Nurses’ Perceptions of Patient Safety in Community Mental Health Settings: A Qualitative Study
Affiliation(s)
1 Caring Sciences, Municipality in Söderhamn, Sweden. 2 Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden. 3 Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden. 4 Department of Endocrinology, Gävle Hospital, Gävle, Sweden. 5 Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden. 6 Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
1 Caring Sciences, Municipality in Söderhamn, Sweden. 2 Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden. 3 Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden. 4 Department of Endocrinology, Gävle Hospital, Gävle, Sweden. 5 Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden. 6 Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden.
ABSTRACT
Mental health care has moved from hospital settings to community mental health settings, and there is a need to explore the perceptions of patient safety among registered nurses working in this field. Patient safety is to include everyone and to be the goal in all aspects of health care. The aim of the study was to explore registered nurses’ perceptions of patient safety in community mental health settings for people with serious mental illness. The study was qualitative and descriptive in nature and interviews were carried out during spring 2012, with seven registered nurses working in community mental health settings for people with serious mental illness in five municipalities in the middle of Sweden. The sampling was purposive and data were analysed using qualitative content analysis. The findings showed that the registered nurses understood patient safety as providing support to people with serious mental illness in regaining and maintaining health through good treatment and respecting self-determination and avoiding coercion. The terms of daily living in small community mental health settings within the a large community health care organization, communication, sufficient knowledge of psychiatric disabilities among people in the residents’ network, and national laws and regulations, all had implications for patient safety. The registered nurses perceived patient safety as involving a wide range of issues that in other areas of care are more often discussed in terms of quality of care. Determining the boundaries of patient safety in community mental health settings for people with serious mental illness can be a first step in establishing workable routines that ensure safe patient care.
Mental health care has moved from hospital settings to community mental health settings, and there is a need to explore the perceptions of patient safety among registered nurses working in this field. Patient safety is to include everyone and to be the goal in all aspects of health care. The aim of the study was to explore registered nurses’ perceptions of patient safety in community mental health settings for people with serious mental illness. The study was qualitative and descriptive in nature and interviews were carried out during spring 2012, with seven registered nurses working in community mental health settings for people with serious mental illness in five municipalities in the middle of Sweden. The sampling was purposive and data were analysed using qualitative content analysis. The findings showed that the registered nurses understood patient safety as providing support to people with serious mental illness in regaining and maintaining health through good treatment and respecting self-determination and avoiding coercion. The terms of daily living in small community mental health settings within the a large community health care organization, communication, sufficient knowledge of psychiatric disabilities among people in the residents’ network, and national laws and regulations, all had implications for patient safety. The registered nurses perceived patient safety as involving a wide range of issues that in other areas of care are more often discussed in terms of quality of care. Determining the boundaries of patient safety in community mental health settings for people with serious mental illness can be a first step in establishing workable routines that ensure safe patient care.
Cite this paper
Sundin, R. , Nilsson, A. , Waage-Andrée, R. , Björn, C. , (2015) Nurses’ Perceptions of Patient Safety in Community Mental Health Settings: A Qualitative Study. Open Journal of Nursing, 5, 387-396. doi: 10.4236/ojn.2015.54042.
Sundin, R. , Nilsson, A. , Waage-Andrée, R. , Björn, C. , (2015) Nurses’ Perceptions of Patient Safety in Community Mental Health Settings: A Qualitative Study. Open Journal of Nursing, 5, 387-396. doi: 10.4236/ojn.2015.54042.
References
[1] World Health Organization (2004) Patient Safety.
http://www.who.int/patientsafety/about/en/ [2] Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M., Leape, L., Reason, J., Schyve, P., Vincent, C. and Walton, M. (2008) What Exactly Is Patient Safety? In: Henriksen, K., Battles, J.B., Keyes, M.A. and Grady, M.L., Eds., Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment), Agency for Healthcare Research and Quality, Rockville. [3] Mitchell, P.H. (2008) Defining Patient Safety and Quality Care. In: Hughes, R.G., Ed., Patient Safety and Quality: An Evidence-Based Handbook for Nurses, AHRQ Publication No. 08-0043, Agency for Healthcare Research and Quality, Rockville, 1-5. [4] Kanerva, A., Lammintakanen, J. and Kivinen, T. (2013) Patient Safety in Psychiatric Inpatient Care: A Literature Review. Journal of Psychiatric and Mental Health Nursing, 20, 541-548.
http://dx.doi.org/10.1111/j.1365-2850.2012.01949.x [5] Brickell, T.A. and McLean, C. (2011) Emerging Issues and Challenges for Improving Patient Safety in Mental Health: A Qualitative Analysis of Expert Perspectives. Journal of Patient Safety, 7, 39-44.
http://dx.doi.org/10.1097/PTS.0b013e31820cd78e [6] Briner, M. and Manser, T. (2013) Clinical Risk Management in Mental Health: A Qualitative Study of Main Risks and Related Organizational Management Practices. BMC Health Services Research, 13, 44.
http://dx.doi.org/10.1186/1472-6963-13-44 [7] World Health Organization (2008) Integrating Mental Health into Primary Care: A Global Perspective.
http://www.who.int/mental_health/policy/services/integratingmhintoprimarycare/en/ [8] World Health Organization (2011) Mental Health Atlas.
http://whqlibdoc.who.int/publications/2011/9799241564359_eng.pdf [9] Jenkins, R., Othieno, C., Okeyo, S., Aruwa, J., Kingora, J. and Jenkins, B. (2013) Health System Challenges to Integration of Mental Health Delivery in Primary Care in Kenya-Perspectives of Primary Care Health Workers. BMC Health Services Research, 13, 368.
http://dx.doi.org/10.1186/1472-6963-13-368 [10] Hamden, A., Newton, R., McCauley-Elsom, K. and Cross, W. (2011) Is Deinstitutionalization Working in Our Community? International Journal of Mental Health Nursing, 20, 274-283.
http://dx.doi.org/10.1111/j.1447-0349.2010.00726.x [11] Happel, B., Hoey, W. and Gaskin, C.J. (2012) Community Mental Health Nurses, Caseloads, and Practices: A Literature Review. International Journal of Mental Health Nursing, 21, 131-137.
http://dx.doi.org/10.1111/j.1447-0349.2011.00777.x [12] The National Board of Health and Welfare (2014) National Planning Support in 2014—Supply and Demand of Certain Groups of Staff in Healthcare and Dental Care.
http://www.socialstyrelsen.se/publikationer2014/2014-1-32 [13] Mwachofi, A., Walston, S.L. and Al-Omar, B.A. (2011) Factors Affecting Nurses’ Perceptions of Patient Safety. International Journal of Health Care Quality Assurance, 24, 274-283.
http://dx.doi.org/10.1108/09526861111125589 [14] Polit, D.F. and Beck, C.T. (2012) Nursing Research: Generating and Assessing Evidence for Nursing Practice. Lippincott Williams and Wilkins, Philadelphia. [15] Swedish Code of Statutes, SFS (2010) Swedish Act on Patient Safety.
http://www.riksdagen.se/sv/Dokument-Lagar/Lagar/Svenskforfattningssamling/Patientsakerhetslag-2010659_sfs-2010-659/ [16] Graneheim, U.H. and Lundman, B. (2004) Qualitative Content Analysis in Nursing Research: Concepts, Procedures and Measures to Achieve Trustworthiness. Nurse Education Today, 24, 105-112.
http://dx.doi.org/10.1016/j.nedt.2003.10.001 [17] Declaration of Helsinki (2013) World Medical Association.
http://www.wma.net/en/20activities/10ethics/10helsinki/index.html [18] Swedish Ethical Review Act (2003) SFS. Vetting the Ethics of Research Involving Humans.
http://www.epn.se/en/start/startpage/ [19] Argentzell, E., Leufstadius, C. and Eklund, M. (2014) Social Interaction among People with Psychiatric Disabilities—Does Attending a Day Center Matter? International Journal of Social Psychiatry, 60, 519-527.
http://dx.doi.org/10.1177/0020764013502318 [20] Hunt, G.E., Marsden, R. and O’Connor, N. (2012) Clinical Handover in Acute Psychiatric and Community Mental Health Settings. Journal of Psychiatric and Mental Health Nursing, 19, 310-318.
http://dx.doi.org/10.1111/j.1365-2850.2011.01793.x [21] Magnusson, A., Hogberg, T., Lutzen, K. and Severinsson, E. (2004) Swedish Mental Health Nurses’ Responsibility in Supervised Community Care of Persons with Long-Term Mental Illness. Nursing & Health Sciences, 6, 19-27.
http://dx.doi.org/10.1111/j.1442-2018.2003.00171.x [22] Kristiansen, L., Hellzen, O. and Asplund, K. (2010) Left Alone-Swedish Nurses’ and Mental Health Workers’ Experiences of Being Care Providers in a Social Psychiatric Dwelling Context in the Post-Health-Care-Restructuring Era. A Focus-Group Interview Study. Scandinavian Journal of Caring Sciences, 24, 427-435.
http://dx.doi.org/10.1111/j.1471-6712.2009.00732.x
[1] World Health Organization (2004) Patient Safety.
http://www.who.int/patientsafety/about/en/ [2] Emanuel, L., Berwick, D., Conway, J., Combes, J., Hatlie, M., Leape, L., Reason, J., Schyve, P., Vincent, C. and Walton, M. (2008) What Exactly Is Patient Safety? In: Henriksen, K., Battles, J.B., Keyes, M.A. and Grady, M.L., Eds., Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment), Agency for Healthcare Research and Quality, Rockville. [3] Mitchell, P.H. (2008) Defining Patient Safety and Quality Care. In: Hughes, R.G., Ed., Patient Safety and Quality: An Evidence-Based Handbook for Nurses, AHRQ Publication No. 08-0043, Agency for Healthcare Research and Quality, Rockville, 1-5. [4] Kanerva, A., Lammintakanen, J. and Kivinen, T. (2013) Patient Safety in Psychiatric Inpatient Care: A Literature Review. Journal of Psychiatric and Mental Health Nursing, 20, 541-548.
http://dx.doi.org/10.1111/j.1365-2850.2012.01949.x [5] Brickell, T.A. and McLean, C. (2011) Emerging Issues and Challenges for Improving Patient Safety in Mental Health: A Qualitative Analysis of Expert Perspectives. Journal of Patient Safety, 7, 39-44.
http://dx.doi.org/10.1097/PTS.0b013e31820cd78e [6] Briner, M. and Manser, T. (2013) Clinical Risk Management in Mental Health: A Qualitative Study of Main Risks and Related Organizational Management Practices. BMC Health Services Research, 13, 44.
http://dx.doi.org/10.1186/1472-6963-13-44 [7] World Health Organization (2008) Integrating Mental Health into Primary Care: A Global Perspective.
http://www.who.int/mental_health/policy/services/integratingmhintoprimarycare/en/ [8] World Health Organization (2011) Mental Health Atlas.
http://whqlibdoc.who.int/publications/2011/9799241564359_eng.pdf [9] Jenkins, R., Othieno, C., Okeyo, S., Aruwa, J., Kingora, J. and Jenkins, B. (2013) Health System Challenges to Integration of Mental Health Delivery in Primary Care in Kenya-Perspectives of Primary Care Health Workers. BMC Health Services Research, 13, 368.
http://dx.doi.org/10.1186/1472-6963-13-368 [10] Hamden, A., Newton, R., McCauley-Elsom, K. and Cross, W. (2011) Is Deinstitutionalization Working in Our Community? International Journal of Mental Health Nursing, 20, 274-283.
http://dx.doi.org/10.1111/j.1447-0349.2010.00726.x [11] Happel, B., Hoey, W. and Gaskin, C.J. (2012) Community Mental Health Nurses, Caseloads, and Practices: A Literature Review. International Journal of Mental Health Nursing, 21, 131-137.
http://dx.doi.org/10.1111/j.1447-0349.2011.00777.x [12] The National Board of Health and Welfare (2014) National Planning Support in 2014—Supply and Demand of Certain Groups of Staff in Healthcare and Dental Care.
http://www.socialstyrelsen.se/publikationer2014/2014-1-32 [13] Mwachofi, A., Walston, S.L. and Al-Omar, B.A. (2011) Factors Affecting Nurses’ Perceptions of Patient Safety. International Journal of Health Care Quality Assurance, 24, 274-283.
http://dx.doi.org/10.1108/09526861111125589 [14] Polit, D.F. and Beck, C.T. (2012) Nursing Research: Generating and Assessing Evidence for Nursing Practice. Lippincott Williams and Wilkins, Philadelphia. [15] Swedish Code of Statutes, SFS (2010) Swedish Act on Patient Safety.
http://www.riksdagen.se/sv/Dokument-Lagar/Lagar/Svenskforfattningssamling/Patientsakerhetslag-2010659_sfs-2010-659/ [16] Graneheim, U.H. and Lundman, B. (2004) Qualitative Content Analysis in Nursing Research: Concepts, Procedures and Measures to Achieve Trustworthiness. Nurse Education Today, 24, 105-112.
http://dx.doi.org/10.1016/j.nedt.2003.10.001 [17] Declaration of Helsinki (2013) World Medical Association.
http://www.wma.net/en/20activities/10ethics/10helsinki/index.html [18] Swedish Ethical Review Act (2003) SFS. Vetting the Ethics of Research Involving Humans.
http://www.epn.se/en/start/startpage/ [19] Argentzell, E., Leufstadius, C. and Eklund, M. (2014) Social Interaction among People with Psychiatric Disabilities—Does Attending a Day Center Matter? International Journal of Social Psychiatry, 60, 519-527.
http://dx.doi.org/10.1177/0020764013502318 [20] Hunt, G.E., Marsden, R. and O’Connor, N. (2012) Clinical Handover in Acute Psychiatric and Community Mental Health Settings. Journal of Psychiatric and Mental Health Nursing, 19, 310-318.
http://dx.doi.org/10.1111/j.1365-2850.2011.01793.x [21] Magnusson, A., Hogberg, T., Lutzen, K. and Severinsson, E. (2004) Swedish Mental Health Nurses’ Responsibility in Supervised Community Care of Persons with Long-Term Mental Illness. Nursing & Health Sciences, 6, 19-27.
http://dx.doi.org/10.1111/j.1442-2018.2003.00171.x [22] Kristiansen, L., Hellzen, O. and Asplund, K. (2010) Left Alone-Swedish Nurses’ and Mental Health Workers’ Experiences of Being Care Providers in a Social Psychiatric Dwelling Context in the Post-Health-Care-Restructuring Era. A Focus-Group Interview Study. Scandinavian Journal of Caring Sciences, 24, 427-435.
http://dx.doi.org/10.1111/j.1471-6712.2009.00732.x