Constrained nursing: Nurses' and assistant nurses' experiences working in a child and adolescent psychiatric ward

Moral distress among inpatient child and adolescent psychiatry staff: a mixed-methods study of experiences and associated factors

BACKGROUND

Moral distress among healthcare staff is associated with emotional strain and workforce attrition but remains insufficiently explored in child and adolescent psychiatry (CAP). We investigated the experiences and factors contributing to moral distress among staff in inpatient CAP.

METHODS

We conducted a 2023 nationwide mixed-methods survey with 106 staff members from CAP inpatient units in Sweden. Quantitative data on moral distress were collected using the Stress of Conscience Questionnaire, while open-ended questions provided qualitative data on perceptions of moral distress and the impact of working with coercive measures. Findings were integrated using triangulation.

RESULTS

Staff reported high levels of moral distress, with physicians experiencing the highest. Triangulation revealed converging findings with younger and less experienced staff experiencing more moral distress. Aligning with the qualitative theme "Providing care one does not believe in", moral distress was also strongly associated with quantitative data of a demanding work environment, low social support, and intention to resign from job. The theme "Ethical dilemmas about coercive measures" indicated how coercive measure use could contribute to moral distress, while a more positive attitude to coercive measures was associated with lower moral distress.

CONCLUSIONS

Moral distress among CAP inpatient staff in Sweden was pronounced, particularly among younger, less experienced professionals, and physicians. Addressing moral distress appears critical in supporting staff well-being, promoting workforce retention, and maintaining high-quality patient care.

Inpatient pediatric nursing staff experiences treating psychiatric patients: A mixed methods study

PROBLEM

A gap in the literature exists attempting to understand the impact that the influx of pediatric psychiatric patients has had on inpatient general medicine pediatric nursing staff.

METHODS

A mixed-method research study was conducted among full- and part-time pediatric nurses and nursing assistants working on general pediatric units. Quantitative data was collected via an anonymous survey using the Professional Quality of Life Scale version 5 and Support Appraisal for Work Stressors scale. Surveys were followed by semistructured interviews.

FINDINGS

Of the 158 staff eligible, 47 (29.7%) participated in the quantitative portion. [Correction added on 29 September 2023, after the first online publication: In the preceding sentence, the participation rate was revised from 23.5% to 29.7% in this version.] Significant differences were found between roles, with nurses experiencing lower levels of compassion satisfaction and higher levels of burnout. Role differences were seen in supervisor support and nonwork support, with nurses reporting less support from both. Supervisor support showed a significant correlational relationship with compassion satisfaction and burnout. Nonwork support showed similar correlations with compassion satisfaction and burnout. Themes that emerged from the interviews were Barriers to Care, Emotional Impact, and "Help Me Help You."

CONCLUSION

Nurses may be at greater risk for compassion fatigue due to perceived inadequate support from leadership, unclear role expectations, and lack of resources.

Experience of hospitalization of the family with children and adolescents in psychological distress

OBJECTIVE

To learn about the experience of families of children and adolescents in psychological distress facing hospitalization in a psychiatric inpatient unit of a general university hospital.

METHOD

This is a qualitative phenomenological-social study, with data collection carried out from February to March 2022 through open interviews, analyzed using Alfred Schutz's framework with the construction of categories of meaning.

RESULTS

Based on the analysis of eight interviews, it was possible to understand changes in the families' way of life, impacts on their routine, work, and social relationships. Their expectations were about the recovery of mental health and autonomy.

CONCLUSION

This study allowed us to understand the experience of families faced with the hospitalization of children and adolescents in psychological distress and understand their members' needs. The need for implementation of care spaces that incorporate the relationship between the multidisciplinary team and the family is highlighted.

Moral injury and associated context, contributors and consequences within mental healthcare professionals: a scoping review

OBJECTIVES

We sought to examine the contributory factors as well as consequences of moral injury amongst healthcare workers within mental healthcare settings.

METHODS

Several databases were searched for relevant studies from database inception until May 2023. Keywords and concepts included moral injury and distress in mental healthcare and psychiatry. We identified 961 studies, of which 48 were assessed for eligibility. Eventually, 35 studies were included in the review. Papers were selected for inclusion if 1) they included mental healthcare professionals (MHP) regardless of practice setting, 2) moral injury as experienced by MHP was one of their main variables of interest, 3) were written in English. Year of publication, location of study, participant characteristics, study design, settings in which injury occur (context), factors contributing to moral injury (contributors), and its effects on MHP (consequences) were extracted from the studies.

RESULTS

The majority of studies were conducted in the West (n = 26, 74.3%). Contributors to moral injury were found at the individual (e.g. poor competence), practice setting (e.g. lack of resources), and organizational levels (e.g. inconsistent policies). Moral injury had negative repercussions for the individual (e.g. psychological and physical symptoms), healthcare teams (e.g. lack of trust and empathy), and healthcare system (e.g. staff attrition).

CONCLUSIONS

Seen through the moral habitability framework, interventions must include an acknowledgment of the influence of various factors on the ability of MHP to enact their moral agency, and seek to establish safe moral communities within a supportive moral climate.

The time, places, and activities of nurses in a psychiatric inpatient context - A time and motion study with a time-geographic perspective

Nurses in psychiatric inpatient care spend less time than desired with patients and investigation of the nature of nursing in this setting is needed. This study explores how nursing activities in psychiatric inpatient wards is distributed over time, and with a time-geographic perspective show how this relates to places. Observations were used to register place, activity, and time. A constructed time-geographic chart mapped the nurses' path which showed that nurses spent little time in places where patients are. There might be constraints that affect nursing. Nurses need to evaluate where time is spent and interventions that facilitate relationships are needed.

Learning your limits: Nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care

Young unaccompanied refugees come in contact with acute psychiatric care due to pre-existing mental health conditions as well as stressful and traumatic experiences before, during, and after migration. Previous research on nurses' experiences of caring for refugees has primarily reported on difficulties related to cultural differences and communication and how nurses might distrust refugees. This study aimed to describe registered nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care. Semi-structured interviews with ten nurses were analysed using a method for qualitative content analysis. Data were collected in Sweden during 2019 and 2020. Results describe nurses' experiences of caring for young unaccompanied refugees in acute psychiatric care in one theme: learning your limits and three sub-themes: feeling powerless but doing what you can; taking a stance in a politicized environment; and being frustrated and in need of support. Findings highlight the potential and limitations of mental health nursing, the importance of reflection and peer support, and the importance of viewing the roles and responsibilities of mental health nurses and nursing in a societal context. These findings suggest that nurses can make a difference for young unaccompanied refugees in acute psychiatric care. However, in doing so, nurses need support in realizing what they can and cannot achieve. The study is reported in accordance with the COREQ guidelines.