According to literature Safety, often defined as freedom from psychological and physical injury. The safety of patient is always important issue in health care settings both in medical and mental health care settings. All patients are vulnerable, but mentally ill patients are particularly more vulnerable to violence, abuse and negligence, and the impact of such unethical acts on their physical and emotional health is often neglected. (Bhimani, 2010). As a health care provider it is important that we should ensure safe environment in which patients feel that they are being cared for their dignity, privacy and safety. Furthermore assess the patients specifically those who are at high risk to harm themselves as well as others. The incidence should be reported and document in incident form. As literature also stated that the significance of Patient safety is the reduction of unsafe acts within health care settings through the use of best practices and sound knowledge to obtain optimal patient outcomes (Brickell et al., 2009). We can ensure patient safety by helping patients to re-establish personal control by including them in decisions, about their care and restricting their behaviors only as necessary.
This paper will address the patients’ safety incidents in psychiatric settings their contributing factors, significance in mental health and strategies to promote patients’ safety. According to( Bhimani ,2010) the survey conducted in psychiatric hospital London documented that 33%female in-patients experienced unwanted sexual comments and another study is carried out on 142 adult psychiatric patients in which 31 % cases of physical assault, 8% sexual assault and 63%witnessed the traumatic events within psychiatric settings were reported. In west number of studies has recognized a high incidence of in-patient violence in psychiatric hospitals. But, in Pakistan such incidents have not been reported. However the
stigma attached to mentally ill patients, they are teased, called names, beaten, and humiliated in the communities, public and private places but physical and sexual abuse are not common.
According to( Brickell et al., 2009) the most common patient safety issues that arise in the mental health settings are slips, falls, missing patients, seclusion ,restraint use, self-harming behavior, aggression, violence, suicide ,reduced capacity for self-advocacy and adverse medication events(p,324).Suicide is a serious problem and the leading cause of death in inpatient psychiatric settings. The causes of suicide are factors related to the treatment environment, failure to assess patient behavioral characteristics, and staff trust on no-suicide contracts. Approximately 30,000 suicides that occur annually 5% to 6% occur on inpatient hospitals (Lynch et al, 2008). In another study conducted by Brickell et al., (2009) depressive and patients with substance abuse are at risk of aggression against staff, other patients, or self- harm and suicide. Further more in sociocultural context violence, aggression and suicidal behaviors were not accepted and have serious effects on society and psychiatric practice .These are often linked with the risk of harm or danger and have directly or indirectly affecting the quality of life of patients, their families, the community, and mental health workers. Therefore, mental state examination is important to identify such risky behaviors.
“I encountered a 32 years old female patient, was admitted in psychiatric ward with complain of extreme aggression. History revealed that she had attempted self-harm, and use to throw things here and there. Attendant also said that she had threating behavior towards the family members. She started slapping herself, she have knife in her hands showing frequently to the staff due to which staff became aggressive towards the patient.”
So it is high risk that she may cause harm to self as well as others. As a health care provider we should identify and manage such risky behaviors also ensure the safety and staff deal patient in a calm way but in the case scenario staff became aggressive on patient.
According to (Rippon, 2000) three part model including internal, external and situational or interactional explains the causes of aggression .The internal model explains that aggression is due to mental illness and frustration of disease and external model includes all environmental factors like space and location and situational or interactional model states aggression is due to negative staff attitude towards patient because of poor communication and intolerance. Therefore, the establishment of nurse-patient relationship is considered important in health care settings and interpersonal interaction is the core of practice and making the therapeutic relationship is a fundamental element to enhance patient’s safety.
However unsafe psychiatric settings contribute to patient safety incidents and feelings of insecure. In order to prevent the safety incidents Aga khan university hospital is ensuring well-organized safe environment for patients as well as for staff in psychiatric setting .The safety measures and their significance in promotion of mental health include washrooms are locked from outside to prevent suicidal attempts. Wall fans to prevent hanging. Unit medications are locked and are safely administered at counter to prevent adverse medication events. Directly pressing call bells, plastic utensils are used to prevent harming self and others. Security staff is checking belongings and taking all potentially harmful gifts from visitors before allowing them to meet clients. Doors are electronically controlled in order to protect escaping of patients from ward. Suicidal, homicidal and violent patients are placed in observation room under close
supervision. Clients are encouraged to play different activities under supervision of staff. So creating a safe environment is the most effective measure to improve the inpatient safety.
In addition Maslow’s hierarchy address patients needs including patient safety so after physiological needs the next step is to ensure the patients’ safety and security. Feeling of unsafe hinders patient’s recovery from mental illness. So, safe environment has a great impact on mental health. Patients’ safety plays an important role to improve their self-esteem. Moreover, most of psychiatric patients such as depressive patients feel hopelessness and helplessness. In safe psychiatric settings patients will feel secure and ultimately it helps to boost up their self-esteem (Poston, 2009).
According to Stuart (2009) “The highest nursing priority activity with suicidal and homicidal patients is to protect them and others from further harm “.Therefore assessment of risk factors is an important strategy to prevent adverse safety incidents. During interview health care provider should listen closely whether patients gives any history or mention any thinking about any harm to self or others. And to enhance patient safety they are encouraged to play different games in play area, watching television and to do different activities in occupational therapy room under supervision of staff and should be assessed for hallucinations because hallucinations could command patients to harm self or others. Therapeutic relationship with patients will help to identify and manage unsafe behaviors. Close monitoring of patients’ behavior is important to ensure patient safety. Sharp tools, such as knives, razors, scissors, and mirrors should be removed from the client possession and access. Nurse should inquire about the interaction of patient with his family and with other patients and plan accordingly.
Except above mentioned interventions and strategies, further recommendations for promoting the patients’ safety in mental health settings are that health care providers should give teachings on constructive coping strategies such as stress, anger management and plan group activities so that patients would verbalize their feelings, share their experiences and constructing coping strategies with other patients. They should be respected and not treated as a stigma to the society.
In conclusion patient safety is the prevention of safety incidents which occur in an inpatient psychiatric setting such as suicide and homicide, escaping of patients from units, disclosing of patients information to any irrelevant person and violation of patients’ rights and dignity. As healthcare providers we should develop therapeutic relationship with patients and do mental health examination to identify the risk behaviors and also be aware about the safety issues to ensure our own safety and patients’ safety in mental health settings.