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Bakhshi H, Shariati MJ, Basirinezhad MH, Ebrahimi H. Comparison of barriers to effective nurse-patient communication in COVID-19 and non-COVID-19 wards. BMC Nurs 2024; 23:328. [PMID: 38755576 PMCID: PMC11097547 DOI: 10.1186/s12912-024-01947-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Communication is a basic need of humans. Identifying factors that prevent effective nurse-patient communication allows for the better implementation of necessary measures to modify barriers. This study aims to compare the barriers to effective nurse-patient communication from the perspectives of nurses and patients in COVID-19 and non-COVID-19 wards. MATERIALS AND METHODS This cross-sectional descriptive study was conducted in 2022. The participants included 200 nurses (by stratified sampling method) and 200 patients (by systematic random sampling) referred to two conveniently selected hospitals in Shahroud, Iran. The inclusion criteria for nurses were considered having at least a bachelor's degree and a minimum literacy level for patients to complete the questionnaires. Data were collected by the demographic information form and questionnaire with 30 and 15 questions for nurses and patients, which contained similar questions to those for nurses, based on a 5-point Likert scale. Data were analysis using descriptive indices and inferential statistics (Linear regression) in SPSS software version 18. RESULTS The high workload of nursing, excessive expectations of patients, and the difficulty of nursing work were identified by nurses as the main communication barriers. From the patients' viewpoints, the aggressiveness of nurses, the lack of facilities (welfare treatment), and the unsanitary conditions of their rooms were the main communication barriers. The regression model revealed that the mean score of barriers to communication among nurses would decrease to 0.48 for each unit of age increase. Additionally, the patient's residence explained 2.3% of the nurses' barriers to communication, meaning that native participants obtained a mean score of 2.83 units less than non-native nurses, and there was no statistically significant difference between the COVID and non-COVID wards. CONCLUSION In this study, the domain of job characteristics was identified by nurses as the major barrier, and patients emphasized factors that were in the domain of individual/social factors. There is a pressing need to pay attention to these barriers to eliminate them through necessary measures by nursing administrators.
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Affiliation(s)
- Hamed Bakhshi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Javad Shariati
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Hasan Basirinezhad
- Department of Epidemiology and Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Ebrahimi
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.
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Isangula K, Pallangyo ES, Ndirangu-Mugo E. Nurses' and clients' perspectives after engagement in the co-designing of solutions to improve provider-client relationships in maternal and child healthcare: a human-centered design study in rural Tanzania. BMC Nurs 2024; 23:148. [PMID: 38431621 PMCID: PMC10908081 DOI: 10.1186/s12912-024-01808-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND There has been a persistent increase in clients' dissatisfaction with providers' competencies in maternal and child healthcare (MCH). Existing interventions have failed to address the complexity of provider-client relationships. Therefore, targeted, contextualized innovative solutions that place providers and clients at the forefront as agents of change in optimizing intervention design and implementation are needed. The study team adopted a co-design strategy as part of Human- Centered Design (HCD) approach, where MCH nurses, clients, and stakeholders partnered to design an intervention package to improve provider-client relationships in rural Tanzania. OBJECTIVE This paper explored nurses', clients', and MCH stakeholders' perspectives following participation in a co-design stage of the HCD study to generate interventions to strengthen nurse-client relationships in Shinyanga Region. METHODS A qualitative descriptive design was used. Thirty semi-structured key informant interviews were conducted in the Swahili language with purposefully selected nurses, clients, and MCH stakeholders. The inclusion criterion was participation in consultative workshops to co-design an intervention package to strengthen nurse-client relationships. Data were transcribed and translated simultaneously, managed using NVivo, and analyzed thematically. RESULTS Three main themes were developed from the analysis, encompassing key learnings from engagement in the co-design process, the potential benefits of co-designing interventions, and co-designing as a tool for behavior change and personal commitment. The key learnings from participation in the co-design process included the acknowledgment that both nurses and clients contributed to tensions within their relationships. Additionally, it was recognized that the benefits of a good nurse-client relationship extend beyond nurses and clients to the health sector. Furthermore, it was learned that improving nurse-client relationships requires interventions targeting nurses, clients, and the health sector. Co-designing was considered beneficial as it offers a promising strategy for designing effective and impactful solutions for addressing many challenges facing the health sector beyond interpersonal relationships. This is because co-designing is regarded as innovative, simple, and friendly, bringing together parties and end-users impacted by the problem to generate feasible and acceptable interventions that contribute to enhanced satisfaction. Furthermore, co-designing was described as facilitating the co-learning of new skills and knowledge among participants. Additionally, co-designing was regarded as a tool for behavior change and personal commitment, influencing changes in participants' own behaviors and cementing a commitment to change their practices even before the implementation of the generated solutions. CONCLUSION End-users' perspectives after engagement in the co-design process suggest it provides a novel entry point for strengthening provider-client relationships and addressing other health sector challenges. Researchers and interventionists should consider embracing co-design and the HCD approach in general to address health service delivery challenges.
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Affiliation(s)
- Kahabi Isangula
- School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania.
| | - Eunice S Pallangyo
- School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania
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Isangula K, Pallangyo ES, Ndirangu-Mugo E. Interventions co-designed by healthcare providers and clients for improving therapeutic relationships in maternal and child healthcare: a pilot study using human centered design in rural Tanzania. BMC Nurs 2023; 22:314. [PMID: 37704982 PMCID: PMC10500767 DOI: 10.1186/s12912-023-01472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Research shows that poor provider-client interactions in maternity and child health (MCH) continue to affect health outcomes, service uptake, continuity of care, and trust in formal healthcare systems. OBJECTIVE The study's objective was to jointly create a prototype intervention package for enhancing nurse-client relationships using human centered design (HCD) approach. METHODS A five-step HCD methodology was used: (1) Community-driven discovery through qualitative descriptive research methods using 9 focus groups with nurses and clients and 12 key informant interviews with MCH administrators; (2) consultative ideation and co-creation meetings with 10 nurses, 10 clients, and 10 administrators to co-design a rough prototype model; (3) rough prototype validation through qualitative insight gathering using 6 FGDs with nurses and clients; (4) refinement and adaptation meetings with 14 nurses, 14 clients and 12 administrators; and (5) documentation and sharing of lessons learnt. RESULTS According to the community-driven research, poor service, a lack of concern, poor communication, a bad attitude, and unhappiness at work are the nurse factors that affect the relationships between nurses and their patients. Non-compliance with procedures, unfavorable attitudes, poor communication, low education, poverty, and faith in conventional healers were among the client-related factors. Inadequate funding, bad management techniques, improper policy execution, and a lack of an independent institution for handling complaints are the health system factors that affect nurse-client relationships. In response, three ideation and co-creating meetings resulted in 24 interventions. Seven (7) of these were rated as more acceptable and feasible in the local context and formed a rough prototype. During validation, there were some disagreements on the feasibility of curriculum and resource-related interventions. Refinement meetings resulted in a final prototype including four interventions: (i) promotion of patient-centred care; (ii) awards and recognition for nurses; (iii) strengthening complaints mechanisms and (iv) disciplinary measures for abusive nurses and clients. The lessons learnt have been shared through publications and institutional research meetings. CONCLUSIONS HCD approach provides a novel entry point for providers and clients to examine the problems and design interventions for strengthening their therapeutic relationships in MCH care. Researchers, practitioners, and policy developers are welcome to consider the emerging prototype as it was deemed acceptable and potentially feasible in rural African contexts.
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Affiliation(s)
- Kahabi Isangula
- School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania.
| | - Eunice S Pallangyo
- School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania
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Isangula KG, Pallangyo ES, Ndirangu-Mugo E. Improving nursing education curriculum as a tool for strengthening the nurse-client relationships in maternal and child healthcare: Insights from a human-centered design study in rural Tanzania. Front Public Health 2023; 11:1072721. [PMID: 36817890 PMCID: PMC9935566 DOI: 10.3389/fpubh.2023.1072721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Background There are growing evidence of poor nurse-client relationships in maternal and child health (MCH). The nursing curriculum forms an important entry point for strengthening such relationships, consequently improving client satisfaction with nurses' competencies, confidence in the formal healthcare system, healthcare-seeking practices, continuity with care, and MCH outcomes. Objective MCH nurses and clients were invited to design an intervention package (prototype) to improve nurse-client relationships using a human-centered design (HCD) approach. Methods A multi-step HCD approach was employed to first examine the contributors of poor nurse-client relationships using nine focus group discussions with nurses and clients and 12 key informant interviews with MCH administrators. Then, three meetings were held with 10 nurses, 10 clients, and 10 administrators to co-develop an intervention package to address the identified contributors. The solutions were validated by collecting qualitative information through six focus groups with nurses and MCH clients who were not involved in the initial HCD stages. Finally, refinement and adaptation meetings were held with 15 nurses, 15 clients, and 10 administrators. The data were managed with NVivo 12 software and analyzed thematically. Results Nursing curriculum challenges contributing to poor nurse-client relationships in MCH care included inadequate content on nurse-client relationships specifically topics of customer care, communication skills, and patient-centered care; an inadequate practice on communication skills within nursing schools; and the absence of specific trainers on interpersonal relationships. Consequently, improving the nursing curriculum was one of the interventions proposed during the co-design and rated by participants as highly acceptable during validation and refinement meetings. Suggested improvements to the curriculum included increasing hours and credits on communication skills and patient-centered care, including customer care courses in the curriculum and creating a friendly learning environment for clinical practice on strengthening interpersonal relationships. Conclusion Improving the nursing curriculum was considered by nurses and clients as one of the acceptable interventions to strengthen nurse-client relations in MCH care in rural Tanzania. Nursing education policy and curriculum developers need to ensure the curriculum facilitates the development of much-needed interpersonal skills among nursing graduates for them to have positive therapeutic interactions with their clients.
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Affiliation(s)
- Kahabi Ganka Isangula
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania,*Correspondence: Kahabi Ganka Isangula ✉
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Isangula K, Pallangyo ES, Mbekenga C, Ndirangu-Mugo E, Shumba C. Factors shaping good and poor nurse-client relationships in maternal and child care: a qualitative study in rural Tanzania. BMC Nurs 2022; 21:247. [PMID: 36064523 PMCID: PMC9443654 DOI: 10.1186/s12912-022-01021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background Evidence indicates that poor nurse-client relationships within maternal and child health (MCH) continues to impact trust in formal healthcare systems, service uptake, continuity with care and MCH outcomes. This necessitates contextualized innovative solutions that places both nurses and clients at the forefront as agents of change in optimizing intervention designs and implementation. This study explored nurses and clients’ perspectives on the factors shaping nurse-client relationships in MCH care to generate evidence to guide subsequent steps of human centered design (HCD) that involve designing effective strategies for improving therapeutic relationships in Shinyanga, Tanzania. Methods Qualitative descriptive design was employed. About 9 Focus Group Discussions (FGDs) and 12 Key Informant Interviews (KIIs) with purposefully selected nurses and midwives, women attending MCH services and administrators were conducted using semi-structured interview guides in Swahili language. Data were transcribed and translated simultaneously, managed using Nvivo Software and analyzed thematically. Results Factors shaping nurse-client relationships were heuristically categorized into nurse, client and health system factors. Nurse contributors of poor relationship ranged from poor reception and hospitality, not expressing care and concern, poor communication and negative attitudes, poor quality of services, job dissatisfaction and unstable mental health. Client contributors of poor relationship include being ‘much know’, late attendance, non-adherence to procedures and instructions, negative attitudes, poor communication, inadequate education and awareness, poverty, dissatisfaction with care, faith in traditional healers and unstable mental health. Health system contributors were inadequate resources, poor management practices, inadequate policy implementation and absence of an independent department or agency for gathering and management of complaints. Suggestions for improving nurse-client relationship included awards and recognition of good nurses, improving complaints mechanisms, continued professional development, peer to peer learning and mentorship, education and sensitization to clients, improving service quality and working conditions, improving renumeration and incentives, strengthening nursing school’s student screening and nursing curriculum and improving mental health for both nurses and clients. Conclusions The factors shaping poor nurse- client relationships appear to extend beyond nurses to both clients and healthcare facilities and system. Implementation of effective interventions for addressing identified factors considering feasibility and acceptance to both nurses and clients using novel strategies such as HCD could pave the way for employing good nurse-client relationships as a tool for improving performance indicators and health outcomes within MCH care. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01021-x.
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Affiliation(s)
- Kahabi Isangula
- School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania.
| | - Eunice S Pallangyo
- School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania
| | - Columba Mbekenga
- School of Nursing and Midwifery, The Aga Khan University, Dar Es Salaam, Tanzania
| | | | - Constance Shumba
- School of Nursing and Midwifery, The Aga Khan University, Nairobi, Kenya
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Isangula K, Shumba C, Pallangyo ES, Mbekenga C, Ndirangu-Mugo E. Using a human centered design (HCD) approach to strengthen interpersonal relationships in maternal and child health care in rural Tanzania: Study Design (Preprint). JMIR Res Protoc 2022; 11:e37947. [PMID: 35797107 PMCID: PMC9305451 DOI: 10.2196/37947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kahabi Isangula
- School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, United Republic of Tanzania
| | - Constance Shumba
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
| | - Eunice S Pallangyo
- School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, United Republic of Tanzania
| | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, United Republic of Tanzania
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Smyth S, De Vries JMA, Rossetti J, McCann E. "Stuck between a Rock and a Hard Place": How Mental Health Nurses' Experience Psychosocial interventions in Irish Mental Health Care Settings. J Psychiatr Ment Health Nurs 2021; 28:590-600. [PMID: 33075176 DOI: 10.1111/jpm.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Psychosocial interventions (PSI) are recognized and recommended internationally as they primarily focus on improving a client's mental health and preventing relapse. Limited qualitative studies focus on the similarities and differences on offering PSI in practice across many countries. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This manuscript provides readers with qualitative findings of mental health nurses' (MHNs) experiences of using PSI in practice and the need for regular clinical supervision to increase MHNs confidence and enhance the offering of PSI. MHNs want PSI guidelines for the offering of these skills to their client groups across practice settings. MHNs require work release from practice to attend supplementary training on PSI so that they can do their job adequately. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study sheds light on the similarities and differences on PSI in Irish mental health services. It also highlights what MHNs recognize as important for PSI to be implemented. Clinical supervision and the development of PSI guidelines are necessary so that MHNs feel confident delivering these skills. They also need ongoing work release from practice to attend supplementary PSI training to provide best evidence to enhancing client experiences and positive PSI recovery outcomes. ABSTRACT: Description The paper will report on the interview data of trained MHNs' experiences of using PSI within the Irish context. This observational data will be reported elsewhere (Smyth et al. 2020-under review). Introduction This research is conducted when the current reform of Irish mental health governance demands clarification of key psychosocial skills (PSI) required for mental health nurses (MHNs) to embrace recovery-orientated ways of working. There is limited evidence about this important topic in Ireland and across countries. Aim To explore PSI-trained MHNs' experiences of using PSI within Ireland. Method A multiple case study methodology was used and situated within an interpretive paradigm. Data were gathered using semi-structured interviews with 40 PSI-trained MHNs. Findings Three overarching themes developed from the analysis. These included (a) PSI-trained MHNs' understanding and use of PSI; (b) facilitating factors supporting the use of PSI by PSI-trained MHNs; and (c) obstacles limiting the use of PSI by PSI-trained MHNs. Discussion MHNs recognize that regular clinical supervision is required to increase their confidence, along with PSI guidelines for the offering of these skills across practice settings. MHNs also need work release to attend supplementary training on PSI so that they can do their job adequately. Implications for practice This study suggests that MHNs are often stuck between a rock and a hard place when delivering PSI in practice. MHNs need to be aware that this can affect client outcomes. Relevance statement This research identified a gap in knowledge within the Irish context but also across the world on this important topic. MHNs need access to regular clinical supervision, PSI guidelines and ongoing PSI training to feel confident in order to keep abreast of the changes happening in mental health practice and research.
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Affiliation(s)
- Siobhan Smyth
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Jan M A De Vries
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Dublin 2, Ireland
| | | | - Edward McCann
- School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Dublin 2, Ireland
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Tran TV, Tran TD, Nguyen AQ, Dinh TT, Le ATK, Tran HB, Vu PT, Nguyen HT, Dang LVP. Nurse–patient communication: A quality assessment in public hospital. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1752987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tiep Viet Tran
- Oncology Centre, Vietnam-Sweden General Hospital, Quang Ninh, Vietnam
- Vietnam-Sweden Uong Bi Training & Direction Cente, Vietnam-Sweden General Hospital, Quang Ninh, Vietnam
| | - Tinh Dang Tran
- Department of Anesthesia, Bach Mai Hospital, Hanoi, Vietnam
- Bach Mai Medical College, Bach Mai Hospital, Hanoi, Vietnam
| | - Anh Quoc Nguyen
- Department of Anesthesia, Bach Mai Hospital, Hanoi, Vietnam
- Bach Mai Medical College, Bach Mai Hospital, Hanoi, Vietnam
| | - Thanh Thi Dinh
- Laboratory Centre, Hanoi University of Public Health, Hanoi, Vietnam
| | - Anh Thi Kim Le
- Faculty of Fundamental Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Hieu Ba Tran
- Coronary Care Unit, Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Department of Medicine, Hanoi National University, Hanoi, Vietnam
| | - Phuong Thi Vu
- Department of Biochemistry, Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam
| | - Hoai Thu Nguyen
- Department of Endocrinology-Rheumatology, National Geriatric Hospital, Hanoi, Vietnam
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van Daalen-Smith C, Adam S, Hassim F, Santerre F. A World of Indifference/Un Monde D'Indifférence: Canadian Women's Experiences of Psychiatric Hospitalization/Expériences Canadiennes d'hospitalization psychiatrique au Canada. Issues Ment Health Nurs 2020; 41:315-327. [PMID: 31770058 DOI: 10.1080/01612840.2019.1661047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article presents findings and analysis stemming from a two-year qualitative study that explored, in their own voices, women's lived experience of psychiatric hospitalization. Feminist Standpoint Theory and Foucauldian analysis frame and provide the moorings for validity, methodology, and analysis of this woman-centred inquiry. The verbatim representation of lived experience, coupled with the coauthoring of this article with two of the study's participants provides an authentic articulation of participant standpoint. Furthermore, this approach creates a space in nursing scholarship in which the co-development of knowledge is also made possible. Overarching themes of docility-making, harm, betrayal, indifference, and resistance are presented and situated in a broader analysis of the hegemony of bio-psychiatric discourse and its colonization of nursing practice. In order to disrupt systems that fail to meet patient needs and fail to represent nursing's values and ethos, we shed light on the possible systemic factors behind the experience of "indifference".
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Affiliation(s)
| | - Simon Adam
- School of Nursing, York University, Toronto, Toronto, Ontario, Canada
| | - Fatima Hassim
- Sheridan College Institute of Technology and Advanced Learning, Oakville, Ontario, Canada
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Rio JHM, Fuller J, Taylor K, Muir-Cochrane E. A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice. Int J Ment Health Nurs 2020; 29:290-298. [PMID: 31859453 DOI: 10.1111/inm.12684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 02/03/2023]
Abstract
It is mental health consumer's human right to lead a fulfilling life as they are empowered to actively manage their recovery. This can be facilitated through care planning, yet research suggests that the care plan is not routinely created, discussed, or updated in acute mental health settings. Research on care planning and the role of the mental health nurse highlights the importance of therapeutic communication in care plan development. This paper argues that the lack of meaningful care plan discussions between consumers and mental health nurses in an acute setting is a limitation to the practice of fully accountable mental health nursing care. We explore this limitation in quality care provision by examining literature on accountability and conclude that in mental health nursing, accountability is frequently enacted through an overarching focus on the organizational need to manage risks, rather than on therapeutic engagement.
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Affiliation(s)
- Josephien H M Rio
- College of Nursing & Health Sciences Flinders University, Adelaide, Australia.,Mental Health - Central Australian Health Service, Alice Springs, Australia
| | - Jeffrey Fuller
- College of Nursing & Health Sciences Flinders University, Adelaide, Australia
| | - Kerry Taylor
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
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Hechinger M, Mayer H, Fringer A. Kenneth Gergen's concept of multi-being: an application to the nurse-patient relationship. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:599-611. [PMID: 30989571 PMCID: PMC6842346 DOI: 10.1007/s11019-019-09897-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The nurse-patient relationship is of great significance for both nurses and patients. The purpose of this article is to gain an understanding of how the individual is constituted through a focus on the execution of the patient's and nurse's role in the joint relationship. The article represents a social-constructionist consideration using Kenneth Gergen's concept of multi-being. Gergen's notions of the self as a multi-being focuses on the individual's relational character through former relationships and social interactions. Gergen's concept is applied onto nurses and patients as individuals to gain an understanding of the broader institutional and social context of each role and their interactions within the nurse-patient relationship. The article focuses on the nurse-patient relationship in general with regard to specific challenges in the home care setting. Various demands and experiences from a myriad of past relationships merge as potential actions for nurses and patients during the forming of a relationship. Nurses as multi-beings see themselves confronted with guidelines and legal conditions, their own as well as the patients' expectations and the actual possible forming of a relationship in the light of daily nursing care. Patients as multi-beings experience an extended social environment that comprises the nurse-patient relationship while simultaneously having to cope with illness and increasing care dependency within their own homes. Discrepancies can be observed in the relationship with regard to the inherent human qualities, the demands of forming a relationship, and the actual relationship arising due to framework conditions.
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Affiliation(s)
- Mareike Hechinger
- Department of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria
| | - Hanna Mayer
- Department of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria
| | - André Fringer
- School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences ZHAW, Technikumstrasse 81, 8400 Winterthur, Switzerland
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Taghavi Larijani T, Saatchi B. Training of NANDA-I Nursing Diagnoses (NDs), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC), in Psychiatric Wards: A randomized controlled trial. Nurs Open 2019; 6:612-619. [PMID: 30918711 PMCID: PMC6419136 DOI: 10.1002/nop2.244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/27/2018] [Accepted: 01/07/2019] [Indexed: 11/09/2022] Open
Abstract
AIM To assess the effect of Training NANDA-I Nursing Diagnoses, Nursing Interventions Classification and Nursing Outcomes Classification (The NNN system), on the nursing care related to the patient safety, in psychiatric wards. METHOD In a randomized controlled trial, 80 nurses were selected randomly and assigned into two, Control and Experimental, groups. Nurses documented reports, reviewed and analysed in terms of using the NNN system. The intervention of the study was the training of the NNN system, based on recognition of the signs, symptoms and aetiology of the important phenomena in the psychiatric wards. RESULTS The Control Group used the NNN system (N = 34), both before and after the intervention, while the experimental group usage increased from (N = 26)-(N = 434). Therefore, the NNN system training, can improve the nursing care related to the patient safety in psychiatric wards.
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Affiliation(s)
- Taraneh Taghavi Larijani
- Psychiatric Nursing Department, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Babak Saatchi
- Psychiatric Nursing Department, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
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McAllister S, Robert G, Tsianakas V, McCrae N. Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review. Int J Nurs Stud 2019; 93:106-118. [PMID: 30908958 DOI: 10.1016/j.ijnurstu.2019.02.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/18/2019] [Accepted: 02/23/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The review aimed to 1) explore the constituents of nurse-patient therapeutic engagement on acute mental health wards; 2) map factors that influence engagement to the Theoretical Domains Framework and 3) integrate results into a conceptual model of engagement to inform the development of interventions to improve engagement. DESIGN A systematic integrative review using an established framework specific to the integrative review methodology. DATA SOURCES Database searches (CINAHL, PsycINFO, BNI and Cochrane Library) and hand searching identified 3414 articles. After screening, applying eligibility criteria, and quality appraisal, 37 articles were included: n = 27 empirical research studies, n = 10 expert opinion pieces, n = 1 case study and n = 1 theoretical report. REVIEW METHODS Peer-reviewed empirical studies, theoretical reports or expert opinion pieces that explored therapeutic engagement as a stated aim and were conducted in acute mental health inpatient settings from the patient or nurse perspective were included. Data were extracted from the introduction, results and discussion sections of empirical research, and the complete article of theoretical and expert opinion pieces. Data were coded then grouped into subthemes and themes. Data relating to influencing factors were further categorised according to the Theoretical Domains Framework. Results were synthesised into a conceptual model of engagement. RESULTS Five conceptually distinct, but closely related constructs of engagement - called the "Principles of Engagement" - emerged: 1) Understanding the person and their experiences; 2) Facilitating growth; 3) Therapeutic use of self; 4) Choosing the right approach and 5) Authoritative vs. emotional containment. Influences on engagement ranged across all 14 theoretical domains of the Theoretical Domains Framework. CONCLUSION A holistic understanding of the essential components of engagement may make it easier for nurses to recognise what they do, and to do it well. The model can be used to generate testable hypotheses about how and where to target behavioural change interventions. The Principles of Engagement must be reflected in the development of interventions to improve engagement.
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Affiliation(s)
- Sarah McAllister
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom.
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
| | - Vicki Tsianakas
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
| | - Niall McCrae
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom
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Widyawati IY, Nursalam N, Kusnanto K, Hargono R, Hsieh PL. Grieving as an Internal Factor of Nurse-Patient Interaction in a Dialysis Unit. JURNAL NERS 2018. [DOI: 10.20473/jn.v13i1.8005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The quality of the nurse-patient interaction is one factor that affects the patient adherence, but a study that provides an overview of factors in the nurse-patient interaction in improving or maintaining dialysis patient adherence has not been found. The aim of this study was to provide an overview of the various factors involved in the interaction process between nurses and patients undergoing dialysis in relation to their adherence to fluid and dietary restrictions.Methods: A qualitative research design with an interpretive phenomenology approach was used in this study. The researcher intends to interpret the findings of the research, in this case the activity of the dialysis patients, in order to get a picture of the various factors involved in the process of interaction between nurse and dialysis patient. The unit of analysis used in this study was the disclosure or exposure of the internal factors of the nurse-patient interaction process, especially in relation to fluid and dietary restrictions. There were 15 participants who were selected based on the inclusion criteria. In-depth interviews, with field notes, were used in this study as the data collection method.Results: The analysis of the theme based on the goal of the research includes grieving, needs and values/morals, but in this article, the researchers only describe one theme - grieving.Conclusion: This result provides an overview of the findings on nurse-patient interaction factors that can serve as baseline data for the development of nursing care, both in nursing assessments and interventions aimed at improving dietary adherence and the fluid restriction of dialysis patients.
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15
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Beentjes TAA, Goossens PJJ, Jongerden IP. Nurses' Experience of Maintaining Their Therapeutic Relationship With Outpatients With Bipolar Disorder and Their Caregivers During Different Stages of a Manic Episode: A Qualitative Study. Perspect Psychiatr Care 2016; 52:131-8. [PMID: 25772270 DOI: 10.1111/ppc.12109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 01/19/2015] [Accepted: 02/11/2015] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Caregivers often consult community mental health (CMH) nurses when they recognize prodromes of mania in the outpatient. The purpose of this study was to determine nurses' experiences of their therapeutic relationship and nursing interventions to outpatients and caregivers during different stages of mania. DESIGN AND METHODS A qualitative study was conducted. Nine nurses were interviewed. FINDINGS CMH nurses experienced dual loyalty when facing conflicting interests. They strived to stay connected to patients and caregivers with an open and nonjudgmental attitude. In euthymic episodes, nurses anticipated by developing good relationships with both and by making relapse prevention plan. PRACTICE IMPLICATIONS Early involvement of caregivers in the treatment is recommended.
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Affiliation(s)
- Titus A A Beentjes
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands.,Saxion University of Applied Science, Faculty of Health, Deventer, the Netherlands.,Dimence Group Mental Health Care Center, Bipolar Specialists Center, Deventer, the Netherlands.,Nursing Science Program, Clinical Health Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter J J Goossens
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands.,Dimence Mental Health Care Centre, Bipolar Specialists Center, Deventer, the Netherlands.,Ghent University, Department of Nursing Sciences, Ghent, Belgium.,GGZ-VS, Institute for Education of Clinical Nurse Specialist in Mental Health, Utrecht, the Netherlands
| | - Irene P Jongerden
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.,Clinical Health Sciences Program, University Medical Center Utrecht, Utrecht, the Netherlands
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Pazargadi M, Fereidooni Moghadam M, Fallahi Khoshknab M, Alijani Renani H, Molazem Z. The Therapeutic Relationship in the Shadow: Nurses' Experiences of Barriers to the Nurse-Patient Relationship in the Psychiatric Ward. Issues Ment Health Nurs 2015; 36:551-7. [PMID: 26309175 DOI: 10.3109/01612840.2015.1014585] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The therapeutic relationship is widely accepted as the basic core and essence of the psychiatric nurse's role and is thus essential for providing quality mental health care. A detailed and clear perception of the issues that facilitate or obstruct this relationship is therefore important. The purpose of this study was to gain insights into the experiences of nurses working in psychiatry wards, of the barriers to the nurse-patient relationship. A qualitative content-analysis study was undertaken using a purpose-based sampling approach with the participation of 15 nurses employed in psychiatric wards in hospitals located in South Iran. Semi-structured interviews provided the source of data, and an inductive content-analysis approach was used for data analysis. The main concept extracted from the study was identified as 'the therapeutic relationship in the shadow', which captured the sense that this critical relationship is mostly unseen in the daily practice of the nurses interviewed. Factors that functioned as barriers to this relationship were classified into three main categories: nurse-related, patient-related and organization-related. The results of this study revealed that, despite the widely claimed importance of the nurse-patient relationship in psychiatric settings, this relationship is powerfully influenced by individual and organizational factors that have not been considered adequately in previous research. It is strongly recommended that greater consideration of these factors be given to care planning in psychiatric wards.
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Affiliation(s)
- Mehrnoosh Pazargadi
- a Shahid Beheshti University of Medical Sciences , Faculty of Nursing and Midwifery , Tehran, Islamic Republic of Iran
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17
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Zamanzadeh V, Rassouli M, Abbaszadeh A, Nikanfar A, Alavi-Majd H, Ghahramanian A. Factors Influencing Communication Between the Patients with Cancer and their Nurses in Oncology Wards. Indian J Palliat Care 2014; 20:12-20. [PMID: 24600177 PMCID: PMC3931236 DOI: 10.4103/0973-1075.125549] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims: The purpose of this study was to demonstrate the factors influencing nurse-patient communication in cancer care in Iran. Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in oncology wards of hospitals in Tabriz. Data was collected through purposive sampling by semi-structured deep interviews with nine patients, three family members and five nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control. Results: The main theme of the research emerged as “three-factor effects” that demonstrates all the factors related to the patient, nurse, and the organization and includes three categories of “Patient as the center of communication”, “Nurse as a human factor”, and “Organizational structures”. The first category consists of two sub-categories of “Imposed changes by the disease” and the “patient's particular characteristics”. The second category includes sub-categories of “sense of vulnerability” and “perception of professional self: Pre-requisite of patient-centered communication”. The third category consists of the sub-categories of “workload and time imbalance”, “lack of supervision”, and “impose duties in context of neglecting nurse and patient needs”. Characteristics of the patients, nurses, and care environment seemed to be the influential factors on the communication. Conclusions: In order to communicate with cancer patients effectively, changes in philosophy and culture of the care environment are essential. Nurses must receive proper trainings which meet their needs and which focus on holistic and patient-centered approach.
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Affiliation(s)
- Vahid Zamanzadeh
- Nursing and Midwifery School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Rassouli
- Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Abbaszadeh
- Nursing and Midwifery School, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Nikanfar
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Alavi-Majd
- Para Medicine School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Ghahramanian
- Nursing and Midwifery School, Kerman University of Medical Sciences, Kerman, Iran
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Cleary M, Hunt GE, Horsfall J, Deacon M. Nurse-patient interaction in acute adult inpatient mental health units: a review and synthesis of qualitative studies. Issues Ment Health Nurs 2012; 33:66-79. [PMID: 22273340 DOI: 10.3109/01612840.2011.622428] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mental health nurses work with acutely unwell patients, and the busy setting is characterised by unpredictable events. This paper is a report of a review conducted to identify, analyse and synthesize research in adult acute inpatient mental health units, which focused on nurse-patient interaction. Several electronic databases were searched using relevant keywords to identify studies published from 1999-present. Qualitative studies published in English were included if they specifically investigated nurse-patient interaction in acute inpatient care in adult settings. Eighteen studies were included (23 papers). Findings were grouped into the following six categories: 1) sophisticated communication; 2) subtle discriminations; 3) managing security parameters; 4) ordinary communication; 5) reliance on colleagues; and 6) personal characteristics. These studies of acute inpatient mental health units reveal that nurse communication involves interpersonal approaches and modalities that exemplify highly developed communication and personal skills designed specifically for this challenging setting. Further quality research should focus on the conditions that enable the development of therapeutic interactional skills and the relationship of these skills to the nuanced context in which they are practiced.
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Affiliation(s)
- Michelle Cleary
- University of Western Sydney, School of Nursing & Midwifery, Sydney, NSW, Australia.
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Gildberg FA, Elverdam B, Hounsgaard L. Forensic psychiatric nursing: a literature review and thematic analysis of staff-patient interaction. J Psychiatr Ment Health Nurs 2010; 17:359-68. [PMID: 20529188 DOI: 10.1111/j.1365-2850.2009.01533.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In Denmark the increasing number of forensic mental health patients has led to prioritized services, including the area of nursing; however, this field is subject to sparse research. The aim of this study was to review existing research literature and in doing so investigate what characterizes forensic mental health staff interaction with forensic mental health inpatients and furthermore to investigate what significance these staff characteristics have for the inpatients. The literature review spans the period September 1997 to January 2009 and was based on a systematic keyword combination search in the following databases: CINAHL, CSB, PsycINFO, Scopus, Pubmed, MEDLINE and Sociological Abstracts. The articles were categorized using a literature matrix and analysed using content analysis. Seventeen quantitative and qualitative research studies were analysed. The results show that the interaction between forensic staff and forensic inpatients is characterized by two overriding themes: parentalistic & behaviour-changing care and relational & personal quality-dependent care. Only a few of the findings represent a clear account of how the interactional characteristics impact on the forensic inpatient. The conclusion is that no clear account of the patient impact issue can be reached at this point and that further investigation needs to take place.
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Affiliation(s)
- F A Gildberg
- Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C,Denmark.
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20
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Anoosheh M, Zarkhah S, Faghihzadeh S, Vaismoradi M. Nurse-patient communication barriers in Iranian nursing. Int Nurs Rev 2009; 56:243-9. [DOI: 10.1111/j.1466-7657.2008.00697.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fleischer S, Berg A, Zimmermann M, Wüste K, Behrens J. Nurse-patient interaction and communication: A systematic literature review. J Public Health (Oxf) 2009. [DOI: 10.1007/s10389-008-0238-1] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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22
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Dziopa F, Ahern K. Three different ways mental health nurses develop quality therapeutic relationships. Issues Ment Health Nurs 2009; 30:14-22. [PMID: 19148817 DOI: 10.1080/01612840802500691] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to determine if there were different ways in which mental health nurses develop quality therapeutic relationships with patients. A taxonomy of 140 attributes were identified as important to the formation of a quality therapeutic relationship in mental health nursing. These attributes provided the basis for the development of a Q-sort instrument, which was piloted. Results led to the identification of three clusters of mental health nurses who share similar beliefs regarding the attributes required to develop a quality therapeutic relationship with patients. These groupings of attributes were called "Equal Partner," "Senior Partner," and "Protective Partner." Recommendations are provided and include that nurses consider their nursing style in their choice of employment environment and that managers consider their nurses' individual styles in determination of an optimal case mix.
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Affiliation(s)
- Fiona Dziopa
- School of Nursing & Midwifery, The University of Queensland, Ipswich, Australia. Fiona
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23
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Abstract
Pro re nata (PRN; 'as needed') medication is an archetypal mainstay for managing acute psychiatric inpatient symptoms and behaviours. Psychiatric and mental health nursing practices have circumnavigated the development of a uniform medical-ethical standard for the administration of PRN psychotropic medication. This paper examines the evidence for administration of PRN psychotropic medications and, in the context of evidence-based best practice, current mental health policy and professional ethics, proposes a standardized Australian PRN administration protocol. The procedures and circumstances leading to a nurse administering psychotropic PRN medication are divided into five simple steps, namely (i) medical prescription; (ii) nurse evaluation of patient indications for an intervention; (iii) nurse consideration of therapeutic options; (iv) obtaining patient informed consent; and (v) documentation of outcomes of PRN administration. The literature associated with each step is reviewed, along with national and international professional ethics, guidelines and patient rights documents pertaining to the care of mental health patients. Recommendations for best-practise care are discussed for each step. There is a lacuna of published evidence supporting the use of PRN medications in psychiatric inpatients. Yet there is published evidence that PRN medications are associated with increased risks of morbidity, inappropriate use, may result in above-recommended dosages or polypharmacy, and complicate the assessment of efficacy of regular scheduled medicines. Alternative non-pharmacological treatment options to PRN medication are effective and associated with fewer side-effects. There are no national explicit standards, operational criteria or quality assurance for the use of PRN medication in inpatient psychiatric units. Contemporary PRN practices are largely unregulated and driven by essentially anecdotal evidence, leaving the clinicians and the service open to claims of poor accountability and misuse (intentional and unintentional) of psychotropic medications. Development of best practice guidelines for the use of PRN administration is essential.
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24
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Curtis J, Baker JA, Reid AR. Exploration of therapeutic interventions that accompany the administration of p.r.n. ('as required') psychotropic medication within acute mental health settings: a retrospective study. Int J Ment Health Nurs 2007; 16:318-26. [PMID: 17845551 DOI: 10.1111/j.1447-0349.2007.00487.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Within acute mental health settings, pro re nata (p.r.n.) 'as required' medication is a widely used adjunct to regular treatment plans, and is administered at the discretion of a registered nurse. However, there is concern that some orders may benefit staff more than patients by providing a 'quick fix' to compensate for inadequate therapeutic programmes. Previous authors assert that p.r.n. medication administration should not be the first line of action, but should be used when other less invasive interventions such as de-escalation, talking, or separation from the group are unsuccessful. This project explored the occurrence of p.r.n. medication administration and the type of alternative therapeutic interventions that are documented as accompanying its administration. A retrospective 1-month chart audit was undertaken for a cohort of inpatients in a 20-bed mental health facility attached to a regional hospital in New South Wales, Australia. Forty-seven patients (73.4%) received p.r.n. medication at least once, with a total of 309 doses of p.r.n. medication administered during this time. There were wide variations in the documented rationales, and for nearly three-quarters (73%) of p.r.n. medication administrations, no other therapeutic intervention was documented as occurring prior to administration.
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Affiliation(s)
- Janette Curtis
- School of Nursing, Midwifery and Indigenous Health, University of Wollongong, New South Wales, Australia.
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25
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Lau VMH, Callaghan P, Twinn SF, Goodfellow B. The nursing gaze: power relations in a study of nurse-resident interactions in learning disability. J Psychiatr Ment Health Nurs 2007; 14:346-55. [PMID: 17517025 DOI: 10.1111/j.1365-2850.2007.01088.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The researchers observed nurse-resident interactions in learning disability units in Hong Kong and interviewed a purposeful sample of nurses who had varying levels of interaction. The median interaction rate between nurses and residents was 27.5% with most interactions relating to physical care. When not interacting with residents, nurses performed administrative tasks. Factors that influenced nurses' interactions revolve around their orientation to a new clinical setting, stresses in the care setting and nurses' coping strategies, contextual constraints, and nurses' prioritization of care. Support for Goffman's self-mortification principle, Foucault's notion of the clinical gaze and infantilism theory were evident in the practice of the nurses studied.
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26
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Shattell MM, McAllister S, Hogan B, Thomas SP. "She took the time to make sure she understood": mental health patients' experiences of being understood. Arch Psychiatr Nurs 2006; 20:234-41. [PMID: 17010827 DOI: 10.1016/j.apnu.2006.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 01/31/2006] [Accepted: 02/19/2006] [Indexed: 10/24/2022]
Abstract
The foundation of psychiatric/mental health nursing is the relationship between nurse and patient. Caring for persons with mental illness within the context of this relationship requires knowledge of the individual. To gain this knowledge, understanding the patient's perceptions and concerns is essential. Research suggests that this understanding does not always occur. The study reported here examined what it means to individuals with mental illness to be understood. In-depth phenomenological interviews revealed three predominant themes: "I was important," "it really made us connect," and "they got on my level." Nurses can use these findings to improve the care of those with mental illness.
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Affiliation(s)
- Mona M Shattell
- School of Nursing, University of North Carolina at Greensboro, Moore Building 320, Greensboro, NC 27402, USA.
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Shattell M, Hogan B. Facilitating Communication: How to Truly Understand What Patients Mean. J Psychosoc Nurs Ment Health Serv 2005; 43:29-32. [PMID: 16294835 DOI: 10.3928/02793695-20051001-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. Patients experience greater satisfaction with nursing care when they are truly understood. 2. Being aware of taken-for-granted meanings and committing the time to seek clarification and explore meanings are two basic principles that can facilitate understanding. 3. Techniques nurses can use to facilitate understanding include restating what was heard to ensure understanding and to demonstrate active listening, asking open-ended questions, and checking for understanding.
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Affiliation(s)
- Mona Shattell
- University of North Carolina at Greensboro, 27402, USA.
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28
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Rydon SE. The attitudes, knowledge and skills needed in mental health nurses: the perspective of users of mental health services. Int J Ment Health Nurs 2005; 14:78-87. [PMID: 15896254 DOI: 10.1111/j.1440-0979.2005.00363.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Knowledge about the practice and roles of mental health nurses in New Zealand is currently limited. In a sociopolitical climate where the views of users of mental health services are increasingly incorporated into education and the planning and delivery of services, there is a need for research that reflects the perspective of users. In this study a qualitative descriptive methodology with focus group interviews was used to explore with users of mental health services, the attitudes, knowledge and skills that they need in mental health nurses. Users of mental health services valued the therapeutic work of mental health nurses, and identified positive attitudes towards users of mental health services as essential in mental health nurses. However, they did not consistently experience a therapeutic approach in their interactions with mental health nurses.
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Affiliation(s)
- Sharon E Rydon
- School of Health Sciences, Albany Campus, Massey University, Auckland, New Zealand.
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Hamilton B, Manias E, Maude P, Marjoribanks T, Cook K. Perspectives of a nurse, a social worker and a psychiatrist regarding patient assessment in acute inpatient psychiatry settings: a case study approach. J Psychiatr Ment Health Nurs 2004; 11:683-9. [PMID: 15544666 DOI: 10.1111/j.1365-2850.2004.00785.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This case study explores what informs and organizes the assessment of patients, as undertaken by a nurse, a social worker and a psychiatrist in public, metropolitan, acute mental health service settings. The research data are the transcripts of in-depth interviews with three experienced practitioners, one from each of the three disciplines. The analysis draws on Foucauldian concepts: discourse as constructed through practices of discipline and the gaze. We explored examples of taken-for-granted assessment practices and their interplay with discourse. The findings suggest that participating practitioners use language in assessment in ways that support the powerful discourses of the professional disciplines. The competing discourse of management, associated with industry and economics, is evident in hospital admission processes, dictating the times and places of assessment. Professional and management discourses both effectively marginalize the perspective of another player in assessment, the patient.
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Affiliation(s)
- B Hamilton
- School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.
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Abstract
AIMS The aims of this paper are to review a theoretical model useful for developing nursing knowledge related to nurse-patient interaction, review the literature on nurse-patient interaction, and discuss areas for further research. THEORETICAL MODEL: Goffman's theory of face work. RESULTS Nurse-patient interaction is a central element of clinical nursing practice. This paper shows how Goffman's model can be used as a theoretical framework for understanding nurse-patient communication. RELEVANCE TO CLINICAL PRACTICE Issues such as power, the social and cultural context, and interpersonal competence are shown to be important in the quality of nurse-patient interactions and nurses need to take cognizance of these factors in their interactions with patients.
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Affiliation(s)
- Mona Shattell
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Abstract
The purpose of this ethnographic study was to understand how nurses construct their practice in an acute inpatient psychiatric unit in light of the current challenges, demands and influences brought about by service reform. During a 5-month period, fieldwork observations, interviews and discussion groups occurred in a 22-bed acute inpatient mental health facility in New South Wales, Australia. The findings demonstrate how the current role of acute care has resulted in nurses working in increasingly complex environments characterized by competing priorities and new demands. Nurses struggled to fit the changed service philosophy with traditional models of practice within this fluid and changing environment. The findings are relevant within the context of current debates and can be used to enhance the understanding of contemporary acute mental health nursing practice and inform the continued development of mental health nursing in these settings.
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Affiliation(s)
- Michelle Cleary
- Central Sydney Area Mental Health Service, Rozelle, New South Wales, Australia.
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Abstract
The nurse-patient relationship has traditionally been viewed as the essence of nursing practice. This paper disputes that the ideals of such a relationship occur effortlessly in nursing practice. Findings from a phenomenological study of individuals hospitalized with a depressive illness found that a therapeutic relationship did not come instinctively to the mental health nurses, and that there was a dichotomy between the close relationship expected by patients and the distant relationship provided by nurses. It is unclear whether nurses' distancing behaviour was as a result of the participant's depressive illness, a normal part of nursing practice, or whether other features such as nurses' workloads were an influencing factor. Further research is required to explore this issue.
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Affiliation(s)
- Wendy Moyle
- Faculty of Nursing and Health, Griffith University, Kessels Road, Nathan, Qld 4111, Australia.
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Fishwick M, Tait B, O'Brien AJ. Unearthing the conflicts between carer and custodian: implications of participation in Section 16 hearings under the Mental Health (Compulsory Assessment and Treatment) Act (1992). THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF MENTAL HEALTH NURSING 2001; 10:187-94. [PMID: 11493290 DOI: 10.1046/j.1440-0979.2001.00209.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mental health nursing occurs within a legal and ethical framework that presents conflicts between a paternalistic custodial role and an ethical commitment to autonomy. This paper considers the ethical conflict for nurses posed by acting as second health professional at judicial reviews under Section 16 of the Mental Health (Compulsory Treatment and Assessment) Act. Issues of advocacy and paternalism are discussed in light of the conflict between therapeutic and legislated roles. Strategies aimed at protecting the therapeutic relationship are outlined as a response to the current lack of guidelines in this area. Participation in legal processes of committal requires that nurses reflect carefully and critically on the ethical issues raised.
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Affiliation(s)
- M Fishwick
- Auckland Healthcare and Mental Health Nursing, University of Auckland, Auckland, New Zealand
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