Journal of Qualitative Research in Health Sciences
Journal of Qualitative Research in Health Sciences

Safety Challenges in Psychiatric Departments from Nurses’ Perspective: A Qualitative Study

Document Type : Original Article

Authors

Mahya Torkaman 1
Marzieh Momennasab 2
Shahrzad Yektatalab 3
Mahin Eslami Shahrbabaki 4

1 Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

3 Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

4 Neurology Research Center , Shahid Beheshti Hospital , Afzalipoor School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

10.34172/jqr.1500
Abstract
Background: Despite international concerns and efforts to provide safe care, there are still many obstacles ahead and nurses are facing many challenges concerning patient safety in psychiatric departments. To this end, the present study sought to describe safety challenges in psychiatric departments from the nurses’ perspective.
Methods: This qualitative study was conducted using the conventional content analysis approach. Data were collected through 12 semi-structured interviews and observations. The participants were selected using purposive sampling from nurses working at a psychiatric hospital in southeastern Iran in 2021 and the sampling process continued until data saturation. Data analysis was performed using Graneheim and Lundman’s content analysis approach.
Results: The data analysis revealed four main themes: “an exhaustive environment”, “inadequate facilities”, “ineffective communication”, and “non-safety oriented organizational climate”.
Conclusion: Efforts have been made in Iran to review and improve patient safety programs in the form of annual clinical governance and accreditation. However, despite the implemented programs, there are still fundamental challenges in providing safe care.

Highlights

Marzieh Momennasab (PubMed) (Google Scholar)

Keywords

Safety challenges
Nurses
Psychiatric departments
Qualitative study
  1. Burwell SM. Setting value-based payment goals--HHS efforts to improve US health care. N Engl J Med. 2015;372(10):897- 9. doi: 10.1056/NEJMp1500445.
  2. Thom KA, Heil EL, Croft LD, Duffy A, Morgan DJ, Johantgen M. Advancing interprofessional patient safety education for medical, nursing, and pharmacy learners during clinical rotations. J Interprof Care. 2016;30(6):819-22. doi: 10.1080/13561820.2016.1215972.
  3. Mansouri SF, Khaleghdoost Mohammadi T, Adib M, Kazemnejad Lili E, Soodmand M. Barriers to nurses reporting errors and adverse events. Br J Nurs. 2019;28(11):690-5. doi: 10.12968/bjon.2019.28.11.690.
  4. Vaziri S, Fakouri F, Mirzaei M, Afsharian M, Azizi M, Arab-Zozani M. Prevalence of medical errors in Iran: a systematic review and meta-analysis. BMC Health Serv Res. 2019;19(1):622. doi: 10.1186/s12913-019-4464-8.
  5. Marcus SC, Hermann RC, Frankel MR, Cullen SW. Safety of psychiatric inpatients at the veterans health administration. Psychiatr Serv. 2018;69(2):204-10. doi: 10.1176/appi. ps.201700224.
  6. Chunduri S, Browne S, Pollio DE, Hong BA, Roy W, Roaten K, et al. Suicide risk assessment and management in the psychiatry emergency service: psychiatric provider experience and perceptions. Arch Suicide Res. 2019;23(1):1-14. doi: 10.1080/13811118.2017.1414648 .
  7. Cruz Antolin AJ, Otin Grasa JM, Mir Abellán R, Miñambres Donaire A, Grimal Melendo I, de la Puente Martorell ML. [Patient safety in psychiatric hospitalization - what incidents are reported and managed?]. J Healthc Qual Res. 2018;33(5):290- 7. doi: 10.1016/j.jhqr.2018.06.004. [Spanish].
  8. Shields MC, Stewart MT, Delaney KR. Patient safety in inpatient psychiatry: a remaining frontier for health policy. Health Aff (Millwood). 2018;37(11):1853-61. doi: 10.1377/ hlthaff.2018.0718.
  9. Motamed M, Yahyavi ST, Sharifi V, Alaghband-Rad J, Aghajannashtaei F. Emergency psychiatric services in Roozbeh hospital: a qualitative study of the staff’s experiences. Perspect Psychiatr Care. 2019;55(2):249-54. doi: 10.1111/ppc.12348.
  10. Razzani B, Atashzadeh-Shoorideh F, Jamshidi T, Barkhordari- Sharifabad M, Lotfi Z, Skerrett V. The effect of education around ethical principles on nurses’ perception to patient safety culture in an Iranian mental health inpatient unit: a pilot study. BMC Nurs. 2020;19:10. doi: 10.1186/s12912- 020-0402-7.
  11. Thibaut B, Dewa LH, Ramtale SC, D’Lima D, Adam S, Ashrafian H, et al. Patient safety in inpatient mental health settings: a systematic review. BMJ Open. 2019;9(12):e030230. doi: 10.1136/bmjopen-2019-030230.
  12. Maher A, Ayoubian A, Rafiei S, Sheibani Tehrani D, Mostofian F, Mazyar P. Developing strategies for patient safety implementation: a national study in Iran. Int J Health Care Qual Assur. 2019;32(8):1113-31. doi: 10.1108/ ijhcqa-02-2019-0043.
  13. Behzadifar M, Bragazzi NL, Arab-Zozani M, Bakhtiari A, Behzadifar M, Beyranvand T, et al. The challenges of implementation of clinical governance in Iran: a meta-synthesis of qualitative studies. Health Res Policy Syst. 2019;17(1):3. doi: 10.1186/s12961-018-0399-5.
  14. Lindgren BM, Lundman B, Graneheim UH. Abstraction and interpretation during the qualitative content analysis process. Int J Nurs Stud. 2020;108:103632. doi: 10.1016/j. ijnurstu.2020.103632.
  15. Lincoln YS, Guba EG. Establishing Dependability and Confirmability in Naturalistic Inquiry Through an Audit. 1982. Available from: https://eric.ed.gov/?id = ED216019.
  16. Abdelhadi N, Drach-Zahavy A, Srulovici E. The nurse’s experience of decision-making processes in missed nursing care: A qualitative study. J Adv Nurs. 2020;76(8):2161-70. doi: 10.1111/jan.14387.
  17. Suhonen R, Stolt M, Habermann M, Hjaltadottir I, Vryonides S, Tonnessen S, et al. Ethical elements in priority setting in nursing care: a scoping review. Int J Nurs Stud. 2018;88:25- 42. doi: 10.1016/j.ijnurstu.2018.08.006.
  18. Philip S, Woodward-Kron R, Manias E. Overseas qualified nurses’ communication with other nurses and health professionals: an observational study. J Clin Nurs. 2019;28(19- 20):3505-21. doi: 10.1111/jocn.14942.
  19. Tuohy D. Effective intercultural communication in nursing. Nurs Stand. 2019;34(2):45-50. doi: 10.7748/ns.2019.e11244.
  20. Myhre J, Saga S, Malmedal W, Ostaszkiewicz J, Nakrem S. Elder abuse and neglect: an overlooked patient safety issue. A focus group study of nursing home leaders’ perceptions of elder abuse and neglect. BMC Health Serv Res. 2020;20(1):199. doi: 10.1186/s12913-020-5047-4.
  21. Karlsson AC, Gunningberg L, Bäckström J, Pöder U. Registered nurses’ perspectives of work satisfaction, patient safety and intention to stay - a double-edged sword. J Nurs Manag. 2019;27(7):1359-65. doi: 10.1111/jonm.12816.
  22. Al Mousa Y, Callaghan P, Michail M, Caswell G. Saudi service users’ perceptions and experiences of the quality of their mental health care provision in the Kingdom of Saudi Arabia (KSA): a qualitative inquiry. Int J Ment Health Nurs. 2021;30(1):300-16. doi: 10.1111/inm.12784.
  23. Ghavidel F, Fallahi-Khoshknab M, Molavynejad S, Zarea K. The role of organizational factors in nurse burnout: experiences from Iranian nurses working in psychiatric wards. J Family Med Prim Care. 2019;8(12):3893-9. doi: 10.4103/ jfmpc.jfmpc_615_19.
  24. Vahidi M, Ebrahimi H, Namdar Areshtanab H, Asghari Jafarabadi M, West S, Foong A, et al. Providing a safe environment in a psychiatric ward: nurses and vigilance in Iran. Issues Ment Health Nurs. 2019;40(1):65-72. doi: 10.1080/01612840.2018.1463326.
  25. Pariona-Cabrera P, Cavanagh J, Bartram T. Workplace violence against nurses in health care and the role of human resource management: a systematic review of the literature. J Adv Nurs. 2020;76(7):1581-93. doi: 10.1111/jan.14352.
  26. Kiani FZ, Ahmadi A. Barriers and facilitating factors of communication in Iranian educational health care centers: a systematic review. Stride Dev Med Educ. 2019;16(1):e80871. doi: 10.5812/sdme.80871.
  27. Daniel V, Daniel K. Perception of nurses’ work in psychiatric clinic. Clin Med Insights. 2020;1(1):27-33. doi: 10.52845/ CMI/2020v1i1a5.
  28. Kakemam E, Gharaee H, Rajabi MR, Nadernejad M, Khakdel Z, Raeissi P, et al. Nurses’ perception of patient safety culture and its relationship with adverse events: a national questionnaire survey in Iran. BMC Nurs. 2021;20(1):60. doi: 10.1186/s12912-021-00571-w.
  29. Reisi N, Raeissi P, Sokhanvar M, Kakemam E. The impact of accreditation on nurses’ perceptions of quality of care in Iran and its barriers and facilitators. Int J Health Plann Manage. 2019;34(1):e230-40. doi: 10.1002/hpm.2642.
  30. Khoshakhlagh AH, Khatooni E, Akbarzadeh I, Yazdanirad S, Sheidaei A. Analysis of affecting factors on patient safety culture in public and private hospitals in Iran. BMC Health Serv Res. 2019;19(1):1009. doi: 10.1186/s12913-019-4863-x.
  31. Okuyama JH, Galvao TF, Silva MT. Healthcare professional’s perception of patient safety measured by the hospital survey on patient safety culture: a systematic review and meta-analysis. ScientificWorldJournal. 2018;2018:9156301. doi: 10.1155/2018/9156301.
  32. Zeynizadeh-Jeddi S, Yousefian M, Amani F, Pirzadeh A, Farajifard M. Viewpoints of nurses and therapeutic staff toward patient safety culture: a case study in Ardabil, Iran. Patient Saf Qual Improve J. 2021;9(1):55-60. doi: 10.22038/ psj.2021.54574.1302.
  33. Asgarian A, Mahjour P, Heidari H, Khademi N, Ghassami K, Mohammadbeigi A. Barriers and facilities in reporting medical errors: a systematic review study. Adv Hum Biol. 2021;11(1):17-25. doi: 10.4103/aihb.Aihb_80_20.
  34. Mahdaviazad H, Askarian M, Kardeh B. Medical error reporting: status quo and perceived barriers in an orthopedic center in Iran. Int J Prev Med. 2020;11:14. doi: 10.4103/ ijpvm.IJPVM_235_18.
  35. Zegers M, Hanskamp-Sebregts M, Wollersheim H, Vincent C. Patient safety strategies. In: Wensing M, Grol R, Grimshaw J, eds. Improving Patient Care. John Wiley & Sons; 2020. p. 275- 98. doi: 10.1002/9781119488620.ch16.
  36. Brooks Carthon JM, Hatfield L, Plover C, Dierkes A, Davis L, Hedgeland T, et al. Association of nurse engagement and nurse staffing on patient safety. J Nurs Care Qual. 2019;34(1):40-6. doi: 10.1097/ncq.0000000000000334.
  37. Tölli S, Kontio R, Partanen P, Häggman-Laitila A. Patient safety and staff competence in managing challenging behavior based on feedback from former psychiatric patients. Perspect Psychiatr Care. 2020;56(4):785-96. doi: 10.1111/ppc.12493.
  38. Waring J, Allen D, Braithwaite J, Sandall J. Healthcare quality and safety: a review of policy, practice and research. Sociol Health Illn. 2016;38(2):198-215. doi: 10.1111/1467- 9566.12391.
  39. Slemon A, Jenkins E, Bungay V. Safety in psychiatric inpatient care: the impact of risk management culture on mental health nursing practice. Nurs Inq. 2017;24(4):e12199. doi: 10.1111/ nin.12199.
Journal of Qualitative Research in Health Sciences
Volume 14
Pages 1-7

  • Receive Date 26 October 2024
  • Revise Date 06 December 2024
  • Accept Date 22 December 2024

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