Patient-Related Factors that Influence the Experiences of Nurses Working in Acute Psychiatric Wards at Mathari National Teaching and Referral Hospital, Nairobi City County

Abstract

Nursing in acute psychiatry is distinguished by the unique nature and complexity of acute care, and by the factors that influence the experiences of nurses working in acute psychiatric wards. This study investigated patient-related factors that influence the experiences of nurses working in acute psychiatric wards at Mathari National Teaching & Referral Hospital, Kenya's largest psychiatric hospital. The study used a qualitative phenomenological design and conducted ten in-depth interviews to explore individual, occupational, and organizational insights into these experiences. The thematic analysis revealed that several problems significantly affected nurses' experiences. The results of the paper revealed that nurses working in acute psychiatric units have their experiences shaped largely by patient-related factors such as the severity and unpredictability of the illnesses, agitation, aggression, judgment impairment, impulse control issues, and exposure to both physical and verbal violence. These factors also contributed to nurses’ fear, hypervigilance, psychological stress, and emotional fatigue, while patient recovery also gave nurses a sense of professional satisfaction. This research concludes that the complexity and behavioral instability of patients make acute psychiatric nursing challenging. Recommendations include better recognition of behavioral risks; individualized management of behavior and care plans; continuous assessment of the patient’s mental state; de-escalation and therapeutic communication; recognition of specific patient triggers; family participation where possible; and consistent communication of the patient’s behavioral history among clinical team members.