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Psychiatric wards with locked doors: advantages and disadvantages according to nurses and mental health nurse assistants
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. (Caring Sciences)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Caring Sciences)
2006 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 4, 387-394 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objective. To describe nurses’ and mental health nurse assistants’ perceptions of advantages and disadvantages about working on a psychiatric ward with a locked entrance door.

Background. Psychiatric staff sometimes needs to protect patients from harming themselves or others. To keep the entrance door locked may help staff to achieve this goal. How locked entrance doors at psychiatric wards are experienced by staff, working on these wards, has been investigated to a very limited extent.

Design. The study was explorative and descriptive.

Method. Audio taped, semi-structured interviews with open-ended questions about advantages and disadvantages about working on a psychiatric ward with a locked entrance door, were conducted with 20 nurses and 20 mental health nurse assistants. Data were analyzed with content analysis.

Results. A content analysis revealed eight categories of advantages and 18 categories of disadvantages. Most advantages mentioned by nurses and mental health nurse assistants were categorized as providing staff with control over patients, providing patients with a secure and efficient care and protecting patients and staff against ‘the outside’. Most disadvantages mentioned by nurses were categorized as causing extra work for staff, making patients feel confined, making patients feel dependent and creating a non-caring environment. Most disadvantages mentioned by mental health nurse assistants were categorized as causing extra work for staff, making patients feel confined, causing emotional problems for patients, making staff's power obvious and forcing patients to adapt to other patients’ needs. Nurses and mental health nurse assistants mentioned more disadvantages than advantages and nurses mentioned more disadvantages than mental health nurse assistants.

Conclusion. Nurses and mental health nurse assistants perceive a number of advantages and disadvantages for themselves, patients and significant others with a locked door at a psychiatric ward. Most of these concern patients’ experiences.

Relevance to clinical practice. It is important for staff working within psychiatric care to reflect upon the fact that a locked entrance door is connected with a range of negative as well as positive perceptions and to minimize patient and own concerns connected to the locked door.

Place, publisher, year, edition, pages
2006. Vol. 15, no 4, 387-394 p.
Keyword [en]
locked; nursing; perceptions; psychiatry; staff; ward
National Category
Psychiatry Nursing
Identifiers
URN: urn:nbn:se:uu:diva-93745DOI: 10.1111/j.1365-2702.2006.01489.xPubMedID: 16553751OAI: oai:DiVA.org:uu-93745DiVA: diva2:167320
Available from: 2005-11-24 Created: 2005-11-24 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Patient and Staff Perceptions of Medication Administration and Locked Entrance Doors at Psychiatric Wards
Open this publication in new window or tab >>Patient and Staff Perceptions of Medication Administration and Locked Entrance Doors at Psychiatric Wards
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim was, within psychiatric inpatient care, to explore patient and staff perceptions with regard to medication administration and locked entrance doors. In Study I, medication administration was illuminated according to a mini-ethnographic approach. Nurses and voluntarily admitted patients were observed and interviewed. Two central categories of patient and nurse experiences were identified, get control and leave control. In Study II, patients and nurses were interviewed about patient experiences of forced medication. Identified experiences were related to the disease, being forcibly medicated, and the drug. In Study III, the frequency of and reasons for locked entrance doors on Swedish psychiatric inpatient wards were investigated. Seventy three per cent of the doors were locked on a specific day. According to ward managers, doors were most often locked in order to prevent patients from escaping, provide security and safety, and because legalisation. In Study IV/V, voluntarily admitted patients/mental nurse assistants and nurses were interviewed about advantages and disadvantages about being cared for/working on a psychiatric inpatient ward with a locked entrance door. Most advantages mentioned by patients and staff were categorised as protection against “the outside”, secure and efficient care, and control over patients. Most disadvantages mentioned by patients were categorised as confinement, dependence on the staff, and emotional problems for patients. Most disadvantages mentioned by staff were categorised as extra work, confinement, dependence on the staff, and a non-caring environment. In conclusion, medication administration and locked entrance doors are perceived as connected with staff’s control and restricted freedom for patients. Increased reflection among staff about how medication administration and locked entrance doors are perceived by patients would increase staff’s possibilities to prevent potential experiences of coercion due to these situations among patients in psychiatric inpatient care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 52 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 85
Keyword
Nursing, forced medication, locked ward, medication administration, patient, perception, psychiatry, staff, Omvårdnad
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-6133 (URN)91-554-6398-3 (ISBN)
Public defence
2005-12-14, Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2005-11-24 Created: 2005-11-24 Last updated: 2009-06-01Bibliographically approved

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Haglund, Kristinavon Knorring, Larsvon Essen, Louise

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