Pelto-Piri Veikko, Wallsten Tuula, Hylén Ulrika, Nikban Iradj, Kjellin Lars
1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
2Centre for Clinical Research, Uppsala University, County Hospital Västerås, Västerås, Sweden.
Int J Ment Health Syst. 2019 Apr 8;13:23. doi: 10.1186/s13033-019-0282-y. eCollection 2019.
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.
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.
The main results can be summarized in three themes: (1) 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) 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) 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.
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.
精神科住院护理面临的一项重大挑战是营造一个能促进患者康复、保障患者安全并为工作人员提供良好工作环境的氛围。由于针对该问题的指南和项目都强调在营造安全环境方面进行一级预防的重要性，因此需要对患者的安全感认知有更深入的了解。本研究的目的是增进我们对精神科住院护理中安全感或不安全感的理解。
在这项定性研究中，对来自四个机构的17名成年患者（5名女性和12名男性）进行了开放式问题访谈，这四个机构分别是一家综合精神科诊所、一家精神科成瘾诊所和两家法医精神科诊所。访谈指南中的主要问题涉及患者的安全感或不安全感。采用归纳法进行主题内容分析，以生成代码，进而提炼出主题和子主题。
主要结果可归纳为三个主题：（1）这涉及精神科和社会服务机构满足患者需求的能力。护理延迟和过程不可预测的情况屡见不鲜。结构化环境大多被视为积极的。（2）这关乎病房中的日常生活，病房生活往往被认为社交匮乏且枯燥，工作人员缺乏沟通。参与者强调患者必须对自己的行为以及其他病友负责。（3）这涉及参与者进行风险分析以及应对不友好或有攻击性的患者或工作人员的方式。在风险情况下通常的做法是避开。
我们的结果表明，建立可靠的治疗和护理流程、营造活跃的病房社交氛围以及改善医护人员与患者之间的沟通，可增强患者的安全感。工作人员在不侵犯患者个人保密权的前提下，向患者提供有关病房安全状况的一般信息，并建立一个旨在营造促进患者和工作人员安全环境的组织价值观的持续过程，这似乎很重要。
