Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study.

Area of Science:

• Nursing
• Mental Health
• Patient Safety

Background:

• Restricted community mental health services in Iran contribute to psychiatric ward overcrowding.
• Overcrowding is associated with increased violence, suicide, and medical errors.
• Understanding how mental health nurses (MHNs) foster safety in wards remains underexplored.

Purpose of the Study:

• To explore the creation of a safe environment by MHNs in inpatient psychiatric wards.
• Investigate MHNs' perceptions and engagement in maintaining ward safety.

Main Methods:

• An explanatory mixed-methods study was conducted.
• Quantitative phase: Safe Environment Scale administered to 48 MHNs.
• Qualitative phase: Semi-structured interviews with 20 MHNs, analyzed using conventional content analysis.

Main Results:

• MHNs' perception and engagement in creating a safe environment were at a medium level.
• Key qualitative findings included 'Hyper-vigilance to safety and security environment,' 'Therapeutic communication gap,' 'Nurse burnout,' 'Staff safety and security need,' and 'Environmental safety hazards.'

Conclusions:

• MHNs utilize hyper-vigilance to ensure ward security.
• This strategy may paradoxically undermine the establishment and perception of a safe environment.
• Enhanced education, training, and prioritization of therapeutic communication are crucial for MHNs to improve safety.