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The preservation of order: the use of common approach among staff toward clients in long-term psychiatric care
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing.
2007 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 17, no 6, 718-729 p.Article in journal (Refereed) Published
Abstract [en]

The authors performed this grounded theory study to gain a deeper understanding of the kinds of social processes that lead to a need among psychiatric nursing staff to reach a common approach on how to act toward individual clients in long-term psychiatric care. They present a theory about the development of such common approaches among staff. The main findings were that in psychiatric group dwellings, when the internal order is perceived as having been disturbed, the staff preserve or restore the internal order by formulating and reaching a common approach. The staff negotiated with each other to achieve an agreement on how to act and behave toward the individual client. The authors isolate and describe different types of order-disturbing incidents and the common approaches taken by the staff in dealing with them. However, their data also show that staff often had difficulties in maintaining a common approach over time.

Place, publisher, year, edition, pages
2007. Vol. 17, no 6, 718-729 p.
Keyword [en]
Attitude of Health Personnel, Decision Making, Hierarchy, Social, Humans, Long-Term Care/psychology, Mental Disorders/*nursing, Negotiating, Nurse-Patient Relations, Nursing Staff/psychology, Psychiatric Nursing/*methods, Qualitative Research, Sweden, Time Factors
National Category
URN: urn:nbn:se:umu:diva-6862DOI: 10.1177/1049732307302668PubMedID: 17582016OAI: diva2:146532
Available from: 2007-12-20 Created: 2007-12-20 Last updated: 2012-05-04Bibliographically approved
In thesis
1. Mellan frihet och trygghet: personalgemensamt förhållningssätt i psykiatrisk omvårdnad
Open this publication in new window or tab >>Mellan frihet och trygghet: personalgemensamt förhållningssätt i psykiatrisk omvårdnad
2012 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Between freedom and safety : common staff approach in psychiatric care
Abstract [en]

Background: The common staff approach in psychiatric care has not been studied explicitly before. Earlier studies in related areas of social processes in psychiatric care highlight the importance of the interaction between the patient and the carer to understanding communication patterns and attitudes. Other studies on social order and power in psychiatric care shows carers and patients as taking part in a hierarchical system in which patients are subordinate to carers.

Aim: The overall aim of this thesis is to study the phenomenon of the common staff approach in psychiatric care, how it emerges, and how it is used and experienced by both carers and patients.

Method: In the first study, grounded theory was applied to data from observations and interviews carried out with carers and clients in two psychiatric care group dwellings. In the second and third studies, a phenomenological hermeneutic method was used to analyse narrative interviews conducted with nine careers working on psychiatric wards and nine patients with experience of psychiatric in-care, respectively. In the fourth study, qualitative content analysis was used to analyse data obtained by a vignette method from interviews with 13 carers with experience of working in psychiatric in-care.

Results: A common staff approach can be understood as a social process in municipality-level group dwellings and psychiatric in-care, imposed by carers on clients or patients with the aim of restoring a predetermined order desired by the carers. When the order is disturbed the carers try to restore it by adopting a common and consistent approach towards the single patient perceived as the threat to order.

Barriers to the success of a common staff approach, from the point of view of the carers, include the likelihood that colleagues will interpret situations differently, the chance that patients might succeed in dividing carers into “good” and “bad” camps, and the knowledge that the patient suffers under a common staff approach.

The patients’ experiences partly confirm those of the carers – the dominant picture is that the patient feels persecuted and suffers under a common staff approach. However in some situations, patients can perceived the common approach as supportive and aimed to promote their recovery.

Carers’ ethical reasoning about the common staff approach is usually applied on an individual basis; it can change depending upon the patient, the situation, and the proposed approach, as well as upon how the approach might affect other patients, staff members, or the carers themselves.

Conclusions: The overall results from the four studies show that the common staff approach may meet carers’ needs, which under the approach take precedence over those of patients, but that the approach is more an exercise in asserting power and maintaining control than it is a therapeutic technique; that it is a difficult choice for the single carer to choose between the interests of the patient and the approval of colleagues; that the patient often suffers when a common staff approach is used; and that carers are seldom aware of the suffering experienced by the patient being managed by such an approach. A common staff approach has no part in a care-strategy; it is not an intentional care-plan; instead it appears to be a way for carers who feel vulnerable and under pressure to maintain order by controlling particular patients.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2012. 79 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1480
common staff approach, psychiatric care, social process, power, experience, grounded theory, phenomenological research, content analysis, vignettet method, personalgemensamt förhållningssätt, psykiatrisk omvårdnad, sociala processer, makt, upplevelser, grounded theory, fenomenologisk hermeneutik, innehållsanalys, vinjettmetod
National Category
Research subject
omvårdnadsforskning med samhällsvetenskaplig inriktning; Caring Sciences
urn:nbn:se:umu:diva-54573 (URN)978-91-7459-370-9 (ISBN)
Public defence
2012-05-25, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (Swedish)
Available from: 2012-05-04 Created: 2012-04-30 Last updated: 2012-05-04Bibliographically approved

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