nursingforsocialjustice

Here is something that I struggle with everyday:

I did my BSN in Calgary, Alberta. I started my program in 2006. When I did my first mental health inpatient rotation in 2007, my placement was on an acute inpatient psychiatric (the terminology of the time) unit. The main unit doors were magnetic locked, but the nurses had the ability to lock them when necessary and leave them unlocked so that patients could come and go during the day. There were no doors or glass, or walls separating the staff and the patients in the main section of the unit. There was a desk with computers, and patients could see all the nurses. The interview rooms had glass walls. The high observation rooms were separated from the rest of the unit, with a glass wall so nurses could see patients and patients could see nurses. The inpatient mental health unit was a mix of people certified under the mental health act and those who were voluntary patients (in contrast to other inpatient health areas where every patient is there voluntarily by their decision or their substitute decision-maker).

Fast forward to 2008, I had my first job on an acute inpatient unit in Vancouver, British Columbia. The doors to the unit were really only closed at night and sometimes during the day. The doors locked to the outside, meaning when they were closed outsiders could not enter, but insiders could get out. The mix was also involuntary and voluntary patients. Fast forward to my last hospital-based inpatient mental health staff nurse job in 2017. The unit locked. There was no ability for the staff to unlock the unit. The population served was mostly people under the age of majority but this was not the deciding factor.

What changed in between a time when nurses had the discretion to unlock the external doors of a mental health inpatient unit dependent on the acuity of patients, to the time where they all lock as part of the design? When we say terms like “recovery oriented” and “trauma informed” does the underlying philosophy match the structures that are used to create the environmental design?

When we use terms like “safety” what do we mean? And who’s idea of safety is informing decisions about environmental design of mental health service spaces?

When we separate ourselves from our patients with physical environmental structures and aren’t critical of why such environments are built what is the effect on nurses, and nursing?

What kinds of philosophical clashes happen when we might align with an interpersonal relations perspective or a human becoming perspective and the focus of the patient experience is living with being detained for medical treatments they don’t agree with? How does that impact nursing praxis?

The nursing perspective isn’t an extension of the psychiatric perspective. It isn’t an extension of a risk management perspective. And, the story of psychiatry in BC isn’t a beautiful story of physicians empowering nurses to actualize and implement the art of nursing. It’s not a story of two disciplines growing as equal partners in developing person centred and recovery oriented strengths-based spaces.

Peace,

Michelle D.