Abstract
BackgroundThere is an increasing trend of door locking practices in acute psychiatric care. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses’ experiences of open and locked working spaces.ResultsA sequential mixed-method designexplored the experiences of nurses working in both open and locked psychiatric acute care units. Participants experiences revealed four types of doors related to the quality of recovery-oriented care: (a) the open door, (b) the invisible door, (c) the restraining door, and (d) the revolving door. Open doors and permeable spacesgenerated trust and facilitated the diffusion of tension and the necessary perception of feeling safe in order to be involved in therapeutic engagement. When the locked unit was experienced as a caring environment, the locked doors appeared to be “invisible”. The restraining doors symbolized loss of control, social distance and stigma echoing the consequences of restrictingpeople’s crucial control over spaceduring the COVID-19 pandemicin relation toviolence within families, groups and communities. The revolving door (service users’ abscondence/re-admission) symbolised the rejection of the offered therapeutic environment and was a source of indignation and compassion fatigue in both open and locked spaces attributed to internal structural acute care characteristics (limited staffing levels, support, resources and activities for service users) as well as ‘locked doors’ in the community (limited or no care continuity and stigma).ConclusionsThe impact of COVID-19 restrictions on people’s crucial control of space provides an impetus for erecting barriers masked by the veil of habit and reconsidering the impact of the simple act of leaving the door open/locked to allow both psychiatric acute care unit staff and service users to reach their potential.
Highlights
Persons with mental health problems often experience distressing feelings culminating in a crisis which neither themselves nor their families can contain prior to seeking refuge to a bigger system of relationships in acuteMissouridou et al BMC Psychiatry (2022) 22:2 of trust and respect, in which they are listened to, are of great importance to them [3]
Four types of doors were identified in interview transcripts (a. the open door, b. the invisible door, c. the restraining door, and d. the revolving door), while eighteen sub-themes described their working experiences and perceptions in relation to the four door types in acute psychiatric care units (Table 1)
Overall, in the present study we identified four types of doors in nurses’ experiences of their working environments: the open doors, the invisible doors, the restraining doors and the revolving doors
Summary
Persons with mental health problems often experience distressing feelings culminating in a crisis which neither themselves nor their families can contain prior to seeking refuge to a bigger system of relationships in acuteMissouridou et al BMC Psychiatry (2022) 22:2 of trust and respect, in which they are listened to, are of great importance to them [3]. Peplau [5] described therapeutic relationships as the foundation of psychiatric nursing because they create feelings of being held together and of being safe. She urged nurses to focus on persons rather than patients and ‘give up the notion of a disease, such as schizophrenia and to think exclusively of patients as persons’ [6]. Understanding the person and their experiences, facilitating growth, therapeutic use of self, choosing the right approach and authoritative vs emotional containment, emerged as the “Principles of Engagement” in acute mental health wards [7]. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses’ experiences of open and locked working spaces
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