Nurses' Experiences of Psychiatric Care in Acute Care Units with an Open Door Policy.

Social distancing and the recent lock down due to COVID-19 has increased the feeling of disconnection, isolation, and suffering in vulnerable individuals and has brought forward questions regarding open acute care psychiatric units that cannot be answered by the literature. In Greece, there is no available research on how open ward environments are perceived and experienced by mental health professionals. The aim of the present study was to illuminate nurses' experiences of working in a public psychiatric hospital which traditionally operates with open doors. Eleven nursing care providers were interviewed, and thematic analysis was employed to explore their experiences of working in locked psychiatric acute care units. Participants described nursing care in units with an open door policy as "acceptance," "availability of staff," "real respect for the person," "ensuring patients' rights," "listening to the person," and "negotiation and not imposition." Trust in therapeutic relationships was perceived as greatly dependent on the trust being given to patients indirectly by the open door policy. Being trusted enhanced patients' self-determination and self-confidence leading to their empowerment. Containment of an acute mental health crisis took place through medication and meaningful discussions with patients and significant others rather than locking the door of the unit. Overall, meaningful care led to professional emancipation, but compassion fatigue narratives emphasized the need for continuous education, support and clinical supervision as necessary support for mental health nurses in a system of mental health provision often reduced to the point of crisis.

Psychiatric Care in Acute Care Units with Locked Doors: Nursing Care Providers' Perceptions and Experiences.

Social distancing and the recent lockdown due to COVID-19 have increased the feeling of disconnection, isolation, and suffering in vulnerable individuals and have brought forward questions regarding locked acute care psychiatric units that cannot be answered by the literature. In Greece, there is no available research on how locked ward environments are perceived and experienced by mental health professionals. The aim of the present study is to illuminate nursing care providers' perceptions of psychiatric care in units with locked doors. Fifteen nursing care providers were interviewed and inductive content analysis was employed to explore their experiences of working in locked psychiatric acute care units. Negative and positive feelings about door locking did not appear to match the specific system of practice. Some participants described how locked doors influenced their professional role by placing emphasis on control rather than care while others regarded locked doors as a symbolic way of therapeutic boundary setting. Participants had positive experiences when they perceived their working environment as caring. The therapeutic benefits of locked doors were prominent when locked doors were perceived as "invisible."