Exploring the Barriers and Facilitators to Ensuring the Safety of Hospitalized Patients in Psychiatric Wards from Nurses' Perspectives: A Qualitative Study
DOI:
https://doi.org/10.22100/ijhs.v12i2.1371Keywords:
Patient safety, Psychiatric nursing, Mental health, Thematic analysis, Qualitative researchAbstract
Background: Patient safety in psychiatric wards involves unique challenges beyond typical healthcare concerns, requiring specialized protocols to address risks such as self-harm, aggression, and environmental hazards. Nurses, as frontline caregivers, play a critical role in ensuring safety while balancing patient autonomy and recovery. This study explores nurses’ perspectives on barriers and facilitators of patient safety in psychiatric settings. This study, conducted in Qazvin City, Iran., addresses a gap in context-specific qualitative research.
Methods: A descriptive qualitative design was employed, following the COREQ checklist, with semi-structured interviews conducted at three psychiatric wards in 22 Bahman Teaching Hospital, Qazvin City, Iran. A total of 19 registered nurses with at least one year of psychiatric experience were recruited, ensuring diversity in experience, gender, and ward type. Data were collected via an interview guide covering safety perceptions, barriers, facilitators, and improvement strategies. Thematic analysis, using both inductive and deductive approaches, was employed to extract key themes from the data, supported by NVivo 12. Rigour was enhanced through member checking, triangulation, and reflexive journaling.
Results: Four themes were extracted through iterative coding and categorization of interview data, revealing: (1) Perceptions of patient safety, emphasizing physical, emotional, and cultural dimensions; (2) barriers, including staffing shortages, inadequate training, patient-related challenges (e.g., aggression, substance use), and environmental constraints (e.g., poor ward design); (3) facilitators, such as effective communication, teamwork, supportive management, and comprehensive training; and (4) strategies, including improving staffing, enhancing training, modifying environments, and implementing evidence-based protocols. Nurses highlighted emotional safety and cultural competence as critical to reducing incidents and fostering trust. These themes provided a deeper understanding of how systemic, environmental, and relational factors interact to shape patient safety, highlighting the need for tailored interventions in psychiatric care.
Conclusion: Patient safety in psychiatric wards involves a complex interplay of systemic, environmental, and relational factors. Addressing barriers such as understaffing and training gaps while leveraging facilitators such as communication and teamwork can enhance safety outcomes. Context-specific strategies, including tailored protocols and ward redesign, are essential for creating safe, therapeutic environments. These findings offer actionable insights for policymakers and clinicians to improve psychiatric care safety.
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