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"There should be something gained": carers' ethical reasoning about using a common staff approach in psychiatric in-care
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing.
Faculty of Health and Science, Nord-Tröndelag University College, Namsos Norway.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Thirteen carers experienced in caring for psychiatric in-patients were interviewed about their ethical reasoning when using a common staff approach to restricting smoking for a psychiatric in-patient. A constructed case structure and a vignette method were used in the interviews, and manifest content analysis of the texts exposed five ethical positions (i.e. categories) adopted by the carers: “It is best for the person,” “It is best for the patient,” “It is best for people related to the person/patient,” “It is best for me as a carer,” and “It is best according to rules and regulations”. A second manifest content analysis of language showed 101 terms that expressed value judgments; 97 that concerned rights and obligations, mostly about responsibility and restricting other people’s actions; and 210 that concerned human actions, mainly in regard to personal experiences. Some carers argued at first from one ethical position, but when the question in the vignette was changed, abandoned their earlier position and argued from an opposite ethical position. These results may be understood in light of dialog philosophy; ethical reasoning during use of a common staff approach tends to focus either on relations with others or with oneself.

Keyword [en]
ethics, nursing, common approach, psychiatry, content analysis, vignette
National Category
URN: urn:nbn:se:umu:diva-54540OAI: diva2:524156
Available from: 2012-04-30 Created: 2012-04-28 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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Enarsson, PerSandman, Per-Olof
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