The Library

Factors affecting staff morale on inpatient mental health wards in England : a qualitative investigation

Tools

Totman, Jonathan, Lewando Hundt, Gillian, Wearn, Elizabeth, Paul, Moli and Johnson, Sonia. (2011) Factors affecting staff morale on inpatient mental health wards in England : a qualitative investigation. BMC Psychiatry, Vol.11 (No.68). ISSN 1471-244X

Preview

PDF
WRAP_Paul_1471-244X-11-68.pdf - Published Version - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Download (294Kb)

Official URL: http://dx.doi.org/10.1186/1471-244X-11-68

Abstract

Background: Good morale among staff on inpatient psychiatric wards is an important requirement for the
maintenance of strong therapeutic alliances and positive patient experiences, and for the successful
implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and
poor morale.
Method: We conducted individual and group interviews with staff of a full range of disciplines and levels of
seniority on seven NHS in-patient wards of varying types in England.
Results: Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive
ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures
maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel
safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation.
Conclusions: Increasing employee voice, designing jobs so as to maximise autonomy within clear and wellstructured
operational protocols, promoting greater staff-patient contact and improving responses to violence may
contribute more to inpatient staff morale than formal support mechanisms.

Item Type:

Journal Article

Subjects:

R Medicine > R Medicine (General)

Divisions:

Faculty of Social Sciences > School of Health and Social Studies
Faculty of Medicine > Warwick Medical School > Mental Health and Wellbeing
Faculty of Medicine > Warwick Medical School
Faculty of Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH)

Library of Congress Subject Headings (LCSH):

Employee morale, Hospitals -- Employees -- Job satisfaction, Mental health personnel -- Job satisfaction

Journal or Publication Title:

BMC Psychiatry

Publisher:

BioMed Central Ltd.

ISSN:

1471-244X

Official Date:

21 April 2011

Dates:

Date	Event
21 April 2011	Published

Volume:

Vol.11

Number:

No.68

Identification Number:

10.1186/1471-244X-11-68

Status:

Peer Reviewed

Publication Status:

Published

Access rights to Published version:

Open Access

Funder:

National Institute for Health Research (Great Britain) (NIHR)

Grant number:

08/1604/142 (NIHR)

References:

1. McGeorge M, Lelliott P, Stewart J: Managing violence in psychiatric wards:
Preliminary findings of a multi-centre audit London: Royal College of
Psychiatrists’ Research Unit Report; 2000.
2. Lelliott P, Quirk A: What is life like on acute psychiatric wards? Curr Opin
Psychiatr 2004, 17:297-301.
3. Rose D: Users’ Voices. The perspectives of mental health service users on
community and hospital care London: The Sainsbury Centre for Mental
Health; 2001.
4. Department of Health: Acute Adult In-patient Care: Policy Implementation
Guide London: Department of Health; 2002.
5. Healthcare Commission: National Audit of Violence 2006-7 London: Royal
College of Psychiatrists; 2007 [http://www.rcpsych.ac.uk/quality/quality,
accreditationaudit/nationalauditofviolence/navnationalreports.aspx].
6. Garcia I, Kennett C, Quraishi M, Durcan G: Acute Care 2004: A National
Survey of Adult Psychiatric Wards in England London: The Sainsbury Centre
for Mental Health; 2005.
7. Department of Health: NHS Health and Wellbeing: Final Report Department
of Health; 2009 [http://www.nhshealthandwellbeing.org/FinalReport.html].
8. Johnson S, Lloyd-Evans B, Howard LM, Osborn DPJ, Slade M: Where next
with residential alternatives to admission? Br J Psych 2010, 197:S52-S54.
9. Tansella M, Thornicroft G: Implementation science: understanding the
translation of evidence into practice. Br J Psych 2009, 195:283-285.
10. Cahill J, et al: Systematic Review of staff morale in in-patient units. SDO
website; 2004 [http://www.sdo.nihr.ac.uk/files/project/56-final-report.pdf].
11. Richard D, Bee P, Barkham M, Gilbody S, Cahill J, Glanville J: The prevalence
of nursing staff stress on adult acute psychiatric in-patient wards A
systematic review. Soc Psychiatry Psychiatr Epidemiol 2006, 41:33-43.
12. Bowers L, Allan T, Simpson A, Jones J, Whittington R: Morale is high in
acute inpatient psychiatry. Soc Psychiatry Psychiatr Epidemiol 2009,
44(1):39-46.
13. Wood S, Stride P, Threapleton K, Wearn E, Nolan F, Osborn DPJ, Paul M,
Johnson S: Demands, control, supportive relationships and well-being
amongst British mental health workers. Soc Psychiatry Psychiatr Epidemiol
2010 [http://www.springerlink.com/content/7607692617x826q0/], Online
first publication:.
14. Johnson S, Wood S, Paul M, Osborn DP, Wearn E, Lloyd-Evans B, Totman J,
Araya R, Burton E, Sheehan B, Hundt G, Wellman N, Nolan F, Killaspy H:
Inpatient Mental Health Staff Morale: A National Investigation. Final report
NIHR Service Delivery and Organisation programme; 2011 [http://www.sdo.
nihr.ac.uk/files/project/142-final-report.pdf].
15. Maslach C: A multidimensional theory of burnout. In Theories of work
stress. Edited by: Cooper C. Oxford: Oxford University Press; 1998:68-85.
16. Karasek RA: Job demands, job decision latitude and mental strain:
Implications for job redesign. Admin Sci Quart 1979, 24:285-308.
17. Reid Y, Johnson S, Morant N, Kuipers E, Szmukler G, Thornicroft G,
Bebbington P, Prosser D: Explanations for stress and satisfaction in
mental health professionals: a qualitative study. Soc Psychiatry Psychiatr
Epidemiol 1999, 34:301-308.
18. Reid Y, Johnson S, Morant N, Kuipers E, Szmukler G, Thornicroft G,
Bebbington P, Prosser D: Improving support for mental health staff: a
qualitative study. Soc Psychiatry Psychiatr Epidemiol 1999, 34:309-315.
19. Pope C, Ziebland S, Mays N: Qualitative research in health care: Analysing
qualitative data. Br Med J 2000, 320:114.
20. Braun V, Clarke V: Using thematic analysis in psychology. Qualitative
Research in Psychology 2006, 3:77-101.
21. Hammer TH, Saksvik PØ, Nytrø K, Torvatn H, Bayazit M: Expanding the
psychosocial work environment: workplace norms and work-family
conflict as correlates of stress and health. J Occup Health Psychol 2004,
9(1):83-97.
22. Akerboom S, Maes S: Beyond demand and control: The contribution of
organizational risk factors in assessing the psychological well-being of
health care employees. Work Stress; 2006:20(1):21-36.
23. Bliese Paul D, Castro CA: Role clarity, work overload and organizational
support: multilevel evidence of the importance of support. Work Stress
2000, 14(1):65-73.
24. Pyman A, Cooper B, Teicher J, Holland P: Comparison of the Effectiveness
of Employee Voice Arrangements in Australia. Ind Relat J 2006,
37(5):543-559.
25. Pyman A, Holland P, Teicher J, Cooper B: Industrial Relations Climate,
Employee Voice and Managerial Attitudes to Unions: An Australian
Study. Br J Ind Relat 2010, 48(2):460-480.
26. Marchington M, Wilkinson A: Managing worker voice. Human Resource
Management at Work: People Management and Development London:
Chartered Institute of Personnel and Development; 2005, 265-294.
27. Department of Health: New Horizons: Towards a shared vision for mental
health London: Department of Health; 2009.
28. Cowman S, Bowers L: Safety and security in acute admission psychiatric
wards in Ireland and London: a comparative study. J Clin Nurs 2009,
18(9):1346-1353.
29. Steinert T, Eisele F, Goeser U, Tschoeke S, Uhlmann C, Schid P: Successful
interventions on an organisational level to reduce violence and coercive
interventions in in-patients with adjustment disorders and personality
disorders. Clin Pract Epidemiol Ment Health 2008, 4:27.
30. Bowers L, Nijman H, Allan T, Simpson A, Warren J, Turner L: Prevention and
management of aggression training and officially reported violent
incidents: The Tompkins Acute Ward Study. Psychiatr Serv 2006,
57:1022-1026.
31. Mann P, Sugarman C, Rooney M, Goodman , Lynch J: Service innovation:
policing mental health - the St Andrew’s scheme. The Psychiatrist 2007,
31(3):97-98.