Development and Psychometric Assessment of “Safe Milieu in Psychiatric Ward” Instrument

Abstract

Summary Introduction: Providing safe environment in psychiatric wards is one of the important roles of nurses that has been neglected. Making any changes requires identifying and evaluating the dimensions of the safe environment. Therefore, the purpose of this study was to use the real experiences of people involved in psychiatric wards to explain the concept of safe environment, based on which, a tool for measuring the concept is designed and validated. Method: In the first stage of this mixed study with Exploratory Sequential Design, a qualitative study was conducted to explain the concept of safe environment in psychiatric wards with a conventional content analysis approach. For this purpose, semi-structured interviews were conducted with seven patients at the point of discharge and 16 nurses, one psychiatrist, one psychologist, and one support staff were selected through purposeful sampling. Also, for writing field notes, The researcher observed wards for 84 hours. tool items were designed using findings of qualitative stage and a literature review. Then, face validity, content validity (determination of content validity ratio and content validity index), and construct validity (using exploratory factor analysis on 120 nurses working in psychiatric wards), internal consistency, stability (20 nurses), and the agreement between raters of tool was evaluated. Findings: Data analysis in the qualitative part led to the identification of four themes: "Living environment without probability of accidents ", "empowerment of staff", "staff engagement" and "family involvement". After explaining the concept of safe environment in psychiatric departments, tool draft with 117 items in the 5-point Likert scale was designed. After determining the face validity and content validity, tool items were divided into two parts of the scale (items related to employee engagement And family involvement and perception of physical environment) and observation checklists (items related to staff empowerment and Living environment without probability of accidents). The exploratory factor analysis of the 33-item scale indicated that there were two dimensions that were referred to as "engagement" with The percentage of variance 38.32 and "perception of the physical environment" with The percentage of variance 7.92. The Cronbach's alpha coefficient of the final scale with 29 items, was calculated to be 0.920 and for demensions of engagement and perception of the physical environment was 0.931 and 0.760, respectively. In-class correlation coefficient for parts of scale and checklist was 0.912 and 0.809 respectively. Conclusion: The results of the study showed that staff, family and patient are involved in safe psychiatric wards. The patient is at the heart of attention and has not been abandoned. Through their interventions, employees also empower patients to reach self-control, and on the other hand, employees can be empowered by the organization. In such environment, professional accountability of staff and teamwork within the discipline and between disciplines is very important. The patient lives in a natural environment where all their needs are provided but without any chance of accident occurrence. The results of the quantitative section showed that the tool could be used in education, management and services. An analysis of the confirmatory factor analysis of tool is suggested for further studies.