving consumers on inpatient mental health units is however very limited. A qualitative, phenomenological study was conducted. Semi‐structured interviews with 13 consumers staying on an inpatient mental health unit of a general hospital were used. The interviews were transcribed verbatim and thematically analysed. Data saturation was reached after 11 interviews when no new themes or codes emerged from the data. Three themes were generated from the interviews: (i) the first moments on the inpatient mental health unit; (ii) the nurse as an ally; and (iii) informing each other. The COREQ‐checklist was used. According to consumers, nursing handover involving consumers initiated a change in the relationship between consumers and nurses. Consumers and nurses got to know each other better during handover and built a relationship of trust. The introduction of nursing handover involving consumers created an accessible opportunity for consumers to exchange information with nurses and ask questions concerning their admission. Consumers felt jointly responsible for the continuity of the information about their healthcare process. Due to the use of nursing handover involving consumers, consumers experienced the opportunity to take more control in their health process and ensured that information is correct and complete.

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Understanding how personhood impacts consumers’ feelings of safety in acute mental health units: a qualitative study

Cited by 11 publications

References 34 publications

Safewards: An integrative review of the literature within inpatient and forensic mental health units

Safewards: An integrative review of the literature within inpatient and forensic mental health units

How does the environment influence consumers' perceptions of safety in acute mental health units? A qualitative study

Nursing handover involving consumers on inpatient mental healthcare units: A qualitative exploration of the consumers’ perspective

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