Inger M Johansson1, Ingela Skärsäter, Ella Danielson. 1. The Sahlgrenska Academy at the University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden. inger.x.johansson@vgregion.se
Abstract
BACKGROUND: The deinstitutionalization of psychiatric care has led to a concentration of patients to fewer wards. This leads to difficulties in separating voluntarily and involuntarily admitted patients, and there is a risk that the interest in safeguarding patients' autonomy will decrease. AIMS: The aim of this study was to elucidate the meaning care has to patients on a locked acute psychiatric ward. The study was performed on a ward for patients with affective and eating disorders who were admitted both voluntarily and involuntarily. METHODS: Interviews were conducted and analysed using qualitative content analysis. RESULTS: The results show that to the patients, care had contradictory qualities some alleviated their suffering while others contributed to stress. The alleviation from suffering originated from the experiences of strengthened integrity and self-determination, from being supported, and having a place of refuge on the ward. In contrast to this, there were experiences of being dependent and trapped because of lack of influence and choice, and being controlled. CONCLUSIONS: In conclusion, this qualitative study shows that to the patients, care can mean being disciplined in a way that risks undermining the alleviation of suffering that care can provide. It is thus important to be observant when it comes to manifestations of control in care. The study also shows that the support of fellow patients has a value as a complement to the care given by staff members and next of kin, something that needs to be further investigated.
BACKGROUND: The deinstitutionalization of psychiatric care has led to a concentration of patients to fewer wards. This leads to difficulties in separating voluntarily and involuntarily admitted patients, and there is a risk that the interest in safeguarding patients' autonomy will decrease. AIMS: The aim of this study was to elucidate the meaning care has to patients on a locked acute psychiatric ward. The study was performed on a ward for patients with affective and eating disorders who were admitted both voluntarily and involuntarily. METHODS: Interviews were conducted and analysed using qualitative content analysis. RESULTS: The results show that to the patients, care had contradictory qualities some alleviated their suffering while others contributed to stress. The alleviation from suffering originated from the experiences of strengthened integrity and self-determination, from being supported, and having a place of refuge on the ward. In contrast to this, there were experiences of being dependent and trapped because of lack of influence and choice, and being controlled. CONCLUSIONS: In conclusion, this qualitative study shows that to the patients, care can mean being disciplined in a way that risks undermining the alleviation of suffering that care can provide. It is thus important to be observant when it comes to manifestations of control in care. The study also shows that the support of fellow patients has a value as a complement to the care given by staff members and next of kin, something that needs to be further investigated.