Abstract
Social distancing and the recent lock down due to COVID-19 has increased the feeling of disconnection, isolation, and suffering in vulnerable individuals and has brought forward questions regarding open acute care psychiatric units that cannot be answered by the literature. In Greece, there is no available research on how open ward environments are perceived and experienced by mental health professionals. The aim of the present study was to illuminate nurses’ experiences of working in a public psychiatric hospital which traditionally operates with open doors. Eleven nursing care providers were interviewed, and thematic analysis was employed to explore their experiences of working in locked psychiatric acute care units. Participants described nursing care in units with an open door policy as “acceptance,” “availability of staff,” “real respect for the person,” “ensuring patients’ rights,” “listening to the person,” and “negotiation and not imposition.” Trust in therapeutic relationships was perceived as greatly dependent on the trust being given to patients indirectly by the open door policy. Being trusted enhanced patients’ self-determination and self-confidence leading to their empowerment. Containment of an acute mental health crisis took place through medication and meaningful discussions with patients and significant others rather than locking the door of the unit. Overall, meaningful care led to professional emancipation, but compassion fatigue narratives emphasized the need for continuous education, support and clinical supervision as necessary support for mental health nurses in a system of mental health provision often reduced to the point of crisis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Barry CA, Britten N, Barbar N, Bradley C, Stevenson F (1999) Using reflexivity to optimize teamwork in qualitative research. Qual Health Res 9(1):26–44
Begley C (1996) Using triangulation in nursing research. J Adv Nurs 24:122–128
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):7–101. https://doi.org/10.1191/1478088706qp063oa
Ghebreyesus TA (2020) Addressing mental health needs: an integral part of COVID-19 response. World Psychiatry 19(2):129
Vieta E, Pérez V, Arango C (2020) Psychiatry in the aftermath of COVID-19. Rev Psiquiatr Salud Ment (Barc) 13(2):105–110
Bilanakis N, Kalampokis G, Christou K, Peritogiannis V (2010) Use of coercive physical measures in a psychiatric ward of a general hospital in Greece. Int J Soc Psychiatry 56(4):402–411
Blomqvist M, Ziegert K (2011) ‘Family in the waiting room’: a Swedish study of nurses’ conceptions of family participation in acute psychiatric inpatient settings. Int J Ment Health Nurs 20(3):185–194. https://doi.org/10.1111/j.1447-0349.2010.00714.x
Bowers L (2015) Nursing interventions for substance use during psychiatric hospital admissions: clinical context and predictors. Int J Ment Health Nurs 24:527–537. https://doi.org/10.1111/inm.12152
Bowers L, Alexander J, Bilgin H, Botha M, Dack C, James K, Jarrett M, Jeffery D, Nijman H, Owiti JA, Papadopoulos C, Ross J, Wright S, Stewart D (2014) Safewards: the empirical basis of the model and a critical appraisal. J Psychiatry Ment Health Nurs 21:354–364. https://doi.org/10.1111/jpm.12085
Bowers L, Douzenis A, Galeazzi GM, Forghieri M, Tsopelas C, Simpson A, Allan T (2005) Disruptive and dangerous behaviour by patients on acute psychiatric wards in three European Centres. Soc Psychiatry Psychiatr Epidemiol 40:822–828
Burns T (2016) Locked doors or therapeutic relationships? Lancet Psychiatry 3(9):795–796. 161016/S2215-0366(16)30185-7
Chondros P (2015) The contribution of NGOs in the empowerment of users and family members in Greece: actions and problems. In: Economou M, Javed A, Madianos M, Peppou LE (eds) Psychosis: patient and family. International and Greek examples of psychiatric rehabilitation. Hellenic Branch of the World Association for Psychiatric Rehabilitation, Athens, pp 36–39
Christodoulou G, Ploumpidis D, Christodoulou N, Anagnostopoulos D (2010) Mental health profile of Greece. Int Psychiatry 7:64–67
Di Napoli W, Andreatta O (2014) A “no-restraint” psychiatric department: operative protocols and outcome data from the “opened-doors experience” in Trento. Psychiatr Danub 26(1):138–141
Douzenis A, Michopoulos I, Economou M, Rizos E, Christodoulou C, Lykouras L (2010) Involuntary admission in Greece: a prospective national study of police involvement and client characteristics affecting emergency assessment. Int J Soc Psychiatry 58(2):172–177
Fiste M, Ploumpidis D, Tsiamis C, Poulakou-Rebelakou E, Liappas I (2015) Dromokaition Psychiatric Hospital of Athens: from its establishment in 1887 to the era of deinstitutionalization. Ann General Psychiatry 14(7):1–8
Gustafsson N, Salzmann-Erikson M (2016) Effect of complex working conditions on nurses who exert coercive measures in forensic psychiatric care. J Psychosoc Nurs Ment Health Serv 54(9):37–43. https://doi.org/10.3928/02793695-20160817-06
Hem HM, Heggen K, Ruyter KW (2008) Creating trust in an acute psychiatric ward. Nurs Ethics 15(6):777–788
Huber CG, Schneeberger AR, Kowalinski E, Fröhlich D, von Felten S, Walter M et al (2016) Suicide risk and absconding in psychiatric hospitals with and without open door policies: a 15 year, observational study. Lancet Psychiatry 3(9):842–849. Published: 28 July 2016
Jungfer HA, Schneeberger AR, Borgwardt S, Walter M, Vogel M, Gairing SK et al (2014) Reduction of seclusion on a hospital-wide level: successful implementation of a less restrictive policy. J Psychiatr Res 54:94–99
Kalisova L, Raboch J, Nawka A, Sampogna G, Cihal L, Kallert T, Onchev G, Karastergiou A, del Vecchio V, Kiejna A, Adamowski T, Torres-Gonzales F, Cervilla J, Priebe S, Giacco D, Kjellin L, Dembinskas A, Fiorillo A (2014) Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study. Soc Psychiatry Psychiatr Epidemiol 49:1619–1629
Lanara VA (1991) Heroism as a nursing value – a philosophical perspective. Evniki, Athens
Misouridou E (2017) Secondary posttraumatic stress and nurses’ emotional responses to patient’s trauma. J Trauma Nurs 24:110–115
Muir-Cochrane EC, Baird J, McCann TV (2015) Nurses’ experiences of restraint and seclusion use in short-stay acute old age psychiatry inpatient units: a qualitative study. J Psychiatr Ment Health Nurs 22(2):109–115. https://doi.org/10.1111/jpm.12189
Ploumpidis D (2015) Reform of the psychiatric services in Greece and psychosocial rehabilitation: achievements and open questions. In: Economou M, Javed A, Madianos M, Peppou LE (eds) Psychosis: patient and family. International and Greek examples of psychiatric rehabilitation. Hellenic Branch of the World Association for Psychiatric Rehabilitation, Athens, pp 30–35
Schneeberger AR, Kowalinski E, Fröhlich D, Schröder K, von Felten S, Zinkler M, Beine KH, Heinz A, Borgwardt S, Lang UE, Bux DA, Huber CG (2017) Aggression and violence in psychiatric hospitals with and without open door policies: a 15-year naturalistic observational study. J Psychiatr Res 95:189–195
Stylianidis S, Peppou LE, Drakonakis N, Douzenis A, Panagou A, Tsikou K, Pantazi A, Rizavas Y, Saraceno B (2017) Mental health care in Athens: are compulsory admissions in Greece a one-way road? Int J Law Psychiatry 52:28–34. https://doi.org/10.1016/j.ijlp.2017.04.001
Raboch J, Kalisová L, Nawka A, Kitzlerová E, Onchev G, Karastergiou A &Magliano L (2010) Use of Coercive Measures During Involuntary Hospitalization: Findings From Ten European Countries. Psychiatric services, 61(10):1012–1017. https://doi.org/10.1176/ps.2010.61.10.1012
Zegwaard MI, Aartsen MJ, Grypdonck MH, & Cuijpers P (2015) Mental health nurses’ support to caregivers of older adults with severe mental illness: a qualitative study. BMC nursing, 14(1):1–10
Schreiber LK, Metzger FG, Duncker TA, Fallgatter AJ, & Steinert T (2019) Open doors by fair means: Study protocol for a 3-year prospective controlled study with a quasi-experimental design towards an open Ward policy in acute care units. BMC psychiatry, 19(1): 1–8
Hochstrasser L, Voulgaris A, Möller J, Zimmermann T, Steinauer R, Borgwardt S, ... & Huber CG (2018) Reduced frequency of cases with seclusion is associated with “Opening the Doors” of a psychiatric intensive care unit. Frontiers in psychiatry, 9(57)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this paper
Cite this paper
Missouridou, E. et al. (2021). Nurses’ Experiences of Psychiatric Care in Acute Care Units with an Open Door Policy. In: Vlamos, P. (eds) GeNeDis 2020. Advances in Experimental Medicine and Biology, vol 1337. Springer, Cham. https://doi.org/10.1007/978-3-030-78771-4_15
Download citation
DOI: https://doi.org/10.1007/978-3-030-78771-4_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-78770-7
Online ISBN: 978-3-030-78771-4
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)