What Can Be Learned About Organizational Ethical Blindness When the Wishes of Inpatients in Acute Psychiatric Settings Are Embraced: An Observational Study.

Abstract

The study explores how the co-created non-pharmacological intervention 'Wishing Well' may support patient autonomy and recovery-oriented practice in an acute psychiatric ward. During the 'Wishing Well' meetings, inpatients were invited to express concrete wishes for improving daily ward life, which were then discussed collaboratively with peers and staff. The aim was to examine how wishes expressed by inpatients reflected tensions between everyday ward routines and recovery-oriented values. Observations of 14 consecutive 'Wishing Well' intervention meetings over 7 months were analysed, with a focus on the content of wishes, staff-patient interactions, and subsequent actions. Reporting followed the COREQ guidelines. A total of 100 wishes were expressed. The wishes were categorized using the Safewards domains, which revealed that more than half of the wishes (53%) concerned the physical environment. The wishes also related to the staff team (20%), the regulatory framework (8%), the patient community (6%), patient characteristics (6%), and influences outside the hospital (5%). A small proportion (2%) was unclear and could not be categorized. The wishes concerning the staff team shed light on organizational routines that staff had not recognized as being restrictive or inconsistent with therapeutic ideals of recovery-oriented practices. The findings illustrate that everyday ward routines may unintentionally restrict opportunities for patient autonomy and participation; however, during the meetings staff and patients discussed these routines and negotiated changes to practices. The findings suggest that the 'Wishing Well' intervention may provide opportunities for collaboration and reflection on everyday practices that created tensions in relation to recovery-oriented values.