Qualitative, sense of coherence-based assessment of working conditions in a psychiatric in-patient unit to guide salutogenic interventions

Following a joint initiation by the Salutogenic Research Center at Ben Gurion University and a mental health center in southern Israel of an intervention program based on the salutogenic model for the mental health center’s acute psychiatric in-patient unit, the current qualitative sense of coherence-based assessment aimed at assessing the unit’s needs for the purpose of developing the rationale and goals of the intervention. The intervention, subject to the current study’s assessment, aims at creating a health promoting community focusing on the advancement of the staff’s individual and collective Sense of Coherence (SOC). The questions addressed during the assessment were aimed at (a) identifying key working conditions and their relation to the three dimensions of SOC; (b) characterizing the SOC grouped working conditions; and (c) deriving recommendations for interventions. Meetings with the Units administrative and professional management were held and fifteen unstructured interviews with the unit’s staff were carried out. The three thematic axes, around which the core ten themes revealed in the interviews revolved, disclosed a salutogenic model of individual and collective SOC, as follows: (1) The comprehensibility axis, comprised of leadership of head nurse; lack of expertise in treatment of patients with mental retardation; lack of attention to the staff’s and unit’s concerns; (2) The environment axis (manageability), comprised of lack of social and academic activities outside the hospital; impossible living and working conditions; patients suffering from diverse problems (retarded, psychotic and retarded and psychotic); (3) The motivation/emotion axis (meaningfulness), comprised of self- fulfillment; Occupational Self-Efficacy; professional/job satisfaction; devotion to the unit and its patients and a strong sense of belonging. An in-depth examination of the three axes revealed two discrete fields: promoting and deterring, in which the motivation/emotion axis encompassed promoting factors, the environment axis encompassed deterring factors, and the comprehensibility axis encompassed both promoting and deterring factors. Furthermore, the interviews were perceived as empowering. Consequently, the intervention, in line with the salutogenic approach, aims at supporting the three dimensions of SOC at individual as well as collective levels, enhancing the staff’s communal SOC which, in turn, could promote the patients’ health and the well-being of their families.