Life in acute mental health settings: experiences and perceptions of service users and nurses (original) (raw)
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Life on the psychiatric ward: a qualitative study
British Journal of Wellbeing, 2011
I t is estimated that 450 million people disorder (WHO, 2001). In Britain more than 1.2 million people were in contact with mental health services in the UK between 2008 and 2009, and more than 28 000 people were admitted to than 7500 patients. The results revealed that over time to discuss their condition and treatment with
What do we know about life on acute psychiatric wards in the UK? a review of the research evidence
Social Science & Medicine, 2001
Despite the development of community care and associated processes of de-institutionalisation, the hospital remains the hub of mental health services in the UK. However, previous quantitative and survey research indicates that quality of care in acute psychiatric (admission) wards has been compromised or is under threat, and points to a bleak experience for people who are admitted. Indicators of this include that there have been increases in admission rates, the proportion of compulsory admissions, and bed occupancy rates. There is also evidence of violence, sexual harassment and substance misuse in this setting, accompanied by rapid staff turnover, low staff morale, and an increasing proportion of 'difficult' patients (especially young men with schizophrenia). This paper reviews the evidence about life on psychiatric wards, focusing on how it is experienced by patients in acute settings. Research conducted in the UK in the 1990s, supports the impression that organisational pressures are having a negative impact on the quality of care. It shows that: nurse-patient (N-P) relationships are perceived to be an important aspect of care, but that N-P contact has declined; and patients are critical of conditions on the ward and view life there as both boring and unsafe. However, very little in-depth ethnographic research has been conducted on acute wards in the UK (and none since the 1970s) leaving us with a 'black box' view of in-patient care in this setting. Studies conducted during earlier 'care paradigms', notably those in the USA by Goffman and Strauss et al., provide useful insights into the patient's experience, but the extent to which these can be conceptually generalised to the present situation is unknown. The paper concludes by outlining questions and priorities for future investigation, focusing on the role of qualitative research. #
Caring for mental health service users on a general ward: a phenomenological approach
International Journal of Healthcare Sciences, 2020
Caring for mental health service users is a public concern especially in situations where these types of patients have to be managed in a general ward. Government is committed to establish measures that would enhance the standard of caring for mental health service users in a general ward setting. This study intended to explore and describe the lived experiences of nurses who care for the mental health service users in public hospital in Libode in the Eastern Cape Province in South Africa. A qualitative, descriptive phenomenological research design to explore and describe the lived experiences of nurses who care for the mental health care users in general wards at a district hospital. Semi-structured individual interviews (n =6) were used to collect data from the se nurses. These interviews were audio-taped and transcribed verbatim and Collaizzi's process of qualitative data analysis was applied for data analysis. This study reported both positive and negative experiences. Positive experiences included the rescue of mental health care users and cooperation among nurses. Negative experiences included the combination of chronic ill patients with known aggressive and unpredictable mental health care users; shortage of staff; unsecured fencing for mental health care users; lack of support from managers and feeling unappreciated were reported. In conclusion, necessary prioritisation of all aspects of services in the management of mental health care users should be adhered to. Secondly, paying attention to all nurses' needs regarding the circumstances they undergo when managing mental health service users should be adhered to.
Curationis, 2012
Psychiatric nurse practitioners (PNPs) working with mental health care users presenting with acute symptoms work in a complex environment. This environment is characterised by mental health care users who may present with a history of violence, sexual assault and substance misuse.The objectives of this study were twofold: firstly, to explore and describe the experiences of PNPs working with mental health care users (MHCUs) presenting with acute symptoms; and secondly, to make recommendations for the advanced PNPs to facilitate promotion of the mental health of PNPs with reference to nursing practice, research and education.A qualitative, explorative, descriptive and contextual design was used. The target population was PNPs working with MHCUs presenting with acute symptoms in a public mental health care institution in Gauteng. Data were collected by means of four focus group interviews involving 21 PNPs. The researcher made use of drawings, naïve sketches and field notes for the pur...
Thematic analysis of psychiatric patients' perceptions of nursing staff
International Journal of Mental Health Nursing, 2014
Therapeutic and informal interactions with nurses are integral to the quality of care that psychiatric patients receive. How well these interactions are performed, and their impact on the experience and outcomes of inpatient care, have not been subject to systematic evaluation. The aim of the present study was to examine patients' perceptions of the personal and professional qualities of nursing staff and how these contribute to the ward environment. Patients (n = 119) from 16 acute psychiatric wards were interviewed using a schedule developed by a service-user researcher. Transcriptions of interviews were coded and organized into six themes: staff duties, staff disposition, control, communication and engagement, therapeutic ward environment, and consistency. Patients recognized that nurses have a difficult and stressful job, but frequently expressed feelings of anger, frustration, and hopelessness about their experience of the wards. Patients frequently felt that nursing staff did not understand issues from their perspective or attempt to empathize with them. The findings indicate poorly-communicated and inconsistent care. Initiatives to improve patients' experiences of acute psychiatric wards are urgently needed.
Psychology and Psychotherapy: Theory, Research and Practice, 2019
Objectives. The quality of therapeutic relationships in psychiatric services has a significant impact upon the therapeutic outcomes for people diagnosed with a severe mental illness. As previous work has not explicitly explored service users’ in-depth views about the emotional impact of these relationships, the objective of this work was to bring this perspective to the fore and to gain a greater understanding about which relational components can lead to psychological change. Design. The project was conducted alongside a service user organization. An interview design was used to qualitatively explore service users’ experiences and perceptions of their relationships with mental health practitioners. Methods. Eight individuals who had experience of the mental health system in the United Kingdom were interviewed. Interpretative phenomenological analysis was used to analyse the data. Findings. Three superordinate themes emerged from the analysis. These were (1) Trying to survive: am I a person or just an object in the system?; (2) Traumatic experiences within relationships; and (3) Helpful and transformative relationships. Further, the key transformative components of these relationships were power, safety, and identity. Conclusions. Mental health services should be more focused upon care, rather than control. The Power Safety Identity (PSI) model, a reflexive model based upon key relational components highlighted by participants, is proposed for services and professionals to consider their work. The components of this model are managed by mental health practitioners and can determine whether these relationships maintain, increase, or alleviate psychological distress.
Journal of Psychiatric and Mental Health Nursing, 2007
How mental health nursing can best improve service users' experiences and outcomes in inpatient settings: responses to a national consultation Despite a number of national developments in the past few years, concerns remain about the experience and outcomes for service users in inpatient care settings. As part of a national review of mental health nursing in England, a consultation exercise was carried out to ascertain the opinions of a wide range of stakeholders in order to inform subsequent recommendations. The consultation question specifically related to inpatient care was 'How can mental health nurses best improve service users' experiences, and outcomes, in inpatient care settings?' The consultation generated a total of 326 written responses, mostly from groups and organizations. Responses were subject to content analysis and the three largest categories were 'Service users influencing services' (n = 80, 31%), 'Service users involved in own care' (n = 74, 29%) and 'Direct clinical time' (n = 68, 26%), including respondents citing the need for protected therapeutic engagement time. Many of the themes raised in the consultation were subsequently reflected in the recommendations made in 'From values to action; the Chief Nursing Officer's review of mental health nursing'.
Organisational Considerations for Supporting Mental Health Nurses (MHN) in Practice
International Journal of Nursing Science, 2012
It is estimated that by 2020 15% of the world's population will be affected by mental illness requiring an inpatient hospital admission. Registered nurses are the largest health care discipline working within inpatient mental health care settings however there is a growing international shortage of registered nurses choosing to work within this specialty. Research reports that issues such as workplace violence, stress and limited career structure are the primary reasons cited by registered nurses for not choosing to work in mental health care. This paper reports on the findings of a study that explored the workplace practices and experiences of registered nurses currently working within an acute inpatient facility. Thirteen mental health nurses participated. Individual interviews and focus groups were used to collect the data. A major theme to emerge from the study was Therapeutic relationships. The theme outlined the expertise required to effectively care for clients experiencing mental illness within this environment and the positive rewards experienced by nurses within the therapeutic relationship. A sense of strength, professional pride and dedication emerged from the research data and a distinctive new vision of mental health nursing was defined.
2019
The number of descriptive studies on the experiences of service users in psychiatric emergency wards is increasing. However, the experiences of users throughout the whole psychiatric emergency procedure, the “patient journey” from the moment of mental health crisis to admission to a psychiatric inpatient unit, have rarely been studied. Furthermore, there is little research on perceived solutions for improvement of the “patient journey” from different perspectives (those of service users and other stakeholders such as health care professionals, family members, police, representatives of the municipality, and ambulance staff). A responsive evaluation including interviews, focus groups and a dialogue session with a transformative aim was conducted in a mixed team of researchers with and without experiential knowledge. Service users and other stakeholders agreed on two main issues that needed to be improved: making contact with service users on the “patient journey”, and better signalin...