Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice (original) (raw)
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Nurses' perceptions of patient safety in psychiatric wards
IOSR Journals , 2019
Background:Considering the safety of patients is the first priority to ensure the high quality of health care. A varietyoffactorshave been reported to directly affect patient safety; institutions, healthcare professionals, and patients are significant factors.Aim: The aim of this study is to explore psychiatric nurses’ perceptions of patient safety at one hospital in Saudi Arabia. Method: Research data was collected using focus group interviews with nurses working inmale and female psychiatric wards. Data was analysed using thematic analysis. Results: thematic analysis identified three main themes that reflect psychiatric nurses’ perceptions of patient safety culture: staffing issues, patient issues, and hospital issues. A number of sub-themes were identified under each theme. Based on the results, a number of recommendations were madetoenhance the culture of patient safety.
Iranian Journal of Psychiatry and Behavioral Sciences, 2018
Background: Patient's safety is the foundation of health qualified to care, which in the inpatient psychiatric wards, is a different but important and challenging issue. Objectives: This study focused on nurses' opinions and experiences about patient safety in inpatient psychiatric wards. Methods: This was a qualitative study based on conventional content analysis and inductive method. Thus, 19 psychiatric nurses were selected from three hospitals using purposive sampling. Data were collected using in-depth semi-structured interviews. Results: Analysis of the data revealed the main theme "intelligent care and protection from risk creators" and two themes including 'vigilant care' and 'close observing' with eight related categories. Conclusions: This study adds a unique insight into patient safety in acute psychiatric wards. The findings suggest that the nurse should take vigilant care and be sensitive to any change in behavior and suspicious behaviors of patients. Continuous observation and objective observation, specific and appropriate intervention, and curious attention are essential. Safety access should be closely monitored.
BMC Health Services Research, 2011
Background: This study seeks to broaden current understandings of what patient safety means in mental healthcare and how it is accomplished. We propose a qualitative observational study of how safety is produced or not produced in the complex context of everyday professional mental health practice. Such an approach intentionally contrasts with much patient safety research which assumes that safety is achieved and improved through top-down policy directives. We seek instead to understand and articulate the connections and dynamic interactions between people, materials, and organisational, legal, moral, professional and historical safety imperatives as they come together at particular times and places to perform safe or unsafe practice. As such we advocate an understanding of patient safety 'from the ground up'.
Deconstructing risk assessment and management in mental health nursing
Journal of Advanced Nursing, 2003
Deconstructing risk assessment and management in mental health nursing Rationale. Risk assessment and management have a taken a central position in the delivery of contemporary mental health services. However, these concepts are generally taken-for-granted as necessary and unavoidable aspects of mental health nursing practice. This deconstructive analysis explores some of the assumptions and values that underpin these concepts. Aims. The aims of the study were to provide a deconstructive analysis of the concepts of risk and risk management, and to explore the historical context of mental disorder and the concept of risk, the clinical context of risk assessment and management, the cultural, political and economic context of risk, and the impact on mental health nursing and consumers of mental health services. Design. This paper takes a deconstructive approach to the exploration of the historical, clinical, cultural, political and economic context of the concept of risk and its assessment and management. This is undertaken by providing a critical review of the history of mental illness and its relationship to risk, examination of government policy on clinical risk management, analysis of a risk assessment model and a discussion of the political and economic factors that have influenced the use of risk assessment and mangement in clinical practice. Findings. The concept of risk and its assessment and management have been employed in the delivery of mental health services as a form of contemporary governance. One consequence of this has been the positioning of social concerns over clinical judgement. The process employed to assess and manage risk could be regarded as a process of codification, commodification and aggregation. In the mental health care setting this can mean attempting to control the actions and behaviours of consumers and clinicians to best meet the fiscal needs of the organization. Conclusion. The mental health nursing profession needs to examine carefully its socially mandated role as guardians of those who pose a risk to others to ensure that its practice represents its espoused therapeutic responsibilities.
Patient Safety In Inpatient Psychiatry: A Remaining Frontier For Health Policy
Health Affairs, 2018
Behavioral health care has been slow to take up robust efforts to improve patient safety. This lag is especially apparent in inpatient psychiatry, where there is risk for physical and psychological harm. Recent investigative journalism has provoked public concern about instances of alleged abuse, negligence, understaffing, sexual assault, inappropriate medication use, patient self-harm, poor sanitation, and inappropriate restraint and seclusion. However, empirical evidence describing the scope of unsafe experiences is limited. While evidence-based inpatient psychiatry requires care to be trauma-informed, market failures and a lack of payment alignment with patient-centered care leave patients vulnerable to harm. Existing regulatory mechanisms attempt to provide accountability; however, these mechanisms are imperfect. Furthermore, research is sparse. Few health services researchers study inpatient psychiatry, the issue has not been a priority among research funders, and data on inpatient psychiatry is excluded from national surveys of quality. Several policy levers could begin to address these deficiencies. These include aligning incentives with patient-centered care, building trauma-informed care into accreditation and monitoring, conducting trend analyses of critical incidents, and improving research capacity.
Journal of Psychiatric Nursing
T he increase in patient's death or disability due to a preventable harm in recent past has led to a discourse around "patient safety" within a separate academic and scientific discipline. With many medical errors being reported, the World Health Organization has called it an endemic concern. Patient safety has been primarily addressed in clinical settings dealing with physical health but a need arises to explore the differential concerns related to patient safety in a mental health-care setting. Risks like medication errors and falls may be similar to other health care disciplines but "some unsafe behaviors associated with serious mental health problems (e.g., self-harm), and the measures taken to address these (e.g., restraint), may result in further risks to patient safety. " [1] Nurses in inpatient psychiatric wards face a number of critical incidents related to their patients, such as aggressiveness, violence, and thought disturbances (delusions, paranoiac thoughts, and hallucinations). [2] Critical incidents, such as aggression, violence, and provocative attitude, in acute admission wards are a frequent Objectives: In psychiatric wards, nursing staff plays a central role in handling unique patient safety issues due to their proximity and extended interaction with the patients. This qualitative exploratory study aims to understand the sociocultural and institutional factors that act as opportunities and/or barriers to provision of patient safety in an in-patient psychiatric unit. Methods: Employing participant observation and critical incident technique that guided the semi-structured interviews, 23 nursing staff of a tertiary care hospital in Rawalpindi, Pakistan, were approached in their natural setting, that is, the wards or outpatient departments during the months of March-June 2021. Results: Using a-priori and emerging codes, six themes were revealed: "Socialization" of mental health, Role Conflict: Nurturing versus Controlling, Approaches: Proactive versus Reactive, Potential Risks to Patient Safety, Indigenous "Painless" procedures for physical restraint, Gender roles matter. The study discusses how the increasing awareness around mental health influences care decisions, how family members act as extensions to nursing role and how the nurses exhibit ambivalence toward the use of restraints. Conclusion: The study concludes that the conceptualization of nurses regarding mental health issues, patient safety, physical restraints, seclusion, cultural, and gender norms is also reflected in their care provision. Nurses' autonomy, decision-making, cultural context, and training in clinical interventions are significant for patient safety in psychiatric nursing practice.
Patient safety in psychiatric inpatient care: a literature review
Journal of Psychiatric and Mental Health Nursing, 2013
• The literature review was intended to form an understanding of the patient safety concept and its intension in psychiatric inpatient care and its constitutive factors from the perspective of organization management, staff and patients. • Organization safety culture is present in all aspects of patient safety and within it organization management has a major role in creating good working conditions and environment for the staff. Staff produces its individual output, which is influenced by management, while the patient's role is more that of an informant according to the existing literature. In future, there will definitely be a need to emphasize the patient's role in developing patient safety practices and organization safety culture. • It is important to develop inpatient care by paying attention to the diversity of the patient safety concept as different aspects are so closely connected. Lack of attention in one area may affect others, leading to errors and adverse events in care. The diversity of the concept should be noted in research, education, and when making patient safety plans in organizations.
Patient Safety and Risk Management in Mental Health
Textbook of Patient Safety and Clinical Risk Management, 2020
This chapter will review the most common adverse events that happen in a psychiatric unit and the safety measures that are needed to decrease the risk of errors and adverse events. The adverse events and errors that may happen in a psychiatric unit are unique and will be examined in detail. This section will also highlight the role of staff members and patients in preventing or causing the error.
Safety and security in acute admission psychiatric wards in Ireland and London: a comparative study
Journal of Clinical Nursing, 2009
Aims and objectives. The comparative element of this study is to describe safety and security measures in psychiatric acute admission wards in the Republic of Ireland and London; to describe differences and similarities in terms of safety and security patterns in the Republic of Ireland and London; and to make recommendations on safety and security to mental health services management and psychiatric nurses. Background. Violence is a serious problem in psychiatric services and staff experience significant psychological reactions to being assaulted. Health and Safety Authorities in the UK and Ireland have expressed concern about violence and assault in healthcare, however, there remains a lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals. Design. A descriptive survey research design was employed. Methods. Questionnaires were circulated to all acute wards in London and in Ireland and the resulting data compared. Results. A total of 124 psychiatric wards from London and 43 wards from Ireland were included in this study and response rates of 70% (London) and 86% (Ireland) were obtained. Differences and similarities in safety and security practices were identified between London and Ireland, with Irish wards having generally higher and more intensive levels of security. Conclusions. There is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards in the Republic of Ireland and London. Given the trends in European Union (EU) regulation, there is a strong argument for the publication of acceptable minimum guidelines for safety and security in mental health services across the EU. Relevance to clinical practice. There must be a concerted effort to ensure that all policy and procedure in safety and security is founded on evidence and best practice. Mental health managers must establish a review of work safety and security procedures and practices. Risk assessment and environmental audits of all mental health clinical environments should be mandatory.