Nurses' Perceptions of Locked Doors to Prevent Absconding on Acute Mental Health Inpatient Units: A Qualitative Descriptive Study

Locked entry and exit doors are common on contemporary mental health inpatient units, with previous research suggesting clinicians believe they reduce the risks of absconding, prevent the importation of illicit substances, and reduce aggression. However, this focus on reducing risk is at the cost of therapeutic relationships, resulting in mental health consumer perception that mental health units are punitive and create a custodial feel. The aim of this paper is to describe nurses' experiences of using locked doors on mental health inpatient units to prevent consumers absconding. We used a Qualitative Descriptive approach, with semi-structured interviews conducted with 15 Australian mental health nurses. Data were analysed using Braun and Clarke's (2006) method of thematic analysis and reported in accordance with the Consolidated Checklist for Reporting Qualitative Data (CORE-Q guidelines). Three themes emerged during data analysis: (1) Locked doors and absconding: Nurse perceptions, (2) Smoking as a driver of absconding, and (3) Locked in and lashing out: Aggression linked to door locking. Participants in this study expressed that locking doors was necessary to prevent absconding. However, they also felt that door locking was restrictive and detrimental to the therapeutic relationship. There is a need to examine the impact of locked doors on the mental health nursing role, in addition to enhancing nursing skills in risk assessment, shared decision making, and ways to enhance the therapeutic relationship and milieu of the ward.