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Issues in Mental Health Nursing
ISSN: 0161-2840 (Print) 1096-4673 (Online) Journal homepage:
Challenges Encountered by Nurses Working in
Acute Psychiatric Wards: A Qualitative Study in
Koroush Zarea, Malek Fereidooni-Moghadam, Shahram Baraz & Noorollah
To cite this article: Koroush Zarea, Malek Fereidooni-Moghadam, Shahram Baraz & Noorollah
Tahery (2017): Challenges Encountered by Nurses Working in Acute Psychiatric Wards: A
Qualitative Study in Iran, Issues in Mental Health Nursing, DOI: 10.1080/01612840.2017.1377327
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Published online: 24 Oct 2017.
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Date: 25 October 2017, At: 03:39
ISSUES IN MENTAL HEALTH NURSING./..
Challenges Encountered by Nurses Working in Acute Psychiatric Wards: A Qualitative
Study in Iran
Koroush Zarea, PhDa , Malek Fereidooni-Moghadam, PhDb , Shahram Baraz, PhDa , and Noorollah Tahery, PhD Studentc
Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; b Nursing and Midwifery Care
Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran; c Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
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Background: The provision of care to patients with psychiatric disorders and working in a challenging environment lead to many problems among psychiatric nurses. The aim of this study was to explore the challenges nurses faced while working in acute psychiatric wards. Design: A qualitative design using content
analysis was used. Fifteen nurses working in psychiatric wards in hospitals affiliated to a university hospital in an urban area of Iran were chosen using a purposive sampling approach. Semi-structured interviews
were used for data collection. An inductive content analysis method was used to analyse the collected data.
Results: Four themes were developed based on the analysed data: “experiencing psycho-social challenges,”
“experiencing psychological challenges,” “encountering catalysts causing challenges,” and “employing various strategies for coping with challenges.” Conclusions: Given the importance of physical and mental wellbeing of nurses and the moral and professional responsibility of an organization to protect staff health, it
is of prime importance to examine the inpatient psychiatric nurses’ experiences to better understand them
and hopefully use such knowledge so as to improve their work life.
Psychiatric nursing is a specialized field of nursing practice that
focuses on the provision of care to patients with mental disorders
(Barker, 2009; Humble & Cross, 2010). Nurses working in acute
psychiatric care units need to deliver high quality care to patients
in a complex and challenging work environment (Chambers,
Kantaris, Guise, & Valimaki, 2015; Moghadam, Pazargadi, &
Khoshknab, 2013). Therefore, providing care in such an environment is associated with some challenges and stress.
A plethora of studies have considered psychiatric nursing
as a stressful profession (Abdalrahim, 2013; McGrath, Reid, &
Boore, 2003; Ward, 2011). In a study conducted by Carson,
Leary, de Villiers, Fagin, and Radmall (1995), it was revealed
that psychiatric nurses experienced significantly high levels
of work stress. Despite the fact that psychiatric nursing has
various similarities to other nursing specialties, it is different
because staff members have deeper relationships with their
patients, attempt to put a stop to self-harm, and regularly come
across challenging behaviours in the environment (Dallender,
Nolan, Soares, Thomsen, & Arnetz, 1999; Jenkins & Elliott,
2004). Also, patients with psychiatric disorders admitted to
acute inpatient settings mainly suffer from severe psychologic
signs and symptoms. Additionally, pursuant to legal and ethical
aspects of patient care, most patients have complex needs (Bee,
Richards, Loftus, Baker, & Cox, 2006; Currid, 2009). Consequently, risks for suicide, self-harm, and violence (Rooney, 2009)
create a potentially challenging care environment for psychiatric
nurses (Howard & Holmshaw, 2010; Humble & Cross, 2010).
CONTACT Malek Fereidooni-Moghadam
©  Taylor & Francis Group, LLC,
Hughes and Umeh (2005) declared that caring for and managing patients, psychiatric nurses had conflicting roles causing
stress. Accordingly, some issues that result in numerous problems for nurses working in psychiatric wards and even involve
professionals’ own mental health have been reported in many
studies (Chambers et al., 2015; McTiernan & McDonald, 2015;
Pazargadi, Fereidooni Moghadam, Fallahi Khoshknab, Alijani
Renani, & Molazem, 2015; Robinson, Clements, & Land, 2003)
as follows:
r having compassionate involvement with patients’ agonizing experiences,
r encountering the same patients rotating in and out of services,
r enjoying less palpability of interventions and outcomes
compared with other nursing disciplines,
r providing full-time care to patients with a variety of psychiatric disorders, and
r working in a provocative environment beset with high levels of stress and distress.
It is worth mentioning that in the psychiatric nurses’ environment, stress is highly prevailing, so it influences the provided
care and staff health (Currid, 2009). The Royal College of Nursing (2005) reported that 40% of nurses in acute mental health
care had signs of mental ill health and 14% of them were categorized as in distress. In Chambers et al.’s study (2015), psychiatric
nurses experienced various psychological challenges and problems. To put in a nutshell, there is dearth of study on stress and
challenges encountered by nurses in acute psychiatric settings
Isfahan University of Medical Sciences, Isfahan, Iran.
and their threatening effects on the nurses’ health and profession (Abdalrahim, 2013); so it is important to address the issue at
hand, especially from the perspective of the nurses themselves.
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Background in Iran
In Iran, there are approximately 8600 psychiatric beds and over
123 psychiatric care centres offering specialized care to chronically and mentally ill patients (MoHME, 2011). Psychiatric
nurses, assistant nurses, and service providers work in such
centres. Nurses often have a bachelor’s degree or higher in
nursing as the requirement for practice. Assistant nurses often
have passed a 1-year education period in the field of nursing and perform routine patient care under the supervision of
nurses. Service providers have attended a 6-month education
period in psychiatric wards and are responsible for performing basic patient care activities such as activities of daily living
(Zarea, Nikbakht-Nasrabadi, Abbaszadeh, & Mohammadpour,
Psychiatric nursing education in the bachelor’s degree
is composed of theoretical and clinical courses. Theoretical education includes basic and specialized education in
relation to different aspects of psychiatric nursing. After
the completion of theoretical courses, students participate
in the clinical placement of practical courses in clinical
psychiatric settings. Being performed in psychiatric wards,
clinical placement usually is consisted of two 10-day education periods with the supervision of nurse instructors.
Many nursing students after graduation are able to provide
competent care for psychiatric patients (Pazargadi et al.,
After the completion of general and specialized courses
during the 4 years of nursing education in Iran, nurses are
certified to work in healthcare centres and are authorized to
practise in different areas according to their interests and/or
healthcare centres’ needs (Pazargadi et al., 2015). It should
be noted that no specific entrance exam is available to select
nurses for working in psychiatric wards (INO, 2011). Therefore, psychiatric nurses may not have sufficient knowledge and
skills for working with mentally ill patients. According to the
INO’s (Iranian Nursing Organization) report, psychiatric nurses
are not appropriately selected for this job. Also, they often
have been transferred to psychiatric wards due to poor performances in other nursing wards (INO, 2011; Zarea et al.,
There are a few qualitative studies on the experiences of
nurses working in psychiatric wards in Iran. Zarea et al. (2013)
reported that psychiatric nurses faced several socio-cultural
and organizational challenges. Also, Soleimani, Sharifi, and
Tehranidoost (2005) discovered that more than 55% of psychiatric nurses had the intense feelings of personal inadequacy.
Also, they experienced fatigue, emotional exhaustion, and selfefficiency (Solimani et al., 2005).
Therefore, the aim of this study was to explore challenges
nurses face while working in acute psychiatric wards. Certainly,
qualitative studies are important for the exploration of the experiences of nurses involved in the provision of care to patients
with psychiatric disorders.
The qualitative study was carried out from 2014 to 2015. Participants were 15 nurses including 8 males and 7 females working
in the psychiatric wards of four teaching hospitals affiliated to
a university in the south of Iran. They were selected by using
the purposive sampling method. Data was collected based on
the nurses’ experiences of working in acute psychiatric wards.
The inclusion criteria were as follows: having a bachelor’s
degree or higher in nursing, at least 1-year work experience
in psychiatric wards, and willingness to participate in this
Data collection
Semi-structured, face-to-face, and individual interviews were
held with the nurses. The main questions asked in this study
were: “Please tell me about your experiences of working in this
ward?” and “What challenges do you face during working in
this ward?”. To follow the participants’ thoughts and improve
the depth of interviews, branching questions were asked. All
interviews were tape-recorded and transcribed verbatim after
each interview. The interviews were performed by the second author, who participated in the study as an observer, and
lasted between 30 and 90 minutes. Data analysis was conducted consequently. According to the available guideline and
studies (Elo & Kyngas, 2008; Zarea, Fereidooni-Moghadam,
& Hakim, 2016), the data collection and analysis were continued until themes were developed and data saturation was
Data analysis
For data analysis, an inductive content analysis was performed.
Sentences were abridged into phrases and words to achieve patterns in data (Elo & Kyngas, 2008). To this end, the interviews
were transcribed verbatim and considered as the unit analysis. The transcriptions were read several times to understand
the general meaning behind the data. Meaningful units were
identified as sentences or entire paragraphs. Primary codes were
developed from the meaningful units, which were further categorized into more definite categories or sub-categories based on
their similarities and differences. Finally, themes with regard to
the underlying meanings in the interviews were extracted (Elo
& Kyngas, 2008).
Long-term engagement with the participants, reading the transcription several times to obtain the sense of whole, and peer
checking helped with the credibility of the data. Also, the coded
interviews were returned to some of the participants to ensure
that the data collection and analysis were in line with the
participants’ perspectives and thoughts (Holloway & Wheeler,
Table . -A Summary of the Findings.
Experiencing psycho-social challenges
Experiencing psychological challenges
Encountering catalysts causing challenges
Employing various strategies for coping with challenges
Affected quality of life,
Perspective of the society,
Losing professional identity,
Work dissatisfaction
Permanent stress and anxiety,
Eroding the sense of well-being,
Sense of exhaustion,
Continuous concerns about patients
The patient health condition,
A lack of requirements for ensuring professional competence,
Limited role,
The long-term presence of nurses in the psychiatric ward
Active approaches
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Passive approaches
Ethical considerations
The Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences, Iran approved this study’s research proposal. The purpose and method of this study were described to
the participants. They were ensured that their identity would not
be revealed throughout the study process. The written informed
consent form was signed by those participants who willingly
agreed to take part in this study.
In this study, 15 nurses held a bachelor’s or master’s degree in
nursing. The range of the participants’ age was 25–53 years. They
had 28 years of work experience in psychiatric wards.
Four themes were developed from the data analysis: “experiencing psycho-social challenges,” “experiencing psychological challenges,” “encountering catalysts causing challenges,”
and “employing various strategies for coping with challenges”
(Table 1).
Experiencing psycho-social challenges
Several psycho-social challenges were notified by the nurses in
the study. The nurses stated that their quality of work life and
personal life were affected by encountering different challenges,
as one of them declared that:
“After work, I went home and realized that my mood was affected.
I realized that I experienced discomfort in my work shift, because
two patients had conflicts together, and I had to restrain them. Now,
I am feeling unhappy, because it certainly involved my personal life.”
(Participant No. 11).
Another nurse asserted that:
“ … I often become irritable; I cannot tolerate it anymore. It can
be said I’ve become depressed or the quality of my life has been
affected.” (Participant No. 5).
Another challenge which was experienced by the psychiatric
nurses was the social perspectives towards nurses who provided
care to mentally ill patients and were labelled with negative
Transfer requests,
Interactions with colleagues
Avoiding the patient,
Avoiding the patient-related activities,
Inevitable adaptation strategies
“Many people have a different perspective towards nurses working
in the psychiatric ward. For example, you see that we have financial
problems or a problem with our working hours. I may speak with
administrative staff and raise my voice a little bit. He/she then may
say: ‘Oh, this nurse has been affected because of caring for mentally
ill patients”’ (Participant No. 8).
Another nurse expressed how the society negatively considered nurses and labelled them unprofessional as follows:
“The society and even healthcare officials do not have an appropriate perspective toward the psychiatric ward. Surprisingly, our family members also label us negatively. If I become angry, well, I may
really become angry, whatever I do, they say: ‘Since he/she works in
a psychiatric ward, he/she may have a problem himself/herself [psychological problem]’.” (Participant No. 6).
Losing professional identity and work dissatisfaction were
also mentioned as some psychosocial consequences of working
in a psychiatric ward. One nurse expressed her job dissatisfaction as follows:
“I have no job satisfaction, or in other words, I do not feel that the
work that I do here is specialized. Perhaps my physical workload here
is less than other wards, but I have no job satisfaction. I do not know
what on earth I am doing here.” (Participant No. 5).
Experiencing psychological challenges
Another main theme was the psychological challenges of working in the psychiatric ward. Nurses in this study reported a range
of psychological effects from working in this environment:
“Working with a mentally ill patient is really a very difficult task.
There is always the possibility of conflict with the patients, because
in the long term, they can affect the nurse’s mental well-being. Most
nurses working in the psychiatric ward begin to experience unpleasant conditions or even show some psychiatric symptoms.” (Participant No. 8).
Several nurses shared their experiences of stress and anxiety
as follows:
“Well, you know, I am constantly worried and stressed out all times.
Beyond that I’ll be hurt by the patient, I am afraid that the patient
may harm himself/herself.” (Participant No. 2).
“I have always said to myself: ‘Oh, when I enter the ward, I do not
know what will happen, how many patients should be controlled
for their dangerous behaviours, how many patients may become
aggressive toward me or throw objects at me, and most importantly,
how many patients may try to escape from the ward! These are the
sources of stress that always I face in the ward.” (Participant No. 6).
Irritability was felt as one of the negative consequences of
working in the psychiatric ward:
“ … I become irritable easily; I don’t have any tolerance and often
lose my temper.” (Participant No. 5).
Other psychological consequences expressed by the nurses
were the eroding sense of well-being and sense of exhaustion:
“ … This concern [concern about the patient] always makes my
mind busy, and I feel that I am being gradually worn down.” (Participant No. 2).
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“ … I am feeling really worn down, I think I cannot go on here … I
am really exhausted.” (Participant No. 5).
Lastly, a continuous concern about patients was another psychological challenge of working in the psychiatric ward:
“Working with psychiatric patients may not be easily accepted by
others. For instance, when going home from the workplace, the
nurse, who is physically tired, is always worrying about a patient who
has suicidal thoughts. As a nurse, I worry that something bad might
happen to she/he with such suicidal thoughts. Though informing
other clinicians of such a thing by writing the patient’s status in
the medical records and asking them to carefully observe or control for his/her potentially dangerous behaviours, but the nurse still
remain worried. The nurse always is ready to hear bad news about
the patient.” (Participant No. 6).
Another nurse described her/his concerns as follows:
“ … My mind is involved in the patient’s care. The patient may
have a range of symptoms, taking some drugs. When the patient is
discharged from the hospital, his/her file is closed. However, some
patients may leave, but their health files remain open in my mind
or even my soul. This means that I think about whether or not those
patients that have left the ward are doing well or their problems have
been solved. Thus, in a part of my mind, my feelings towards the
patient are involved.” (Participant No. 2).
Encountering catalysts causing challenges
This theme referred to reasons and factors that provoked
or caused challenges for nurses while caring for psychiatric
patients. Patients’ health conditions, their symptoms, and the
nature of their disorders were some causes for concerns.
“I am very emotional; sometimes the life of some of them [patients]
is so painful that anyone would be affected. Of course, a nurse working in other wards may become involved in the familial and physical
problems of them. He/she only resolves the physical problems of the
patient. However, that is not the case at the psychiatric ward. Here,
I have a kind of emotional involvement with the patient’s problems,
because of the emotional nature of the problem. This inevitably has
an impact on me as a nurse.” (Participant No. 17).
“ … I cannot say that working here does not affect me. When I find
the patient’s problems, they definitely affect me. For example, some
patients come from prison and have criminal records, and I must
take care of them. Of course, it has an impact on me.” (Participant
No. 6).
The lack of requirements for ensuring professional competence among psychiatric nurses was another factor resulting in
negative effects on the nurses. This discontentment expressed by
the nurses, in addition to other factors, may be due to both lack
of job satisfaction and their limited role in providing care. One
nurse expressed her unpleasant mental state as follows:
“ … really they are not just nursing tasks, I feel like I can do much
more than I did. Nurses might have many roles in the society and in
the psychiatric ward. I feel that my work actually is a kind of repetitive chain of actions and I’m able to do more for the patient. Actually,
I do not feel that I am doing my role properly. The control of events
is my main task. When I arrive at home from work, I don’t feel good.”
(Participant No. 11).
The elongated presence that nurses must maintain in the psychiatric ward was mentioned as one of the most important effective factors:
“ … Well, I might get tired after seven years of working in this ward.
Work rotations should be implemented in healthcare staff. After
working here for two years, I’ve lost my motivation. This is not good,
it really affects me.” (Participant No. 2).
Employing various strategies for coping with challenges
The nurses noticed that they had used various strategies and
actions for dealing with physical and psychological problems in
the psychiatric ward. Some of these strategies were done actively
and consciously by the nurses, but the other ones were passive
in nature and actually the nurses were compelled to use them.
These two major strategies were labelled as active and passive
Passive approaches involved inevitable coping strategies that
nurses attempted to eventually use in practice. One of these
strategies was evading doing principled work; in other words,
the nurses evade doing principled work to reduce the negative
effects of working with mentally ill patients.
“ … [There is] a large amount of work and the working environment
is challenging. Since work is not standardized, a great amount of
stress is imposed on nurses. If the nurse wants to work according
to principles and standards, he/she definitely experiences problems.
The nurse is unable to meet the patient and his/her family members’
needs as well.” (Participant No. 5).
“I did not want to work in the psychiatric ward, but I had no choice.
As a result, I always fulfil my work shifts just and then I leave.” (Participant No. 17).
Other nurses expressed some inevitable adaptation strategies
as follows:
“I have to deal with anxiety. It would have worn me out, if I’d thought
about it too much.” (Participant No. 3).
“ … I’ve begun to adapt gradually. I’ve just adapted to this situation.”
(Participant No. 2).
Active approaches to manage the effects and consequences
of working with psychiatric patients were also mentioned as
another strategy applied by nurses working in the psychiatric
wards. They highlighted a need for a change in the workplace
in order to mitigate the negative consequences of patient care.
For instance, some nurses suggested the need for personnel
“ … Well, there should be rotation for nurses. Why should I stay in
this ward for two years or more? I’ll lose my work motivation and
only negative feelings will remain, if I stay in this ward.” (Participant
No. 2).
“ … The workplace needs to be changed after a while. Monotony, not
only in the psychological ward but also in other wards can reduce
nurses’ work motivation and satisfaction. Surely, this is crucial for
nurses who are working in the psychiatric ward to change their
workplace ….” (Participant No. 5).
Interacting with colleagues was also mentioned as a coping mechanism used by nurses to overcome the negative consequences of working in the psychiatric ward:
“We sit together, sometimes we talk about our patients. We chat with
one another, drink tea together, and alleviate our stress” (Participant
No. 3).
Another active approach for adaptation was mentioned as
transfer requests:
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“ … Because of the constant stress, anxiety, and tension in this ward,
I had to request for a transfer from here.” (Participant No. 2).
“Why does nobody want to get stuck in this ward and after a while
everyone wants to leave it? It is because of stress and anxiety. I have
also requested for a transfer from this ward several times.” (Participant No. 6).
Psychiatric nursing aims to provide high quality care to patients
suffering from mental disorders. However, the provision of care
to such patients is accompanied with some challenges. Since a
few qualitative studies had been found on this phenomenon with
a focus on nurses’ perspectives in Iran, this study was conducted
to explore the perspectives of 15 nurses working in psychiatric
wards of selected hospitals in an urban area in the south of Iran.
The nurses in this study were involved in the psycho-social
challenges such as the society’s perspective towards nursing
practice, in which nurses working in psychiatric wards and with
mentally ill patients was negatively labelled. Nurses expressed
that such perspectives negatively affected their practice, quality of work life, and personal life. In addition, nurses expressed
a loss of professional identity and job dissatisfaction as the
psycho-social consequences of their practice in the psychiatric
ward, which influenced their practice and interactions with
In the realm of psychiatric nursing, there is a certain stigma
on mental illnesses and the treatment of mentally ill patients,
which is derived from the history of psychiatric care in which
mentally ill patients are labelled as insane. It is indirectly
extended to nurses and those working with mentally ill patients.
Such ideas have led to the feelings of frustration, shame, despair,
and society’s confusion over the issue that mental illnesses influence psychiatric nurses (Happell, 2008; Humble & Cross, 2010).
The results of the study by Li and Zhao (2004) showed that high
levels of mental stress in Chinese psychiatric nurses were related
to negative attitudes of the society towards them and their work
with mentally ill patients. Also, they were not fully understood
by patients and their family members.
In Iran, studies generally indicated the poor perception of
nurses’ roles in the Iranian society. Iranian ancient texts and
poems depicted a poor cultural background on nursing care
(Nikbakht-Nasrabadi, Emami, & Parsa-Yekta, 2003; Zarea et al.,
2009). In the study by Zarea et al. (2013), the experiences of
nurses working in psychiatric wards using a phenomenological
approach were explored. Cultural and social challenges that
nurses faced were mostly due to negative attitudes of the society.
Such a poor image stemmed from the fact that the behaviours
of nurses interacting with patients with mental disorders surely
will be affected. The perception of Iranian nurses was also
negatively affected by the generally negative perception of the
society towards nursing (Zarea et al., 2013).
Experiencing psychological challenges by nurses was
revealed as another theme in this study. Such challenges
encompassed a wide range of psychological symptoms and
mental disorders including stress and anxiety, irritability, and
constant concern for patients.
Various researchers declared that as a discipline, mental
health nursing was highly associated with stress and exhaustion.
It is believed that psychiatric nurses experience higher levels of
emotional exhaustion and stress in comparison with other occupational groups (Abdalrahim, 2013; McTiernan & McDonald,
2015). A qualitative study conducted by Ward (2011) showed
that the findings of their investigation unanimously supported
current literature on the issue that mental health nursing was
a stressful profession. The Royal College of Nursing discovered
that 40% of nurses in England, Northern Ireland, Scotland, and
Wales showed the symptoms of mental disorders and 14% of
them were distressed out (Royal College of Nursing, 2005). In
addition, Chambers et al. (2015) found that nurses experienced
psychological challenges and problems including cognitive dissonance, conflicts between benevolence and malevolence, and
feelings of fear, anxiety, and vulnerability. Also, the study carried out by Kindy, Petersen, and Parkhurst (2005) reported that
nurses’ personal life was negatively affected even when they were
outside of the workplace.
It is worth mentioning that one of the themes extracted in
the study by Currid (2009) was the inability of nurses to separate
from work. They were unable to stop thinking about their work
after arriving at their own homes.
In the current study, encountering catalysts causing challenges was found as another theme. In particular, the severity
of patients’ conditions and the nature of the patients’ disorder and symptoms, especially their aggressive behaviours
were mentioned as significant factors underlying the negative
consequences of working in the psychiatric ward.
According to some researchers, the high levels of stress
among nurses were associated with ongoing conflicts and the
interactions of psychiatric nurses with patients suffering from
severe mental disorders (Taylor & Barling, 2004). Working in
sealed units and providing care for patients being in dire need of
nonstop observation and intricate treatment programs, psychiatric nurses are put in jeopardy of various tough work-related
stressors (White, 2006). In addition, psychiatric nurses have
closer communications and relationships with their patients
and are involved in the prevention of self-harming behaviours.
Therefore, they often encounter a greater number of challenging patients in their workplace (Currid, 2009). Moreover,
violent attacks and threats from patients and their relatives have
become growing concerns in psychiatric wards and are some
of the most significant factors associated with staff stress and
anxiety (Currid, 2009).
The lack of requirements for ensuring professional competence among psychiatric nurses and the limited role of nursing
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activities were also expressed as factors that negatively affected
psychiatric nurses. Many nurses stated that caring tasks in the
psychiatric ward did not correspond to their subjective ideals
and mainly included routine and repetitive tasks such as medication administration or patients’ control. Therefore, these activities did not provide opportunities for nurses to improve their
competencies. Cleary, Walter, and Hunt (2005) reported that
35% of psychiatric nurses believed that the reality of mental
health care was different from their initial expectations. Therefore, there are fundamental differences between ideals in mental health care and the reality of clinical practice in psychiatric
wards (Cleary et al., 2005).
The long-term presence of nurses in the psychiatric ward was
another factor mentioned by the nurses. Nurses considered their
long presence in the ward mandatory and often due to the high
demand for mental health care by nursing professionals. Therefore, they experienced dissatisfaction and physical or mental
problems. Ward and Cowman (2007) showed that psychiatric
nurses who had a right to choose their workplace enjoyed greater
satisfaction with their profession.
“Employing various strategies for coping with challenges”
was the fourth extracted theme in the study. In other words,
nurses exhibited some coping strategies in order to reduce or
eliminate the impact of the negative aspects of their work. The
strategies included both passive and active approaches. Passive approaches involved avoiding from the patient and their
related-activities. Necessary adaptation was also expressed as
another passive approach among nurses for coping with the consequences of working in the psychiatric ward.
Nurses’ withdrawal from having interactions with patients
was previously suggested by another study (Fourie, McDonald,
Connor, & Bartlett, 2005). This may be the result of working in
acute hospital settings and an attempt by nurses to protect themselves from burnout (Mullen, 2009). Psychiatric nurses work in
an environment with high emotional engagement and demanding patients. In such situations, psychiatric nurses used coping strategies to escape from patients and their ever-increasing
demands (Fisher, 2011). Also, nurses’ work environment has a
significant impact on nursing practice and outcomes of psychiatric care. Therefore, the importance of nurses’ engagement in
psychiatric care have been emphasized (Gabrielsson, Sävenstedt,
& Olsson, 2016; Polacek et al., 2015).
Psychiatric nurses also used active approaches to mitigate the
effects and consequences of working with psychiatric patients.
Such methods were used consciously and purposefully by the
nurses. Nurses mentioned they needed to change their environment and also requested to be transferred from the psychiatric ward to other wards. Another active adaptation approach
was the interaction with other colleagues for reducing stress and
finding solutions for their concerns regarding patient care.
Other studies showed that nurses applied different coping
strategies to deal with stress. For example, nurses impatiently
waited for the end of their shift to go home and to talk to
friends and colleagues with whom they had a close relationship (Cai, Li, & Zhang, 2008). Positive coping strategies were
also described in the study of Cai et al. (2008). They stated
that psychiatric nurses attempted to recognize the positive
aspects of their situation, entertain themselves, participate in
nursing activities, talk to others regarding their problems, and
remember their important life values (Cai et al., 2008). On the
other hand, because of work-related stress in psychiatric wards,
some nurses preferred to change their work environment;
hence, such views have led to nurse shortages and losing staff
in the field of psychiatric nursing. In other studies, this was one
of the barriers to the provision of high quality care (Zarea et al.,
2013). In Iran, working as a nurse in the mental health setting
is represented as the last resort for nurses (Zarea et al., 2013).
The results of this study showed that the provision of care to
patients with severe mental disorders in the psychiatric ward
led to several physical, psychological, and social consequences
for nurses. Given the importance of the physical and mental
well-being of nurses and the moral and professional responsibility of organization to protect staff health, it’s significant to
examine the inpatient psychiatric nurses’ experiences to better
understand their experience and hopefully use that knowledge
to enhance their work life. Few nurses are interested in the
specialty, especially working in inpatient areas. We have got to
know more about their work-life experience so that improvements can be made and the retention of nurses can be improved.
Then, more research, especially qualitative studies in this area
is recommended.
The researcher gratefully thanks the Deputy of Research and Technology, Ahvaz Jundishapur University of Medical Sciences for their financial
and spiritual support. The researcher also acknowledges with gratitude the
cooperation of the nurses who participated to this study.
Conflict of interest
The authors declare that there is no conflict of interest.
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