Other Titles
Ward Rules, Restriction, and Perceived Safety in Acute Psychiatric Inpatient Care [Title Slide]
Abstract
Patients’ perceptions of psychiatric wards often differ from staff views. Closed wards may feel oppressive, and restrictive practices can increase anxiety. In contrast, open-door policies, meaningful activities, and social connections improve perceived safety. Safewards strategies, such as Calm Down Methods and Reassurance, help create a calmer environment but require sufficient staffing, training, and alignment with ward culture. High staff turnover and inconsistent training threaten sustainability.
Interactions between staff and patients strongly influence the inpatient experience. Patients value respect, empathy, and genuine engagement. Impersonal or standardized responses can increase feelings of neglect. Safewards encourages humanized communication through Soft Words, Talk Down/Through, Positive Words, Bad News Mitigation, and Know Each Other. These strategies are less effective if staff are resistant or language feels authoritarian. Mutual Help Meetings and Discharge Messages can enhance participation and belonging, though low-turnover wards may unintentionally increase hopelessness.
High-quality psychiatric hospitalization depends on autonomy, connection, and meaningful engagement rather than strict rules alone. Safewards provides a structured framework to reduce restrictions, improve communication, and promote collaborative care. Effective implementation requires transforming authority-driven wards into shared decision-making environments, supported by consistent leadership, clear communication, adequate staffing, staff training, and cultural change to overcome entrenched institutional habits.
This review highlights the importance of understanding patients’ perspectives in acute psychiatric care. Transparent rules, flexible policies, supportive staff, and a conducive environment enhance safety, trust, and satisfaction. Challenges to implementation include staff resistance, limited leadership support, resource constraints, and the risk of paternalistic practices. Addressing these barriers is essential for improving patient experience, fostering engagement, and ensuring a safer, more collaborative inpatient setting.
Notes
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References:
Alexander, J. (2006). Patients' feelings about ward nursing regimes and involvement in rule construction. Journal of Psychiatric and Mental Health Nursing, 13(5), 543–553. https://doi.org/10.1111/j.1365-2850.2006.00977.x
Adler, R. H. (2020). Bucking the system: Mitigating psychiatric patient rule breaking for a safer milieu. Archives of Psychiatric Nursing, 34(3), 100–106. https://doi.org/10.1016/j.apnu.2020.03.002
Bladzinski, P., Hat, M., Daren, A., Kruk, D., Depukat, A., Cichocki, L., … Cechnicki, A. (2020). Subjective evaluation of admission and first days of hospitalization at a psychiatric ward from the perspective of patients. Advances in Psychiatry and Neurology / Postepy Psychiatrii i Neurologii, 29(1), 39–53. https://doi.org/10.5114/ppn.2020.94694
Corbetta, M., Corso, B., & Camuccio, C. A. (2022). Rules and ward climate in acute psychiatric setting: Comparison of staff and patient perceptions. International Journal of Mental Health Nursing, 31(3), 611–624. https://doi.org/10.1111/inm.12980
Gros, C. P., Parr, C., Wright, D. K., Montreuil, M., & Frechette, J. (2017). Hospital rules and regulations: The perspectives of youth receiving psychiatric care. Journal of Child and Adolescent Psychiatric Nursing, 30(1), 18–24. https://doi.org/10.1111/jcap.12166
Knauf, S. A., O'Brien, A. J., & Kirkman, A. M. (2023). An analysis of the barriers and enablers to implementing the Safewards model within inpatient mental health services. International Journal of Mental Health Nursing, 32(6), 1525–1543. https://doi.org/10.1111/inm.13188
Liwinski, T., Davidson, R., Sarlon, J., Gaupp, R., Imfeld, L., Bruhl, A. B., Vogel, M., Huber, C. G., & Lang, U. E. (2025). Patient perspectives on open-door policies in psychiatry: Mixed methods study. Journal of Medical Internet Research, 27, e73610. https://doi.org/10.2196/73610
Molin, J., Graneheim, U. H., & Lindgren, B. M. (2016). Quality of interactions influences everyday life in psychiatric inpatient care—Patients' perspectives. International Journal of Qualitative Studies on Health and Well-Being, 11, 29897. https://doi.org/10.3402/qhw.v11.29897
Pelto-Piri, V., Wallsten, T., Hylen, U., Nikban, I., & Kjellin, L. (2019). Feeling safe or unsafe in psychiatric inpatient care: A hospital-based qualitative interview study with inpatients in Sweden. International Journal of Mental Health Systems, 13, 23. https://doi.org/10.1186/s13033-019-0282-1
Semyonov-Tal, K. (2021). Complaints and satisfaction of patients in psychiatric hospitals: The case of Israel. Journal of Patient Experience, 8, 2374373521997221. https://doi.org/10.1177/2374373521997221
Silva, B., Bachelard, M., Bonsack, C., Golay, P., & Morandi, S. (2023). Exploring patients' feeling of being coerced during psychiatric hospital admission: A qualitative study. Psychiatric Quarterly, 94(3), 411–434. https://doi.org/10.1007/s11126-023-10039-6
Thibeault, C. A., Trudeau, K., d'Entremont, M., & Brown, T. (2010). Understanding the milieu experiences of patients on an acute inpatient psychiatric unit. Archives of Psychiatric Nursing, 24(4), 216–226. https://doi.org/10.1016/j.apnu.2009.07.002
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Literature Review
Research Approach
Other
Keywords:
Acute Care, Continuing Education, Psychiatric Treatment, Hospital Wards, Patients' Attitudes, Patient Safety
Recommended Citation
Lan, Sheng-Tsung, "Experiences of Acute Psychiatric Inpatients: A Literature Review" (2026). International Nursing Research Congress (INRC). 311.
https://www.sigmarepository.org/inrc/2026/presentations_2026/311
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-09-25
Experiences of Acute Psychiatric Inpatients: A Literature Review
Toronto, Ontario, Canada
Patients’ perceptions of psychiatric wards often differ from staff views. Closed wards may feel oppressive, and restrictive practices can increase anxiety. In contrast, open-door policies, meaningful activities, and social connections improve perceived safety. Safewards strategies, such as Calm Down Methods and Reassurance, help create a calmer environment but require sufficient staffing, training, and alignment with ward culture. High staff turnover and inconsistent training threaten sustainability.
Interactions between staff and patients strongly influence the inpatient experience. Patients value respect, empathy, and genuine engagement. Impersonal or standardized responses can increase feelings of neglect. Safewards encourages humanized communication through Soft Words, Talk Down/Through, Positive Words, Bad News Mitigation, and Know Each Other. These strategies are less effective if staff are resistant or language feels authoritarian. Mutual Help Meetings and Discharge Messages can enhance participation and belonging, though low-turnover wards may unintentionally increase hopelessness.
High-quality psychiatric hospitalization depends on autonomy, connection, and meaningful engagement rather than strict rules alone. Safewards provides a structured framework to reduce restrictions, improve communication, and promote collaborative care. Effective implementation requires transforming authority-driven wards into shared decision-making environments, supported by consistent leadership, clear communication, adequate staffing, staff training, and cultural change to overcome entrenched institutional habits.
This review highlights the importance of understanding patients’ perspectives in acute psychiatric care. Transparent rules, flexible policies, supportive staff, and a conducive environment enhance safety, trust, and satisfaction. Challenges to implementation include staff resistance, limited leadership support, resource constraints, and the risk of paternalistic practices. Addressing these barriers is essential for improving patient experience, fostering engagement, and ensuring a safer, more collaborative inpatient setting.
Description
Psychiatric inpatient units are highly institutionalized environments where ward rules, physical settings, and staff–patient interactions profoundly shape patients’ hospitalization experience. This presentation synthesizes findings from 11 studies published between 2006 and 2025 that explore acute psychiatric inpatients’ perspectives, highlighting how rules, restrictions, environment, communication, and individual factors influence their sense of autonomy, safety, and overall satisfaction.