'Safer, Not Safe': Service Users' Experiences of Psychological Safety in Inpatient Mental Health Wards in the United Kingdom.

Katharina Sophie Vogt, John Baker, Sarah Kendal, Bethany Leigh Griffin, Emily Mizen, Hannah Sharp, Judith Johnson
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Abstract

Research on patient safety in mental health settings is limited compared to physical healthcare settings. Recent qualitative studies have highlighted that patient safety is more than just physical safety but includes psychological safety. Traditionally, psychological safety has been defined as the belief that it is safe to take interpersonal risks, such as speaking up, without a fear of negative consequences. However, to date, it is not clear what constitutes psychological safety for service users of inpatient mental health settings. To understand this, we conducted 12 interviews with former inpatient mental health service users. Interviews were analysed with Reflexive Thematic Analysis, and five themes were developed. All themes had subthemes. Overall, we found that participants were more readily able to draw on situations where they felt psychologically unsafe, rather than safe. Psychological safety in service users was influenced by (1) healthcare staff attitudes and behaviours towards them, (2) their relationships with other service users, (3) whether they felt they had any control over their environment and medical decision-making regarding their care, (4) their experiences of physically safety, feeling listened to and believed and (5) access to meaningful occupation on the wards. These findings suggest that changes are needed to enhance inpatient mental health service users' general experiences of psychological safety. Further research will need to (1) further develop understanding of the concept of psychological safety for service users and (2) identify interventions, and such interventions should be co-designed with service users.

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更安全,不安全":英国心理健康住院病房服务使用者的心理安全体验》。
与实体医疗机构相比,有关精神卫生机构患者安全的研究十分有限。最近的定性研究强调,患者安全不仅仅是身体安全,还包括心理安全。传统上,心理安全被定义为一种信念,即承担人际交往中的风险是安全的,比如大胆直言,而不必担心负面后果。然而,到目前为止,我们还不清楚什么才是精神健康住院患者的心理安全。为了了解这一点,我们对曾经的住院精神健康服务使用者进行了 12 次访谈。我们使用反思性主题分析法对访谈进行了分析,并形成了五个主题。所有主题都有副主题。总的来说,我们发现参与者更容易描述他们感到心理不安全的情况,而不是安全的情况。影响服务使用者心理安全的因素包括:(1)医护人员对他们的态度和行为;(2)他们与其他服务使用者的关系;(3)他们是否觉得自己可以控制自己所处的环境和有关护理的医疗决策;(4)他们的人身安全体验、被倾听和被信任的感觉;(5)在病房中从事有意义的职业的机会。这些研究结果表明,我们需要做出改变,以提高住院精神健康服务使用者的心理安全感。进一步的研究需要:(1)进一步加深对服务使用者心理安全概念的理解;(2)确定干预措施,这些干预措施应该与服务使用者共同设计。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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