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The relationship between the flexibility/inflexibility of ward nursing regimes and patient outcomes

Alexander, J. (2005). The relationship between the flexibility/inflexibility of ward nursing regimes and patient outcomes. (Unpublished Doctoral thesis, City, University of London)


Background and aims

This thesis compared two acute psychiatric ward nursing regimes in the East End of London. The study focused on ward rules as a means of investigating the relationship between the flexibility/ inflexibility of ward nursing regimes and patient outcomes. Previous studies identified a relationship between ward rules and patient aggression. A few authors also identified a link between absconding and nurses' attitudes towards rule enforcement. However, an in depth exploration of ward rules from the perspective of staff and patients has not been undertaken previously. The study aimed to discover the content of rules within acute psychiatric wards; to explore patients responses to the rules; to evaluate the impact of rules and rule enforcement on nurses patient relationships and on ward events; and to investigate the relationship between ward rules, ward atmosphere and ward design.

Theoretical Framework

A sociological framework was used for the study, and the literature on the sociology of rules, and symbolic interactionism provided a basis for the investigation.

Design and Samples

The design centred on a comparative interview study of 30 patients and 30 nurses within two acute psychiatric wards in different hospitals. Non- participant observations provided a context for the interview data.


Measures of the Ward Atmosphere Scale (WAS) Moos (1974), the Hospital Hostel Practices Profile (HHPP) Wykes et al (1982), ward incidents and levels of as required (PRN) medication were obtained.


The analysis of the quantitative data was assisted by SPSS, and the qualitative analysis by QSR *NUDIST. Thematic and interpretative phenomenological methods were used in the analysis of the qualitative data.

Key findings and implications for clinical practice

A series of 11 interrelated concepts emerged from an analysis of the data, and a synthesis of the main themes. These findings were used to create a conceptual model. The model illustrates the relationship between the themes, and the key concept of ward stability. Recommendations for changes in clinical practice are based on the new knowledge that resulted from the data analysis, and the model explicates the evidence base for this knowledge.


Acute inpatient settings, ward rules, service users experiences, power dynamics

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Nursing
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
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