Nurses' accounts of locked ward doors: ghosts of the asylum or acute care in the 21st century?

Abstract

The practice of locking acute ward doors in the UK to manage patient care has been reported with increasing frequency in a number of recent official documents; however, there is little research examining the practice. This study explores the perceptions and experiences of mental health nurses working on acute wards where the doors are locked for all or part of a shift. Audio-taped, semi-structured interviews were undertaken with 11 qualified mental health nurses and analysed using content analysis. Six broad categories were identified: policies and documentation, locking and unlocking the doors, communicating the decision, reasons for locking the doors, benefits and concerns. The findings suggest that there is a need for mental health nurses to reflect on the reasons for, and wider implications of locking ward doors before their wholesale implementation is considered in the UK.

Effect of Door-Locking Policy on Inpatient Treatment of Substance Use and Dual Disorders

“…In the same study of 21 surveyed substance use units, none had an open door when a committed patient was present. A qualitative study interviewing British nurses also found that the prevention of substance use is an important part of the rationale for locking doors [35]. We did not find evidence for an increase in substance use.…”

Brain injury rehabilitation: The lived experience of inpatients and their family caregivers

“…Previous research exploring nurses' perceptions of brain injury rehabilitation units has also identified that inpatients feel restricted within a locked ward and suggested a link with aggressive behaviour (28). Perceptions of a prison environment have also been recognized within the mental health literature, which debates the balance between patient rights, safety, and health system resources (19,29).…”

“…The rehabilitation unit, in this study, was a 26-bed secured inpatient ward with a combination of shared and single rooms, a dining room, a recreational space, a physiotherapy gym, and outdoor courtyards, and was staffed by a multidisciplinary rehabilitation team (including medical and nursing staff, 2.5 occupational therapists, 3.5 physiotherapists, two speech pathologists, one social worker, and a part-time neuropsychologist). The purpose of the secured ward is to create a safe environment for inpatients, staff, and visitors (19).…”

Critical Incidents During Leave From an Australian Security Hospital – A 12 Year Audit

“…A study of nurses' accounts suggested that by intensifying certain negative ideation experienced by patients (including feeling confined, trapped and isolated from family and friends), locking ward doors may actually contribute to absconding attempts. 66 A 2006 Cochrane review has found no evidence from randomised controlled trials of any beneficial effects of non-pharmacological approaches (including locked wards) to contain disturbed or violent behaviour. 67 A study from an acute psychiatric ward in Berlin which was primarily closed for six months and primarily open for another six months found that absconding, aggressive incidents and coercive medications were observed significantly more often in the closed door period.…”