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Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden
Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Cente.ORCID iD: 0000-0002-3509-8701
Centre for Clinical Research, Uppsala University, County Hospital Västerås, Västerås, Sweden.
Örebro University, School of Medical Sciences. University Health Care Research Cente.
Nikban Psykoterapi AB, Stockholm, Sweden.
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2019 (English)In: International Journal of Mental Health Systems, ISSN 1752-4458, E-ISSN 1752-4458, Vol. 13, article id 23Article in journal (Refereed) Published
Abstract [en]

Background: A 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.

Methods: In 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.

Results: The 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.

Conclusions: 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 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.

Place, publisher, year, edition, pages
BMC , 2019. Vol. 13, article id 23
Keywords [en]
Psychiatry, Inpatients, Safety, Violence, Values, Qualitative interviews, Thematic content analysis
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-73870DOI: 10.1186/s13033-019-0282-yISI: 000464189500001PubMedID: 30996733Scopus ID: 2-s2.0-85064104751OAI: oai:DiVA.org:oru-73870DiVA, id: diva2:1306365
Note

Funding Agencies:

Uppsala-Örebro Regional Research Council  

Region Örebro County  

Region Västmanland in Sweden 

Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-23Bibliographically approved

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Pelto-Piri, VeikkoHylén, Ulrika

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