Psychological Needs and Threat to Safety: Implications for Staff and Patients in a Psychiatric Hospital for Youth.

Abstract

For psychiatric care workers and administrators, physical threat from behaviorally dysregulated patients is an important issue tied to many others, including workers' job satisfaction, motivation, well-being, and attitude toward patients. Yet, the impact of threats to physical safety may be offset by factors in the clinical environment. The authors tested hypotheses derived from self-determination theory concerning the relations of workplace need satisfaction and perceived threat to motivation, attitudes, and well-being among clinical staff within an adolescent psychiatric inpatient hospital. Also tested were relations between need satisfaction and treatment motivation among adolescent patients. To improve the experience of psychiatric workers and their patients, clinical staff and their administrators must attend to the satisfaction of needs for autonomy, relatedness, and competence.For the worker in a psychiatric inpatient facility, the question "How satisfied am I on the job?" can have multiple meanings, and its answer can have multiple determinants. Job satisfaction in the traditional sense conveys a contentment with salient aspects of the job's demands and rewards, a contentment that in turn may be shaped by the affective "climate" of the workplace (Brief & Weiss, 2002). Job demands can of course include everyday work-related responsibilities, whereas rewards are often thought of as tangible things like pay and benefits; in an inpatient setting, the work climate may be shaped by, among other things, the risks to safety inherent in working with behaviorally compromised patients. Yet, presumably there are other aspects of such work settings that can contribute to the overall climate in ways that buffer psychiatric employees from the risks of their jobs while providing them a sense of satisfaction in what they do.There is, in fact, a growing literature that highlights how various attributes of treatment settings affect the motivation and mental health of care workers. This study extends the literature by applying a model of self-motivation and adjustment derived from selfdetermination theory (SDT; Deci & Ryan, 1985;. Specifically tested are the relations of worker outcomes (such as "buying into" or acceptance of hospital programs, attitudes toward patients, and employee well-being and job satisfaction) both with satisfaction of basic psychological needs at work and with the experience of threat to safety on the job. Subsidiary goals of this study included testing whether enjoyment of work, or intrinsic job satisfaction, accounts for more variance in well-being and motivation than does extrinsic job satisfaction, or satisfaction with pay and benefits. Finally, in a parallel model, we also examined whether the relation between need satisfaction and "buying into" the treatment program would hold for psychiatric patients, as we predicted it would for staff.To explicate the basis for these predictions, we present a review of the SDT model of basic needs and their importance in work and treatment settings. We review...

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