Context

High-secure mental health hospitals, also known as high-secure forensic hospitals, are a specialism within mental healthcare.1 They have the dual role of providing a safe healthcare environment and a secure setting for individuals with co-occurring mental health conditions and behaviour that is considered extremely dangerous or high risk.2 Mental health nurses (MHNs) play a key role in providing healthcare and maintaining a high level of security within secure mental health services. However, the setting presents unique environmental, relational and clinical challenges,3 which can lead to occupational stress, burnout4 and make it challenging to recruit and retain staff.1 In light of these challenges, Rooney and colleagues sought to explore the factors that support resilience in mental health nursing staff working at a high-secure unit for men diagnosed with personality disorders.5

Findings

The first theme identified was Management of Emotions, where participants articulated the difference between ‘caring personally’ for patients, and ‘providing care’. Participants highlighted the importance of providing the latter in a conscious and boundaried way, as part of a nurse’s duty of care. The second theme was Teamwork, and it highlighted that an environment where staff felt able to discuss clinical situations and receive supportive feedback was central to building staff resilience and well-being. The third theme was Understanding the Setting. This included developing an understanding of personality disorder, and the experiences of individuals diagnosed with personality disorder. Additionally, understanding that there would be times when there are challenges associated with individuals in severe emotional distress, where progress was difficult to identify, however, it was the role of the nursing staff to support patients to work through the challenges and collaboratively plan a path towards recovery. The fourth theme was Work Life Balance, where participants highlighted that creating a separation between work life and home life was an important part of maintaining resilience.

Commentary

Resilience research with MHNs is limited when compared with the wider nursing field,6 therefore the study by Rooney and colleagues presents a timely contribution to the field. Given the organisational stressors, practice demands and challenges associated with working in high-secure settings, the study findings bring into sharp focus the factors that MHNs and healthcare assistants perceive as crucial for building staff resilience.

Although staff work-life balance and teamwork are not necessarily new recommendations in nursing spaces, this study adds an understanding of how the participants made sense of these in the specific context of a high-secure male personality disorder unit. Additionally, the study identifies that while organisational support can help build staff resilience, it is important to also consider adaptability based on an understanding of the wider and individual staff factors that can foster resilience.

The study has important considerations for managers in secure mental health settings—emphasising they can put systems and structures in place to support staff resilience. Clinical supervision—mentioned briefly in the discussion—is a good example of how managers in secure settings can invest in a robust support mechanism to help build staff resilience and provide individualised staff support. Clinical supervision as a support mechanism is underpinned by decades of research and is recognised as contributing to professional development, quality care, and supporting the safe practice of the profession.7 Furthermore, regulatory bodies such as the Care Quality Commission highlight its benefits.7

Although the sample size in the study was small, it was deemed sufficient for the authors goal of using IPA methodology to gain deep insights into staff experiences. These experiences may resonate with mental health nursing staff practising in other secure environments. There is scope for future research to explore resilience in MHNs in different secure settings, and in different countries to enhance generalisability of the findings.