Locked door psychiatric units have more disadvantages than advantages say staff

The disadvantages of locking the front doors of psychiatric units outnumber the advantages by more than two to one, according to a study published in the latest Journal of Clinical Nursing.

Researchers from Uppsala University in Sweden interviewed 40 mental health nurses and nursing assistants working on seven Swedish psychiatric inpatient wards with locked entrance doors.

The majority of patients in their care (45 per cent) had been diagnosed with mood disorders, 33 per cent had anxiety, personality or other disorders and 22 per cent had schizophrenia and psychotic disorders.

Eight advantages and 18 disadvantages were cited by the staff and most of these concerned patients' experiences.

"Enabling staff to control patients was felt to be an advantage by 85 per cent of staff, providing patients with secure and efficient care by 73 per cent and protection against the outside world by 68 per cent" says lead author Kristina Haglund.

"We know where the patients are" commented one member of staff, while another said that "it gives patients a sense of security when the ward is locked." Another said that family members were relieved to "know that the patient is safe and secure."

But there were twice as many disadvantages to contend with.

"The most common disadvantage, mentioned by 83 per cent of respondents, was that controlling the door was an uncomfortable and time-consuming task for staff, which could interrupt ongoing duties or contact with patients" adds Kristina Haglund.

"75 per cent felt that having a locked door could reduce patients' self-confidence and feeling of personal responsibility. "48 per cent also expressed worries that it created a non-caring environment and could make patients feel that they had to depend on staff to open the door."

One member of staff expressed concern that rattling keys could "intensity the 'prison' atmosphere" and others worried that it added "to the feeling of illness", caused "agitation" or made patients "passive". Staff also talked about difficult issues relating to voluntary patients who didn't need to be locked in.

Locked doors also made staff question their role. "At the same time that you are caring for a patient you must be a sort of guard too" said one respondent. Other staff said it made them feel "shut-in".

There was also practical concern that locked doors could be a hindrance in an emergency.

Just over half of the staff surveyed (53 per cent) had also worked on an open door psychiatric unit. The majority (70 per cent) were female and the average age of the 20 registered nurses was 52 – five years older than the 20 mental health nurse assistants.

The registered nurses had been working in their current role for an average of 10 years, compared with eight years for the nurse assistants.

39 of the 40 participants mentioned both advantages and disadvantages during their taped interviews, which averaged 20 minutes and were carried out by an interviewer with extensive experience of working in mental health care.

One participant – a mental health nursing assistant – mentioned only disadvantages.

Both groups cited an almost equal number of advantages, but registered nurses mentioned more than 27 per cent more disadvantages.

Another survey carried out in the same year as this research found that three-quarters of Swedish psychiatric units were locked.

"It's clear from our research that staff have mixed feelings about locked door psychiatric units" concludes Kristina Haglund.

"On the one hand locked doors can undermine the purpose of the care being provided. But on the other hand, they can help staff to provide patients with a structured and safe environment that reduces the risk of them leaving the ward and harming themselves or others."

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Notes to editors

Psychiatric wards with locked doors – advantages and disadvantages according to nurses and mental health assistants. Haglund, von Knorring and von Essen, Uppsala University, Uppsala, Sweden. Journal of Clinical Nursing. Volume 15, pages 387-394.

Founded in 1992, Journal of Clinical Nursing is a highly regarded peer reviewed Journal that has a truly international readership. The Journal embraces experienced clinical nurses, student nurses and health professionals, who support, inform and investigate nursing practice. It enlightens, educates, explores, debates and challenges the foundations of clinical health care knowledge and practice worldwide. Edited by Professor Roger Watson, it is published 10 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. www.blackwellpublishing.com/jcn


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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