title: Caught between compassion and control: exploring the challenges associated with inpatient adolescent mental healthcare in an independent hospital.
abstract: OBJECTIVE
  To extend our understanding of how healthcare assistants construct and manage demanding situations in a secure mental health setting and to explore the effects on their health and well-being, to provide recommendations for enhanced support.
  
  
  BACKGROUND
  Contemporary literature acknowledges high rates of occupational stress and burnout among healthcare assistants, suggesting the context in which they work places them at elevated risk of physical harm and psychological distress. Yet, there is a deficit of qualitative research exploring the experiences of healthcare assistants in adolescent inpatient facilities.
  
  
  METHODS
  An exploratory multi-method qualitative approach was used to collect data about the challenges faced by healthcare assistants working on secure adolescent mental health wards in an independent hospital during 2014.
  
  
  METHODS
  Fifteen sets of data were collected. Ten participants completed diary entries and five participants were also interviewed allowing for triangulation. Data were analysed using Interpretive Phenomenological Analysis.
  
  
  RESULTS
  The findings illustrated how inpatient mental healthcare is a unique and distinctive area of nursing, where disturbing behaviour is often normalized and detached from the outside world. Healthcare assistants often experienced tension between their personal moral code which orientate them towards empathy and support and the emotional detachment and control expected by the organization, contributing to burnout and moral distress.
  
  
  CONCLUSIONS
  This study yielded insights into mental health nursing and specifically the phenomenon of moral distress. Given the ever-increasing demand for healthcare professionals, the effects of moral distress on both the lives of healthcare assistants and patient care, merits further study.
authors.affiliation: Centre for Technology Enhanced Health Research, Faculty of Health and Life Sciences, Coventry University, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Matthews
authors.affiliation: School of Applied Social Sciences, De Montfort University, Leicester, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Williamson
mesh_terms: D000293:Adolescent; D000328:Adult; D004645:Empathy; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D028681:Moral Obligations; D024802:Nurse's Role / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D011568:Psychiatric Nursing / Q000941:ethics*; D036301:Qualitative Research; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: burnout; diaries; healthcare assistants; mental health nursing; moral distress; phenomenology