Mapping nursing activity in acute inpatient mental healthcare settings

Abstract

Background: The quality of care on acute inpatient mental health units is a matter of national and international concern. A major determinant of the quality of care experienced by service users is the use of nursing time.Aims: To map, classify and compare the patterns of activities for qualified and unqualified nursing staff in three acute inpatient mental health wards in three UK NHS-provider organizations, and to compare the proportions of time dedicated to user-centred and non user-centred activities.Method: Open interviews with staff undertaken hourly during five, three-day data collection periods per ward.Results: A total of 505 hours of nursing activity were assessed. Half of all activity reported was staff-user contact, however, the majority was during containment activities. Qualified staff were responsible for ward administration, unqualified staff for the majority of staff-user interaction. Unqualified staff reported higher satisfaction with their work, positively correlated with patient contact time.Conclusions: Working practices built on highly prescriptive nursing routines need to be reconfigured in order to allow qualified staff more time to engage with patients and unqualified staff to use their time with service users more constructively.Declaration of interest: This study was funded by three mental health trusts in the North West United Kingdom. We know of no financial relationship that may pose a conflict of interest.