A critical inquiry into the lived experience of caring on a psychiatric intensive care unit

Background: the role of the psychiatric intensive care unit has been documented as being there to provide a safe, secure environment for service users with acute problems that require containment and medication compliance (Bowers et al., 2005). However, other interventions are increasingly available with in the field of mental health care (Crowhurst and Bowers, 2002) To increase the awareness and usage of collaborative interventions for psychosis within a psychiatric intensive care unit, a training programme was developed in 2005 by the researcher, and implemented with a ward team of registered nurses and healthcare assistants. The programme has achieved its aim and interventions have changed. The aim of this study was to explore the meaning of the experience for those living it. What does ‘caring’ mean to healthcare staff on a psychiatric intensive care unit? Has the implementation of a practice development for training in psychosocial interventions had an influence on the experience of working on a PICU?

Methods: This study took a Heideggerian hermeneutic and phenomenological inquiry position. Individual interviews were undertaken with healthcare staff participants and their responses were analysed and interpreted. These interpretations were referred back to the participants, who offered their own insight into the researcher’s understanding and a shared interpretation was co-constructed. This was then used to develop a construction of the elements of life on the psychiatric intensive care unit. These constructed elements then formed the starting point for the hermeneutic circle to formulate the fundamental structure of the phenomenon of care and caring.

Results: care on the psychiatric intensive care unit causes healthcare staff to face a dichotomy of roles. While safety and security are very important, collaboration and individualised care are fundamental to the healthcare staff working there. Psychiatric intensive care staff have an eclectic biopsychosocial model of mental health and illness and base their role beyond the provision of security on helping the service user towards self-care and empowerment.

Conclusions: Care on the psychiatric intensive care unit is a multilayered entity: risk awareness and the expectations of the ‘revolving door’ service user combine with the appreciation of team working and a biopsychosocial model of health, illness and recovery. The development of a learning programme in evidence-informed interventions for a whole team, by a whole team including service users, has helped to develop this biopsychosocial model and offer a new view on the role of healthcare assistants. These findings have implications for understanding the importance of a sociological understanding and awareness to the therapeutic relationship in the PICU; and in promoting inclusivity in educational programmes.