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Ontological insecurity of inattentiveness: Conceptualizing how risk management practices impact on patient recovery when admitted to an acute psychiatric hospital

Deering, Kris; Wagstaff, Chris; Williams, Jo; Bermingham, Ivor; Pawson, Chris

Ontological insecurity of inattentiveness: Conceptualizing how risk management practices impact on patient recovery when admitted to an acute psychiatric hospital Thumbnail


Authors

Kris Deering Kris3.Deering@uwe.ac.uk
Associate Lecturer - CHSS - SHSW - UHSW0001

Chris Wagstaff

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Jo Williams Joanne8.Williams@uwe.ac.uk
Senior Lecturer in Mental Health Nursing

Ivor Bermingham

Chris Pawson Chris.Pawson@uwe.ac.uk
Associate Professor in Applied Psychology and Behavioural Science



Abstract

Risk management which assesses and mitigates risks such as suicide and violence is under scrutiny, particularly within psychiatric inpatient settings. Restrictive practices, which result from risk assessment, such as observations, physical restraint and ward seclusion can impact negatively on patient recovery, hindering abilities to develop a meaningful life that emphasizes purpose, hope and autonomy, despite experiencing mental distress. Yet, less is known about the impact from the patient's perspective when first admitted to hospital, a period which among other reasons may come with increasing risk management practices owing to the clinical uncertainties about patient risks. In this grounded theory study, we explore the impact on recovery, interviewing 15 adult participants with patient experiences of being in an acute hospital. The main theme of the study, termed a core category with a grounded theory, was identified as “ontological insecurity of inattentiveness”. This highlighted a staff inattentiveness with involving patients with risk management and explaining the purposes of the practice, which raised insecurities about what was happening to the patients when admitted to hospital. Four subcategories support the core category; discounting the patients' experiences to gain a meaningful grasp of risk management, ambiguity about risk management rules, particularly the reasons around their use, forebodingness to the hospital environment and, management from afar, with patients feeling scrutinized from observations without a voice to offer different views. It is hoped these findings will add to the field of patient involvement in psychiatric inpatient settings, proposing attempts to raise understanding and inclusivity of risk management, starting when first admitted to hospital.

Citation

Deering, K., Wagstaff, C., Williams, J., Bermingham, I., & Pawson, C. (2024). Ontological insecurity of inattentiveness: Conceptualizing how risk management practices impact on patient recovery when admitted to an acute psychiatric hospital. International Journal of Mental Health Nursing, 33(2), 420-430. https://doi.org/10.1111/inm.13245

Journal Article Type Article
Acceptance Date Oct 9, 2023
Online Publication Date Oct 26, 2023
Publication Date Apr 30, 2024
Deposit Date Oct 26, 2023
Publicly Available Date Apr 11, 2024
Journal International Journal of Mental Health Nursing
Print ISSN 1445-8330
Electronic ISSN 1447-0349
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 33
Issue 2
Pages 420-430
DOI https://doi.org/10.1111/inm.13245
Keywords acute psychiatric hospital, patient perspectives, grounded theory, risk management, ontological insecurity, recovery
Public URL https://uwe-repository.worktribe.com/output/11395553

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