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10 A narrative journey into the borderland of patient safety
  1. Lisbeth Lauge Andersen
  1. Roskilde University

Abstract

Introduction This qualitative, participatory ph.d. project explores complex dialogical aspects of the encounter between mental health service users and nurses in somatic hospital. This first part of the project is based on narrative interviews and dialogical narrative interviews with eight service users, who contribute to the further collaborative development of knowledge through mutual analysis on a seminar this summer. Next part of the project involves nurses fra a somatic ward, where I carried out fieldwork comprising interviews and participant observation. Nurses from this ward are already contributing to the co-production of knowledge through a series of workshops, which I facilitate.

The existing body of knowledge reveals that the encounter described above can be challenging and overwhelming for both patients and nurses with consequences for nurses´ work environment as well as patient safety. Service users experiences of stigma, lack of acknowledgement or neglect from staff. Nurses experience uncertainty, lack of skills and knowledge and stress/moral distress, which can contribute to problems regarding recruitment and retention. Mental health service users´ experiences with health care system is crucial because mistrust leads to health avoidance, thus contributing to inequity in health.

Methods I will be presenting the first part of the project focussing on mental health service users experiences with somatic hospitalization for either acute/chronic somatic reasons or psychiatric reasons, the latter e.g. following self-harm or suicide attempt. I carried out eight narrative interviews with service users from all five regions in Denmark. By applying Dialogical Narrative Analysis, which represents a social constructivist approach, I find mental health service users ‘in the borderland’ of patient safety.

Results Their stories reveal that the encounter with somatic staff can have consequences for their safety, since experiencing emotional and psychosocial unintended harm are often internalised, leading to relapse of mental health symptoms, shame and mistrust in the health system. Some even describe that feelings of shame and inferiority can make them self-harm again right after discharge. This not only represents a democratic, ethical, and economical problem but also contributes to inequity in health. The discussion section critically explores and problematizes the conventional understanding and definition of patient safety, emphasising the need of an expansion of the conventional patient safety concept towards a more person-centred, context-sensitive, relational notion of patient safety. What this study adds to the existing body of knowledge is the participatory aspect which enables the development of knowledge through mutual analysis of experiences as well as the empirical material, in collaboration with service users as well as nurses.

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