Imperative ideals and the strenuous reality: focusing on acute psychiatry.

The aim of this study was to describe the complexity of the working situation on an acute psychiatric ward as well as how nurses balance tensions between ideals and the reality of daily work. By means of field research, the study aimed to arrive at a deeper understanding of the reality that nursing staff and patients experience. The analysis shows that the acute and unpredictable character of the working situation in combination with short hospital stays results in a tentative and summary nursing care characterized by 'therapeutic superficiality'. This constitutes a hindrance to encountering the patient as a person. The demand on 'treatment effectiveness' creates work-related stress. Hence, a partly articulated conflict develops between the professional and humanistic ideals of psychiatric nursing and the strenuous reality that the staff have to adjust to. This conflict is solved in various ways, depending on whether they belong to the pragmatic, idealist, traditionalist or enforcer attitude in relation to the ward's mandate. The demand on treatment effectiveness seems to promote a medical model in the daily work, even though a humanistic and existential approach can be traced in the nurses' caring philosophy.