Enabling people, not completing tasks: patient perspectives on relationships and staff morale in mental health wards in England.

Himanshu Mistry,William M M Levack,Sonia Johnson

doi:10.1186/s12888-015-0690-8

Himanshu Mistry, William M M Levack + Show 1 more

Open Access

https://doi.org/10.1186/s12888-015-0690-8

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Abstract

BackgroundMental health inpatient wards are stressful places to work and concerns have been raised regarding quality of patient care and staff wellbeing on these wards. Recent research has suggested that robust support systems and conditions that allow staff to exercise professional autonomy in their clinical work result in better staff morale. Staff value having a voice in their organisations, and say that they would like more interaction with patients and processes to reduce violent incidents on wards. There has been little research into patients’ views on staff morale and on how it may impact on their care. This study aimed to explore staff morale and staff-patient relationships from a patient perspective.MethodsA qualitative investigation was conducted using purposive sampling to select seven inpatient wards in England representing various subspecialties. Semi-structured interviews were carried out with three patients on each ward. A thematic approach to analysis was used, supported by NVivo 10 software.ResultsPatients valued staff who worked together as a cohesive team, treated them as individuals, practised in a collaborative way and used enabling approaches to support their recovery. Participating patients described observing staff closely and feeling concerned at times about their well-being and the impact on them of stress and adverse incidents. They tended to perceive ward staff and patients as closely and reciprocally linked, with staff morale having a significant impact on patient well-being and vice versa. Some participants also described modifying their own behaviour because of concerns about staff well-being. Administrative duties, staff shortages and detrimental effects of violent incidents on the ward were seen as compromising staff members’ ability to be involved with patients’ lives and care.ConclusionPatient views about the factors impacting on staff morale on inpatient wards are similar to those of staff in qualitative studies. Their accounts suggest that staff and patient morale should be seen as interlinked, suggesting there is scope for interventions to benefit both.

Highlights

Mental health inpatient wards are stressful places to work and concerns have been raised regarding quality of patient care and staff wellbeing on these wards
This study is the third component of a national multicentre study of staff morale in inpatient mental health wards which was commissioned by the National Institute of Health Research Service Delivery and Organisation Programme
Multicentre ethics approval was obtained from the Hertfordshire Local Research Ethics Committee and site specific approvals from the participating Trusts. Setting This qualitative investigation of patient views regarding staff morale and its impact on patient experiences was conducted on seven wards in London and the Midlands. These wards were selected from the 100 inpatient mental health wards across England that participated in the initial national survey on staff morale [13]

Summary

Introduction

Mental health inpatient wards are stressful places to work and concerns have been raised regarding quality of patient care and staff wellbeing on these wards. It aimed to reduce activities that did not add value and focused on improving processes in inpatient settings in order to increase the amount of time that nursing and therapy staff spent with patients on therapeutic activities This initiative has been widely adopted by acute mental health services across the NHS, as has the Star Wards programme, which aims to promote “caring conversations” and enrich the range of activities in which staff and patients can engage together on wards [12] Concurrently, attention has increasingly been focused on how better to support mental health staff and reduce their levels of stress and burnout. In the third component (the study presented in this paper), a qualitative investigation was undertaken of inpatients’ perceptions of staff morale within inpatient mental health teams and of its impact on patients

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