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Service users' strategies for managing risk in the volatile environment of an acute psychiatric ward

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  • Quirk, Alan
  • Lelliott, Paul
  • Seale, Clive

Abstract

Previous research shows that too often acute psychiatric inpatient care is neither safe nor therapeutic for patients. Earlier studies focused on promoting safety through good ward design, staff being able to anticipate and prevent violence, and use of medication. The current evidence base overwhelmingly reflects a staff perspective on risk management, and there is little evidence on how service users cope in this environment or about the strategies they employ to manage the risks they face or pose to others. This paper presents findings on this from two studies: (a) ethnographic research on three UK acute psychiatric wards, undertaken between 2000 and 2002, and (b) a content analysis of qualitative data from a 1999/2000 survey of psychiatric wards in England. Findings show that while some users perceive their ward to be comparatively safe--given the crisis they were in before being admitted--it is nonetheless a volatile environment in which risks are concentrated. Many risks, such as physical assault, are attributable to other patients. However, they are better understood as an outcome of the interplay between a range of interactional and contextual factors: for example, low staffing levels/minimal or poor surveillance may increase the risk of assault. Users were found to employ 10 strategies to manage risk on the ward, including actively avoiding risky situations/individuals, seeking staff protection, and getting discharged. Integral to these strategies are the risk assessments that patients make of one another. These findings shed light on how people cope while living in one of the most anxiety-inducing institutions of a 'risk management society'. Service users routinely take an active role in making a safe environment for themselves, in part because they cannot rely on staff to do this for them. Future clinical practice guidelines should consider how to harness what users are already doing to manage risk.

Suggested Citation

  • Quirk, Alan & Lelliott, Paul & Seale, Clive, 2004. "Service users' strategies for managing risk in the volatile environment of an acute psychiatric ward," Social Science & Medicine, Elsevier, vol. 59(12), pages 2573-2583, December.
  • Handle: RePEc:eee:socmed:v:59:y:2004:i:12:p:2573-2583
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    Cited by:

    1. Padraig MacNeela & Anne Scott & Pearl Treacy & Abbey Hyde, 2010. "In the know: cognitive and social factors in mental health nursing assessment," Journal of Clinical Nursing, John Wiley & Sons, vol. 19(9‐10), pages 1298-1306, May.
    2. Curtis, Sarah & Gesler, Wilbert & Wood, Victoria & Spencer, Ian & Mason, James & Close, Helen & Reilly, Joseph, 2013. "Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards," Social Science & Medicine, Elsevier, vol. 97(C), pages 201-209.
    3. Hamilton, Bridget Elizabeth & Manias, Elizabeth, 2007. "Rethinking nurses' observations: Psychiatric nursing skills and invisibility in an acute inpatient setting," Social Science & Medicine, Elsevier, vol. 65(2), pages 331-343, July.
    4. Quirk, Alan & Lelliott, Paul & Seale, Clive, 2006. "The permeable institution: An ethnographic study of three acute psychiatric wards in London," Social Science & Medicine, Elsevier, vol. 63(8), pages 2105-2117, October.

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