title: Enabling people, not completing tasks: patient perspectives on relationships and staff morale in mental health wards in England.
abstract: BACKGROUND
  Mental health inpatient wards are stressful places to work and concerns have been raised regarding quality of patient care and staff wellbeing on these wards. Recent research has suggested that robust support systems and conditions that allow staff to exercise professional autonomy in their clinical work result in better staff morale. Staff value having a voice in their organisations, and say that they would like more interaction with patients and processes to reduce violent incidents on wards. There has been little research into patients' views on staff morale and on how it may impact on their care. This study aimed to explore staff morale and staff-patient relationships from a patient perspective.
  
  
  METHODS
  A qualitative investigation was conducted using purposive sampling to select seven inpatient wards in England representing various subspecialties. Semi-structured interviews were carried out with three patients on each ward. A thematic approach to analysis was used, supported by NVivo 10 software.
  
  
  RESULTS
  Patients valued staff who worked together as a cohesive team, treated them as individuals, practised in a collaborative way and used enabling approaches to support their recovery. Participating patients described observing staff closely and feeling concerned at times about their well-being and the impact on them of stress and adverse incidents. They tended to perceive ward staff and patients as closely and reciprocally linked, with staff morale having a significant impact on patient well-being and vice versa. Some participants also described modifying their own behaviour because of concerns about staff well-being. Administrative duties, staff shortages and detrimental effects of violent incidents on the ward were seen as compromising staff members' ability to be involved with patients' lives and care.
  
  
  CONCLUSIONS
  Patient views about the factors impacting on staff morale on inpatient wards are similar to those of staff in qualitative studies. Their accounts suggest that staff and patient morale should be seen as interlinked, suggesting there is scope for interventions to benefit both.
authors.affiliation: Division of Psychiatry, University College London, Maple House 149 Tottenham Court Road, W1T 7BN, London, UK. himanshu_mistry@yahoo.com.|Hastings Community Mental Health Team, Hawke's Bay District Health Board, Hastings, New Zealand. himanshu_mistry@yahoo.com.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Mistry
authors.affiliation: Rehabilitation Teaching & Research Unit, University of Otago, Wellington, New Zealand. William.levack@otago.ac.nz.
authors.forename: William M M
authors.initials: WM
authors.lastname: Levack
authors.affiliation: Division of Psychiatry, University College London, Maple House 149 Tottenham Court Road, W1T 7BN, London, UK. s.johnson@ucl.ac.uk.
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D004739:England; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D009013:Morale; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010465:Perception; D011369:Professional-Patient Relations; D036301:Qualitative Research; D014937:Work / Q000502:physiology; D055815:Young Adult