Degree Name

Doctor of Philosophy


School of Nursing


Background: Safety in acute mental health units (acute units) is a priority for consumers, carers, nurses, and mental health services. Safety in acute units is frequently conceptualised as the prevention of adverse events. This meaning of safety compels nurses to practice in ways that are focused on risk. This is timeintensive and requires nurses to be hypervigilant to risk. Anomalously, this meaning of safety has been associated with a reduced experience of safety by many consumers. This suggests the meaning of safety applied as the dominant paradigm in mental health services is not consistent with the meaning of safety held by consumers who experience admission to acute units. Consumers are vulnerable when admitted to an acute unit, and there is little understanding about what safety means for them in this setting. As a result, consumers’ safety needs may not be adequately prioritised. This is significant in that feeling safe can assist consumers in their recovery. Assisting consumers’ recovery is a primary objective of mental health services.

Aim: This Doctoral Project seeks to explore what safety means for consumers who have experienced admission to acute units.

Methods: A qualitative descriptive study, informed by naturalistic inquiry was undertaken. Fifteen people who had experienced admission to an acute unit were individually interviewed. Data were collected via individual semi-structured interviews and analysed inductively using thematic analysis.

Findings: Three themes were identified. The first theme, Influence of Nurses related to participants’ descriptions of the important role played by nurses in supporting consumers’ safety. This theme included sub-themes of availability, responsiveness and caring. Each sub-theme explored nursing actions that enhanced participants’ sense of safety in acute units.

The second theme, Personhood related to the need for participants’ identity as a person to be acknowledged when they were admitted to an acute unit. This theme included the sub-themes; seen as an equal, being respected, and able to make choices. These sub-themes were associated with the interactions participants had on acute units that affirmed their social worth and status.

The third theme, Supportive Environment referred to the physical and social context within which participants interacted daily during their admission. This theme incorporated sub-themes of privacy, other consumers, and meaningful activities. The sub-themes reflected the interpersonal needs that participants associated with safety during their acute unit admission.

Discussion: Acute units are considered high risk mental healthcare settings. The dominant risk-oriented approach to safety in mental healthcare services, however, views consumers as primary risks, and consumers are therefore engaged with as risks to be managed. This approach does not align with participants’ descriptions of what safety means for them when they are admitted to acute units. The meanings of safety described by participants in this study revealed the limitations of the riskoriented approach to safety and the potential for this approach to undermine consumers’ safety and recovery.

Conclusion: By describing what safety meant for them when they were admitted to an acute unit, participants articulated what they needed to feel safe, both physically and psychologically, within acute units. These insights can inform the way consumers’ safety is prioritised in mental health services, including the focus of nursing practice and the environment in which care is delivered.

FoR codes (2020)

420504 Mental health nursing



Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.