Abstract
BackgroundA major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff. Since guidelines and programs addressing this issue stress the importance of primary prevention in creating safe environments, more insight is needed regarding patient perceptions of feeling safe. The aim of this study is to enhance our understanding of feelings of being safe or unsafe in psychiatric inpatient care.MethodsIn this qualitative study, interviews with open-ended questions were conducted with 17 adult patients, five women and 12 men, from four settings: one general psychiatric, one psychiatric addiction and two forensic psychiatric clinics. The main question in the interview guide concerned patients’ feelings of being safe or unsafe. Thematic content analysis with an inductive approach was used to generate codes and, thereafter, themes and subthemes.ResultsThe main results can be summarized in three themes: (1) Predictable and supportive services are necessary for feeling safe. This concerns the ability of psychiatric and social services to meet the needs of patients. Descriptions of delayed care and unpredictable processes were common. The structured environment was mostly perceived as positive. (2) Communication and taking responsibility enhance safety. This is about daily life in the ward, which was often perceived as being socially poor and boring with non-communicative staff. Participants emphasized that patients have to take responsibility for their actions and for co-patients. (3) Powerlessness and unpleasant encounters undermine safety. This addresses the participants’ way of doing risk analyses and handling unpleasant or aggressive patients or staff members. The usual way to act in risk situations was to keep away.ConclusionsOur results indicate that creating reliable treatment and care processes, a stimulating social climate in wards, and better staff-patient communication could enhance patient perceptions of feeling safe. It seems to be important that staff provide patients with general information about the safety situation at the ward, without violating individual patients right to confidentiality, and to have an ongoing process that aims to create organizational values promoting safe environments for patients and staff.
Highlights
A major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff
Our results indicate that creating reliable treatment and care processes, a stimulating social climate in wards, and better staff-patient communication could enhance patient perceptions of feeling safe
It seems to be important that staff provide patients with general information about the safety situation at the ward, without violat‐ ing individual patients right to confidentiality, and to have an ongoing process that aims to create organizational values promoting safe environments for patients and staff
Summary
A major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff. In psychiatric inpatient care in Sweden, 83% of nursing staff have reported experiences of violence; 47% in the previous 6 months [10] It is, necessary to minimize violence, including self-harm and coercive measures, in order to create a safe environment. The management can give prerequisites for the prevention of violence through good managerial policies, organizational values and an efficient organization with a clear purpose of care [13, 14] These organizational factors affect the ward structure and make it easier for ward managers and staff to create consistent and reasonable ward rules. Other preventive measures are to take care of agitated patients at an early stage and to use de-escalation methods when appropriate [13, 17, 18]
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