Abstract:Research into psychopathology continues to shed light on how modern society can learn from the past in terms of issues such as whether people are ill, whether they are responsible for their actions, and what constitutes an effective and ethical treatment.
“…This intervention is not only upholding safety, but serving as treatment itself, providing a further justification for practices. The framing of these interventions as necessities, at its extreme, permits the development of inhumane treatment, such as performing unwarranted hysterectomies and lobotomies to treat mental illness (Beer, ; Goffman, ). Freedom of action, including movement in the outside world, is reframed as a privilege which must be earned through acceptable and safe behaviour.…”
Section: Safety In the Era Of Institutionalizationmentioning
The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self‐harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re‐centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re‐evaluating the risk management culture that gives rise to and legitimizes harmful practices.
“…This intervention is not only upholding safety, but serving as treatment itself, providing a further justification for practices. The framing of these interventions as necessities, at its extreme, permits the development of inhumane treatment, such as performing unwarranted hysterectomies and lobotomies to treat mental illness (Beer, ; Goffman, ). Freedom of action, including movement in the outside world, is reframed as a privilege which must be earned through acceptable and safe behaviour.…”
Section: Safety In the Era Of Institutionalizationmentioning
The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self‐harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re‐centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re‐evaluating the risk management culture that gives rise to and legitimizes harmful practices.
“…In describing their practicum environments, participants frequently drew comparisons to mental health facilities from the era of institutionalisation. While only a few participants specifically labelled the environment as “institutional,” many of their descriptors were consistent with its meaning: settings reminiscent of “asylums” from the era of institutionalisation in which individuals with mental health challenges were separated from the general public and confined in prison‐like settings (Beer, ; Goffman, ). As one participant recalled of her first impression of the practicum setting:It felt very institutional.…”
Aims and objectives
The purpose of this study was to explore how undergraduate students perceive and make decisions regarding mental health nursing as a career following completion of an inpatient mental health practicum.
Background
Among nursing students, mental health is consistently perceived as the least desirable nursing career path. However, evidence to explain why this is the case remains limited, with a lack of research exploring students' experiences of mental health settings and how these experiences influence their perceptions of a mental health nursing career. This knowledge gap limits strategies to support nurses' selection of mental health nursing as a career path, contributing to a global shortage of mental health nurses.
Design
This study used a qualitative narrative inquiry design.
Methods
In‐depth interviews (N = 15) were conducted with undergraduate nursing students to explore their experiences of mental health practicums. Participants had all completed a 6‐week practicum in inpatient mental health settings in urban hospitals. Reporting follows COREQ guidelines.
Results
Nursing students' decisions to not choose a career in mental health nursing were influenced by negative practicum experiences, including the institutional environments of the inpatient mental health settings and witnessing of harmful nursing practices. These factors were identified as barriers to pursuing a career in mental health nursing. However, students expressed desire to continue to work with clients with mental health challenges and aimed to pursue nursing careers that preserve this opportunity in different healthcare settings.
Conclusions
These findings expand upon existing literature that frequently positions nursing students as “uninterested” in mental health nursing and offers insights that can contribute to addressing global mental health nursing shortages.
Relevance to clinical practice
This study highlights the need for mental health nurses, nursing leaders, and educators to recognise and respond to students' difficult experiences in the inpatient mental health setting during practicums.
Frontline clinical staff, typically nurses, are routinely faced with the dilemma of managing challenging, defiant and sometimes unsafe behaviours. Structures of ward rules, regulations and ‘behavioural expectations’ are often employed in hospital environments in service of regulating these behaviours and ensuring collective well‐being. Adolescent inpatient populations, however, pose unique and particularly complex challenges for managing behavioural expectations, given the unique needs and inherent tempestuousness of this developmental period. This article presents a critical review of the existing literature on behavioural expectations for inpatient units, which is largely bereft of adolescent‐specific guidelines. Relevant theoretical perspectives are examined that lend understanding to the management of adolescent behaviour. Finally, drawing from neurodevelopmental, attachment and socio‐evolutionary theory, guiding clinical principles and recommendations are derived for best practice in managing challenging adolescent behaviour in hospital settings.
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