Beatrice Gehri successfully defended her thesis on 1 November 2023
Beatrice Gehri’s dissertation is entitled “Quality of care in Swiss psychiatric hospitals considering structures, processes, and patient outcomes from nurses’ perspective” and is embedded in the study Matching Registered Nurse Services with Changing Care Demands in Psychiatric Hospitals (MatchRN Psychiatry).
The overall goal of the study was to deepen our understanding of selected structures, processes and outcomes in psychiatric hospitals from nurses' perspective. A first goal was to explore psychiatric hospital structures such as nurse staffing and the work environment; processes such as nursing care left undone; nurse outcomes, including emotional exhaustion and intention to leave; and patients’ symptom burden.
The dissertation focused on nurses’ work environment and its association with nursing care left undone and patients’ non accidental self-injury. In the first step of the dissertation, we investigated factors such as nurses' control over their work schedules, the level of support they receive from their supervisors, and the prevalence of sudden shift changes and overtime work. We discovered that many nurses lack control over their schedules and report varying degrees of support from their supervisors. Some also frequently have to cover shifts at short notice and engage in overtime work. These factors have been associated with feelings of emotional exhaustion among nurses and the intention to leave. Our findings underscore the importance of enhancing nurses' control over their schedules and providing robust support from their supervisors to mitigate emotional exhaustion and intention to leave.
The second step focused on nursing care left undone. It revealed that, in cases of lacking resources, nurses struggle to complete their responsibilities, particularly those categorized as "indirect" care. This issue is more pronounced when staffing levels are insufficient. Ensuring that hospitals have adequate nursing staff is imperative to address this matter and maintain the quality of patient care.
In a third step, we examined patients' nonaccidental self-injury and its relationship with the nursing work environment. Our research unveiled a connection between high rates of patient self-injury and lower staffing levels and perceived lack of support from nurses' leaders. Addressing these organizational factors alongside patient treatment could lead to improved patient outcomes and reduced self-injury rates, readmissions, and suicides.
The dissertation underscores the vital significance of fostering a positive work environment in Swiss psychiatric hospitals. This includes ensuring appropriate staffing levels and effective leadership. It particularly stresses the importance of comprehending psychiatry-specific factors influenced by patient needs, outcomes, and the processes within the unit.