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Molloy L, Wilson V, O'Connor M, Merrick TT, Guha M, Eason M, Roche M. Exploring safety culture within inpatient mental health units: The results from participant observation across three mental health services. Int J Ment Health Nurs 2024; 33:1073-1081. [PMID: 38415309 DOI: 10.1111/inm.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
In Australia, acute inpatient units within public mental health services have become the last resort for mental health care. This research explored barriers and facilitators to safe, person-centred, recovery-oriented mental health care in these settings. It utilised participant observations conducted by mental health nurses in acute inpatient units. These units were located in three distinct facilities, each serving different areas: a large metropolitan suburban area in a State capital, a mid-sized regional city, and a small city with a large rural catchment area. Our findings highlighted that, in the three inpatient settings, nurses tended to avoid common areas they shared with consumers, except for brief, task-related visits. The prioritisation of administrative tasks seemed to arise in a situation where nurses lacked awareness of alternative practices and activities. Consumers spent prolonged periods of the day sitting in communal areas, where the main distraction was watching television. Boredom was a common issue across these environments. The nursing team structure in the inpatient units provided a mechanism for promoting a sense of psychological safety for staff and were a key element in how safety culture was sustained.
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Affiliation(s)
- Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Val Wilson
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael O'Connor
- Mental Health Commission of New South Wales, Sydney, New South Wales, Australia
| | - Tammy Tran Merrick
- Illawarra Shoalhaven Local Health District Mental Health Service, Wollongong, New South Wales, Australia
| | - Monica Guha
- The Thriving Spirit Project, Orange, New South Wales, Australia
| | | | - Michael Roche
- University of Canberra & ACT Health, Canberra, Australian Capital Territory, Australia
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McCluskey A, Watson C, Nugent L, O'Connor T, Moore Z, Molloy L, Patton D. 'Sometimes You Have No Choice but to Give Them Medication': Experiences of Nurses Caring for People With Auditory Hallucinations in an Acute Unit. Int J Ment Health Nurs 2024. [PMID: 38965712 DOI: 10.1111/inm.13380] [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: 02/09/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024]
Abstract
The aim of this study was to explore psychiatric nurse's experiences of caring for people with auditory hallucinations in an acute unit. A qualitative study was conducted using thematic analysis. The study involved semi-structured interviews with 18 acute unit nurses all of whom provided interventions to patients with auditory hallucinations. Overall, participants identified their role in the management of risk within an acute unit, the importance of their therapeutic role and a perceived over-reliance on medication administration as a primary nursing intervention. These findings thus demonstrate the personal and professional conflict that nurses face when working in an acute unit with patients who experience auditory hallucinations. Nurses are in a prime position to provide effective interventions and assistance for people with auditory hallucinations in an acute unit. The findings of this study indicate that mental health nurses may require additional support and education to provide care in a truly recovery-based manner, with training in specific interventions and engagement skills for people who hear voices. Due to an unpredictable environment and sometimes high-risk workplace, nurses may also benefit from organisational assistance in this area.
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Affiliation(s)
- Anita McCluskey
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chanel Watson
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Tom O'Connor
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery and Lead Researcher, Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Lida Institute, Shanghai, China
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Zena Moore
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery and Lead Researcher, Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Lida Institute, Shanghai, China
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourbe, Victoria, Australia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- University of Wales, Cardiff, UK
| | - Luke Molloy
- Department of Medicine and Health, School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Declan Patton
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Curran MJ, Gannon R, Rivera RR, Li Y, Fitzpatrick JJ. Facilitators of and Barriers to the Therapeutic Nurse-Patient Relationship: Perceptions From Psychiatric Mental Health Nurses. J Am Psychiatr Nurses Assoc 2024:10783903241257633. [PMID: 38910436 DOI: 10.1177/10783903241257633] [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] [Indexed: 06/25/2024]
Abstract
BACKGROUND The therapeutic relationship serves as a cornerstone in psychiatric mental health nursing practice, providing a basis for implementing various interventions. AIMS This study aimed to explore the perspectives of psychiatric mental health nurses regarding factors that facilitate and impede the therapeutic nurse-patient relationship. METHODS A descriptive study was conducted among psychiatric mental health nurses employed at two community psychiatric hospitals in the northeast area of the United States. A list of facilitators and barriers was developed based on an extensive literature review and subsequently validated by three experts in the field of psychiatric mental health nursing. Participants rated these factors on a 10-point scale. RESULTS The study included 74 registered nurses from two psychiatric hospitals, yielding a 24% response rate. The highest-ranked facilitator was awareness that the relationship enables collaborative goal setting with patients. The most significant barrier was insufficient time due to administrative tasks. CONCLUSIONS This study highlights the importance of understanding facilitators and barriers in the therapeutic nurse-patient relationship. Replicating the study nationally on a larger scale among psychiatric mental health nurses is recommended.
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Affiliation(s)
- Mary-Jo Curran
- Mary-Jo Curran, MSN, RN, NP, PMHCNS-BC, New York-Presbyterian Hospital, New York, NY, USA
| | - Ray Gannon
- Ray Gannon, PhD, MSN, AGPCNP-BC, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Reynaldo R Rivera
- Reynaldo R. Rivera, DNP, RN, NEA-BC, FAAN, FAONL, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ying Li
- Ying Li, MS, Weill Cornell Medicine, New York, NY, USA
| | - Joyce J Fitzpatrick
- Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, FNAP, Case Western Reserve University, Cleveland, OH, USA
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El-Abidi K, Moreno-Poyato AR, Cañabate-Ros M, Garcia-Sanchez JA, Lluch-Canut MT, Muñoz-Ruoco E, Pérez-Moreno JJ, Pita-De-La-Vega J, Puig-Llobet M, Rubia-Ruiz G, Santos-Pariente C, López AMR, Golmar LJ, López CE, Roldán-Merino JF. The therapeutic relationship from the perspective of patients and nurses in the first days of admission: A cross-sectional study in acute mental health units. Int J Ment Health Nurs 2024; 33:134-142. [PMID: 37743558 DOI: 10.1111/inm.13227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
The therapeutic relationship (TR) is essential in mental health nursing care and plays a fundamental role in the understanding and treatment of the patient's health status. Despite being a bidirectional construct, limited evidence is available to shed light on this issue in mental health units and even less so in the first days of admission. This study aimed to examine the association and differences between nurses' and patients' perspectives on the establishment of the therapeutic relationship in acute mental health units during the first days of hospitalization. A cross-sectional study was carried out in 12 Spanish mental health units. Data were collected from patients and nurses using the Working Alliance Inventory-Short (WAI-S) questionnaire. A total of 234 cases were analysed, including 234 patients and 58 nurses. The results showed a positive association between nurses' and patients' perspectives on the therapeutic relationship, but also revealed significant differences on each WAI-S dimension. Nurses assigned higher scores compared to patients on the perception of the quality of the therapeutic relationship. The dimensions with the greatest weight from the patients' perspective regarding the quality of the therapeutic relationship were the perception of greater agreement on goals and tasks among nurses. This study demonstrates the importance of establishing shared goals and tasks with nurses from the first days of hospitalization to improve the quality of the therapeutic relationship as perceived by patients. These findings underline the need to consider the different perspectives of both parties to promote a high-quality therapeutic relationship.
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Affiliation(s)
- Khadija El-Abidi
- Institut de Neuropisquiatria i Addiccions, Centre Fòrum, Hospital del Mar, Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
- Grup de Recerca en Cures Infermeres de Salut Mental, Psicocials i de Complexitat, NURSEARCH - 2021 SGR 1083, Barcelona, Spain
| | - Montserrat Cañabate-Ros
- Universidad Católica de Valencia, San Vicente Mártir, Grupo de investigación MHG, Valencia, Spain
- Hospital Clínico Universitario de Valencia, Unidad de hospitalización de psiquiatría y toxicomanía, Valencia, Spain
| | - Juan A Garcia-Sanchez
- Department of Mental Health, Biomedical Research Institute of Malaga (IBIMA), University General Hospital of Málaga, Málaga, Spain
| | - M Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
- Grup de Recerca en Cures Infermeres de Salut Mental, Psicocials i de Complexitat, NURSEARCH - 2021 SGR 1083, Barcelona, Spain
| | - Estibaliz Muñoz-Ruoco
- Psychiatry Service, Galdakao-Usansolo Hospital, Osakidetza-Basque Health Service, Galdakao-Usansolo, Spain
| | - Juan J Pérez-Moreno
- Psychiatry Service, Galdakao-Usansolo Hospital, Osakidetza-Basque Health Service, Galdakao-Usansolo, Spain
| | - Javier Pita-De-La-Vega
- Children's Mental Health Centre, Department of Mental Health, Consorci Sanitari del Maresme, Mataró, Spain
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
- Grup de Recerca en Cures Infermeres de Salut Mental, Psicocials i de Complexitat, NURSEARCH - 2021 SGR 1083, Barcelona, Spain
| | | | | | | | | | - Cristina Esquinas López
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Juan F Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
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Morgan C, Clarkson L, Hiscocks R, Hopkins I, Berry K, Tyler N, Wood L, Jacobsen P. What should inpatient psychological therapies be for? Qualitative views of service users on outcomes. Health Expect 2024; 27:e13889. [PMID: 37822299 PMCID: PMC10726158 DOI: 10.1111/hex.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND There is limited research on what, when and how outcomes should be measured in psychological therapy trials in acute mental health inpatient wards. OBJECTIVES This study aimed to consider what outcomes service users think are important to measure. METHODS This qualitative study explored the views of 14 participants, who had an inpatient admission within the last year, on outcomes of psychological therapies using semistructured interviews. Data were analysed using thematic analysis from a critical realist perspective with both inductive and deductive coding. RESULTS The 126 outcomes that were important to participants were mapped onto an established taxonomy of outcomes across different health areas and the socioecological framework to consider the wider context and help summarise the outcomes. Most of the outcomes were mapped to the intrapersonal and interpersonal level. In addition to the outcome mapping, three themes were constructed from the qualitative data: (1) I am not a problem I am a person, (2) Feeling cared for and loved, (3) What does getting better look like. CONCLUSIONS Our results highlight the need for patient-reported outcomes which are cocreated with service users, disseminating research and training on preventing dehumanising experiences, enhancing psychological safety and therapeutic relationships and improving access to psychological therapy. PATIENT OR PUBLIC CONTRIBUTION The wider People with Personal Experience Involvement Committee at the University of Bath were consulted which included a focus group during the early planning stages. We also collaborated with a person with personal experience, at every stage of the research. This included developing our research question and aims, protocol, participant documents (e.g., information and debrief forms), advertisement and recruitment strategy, interview topic guide, the codes, the final themes and quotes and reviewing the manuscript. People with lived experience of being admitted to an acute mental health inpatient ward participated in our study.
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Affiliation(s)
- Ceri Morgan
- Department of Psychology, University of Bath, Bath, UK
| | - Lucy Clarkson
- Department of Psychology, University of Bath, Bath, UK
| | | | - India Hopkins
- Department of Psychology, University of Bath, Bath, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Rawnsley Building Manchester Royal Infirmary, Manchester, UK
| | - Natasha Tyler
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Lisa Wood
- Division of Psychiatry, University College London, London, UK
- Research and Development Department, North East London NHS Foundation Trust, Goodmayes Hospital, Ilford, UK
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Lamph G, Nowland R, Boland P, Pearson J, Connell C, Jones V, Wildbore E, L Christian D, Harris C, Ramsden J, Gardner K, Graham-Kevan N, McKeown M. Relational practice in health, education, criminal justice, and social care: a scoping review. Syst Rev 2023; 12:194. [PMID: 37833785 PMCID: PMC10571424 DOI: 10.1186/s13643-023-02344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Establishing and maintaining relationships and ways of connecting and being with others is an important component of health and wellbeing. Harnessing the relational within caring, supportive, educational, or carceral settings as a systems response has been referred to as relational practice. Practitioners, people with lived experience, academics and policy makers, do not yet share a well-defined common understanding of relational practice. Consequently, there is potential for interdisciplinary and interagency miscommunication, as well as the risk of policy and practice being increasingly disconnected. Comprehensive reviews are needed to support the development of a coherent shared understanding of relational practice. METHOD This study uses a scoping review design providing a scope and synthesis of extant literature relating to relational practice focussing on organisational and systemic practice. The review aimed to map how relational practice is used, defined and understood across health, criminal justice, education and social work, noting any impacts and benefits reported. Searches were conducted on 8 bibliographic databases on 27 October 2021. English language articles were included that involve/discuss practice and/or intervention/s that prioritise interpersonal relationships in service provision, in both external (organisational contexts) and internal (how this is received by workers and service users) aspects. RESULTS A total of 8010 relevant articles were identified, of which 158 met the eligibility criteria and were included in the synthesis. Most were opinion-based or theoretical argument papers (n = 61, 38.60%), with 6 (3.80%) critical or narrative reviews. A further 27 (17.09%) were categorised as case studies, focussing on explaining relational practice being used in an organisation or a specific intervention and its components, rather than conducting an evaluation or examination of the effectiveness of the service, with only 11 including any empirical data. Of the included empirical studies, 45 were qualitative, 6 were quantitative, and 9 mixed methods studies. There were differences in the use of terminology and definitions of relational practice within and across sectors. CONCLUSION Although there may be implicit knowledge of what relational practice is the research field lacks coherent and comprehensive models. Despite definitional ambiguities, a number of benefits are attributed to relational practices. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021295958.
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Affiliation(s)
- Gary Lamph
- School of Nursing and Midwifery, Edge Hill University, Lancashire Ormskirk, UK
| | - Rebecca Nowland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK.
| | - Paul Boland
- IMPlementation and Capacity Building Team (IMPaCT), Applied Health Research Hub (AHRh), University of Central Lancashire, Preston, UK
| | - Jayn Pearson
- Criminal Justice Partnership, University of Central Lancashire, Preston, UK
| | - Catriona Connell
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Vanessa Jones
- School of Psychology and Counselling, The Open University, Milton Keynes, UK
| | | | - Danielle L Christian
- IMPlementation and Capacity Building Team (IMPaCT), Applied Health Research Hub (AHRh), University of Central Lancashire, Preston, UK
| | - Catherine Harris
- Health Technology Assessment Unit, University of Central Lancashire, Preston, UK
| | | | - Kathryn Gardner
- School of Psychology and Humanities, University of Central Lancashire, Preston, UK
| | - Nicola Graham-Kevan
- School of Psychology and Humanities, University of Central Lancashire, Preston, UK
| | - Mick McKeown
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
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Harrison H, Alarakhia T, Archard PJ. Introducing a group-based psychoeducation intervention for older people in an inpatient mental healthcare setting. Nurs Older People 2023; 35:28-34. [PMID: 37403441 DOI: 10.7748/nop.2023.e1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 07/06/2023]
Abstract
This article reports on a service evaluation of a group-based psychoeducation programme for older people in an inpatient mental healthcare setting. It sought to explore how the programme was experienced by patients and staff, as well as its acceptability and the feasibility for implementation in the longer term. Via questionnaires, views were gathered from patients and staff. A focus group interview with staff facilitating the group sessions was also undertaken, and patient attendance records for sessions were collected and compared with demographic data relating to the two wards housed in the unit where the programme took place. The programme was generally viewed as a positive addition to care delivery by staff and patient respondents in offering an adjunct to pharmacological treatment, increasing familiarity with psychology staff, encouraging patients to develop a greater degree of mastery regarding their health and fostering mutual support among the patient community. The role of the ward environment in supporting access to group-based intervention is also considered.
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Affiliation(s)
| | - Talha Alarakhia
- Children and Adolescents Placement Provisions, Bedford, England
| | - Philip John Archard
- Child and Adolescent Mental Health Service, Leicestershire Partnership NHS Trust, honorary associate professor, University of Leicester, Leicester, England, associate lecturer, Tavistock and Portman NHS Foundation Trust, London, England
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Zetterström L, Linde M, Blomqvist M, Jormfeldt H. Anxiety Communication Notes-A Tool to Facilitate Anxiety Management and Improve the Nurse-Patient Relationship in Mental Health Nursing. Issues Ment Health Nurs 2023; 44:900-910. [PMID: 37734062 DOI: 10.1080/01612840.2023.2251058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Mental health care tends to be dominated by a biomedical perspective at the expense of a more recovery-oriented approach. Research on nurse-led interventions intended to strengthen the patient's ability to manage anxiety is sparse in this context. The aim of this study was to describe nurses' experiences of the use of anxiety communication notes in nursing patients experiencing anxiety in mental health inpatient care. Data were collected by interviewing twelve nurses working in two mental health inpatient care wards in southwestern Sweden. Semi-structured interviews were conducted, and qualitative content analysis was used to analyze the data. Findings showed that the use of anxiety communication notes was perceived to provide a nursing structure to foster the development and practice of adaptive anxiety management through a visual representation for mutual understanding of the patient's anxiety pattern. The nurses could also use the anxiety communication notes to support nurse-patient communication and facilitate increased participation and empowerment in the patients' anxiety management.
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Affiliation(s)
| | - Maria Linde
- Department of Psychiatry, Region Halland, Halmstad, Sweden
| | - Marjut Blomqvist
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Liberati E, Richards N, Ratnayake S, Gibson J, Martin G. Tackling the erosion of compassion in acute mental health services. BMJ 2023; 382:e073055. [PMID: 37402535 PMCID: PMC10316385 DOI: 10.1136/bmj-2022-073055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Elisa Liberati
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Natalie Richards
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | | | | | - Graham Martin
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
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10
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Braunschneider LE, Seiderer J, Loeper S, Löwe B, Kohlmann S. Nurses' experiences of a screening and associated psychosomatic consultation service for mental comorbidities in somatic care inpatients - a qualitative study. Front Psychiatry 2023; 14:1148142. [PMID: 37333932 PMCID: PMC10272840 DOI: 10.3389/fpsyt.2023.1148142] [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: 01/19/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background Screening for mental comorbidities and related liaison service can reduce hospital length of stay in somatic hospital care. To develop, test and sustain such health care services, stakeholder feedback is required. One of the most important stakeholders in general hospital care and health care processes are nurses. Aim The aim of this study is to explore nurses' experiencess on standardized nurse-led screening for mental comorbidities and associated psychosomatic consultation service in routine somatic inpatient care. Method Semi-structured qualitative interviews were conducted with 18 nurses that were involved in a nurse-led screening service for mental comorbidities on internal medicine or dermatological wards. Data were analyzed using thematic analysis. Results Eight thematic groups were developed. On the one hand, participants reported benefits of screening: mental health education, general mental health awareness, holistic treatment approach, opportunity to build rapport with patients and reduction in workload. On the other hand, possible psychological effects of the intervention, reasons why patients may not want to be referred and application requirements to facilitate delivery were identified. None of the nurses opposed screening and associated psychosomatic consultation service. Conclusion All nurses endorsed the screening intervention and considered it meaningful. Nurses particularly emphasized the potential for holistic patient care and nurses' improved skills and competencies, but partly critizised current application requirements. Relevance to clinical practice This study adds on existent evidence on nurse-led screening for mental comorbidities and associated psychosomatic consultation service by emphasizing its potential to improve both patient care as well as nurses' perceived self-efficacy and job satisfaction. To take full advantage of this potential, however, usability improvements, regular supervision, and ongoing training for nurses need to be considered.
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Viliardos L, Murphy N, McAndrew S. Mental health challenges facing male survivors of child sexual abuse: Implications for mental health nurses. Int J Ment Health Nurs 2023; 32:490-501. [PMID: 36344441 DOI: 10.1111/inm.13087] [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] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
Child sexual abuse (CSA) is an issue of epidemic proportions in the United Kingdom (UK) and an international public health problem. Evidence suggests that in the UK one in 20 children have been sexually abused, with one in three not telling anyone about it at the time of the abuse. Conservative estimates suggest that around one in six men have experienced sexual abuse before the age of 18. CSA has been correlated with the development of numerous mental health problems, abused men often displaying externalizing behaviours, including substance misuse, 'risky' sexual behaviours, anti-social behaviour, and offending. This article reports on one aspect of a research study focusing specifically on male survivors of CSA and its effect on their mental health. Using narrative research, face-to-face interviews were used to collect the stories of four men who participated in the research. Interviews were audio-recorded and transcribed verbatim. Analysis used a two-phase approach; initially, each narrative was analysed as a whole, with an across transcripts analysis then being carried out identifying shared themes emerging from the individual stories. Whilst findings from the second phase of the analysis identify four themes, it is the theme of 'Blocking the Memories' that is the focus for this article. Making a valuable contribution to existent knowledge regarding the experiences of men who were sexually abused as children, this article will help to inform mental health practitioners who are likely to deliver care to male survivors of CSA.
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Tabvuma T, Stanton R, Happell B. The physical health nurse consultant and mental health consumer: An important therapeutic partnership. Int J Ment Health Nurs 2023; 32:579-589. [PMID: 36567487 DOI: 10.1111/inm.13104] [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] [Accepted: 11/30/2022] [Indexed: 12/27/2022]
Abstract
People diagnosed with mental illness (hereon referred to as consumers) experience a disproportionately lower life expectancy of up 30 years compared to the general population. Systemic issues such as diagnostic overshadowing and stigma from healthcare professionals have inhibited the development of positive therapeutic partnerships that enable consumers to seek and engage support for their physical health concerns. Consumers have called for healthcare professionals to skillfully develop and prioritize therapeutic partnerships whilst coordinating and providing physical healthcare. The aim of this qualitative descriptive research was to explore consumer views and experiences of their interactions with a specialist mental health nursing role, the Physical Health Nurse Consultant. Semi-structured interviews were conducted with 14 consumers from a large public Community Mental Health Service in the Australian Capital Territory. Interviews were transcribed and thematically analysed. Therapeutic partnerships were an overarching theme identified from the data and included three sub-themes: personal attributes of the Physical Health Nurse Consultant; behaviour change engagement strategies; and impact of the therapeutic partnership. Consumers described the personal and professional attributes of the Physical Health Nurse Consultant that enabled the establishment and maintenance of their highly valued therapeutic partnership. This therapeutic partnership was perceived to positively impact their personal and clinical outcomes. With increasing support from consumers, clinical practice settings should move towards embedding a Physical Health Nurse Consultant role in routine practice. Further research exploring the co-development of health behaviour change goals and, barriers and facilitators experienced by the consumers regarding the Physical Health Nurse Consultant is required to further role development.
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Affiliation(s)
- Tracy Tabvuma
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Brenda Happell
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia.,School of Nursing and Midwifery, University College Cork, Cork, Ireland
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13
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Roldán-Merino JF, Tomás-Jiménez M, Schröder A, Lundqvist LO, Puig-Llobet M, Moreno-Poyato AR, Domínguez del Campo M, Sanchez-Balcells S, Lluch-Canut MT. Quality in Psychiatric Care in the Community Mental Health Setting from the Perspective of Patients and Staff. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4043. [PMID: 36901056 PMCID: PMC10002304 DOI: 10.3390/ijerph20054043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
The current paradigm of mental health care focuses on care provided in the community, increasingly moving away from hospital care models that involve considerable economic burden. Patient and staff perspectives on the quality of psychiatric care can highlight strengths and areas for improvement to ensure better care provision. The aim of this study was to describe and compare perceptions of quality of care among patients and staff in community mental health services and to determine possible relationships between these perceptions and other study variables. A comparative cross-sectional descriptive study was conducted in a sample of 200 patients and 260 staff from community psychiatric care services in the area of Barcelona (Spain). The results showed high overall levels of quality of care from patient (m = 104.35 ± 13.57) and staff (m =102.06 ± 8.80) perspectives. Patients and staff both gave high scores to Encounter and Support factors, while factors concerning patient Participation and Environment received the lowest scores. Continuous assessment of the quality of psychiatric care in the community setting is essential to ensure the highest quality of care, taking the perspectives of those involved into account.
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Affiliation(s)
- Juan Francisco Roldán-Merino
- Mental Health Department, Campus Docent Sant Joan de Déu Private Foundation, University of Barcelona, C/Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
- Grupo DAFNiS, Campus Docent Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Spain
- Mental Health, Psychosocial and Complex Nursing Care Research Group—NURSEARCH, University of Barcelona, 08907 Barcelona, Spain
| | - Manuel Tomás-Jiménez
- Mental Health Department, Campus Docent Sant Joan de Déu Private Foundation, University of Barcelona, C/Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
- Grupo DAFNiS, Campus Docent Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Patient Safety Research Group, Hospital Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
| | - Agneta Schröder
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
- Department of Nursing, Faculty of Health Care and Nursing, Norwegian University of Science and Technology (NTNU), 2815 Gjövik, Norway
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
| | - Montserrat Puig-Llobet
- Public Health, Mental Health and Maternal Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Antonio R. Moreno-Poyato
- Mental Health, Psychosocial and Complex Nursing Care Research Group—NURSEARCH, University of Barcelona, 08907 Barcelona, Spain
- Public Health, Mental Health and Maternal Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta Domínguez del Campo
- Mental Health Department, Campus Docent Sant Joan de Déu Private Foundation, University of Barcelona, C/Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
- Grupo DAFNiS, Campus Docent Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Etiopatogenia I Tractament Dels Trastorns Mental Severs (MERITT), Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | | | - Maria Teresa Lluch-Canut
- Public Health, Mental Health and Maternal Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
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14
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Berg J, Lipponen E, Sailas E, Soininen P, Varpula J, Välimäki M, Lahti M. Nurses' perceptions of nurse-patient communication in seclusion rooms in psychiatric inpatient care: A focus group study. J Psychiatr Ment Health Nurs 2023. [PMID: 36718606 DOI: 10.1111/jpm.12907] [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: 12/21/2021] [Revised: 12/16/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Communication between nurses and patients is essential in mental health nursing. In coercive situations (e.g. seclusion), the importance of nurse-patient communication is highlighted. However, research related to nurses' perceptions of nurse-patient communication during seclusion is scant. AIM The aim of this study was to describe nurses' perceptions of nurse-patient communication during patient seclusion and the ways nurse-patient communication can be improved. METHOD A qualitative study design using focus group interviews was adopted. Thirty-two nurses working in psychiatric wards were recruited to participate. The data were analysed using inductive qualitative content analysis. RESULTS Nurses aimed to communicate in a patient-centred way in seclusion events, and various issues affected the quality of communication. Nurses recognized several ways to improve communication during seclusion. DISCUSSION Treating patients in seclusion rooms presents highly demanding care situations for nurses. Seclusion events require nurses to have good communication skills to provide ethically sound care. CONCLUSION Improved nurse-patient communication may contribute to shorter seclusion times and a higher quality of care. Improving nurses' communication skills may help support the dignity of the secluded patients. Safewards practices, such as respectful communication and recognizing the effect of non-verbal behaviour, could be considered when developing nurse-patient communication in seclusion events. RELEVANCE STATEMENT This study deepens the understanding of nurse-patient communication during seclusion events from the perspective of nurses. Caring for patients in seclusion presents challenging situations for nurses and demands that they have good communication skills. To enhance their communication skills in seclusion events, nurses require opportunities to take part in further training after education related to communication skills for demanding care situations. Knowing the appropriate ways to interact with individual patients during seclusion can help nurses create and maintain communication with patients. For mental health nursing, nurses' enhanced communication may promote increased use of noncoercive practices in psychiatric settings. For patients, improving nurses' communication skills may help support dignity and autonomy during seclusion and shorten the time spent in seclusion, resulting in a better quality of care and more positive patient experiences related to care offered in seclusion. In this, the perspectives of people with lived experience of mental health problems should be acknowledged. Components of Safewards practices, such as using respectful and individual communication and paying attention to one's non-verbal communication (Soft Words), could be useful when developing nurse-patient communication in seclusion events.
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Affiliation(s)
- Johanna Berg
- Turku University of Applied Sciences, Turku, Finland
| | | | - Eila Sailas
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland
| | - Päivi Soininen
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya Nursing School, Central South University, Changsha, China
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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15
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Ahn S, Shin S. 'I felt alive': A qualitative study of inpatients' perspectives on good mental health nursing in South Korea. Int J Ment Health Nurs 2023; 32:791-800. [PMID: 36718048 DOI: 10.1111/inm.13122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023]
Abstract
Although mental health nurses continuously strive for patients' well-being, patients still experience inpatient care negatively. To identify an individual's actual, mental health nursing care needs and offers them optimal benefits during their hospital stay, determining what patients perceive as good nursing should be prioritized. This qualitative descriptive study aimed to understand good mental health nursing from the inpatients' perspective. The data were collected through semi-structured interviews with 13 patients admitted to a psychiatric ward in South Korea, and analysed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used to ensure transparency and rigour. The results revealed that patients experienced good mental health nursing when nurses respected their humanity, adopted a practical approach to solve problems pragmatically, and facilitated their recovery. These practices stem from mental health nurses' attitudes towards humanity based on individualized respect, professional ability to handle patients' individual needs, and offering patients hope and confidence for recovery and the future. Therefore, mental health nurses need to focus their efforts on these aspects of nursing attitudes and competencies to ensure that inpatients experience good mental health nursing.
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Affiliation(s)
- Suyoun Ahn
- Samsung Medical Center, Seoul, South Korea
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16
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Pérez-Toribio A, Moreno-Poyato AR, Lluch-Canut MT, Nash M, Cañabate-Ros M, Myklebust KK, Bjørkly S, Puig-Llobet M, Roldán-Merino JF. Transcultural adaptation and assessment of psychometric properties of the Spanish version of the Scale for the Evaluation of Staff-Patient Interactions in Progress Notes. PLoS One 2023; 18:e0281832. [PMID: 36976796 PMCID: PMC10047521 DOI: 10.1371/journal.pone.0281832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/02/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To adapt the Scale for the Evaluation of Staff Patient Interactions in Progress Notes to Spanish and to test the psychometric properties. DESIGN AND METHODS The study was conducted in two phases: (1) Adaptation of the instrument to Spanish following the Standards for Educational and Psychological Testing. (2) Psychometric study in a sample of mental health nurses. FINDINGS The Cronbach's alpha values were 0.97 for the total scale and 0.83 to 0.81 for each dimension. The inter-rater reliability values were between 0.94 and 0.97. PRACTICE IMPLICATIONS The scale is a reliable tool for assessing nurses' clinical notes in relation to the quality of nurse-patient interactions.
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Affiliation(s)
- Alonso Pérez-Toribio
- Unitat de Salut Mental de l'Hospitalet, Servei d'Atenció Primària Delta de Llobregat, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Barcelona, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - María Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - Michael Nash
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Montserrat Cañabate-Ros
- TXP Research Groups, Universidad Cardenal Herrera-CEU, Valencia, Spain
- Hospital Clínico Universitario, Valencia, Spain
| | - Kjellaug K Myklebust
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Stål Bjørkly
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Centre for Forensic Psychiatry, University Hospital, Oslo, Norway
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - Juan F Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
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17
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Tolosa-Merlos D, Moreno-Poyato AR, González-Palau F, Pérez-Toribio A, Casanova-Garrigós G, Delgado-Hito P. Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study. J Clin Nurs 2023; 32:253-263. [PMID: 35075705 PMCID: PMC10078778 DOI: 10.1111/jocn.16223] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units. BACKGROUND In mental health units, the therapeutic relationship is especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care. DESIGN Action and observation stages of a participatory action research project. METHODS Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used. RESULTS The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice. CONCLUSIONS This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse-patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice. RELEVANCE TO CLINICAL PRACTICE These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day-to-day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.
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Affiliation(s)
- Diana Tolosa-Merlos
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Alonso Pérez-Toribio
- Unitat de Salut Mental de l'Hospitalet, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, L'Hospitalet de Llobregat, Spain
| | | | - Pilar Delgado-Hito
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.,GRIN-IDIBELL (Nursing Research Group- Bellvitge Biomedical Research Institute), L'Hospitalet de Llobregat, Spain
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18
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Tolosa-Merlos D, Moreno-Poyato AR, González-Palau F, Pérez-Toribio A, Casanova-Garrigós G, Delgado-Hito P. The therapeutic relationship at the heart of nursing care: A participatory action research in acute mental health units. J Clin Nurs 2022. [PMID: 36566346 DOI: 10.1111/jocn.16606] [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: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/26/2022]
Abstract
AIMS AND OBJECTIVES To explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse-patient therapeutic relationship. DESIGN Participatory Action Research. METHODS Ninety-six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used. RESULTS The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change. CONCLUSIONS This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar. RELEVANCE TO CLINICAL PRACTICE The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units. NO PATIENT OR PUBLIC CONTRIBUTION Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice.
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Affiliation(s)
- Diana Tolosa-Merlos
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | | | - Alonso Pérez-Toribio
- Unitat de Salut Mental de l'Hospitalet, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, L'Hospitalet de Llobregat, Spain
| | | | - Pilar Delgado-Hito
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.,GRIN-IDIBELL (Nursing Research Group - Bellvitge Biomedical Research Institute), L'Hospitalet de Llobregat, Spain
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19
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Taylor F, Galloway S, Irons K, Mess L, Pemberton L, Worton K, Chambers M. Barriers and enablers to implementation of the therapeutic engagement questionnaire in acute mental health inpatient wards in England: A qualitative study. Int J Ment Health Nurs 2022; 31:1467-1479. [PMID: 35976724 PMCID: PMC9804631 DOI: 10.1111/inm.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 01/09/2023]
Abstract
A strong association exists between the quality of nurse-service user therapeutic relationship and care outcomes on acute mental health inpatient wards. Despite evidence that service users desire improved therapeutic engagement, and registered mental health nurses recognize the benefits of therapeutic relationships, such interactions remain sub-optimal. There is a dearth of evidence on factors influencing implementation of interventions to support and encourage therapeutic engagement. This study aimed to understand the barriers and enablers to implementation of the Therapeutic Engagement Questionnaire (TEQ), across fifteen acute inpatient wards in seven English mental health organizations. Qualitative methods were used in which data were collected from ethnographic field notes and documentary review, coded, and analysed using thematic analysis. Theoretical framing supported data analysis and interpretation. Reporting adheres to the Standards for Reporting Qualitative Research. The TEQ as an evidence-based intervention co-produced with service users and nurses was valued and welcomed by many nurse directors, senior clinicians, and ward managers. However, a range of practical and perceptual factors impeded implementation. Furthermore, many existing contextual challenges for intervention implementation in acute inpatient wards were magnified by the COVID-19 pandemic. Suitable facilitation to address these barriers can help support implementation of the TEQ, with some transferability to implementation of other interventions in these settings. Our study suggests several facilitation methods, brought together in a conceptual model, including encouragement of reflective, facilitative discussion meetings among stakeholders and researchers, effort put into winning nurse 'buy-in' and identifying and supporting ward-level agents of change.
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Affiliation(s)
- Francesca Taylor
- Joint Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Sarah Galloway
- South-West London and St George's Mental Health NHS Trust, London, UK
| | | | - Lorna Mess
- North-East London NHS Foundation Trust, London, UK
| | | | - Karen Worton
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, London, UK
| | - Mary Chambers
- Joint Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
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20
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Delaney KR, Loucks J, Ray R, Blair EW, Nadler-Moodie M, Batscha C, Sharp DM, Milliken D. Delineating Quality Indicators of Inpatient Psychiatric Hospitalization. J Am Psychiatr Nurses Assoc 2022; 28:391-401. [PMID: 33190586 DOI: 10.1177/1078390320971367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assuring quality care is critical to the well-being and recovery of individuals receiving inpatient psychiatric treatment, yet a comprehensive map of quality inpatient care does not exist. AIMS To isolate and describe quality elements of inpatient psychiatric treatment. METHODS A survey queried psychiatric inpatient nursing leaders on what they considered to be critical elements of quality. The survey was emailed to 40 American Psychiatric Nurses Association members, and 39 individuals responded. In the survey, participants were asked to comment on the importance of six dimensions of quality as well as quality indicators used on their units. RESULTS Data from this survey indicate how thought leaders conceptualized quality of inpatient care. A unifying philosophy of care was endorsed as a quality element as was structure that affords staff available time on the unit-engaging with patients. While staffing levels were viewed as important, the respondents commented on the nuances between staffing and quality. Participants endorsed the importance of involving individuals in their treatment planning as well as tapping into patients' perspectives on the treatment experience. CONCLUSIONS The participants' responses compliment the quality literature and reinforce the need to develop a comprehensive map of quality elements. These elements interact in complex way, for instance, staffing, engagement, and teamwork is tied to the organizational structure and philosophy of care, which in turn facilitates consumer involvement in care. Thus, gauging the impact of quality on outcomes will demand consideration of the interaction of factors not just the linear relationship of one element to an outcome.
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Affiliation(s)
- Kathleen R Delaney
- Kathleen R. Delaney, PhD, PMH-NP, FAAN, Rush College of Nursing, Chicago, IL, USA
| | | | - Richard Ray
- Richard Ray, MS, RN, PMH-BC, Northwestern Memorial Hospital Stone Institute of Psychiatry, Chicago, IL, USA
| | - Ellen W Blair
- Ellen Blair, DNP, APRN, PMHCNS-BC, Hartford Hospital, Hartford, CT, USA
| | - Marlene Nadler-Moodie
- Marlene Nadler-Moodie, MSN, APRN, PMHCNS-BC, Scripps Mercy Hospital San Diego, CA, USA
| | - Catherine Batscha
- Catherine Batscha, DNP, RN, University of Louisville, Louisville, KY, USA
| | - David M Sharp
- David Sharp, PhD, RN, Mississippi College, Clinton, MS, USA
| | - Dani Milliken
- Dani Milliken, DHA, MS, BSN, RN, Children's Hospital of Orange County, Orange, CA, USA
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21
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Bifarin O, Felton A, Prince Z. Defensive practices in mental health nursing: Professionalism and poignant tensions. Int J Ment Health Nurs 2022; 31:743-751. [PMID: 34564941 DOI: 10.1111/inm.12936] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
Mental health nursing is a skilled profession, well positioned to support patients towards recovery with evidence-based therapeutic interventions. However, the profession continues to be challenged by tensions surrounding the delivery of restrictive interventions and concerns over tendencies towards defensive practices. This paper examines the ambiguity this creates within the mental health nursing role. Organizational cultures that overvalue metrics and administrative tasks create barriers for therapeutic engagement while contributing to role confusion and stress within nursing. We need to address such structural constraints on nurses as mental health nurses' well-being is crucial to service delivery and the realization of therapeutic goals. From the UK perspective, authors argue that there is a need to examine service structures that foster compassionate and transformational leadership to enable mental health nurses to exercise the agency to practice therapeutically. Education and quality nursing research have a pivotal role to play in enabling this shift.
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Affiliation(s)
- Oladayo Bifarin
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK.,Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK.,Local Service Division, Risk and Governance Department, Mersey Care NHS FT, Liverpool, UK
| | - Anne Felton
- Institute of Health and Allied Professions, Nottingham Trent University, Nottingham, UK
| | - Zoe Prince
- Associate Director of Nursing and Patient Experience, Local Service Division, Mersey Care NHS FT, Liverpool, UK
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22
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Corbetta M, Corso B, Camuccio CA. Rules and ward climate in acute psychiatric setting: Comparison of staff and patient perceptions. Int J Ment Health Nurs 2022; 31:611-624. [PMID: 35128772 PMCID: PMC9305954 DOI: 10.1111/inm.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/28/2022]
Abstract
The ward climate or atmosphere refers to its material, emotional and social conditions. A good ward climate in psychiatric settings can influence the mood, behaviour and self-concept of patients and staff members and improve patient outcomes. Many studies have examined the relationship between ward climate and aggression, but only a few have investigated the effect of a ward's environment, rules and activities. This multicentric observational study aimed to assess the relationship between the rules/activities and the climate of four acute psychiatric units of Northern Italy. The Essen Climate Evaluation Scheme (EssenCES) questionnaire, which was administered to patients and staff, was used to evaluate the different dimensions of ward atmosphere. There was a good response rate (79%) in patients and staff members who completed the questionnaire (114 patients and 109 staff). Safety perception appeared to be quite different in patients and staff. The patients who were authorized to have more visiting hours and more time to use their mobile phone had higher scores on Experienced Safety subscale. A negative correlation between the Therapeutic Hold and Experienced Safety subscales was found in the staff members, and this was due to their negative perception. The ward climate seemed to be affected by the unit's rules, especially with respect to visits and the smartphones use. Nurses need to be aware of the importance of ward climate and how their own perception may differ from and that of patients: this gap could lead to decisions detached from the patients' needs.
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Affiliation(s)
| | - Barbara Corso
- Neuroscience InstituteNational Research CouncilPadovaItaly
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23
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Perlman D, Moxham L, Patterson C, Tapsell A, Keough E. The influence of a self-determination theory grounded clinical placement on nursing student's therapeutic relationship skills: A pre-test/post-test study. Int J Ment Health Nurs 2022; 31:305-312. [PMID: 34820992 DOI: 10.1111/inm.12957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
For undergraduate nursing students, an integral mode of learning is their clinical placements. Learning within the clinical setting is influenced by factors such as the facilitators, peers, unit, or department the student is placed on. What is not known is the role of a social context that is grounded in Self-Determination Theory and how this influences the development of therapeutic relationship skills among undergraduate nursing students. The aim of this study was to examine the role of autonomy support in the professional learning of undergraduate nursing students. This study employed a two-group pre-test and post-test design, with undergraduate nursing students placed in either an autonomy-supportive group or a comparison group in an Australian context. Therapeutic relationship skills were assessed at the beginning and end of their compulsory mental health clinical placement. Participants were 210 (n = 210) Australian undergraduate nursing students. Using a tertile split, 140 students were placed into one of two groups based on their perception of autonomy support at the post-test time point. Pre- and post-test therapeutic relationship data were collected for both groups. A repeated measures analysis of variance was used to examine whether engagement in different clinical placements would illicit significant differences in therapeutic relationship skills. Undergraduate nursing students who were engaged in the autonomy-supportive setting had significantly higher scores associated with the therapeutic relationship subscales: Positive Collaboration and Positive Clinical Input. The importance of the social context is underscored, which is strongly influenced by the educational leader, typically referred to as a nurse facilitator.
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Affiliation(s)
- Dana Perlman
- School of Education: Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lorna Moxham
- School of Education: Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Christopher Patterson
- School of Nursing: Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Amy Tapsell
- Global Challenges Program, Research and Innovation Division, University of Wollongong, Wollongong, New South Wales, Australia
| | - Emily Keough
- School of Psychology: Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
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Moreno-Poyato AR, El Abidi K, Rodríguez-Nogueira Ó, Lluch-Canut T, Puig-Llobet M. A qualitative study exploring the patients' perspective from the 'Reserved Therapeutic Space' nursing intervention in acute mental health units. Int J Ment Health Nurs 2021; 30:783-797. [PMID: 33599014 DOI: 10.1111/inm.12848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
This study aimed to explore the perspective of people who had experienced treatment as patients at acute mental health units, regarding an intervention model to improve therapeutic relationships in the units, which had been previously designed by the nurses. The study participants were people linked to collectives for social activism in mental health. Six focus groups were held. The results were classified into three themes: (a) the meaning of a space to enable the establishment of a therapeutic relationship, (b) the procedures to implement the space, and (c) the difficulties to overcome to establish the space. For the participants, the Reserved Therapeutic Space intervention was perceived as a space where they could share expectations and needs with the nurses, considering it as both valid and useful to improve the therapeutic relationship in acute units. For the participants, the intervention should be structured in three stages: orientation, follow-up, and discharge. The content of the intervention should be proposed by the patients based on their needs and concerns. The barriers identified for carrying out the intervention were the lack of relational competence, the violation of rights, and the lack of accessibility of nurses. The facilitating elements were the availability of nurses, active listening, and empathy. The resulting intervention model includes realities of both groups, providing insights for nurses to initiate a space with patients and improve their therapeutic relationship. This intervention model could be used by managers to test its effectiveness.
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Affiliation(s)
- Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - Khadija El Abidi
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Óscar Rodríguez-Nogueira
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Ponferrada, Spain
| | - Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
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Moreno-Poyato AR, Rodríguez-Nogueira Ó. The association between empathy and the nurse-patient therapeutic relationship in mental health units: a cross-sectional study. J Psychiatr Ment Health Nurs 2021; 28:335-343. [PMID: 32657511 DOI: 10.1111/jpm.12675] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/18/2020] [Accepted: 07/07/2020] [Indexed: 12/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Empathy is one of the main attributes for establishing the nurse-patient therapeutic relationship. Davis (1983) identified four components on an empathic response: perspective taking, fantasy, empathetic concern and personal distress. It is essential to deepen our knowledge on the influence of the dimensions of empathy for the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: A significant association exists between the dimensions of empathy and the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship between nurses and patients in mental health units. This study shows that the nurses' perspective on the patient's situation improves the bond, and therefore, this skill is especially useful in the first phase or orientation phase of the therapeutic relationship. However, for the second phase or working phase of the therapeutic relationship, a greater empathic concern among nurses, together with less personal distress, improves collaborative goal setting with patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is important for mental health nurses to be aware of the importance of personal self-awareness and the emotional management of empathy for the construction and development of therapeutic relationships of quality with patients. Knowledge of the relationship between each of the dimensions of empathy in the different stages of the therapeutic relationship is useful for the design of educational programmes, by including training on empathic strategies. ABSTRACT: Introduction Empathy and its dimensions (perspective taking, empathic concern, personal distress and fantasy) are essential for establishing the nurse-patient therapeutic relationship. It is important to know how this influences the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship. Aim To examine whether the dimensions of empathy influence the nurse-patient therapeutic relationship within mental health units. Method A cross-sectional design was used to collect data to measure the therapeutic alliance and the different dimensions of empathy via an online form completed by nurses working at 18 mental health units. Linear regressions were used in the analysis. Results A total of 198 participants completed the questionnaires. Nurses established a greater therapeutic alliance with patients when they were able to adopt their patient's perspective and experience concern. Discussion Nurses' perspective taking is an influential factor impacting the nurse-patient bond in the orientation phase, whereas experiencing greater concern and decreased emotional distress were associated with improved therapeutic alliance in the working phase. Implications for practice These findings may help gain awareness among nurses of the importance of empathy in the nurse-patient relationships, as well as inform educational programmes, by including training in empathic strategies and emotional management.
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Affiliation(s)
- Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Óscar Rodríguez-Nogueira
- Nursing and Physical Therapy Department, SALBIS Research Group, Health Sciences School, Universidad de León, Ponferrada León, Spain
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Moreno-Poyato AR, Rodríguez-Nogueira Ó, Casanova-Garrigos G, El Abidi K, Roldán-Merino JF. The impact of a participatory intervention on the therapeutic relationship in mental health nurses: A multicentre study. J Adv Nurs 2021; 77:3104-3115. [PMID: 33748977 DOI: 10.1111/jan.14835] [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: 12/05/2020] [Revised: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the effects of an intervention aimed at improving the therapeutic relationship, using the participatory-action research method, in terms of improving the quality of the nurse-patient therapeutic relationship. DESIGN A single-group pre-post research design. METHODS Quantitative data were collected between January 2018 and June 2019 using an online form completed by nurses from 18 mental health units (N = 95). Data were collected before and after the intervention, which consisted of the design, implementation and evaluation of strategies to improve the therapeutic relationship through participatory-action research involving nurses. The Working Alliance Inventory-Short, Interpersonal Reactivity Index, Evidence-Based Practice Questionnaire and Practice Environment Scale of the Nursing Work Index were used. The Wilcoxon rank-sum test was used together with the Spearman's correlation coefficient. Two multiple linear regressions models were constructed. RESULTS Overall, the intervention improved the nurse-patient therapeutic relationship. In addition, the results revealed that, above all, the improvement in evidence-based practice along with a decrease in nurses' personal distress were the factors associated with the improvement of the nurse-patient therapeutic relationship. CONCLUSION In mental health units, the therapeutic nurse-patient relationship can be improved through participatory interventions that include the implementation of evidence-based practices. IMPACT This research examined the effects of an intervention aimed at improving the therapeutic relationship among nurses working at mental health units using participatory action research. The results show that the therapeutic relationship can be improved through participatory methods where evidence-based practice is implemented and enhanced among nurses, since a better therapeutic relationship along with reduced staff discomfort are determining factors that influence the quality of the therapeutic relationship. Institutional managers should promote participatory group interventions to enable nurses to develop evidence-based aspects of the therapeutic relationship together with expanding personal aspects and self-knowledge.
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Affiliation(s)
- Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Óscar Rodríguez-Nogueira
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Ponferrada, Spain
| | | | - Khadija El Abidi
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Juan F Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada, School of Nursing, University of Barcelona, Esplugues de llobregat, Spain
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Vandewalle J, Duprez V, Beeckman D, Van Hecke A, Verhaeghe S. Contact between patients with suicidal ideation and nurses in mental health wards: Development and psychometric evaluation of a questionnaire. Int J Ment Health Nurs 2021; 30:219-234. [PMID: 32790049 DOI: 10.1111/inm.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/08/2020] [Accepted: 07/21/2020] [Indexed: 11/27/2022]
Abstract
Suicide prevention and treatment opportunities often depend on interpersonal contact between patients and professionals. Presently, there is a lack of valid and reliable instruments to obtain the perspective of patients with suicidal ideation regarding their contact with professionals in mental health wards. This was a three-stage study to develop and psychometrically evaluate a questionnaire: the Contact with Nurses from the perspective of Patients with Suicidal ideation (CoNuPaS). First, the construct was defined by a systematic review, qualitative study, and face validity among experts. Second, the content was validated through a Delphi procedure with professional experts (n = 14) and cognitive interviews with hospitalized patients (n = 12). Third, using a sample of adult patients with suicidal ideation in the past year (n = 405), the psychometric properties were assessed by an exploratory factor analysis, a test-retest procedure, and the internal consistency. The CoNuPaS comprises 23 items and two subsections, to examine patients' perceptions of contact experiences with nurses (CoNuPaS-experience) and what they find important in that contact (CoNuPaS-importance). The subsections comprise four components: encountering a space to express suicidal thoughts and explore needs, being recognized as a unique and self-determining individual, encountering nurses' availability/information-sharing/transparency on expectations, and trusting nurses in communication about suicidality. Content validity scores were excellent (0.78-1.00); test-retest intraclass correlation coefficient and internal consistency were >0.90. Thus, the CoNuPaS demonstrated good psychometric properties. The availability of a valid questionnaire to examine patient-nurse contact in mental health wards is central to improving understanding of nurses' contributions to suicide prevention and suicidal ideation treatment.
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Affiliation(s)
- Joeri Vandewalle
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Research Foundation-Flanders (FWO), Brussel, Belgium
| | - Veerle Duprez
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent, Belgium.,School of Health Sciences, Örebro University, Örebro, Sweden.,School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Copenhagen, Denmark.,School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium
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Moreno-Poyato AR, Casanova-Garrigos G, Roldán-Merino JF, Rodríguez-Nogueira Ó. Examining the association between evidence-based practice and the nurse-patient therapeutic relationship in mental health units: A cross-sectional study. J Adv Nurs 2020; 77:1762-1771. [PMID: 33336475 DOI: 10.1111/jan.14715] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
AIMS To examine the relationship between the dimensions of evidence-based practice and the therapeutic relationship and to predict the quality of the therapeutic relationship from these dimensions among nurses working in mental health units. DESIGN A cross-sectional design. METHODS Data were collected between February-April 2018 via an online form completed by nurses working at 18 mental health units. Multiple linear regressions were used to examine the relationship between the dimensions of evidence-based practice and therapeutic relationship. Questionnaires were completed by 198 nurses. RESULTS Higher levels of evidence-based practice were a significant predictor of a higher-quality therapeutic relationship (β: 2.276; 95% CI: 1.30-3.25). The evidence-based practice factor which most influenced an improved therapeutic relationship was the nurses' attitude (β: 2.047; 95% CI: 0.88-3.21). The therapeutic relationship dimension which was most conditioned by evidence-based practice dimensions was agreement on tasks, which was most favourable with a better attitude (β: 0.625; 95% CI: 0.09-1.16) and greater knowledge and skills for evidence-based practice (β: 0.500; 95% CI: 0.08-0.93). CONCLUSION In mental health settings, the therapeutic nurse-patient relationship is positively enhanced by evidenced-based practice and the nurse's level of experience, with a great influence on shared decision-making. IMPACT This research sought to examine the relationship between the evidence-based practice and the therapeutic relationship in mental health nursing. This study demonstrates that an improved attitude and knowledge of evidence-based practices of mental health nurses increases shared decision-making with patients, which is a basic requirement for person-centred care. Because the therapeutic relationship is considered the backbone of nursing practice in mental health units, this research will have an impact on both mental health nurses and mental health unit managers.
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Affiliation(s)
- Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Juan F Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada. School of Nursing, University of Barcelona, Barcelona, Spain
| | - Óscar Rodríguez-Nogueira
- Nursing and Physical Therapy Department, SALBIS Research Group, Health Sciences School, Universidad de León, Ponferrada, León, Spain
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Kantaris X, Radcliffe M, Acott K, Hughes P, Chambers M. Training healthcare assistants working in adult acute inpatient wards in Psychological First Aid: An implementation and evaluation study. J Psychiatr Ment Health Nurs 2020; 27:742-751. [PMID: 32246735 DOI: 10.1111/jpm.12633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Healthcare assistants are untrained and unregistered frontline staff but are expected to be proactive in preventing and responding to 'untoward' incidents quickly and efficiently when working within adult acute inpatient psychiatric settings. Healthcare assistants should be trained to provide enhanced care to service users residing in acute psychiatric settings. To date, a training programme in Psychological First Aid has not been expended in such a setting with nonregistered staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE The study demonstrates that training healthcare assistants in Psychological First Aid is useful in improving their confidence in caring for service users, therapeutic engagement with service users and ward culture in general. WHAT ARE THE IMPLICATIONS FOR PRACTICE A training programme in Psychological First Aid for healthcare assistants to enhance ward culture can be implemented in different practice environments. Psychological First Aid is harmonious with nursing values and provides healthcare assistants with a relevant, useful and easily understood toolkit to apply in acute psychiatric settings. ABSTRACT Introduction Healthcare assistants working within adult acute inpatient psychiatric settings are untrained and unregistered, however, they can contribute to quality service if they receive some training. Psychological First Aid training has never been expended in these settings, so this study intends to fill this gap in the existing evidence with this category of healthcare personnel. Aim The aim of this study was to introduce and evaluate first aid training for healthcare assistants. Method A pre/post design was adopted to gather data using questionnaires and interviews. The groups of participants included 16 healthcare assistants trained in Psychological First Aid, a sample of service users and four ward managers. Results Post-training, (a) healthcare assistants and service users ranked the therapeutic milieu of the ward more favourably, (b) the self-efficacy of the healthcare assistants increased, and the number of 'untoward' incidents decreased, and (c) health care assistants' confidence in their skills was high. The ward manager interviews post-training revealed four themes: (a) staff utilization of new skills and renewed enthusiasm, (b) calmer atmosphere on the ward and staff togetherness, (c) confidence and reflection on practice and (d) therapeutic engagement. Discussion Training healthcare assistants is useful in improving staff confidence, therapeutic engagement with service users and ward culture in general. Implications for practice Techniques and skills learnt are relevant and useful to healthcare assistants and provide an easily understood toolkit that is harmonious with nursing values. If executed correctly, the training can enhance practice and care outcomes and the overall service user experience.
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Affiliation(s)
- Xenya Kantaris
- Centre for Public Engagement, Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Michelle Radcliffe
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Kevin Acott
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Peter Hughes
- Springfield Hospital, South West London and St George's Mental Health NHS Trust, London, UK
| | - Mary Chambers
- Centre for Public Engagement, Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
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Molin J, Hällgren Graneheim U, Ringnér A, Lindgren BM. Time Together as an arena for mental health nursing - staff experiences of introducing and participating in a nursing intervention in psychiatric inpatient care. Int J Ment Health Nurs 2020; 29:1192-1201. [PMID: 32618398 DOI: 10.1111/inm.12759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 11/30/2022]
Abstract
A lack of meaningful activities for people with mental ill health admitted to psychiatric inpatient care has been related to feelings of boredom and 'doing nothing' and is not in line with recovery-oriented care. Staff in psychiatric inpatient care report having limited time, ambiguous responsibilities, and insufficient support that counteracts their ideals of good nursing care and puts them at risk for high levels of stress and stress of conscience. Research highlights a need for interactions between patients and staff, but few nursing interventions with such a focus are described in the literature. This qualitative study aimed to illuminate staff experiences of introducing and participating in the nursing intervention Time Together, via qualitative content analysis of 17 individual semi-structured interviews with nursing staff in psychiatric inpatient care. The results show that these staff members experienced Time Together as an arena for mental health nursing. They prepared for the introduction of the intervention by laying a framework for success. Although the actual implementation led to them feeling burdened, they found that Time Together fostered relationships between patients and staff. For successful implementation, mental health nurses need to advocate the intervention. As Time Together constitutes an arena for mental health nursing, play and conversations based on reciprocity and equality can contribute to patients' recovery.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå
| | - Ulla Hällgren Graneheim
- Department of Nursing, Umeå University, Umeå.,Department of Health Sciences, University West, Trollhättan
| | - Anders Ringnér
- Department of Nursing, Umeå University, Umeå.,Department of Pediatrics, Umeå University Hospital, Umeå, Sweden
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Kingston MA, Greenwood S. Therapeutic relationships: Making space to practice in chaotic institutional environments. J Psychiatr Ment Health Nurs 2020; 27:689-698. [PMID: 32061012 DOI: 10.1111/jpm.12620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: While therapeutic relationships remain core to mental health nursing practice and patient recovery, increased managerialism and focus on risk has impacted nurses' therapeutic practice with patients. While there is anecdotal evidence of the impact there has been little research that demonstrates nurses experience of therapeutic engagement within the current context. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper reports on qualitative research that highlights nurses' strong attempts to create the space for therapeutic engagement with clients. This research provides evidence of the constraints on practice imposed by new managerial processes and suggests potential means of responding to them. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses are committed to working therapeutically but struggle to balance this against new managerial demands imposed across many OECD countries. The New Zealand government has recently reported on positive changes to mental health provision but does not suggest changes to the structures that impede good practice. This research indicates that structural change is essential to therapeutic engagement. ABSTRACT: Introduction Increasing managerialism, driven in part by notions of risk, compromises the mental health nurses therapeutic engagement with clients potentially impacting their recovery. While the importance of therapeutic relationships in mental health recovery is acknowledged, there is little evidence about how managerial processes encroach on this relationship. Aim To explore mental health nurses experience of engaging in therapeutic relationships within the current practice environment. Method This paper utilized an interpretive phenomenological approach, using interviews with mental health nurses. Results Managerial processes significantly impacted the practice of nurses who struggled to make space for therapeutic relationships within a chaotic milieu. The chaos is associated with increasing austerity within the health system; this has resulted in high staff turnover and staff shortages. Discussion Managerial demands dominate the practice field at the expense of therapeutic engagement between nurses and clients ultimately affecting client recovery. While nurses' integrity means they desperately try to make space for the therapeutic work, they often become burnt out and disheartened. Implications for practice While nurses are often blamed for failures in the system, the structures that disable nurses in their attempts to practice therapeutically require urgent responses, strengthening professional organizations and engaging in democratic partnerships with consumer groups.
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Affiliation(s)
- Mark A Kingston
- Mount Isa Mental Health Service, Mount Isa Hospital, Mount Isa, Queensland, Australia
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Gedik MM, Partlak Günüşen N, Çelik Ince S. Experiences of individuals with severe mental illnesses about physical health services: A qualitative study. Arch Psychiatr Nurs 2020; 34:237-243. [PMID: 32828355 DOI: 10.1016/j.apnu.2020.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 01/17/2023]
Abstract
AIM This study aims to understand the ideas and experiences of individuals' with severe mental illnesses regarding their access to physical health care services. METHODS In this study, a qualitative descriptive approach and content analysis were used. The sample comprised 14 individuals with severe mental illnesses in a psychiatric clinic. RESULTS Three themes emerged: i) a barrier theme related to the patient and the illness, health care professionals, and the health system; ii) a theme that comprised facilitators, for example, health care system facilitators and family support; and iii) an expectations theme, comprising patients' and health care services. CONCLUSION Individuals with severe mental illnesses must overcome many barriers while receiving physical health care, and nursing interventions are critical for increasing these patients' access to physical health services.
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Affiliation(s)
- Mukaddes Müberra Gedik
- Health Sciences Institute, Psychiatric Nursing Program, Dokuz Eylul University, 35340 Izmir, Turkey
| | | | - Sevecen Çelik Ince
- Psychiatric Nursing Department, Zonguldak Bülent Ecevit University, 67600 Zonguldak, Turkey.
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The perspectives of adults with suicidal ideation and behaviour regarding their interactions with nurses in mental health and emergency services: A systematic review. Int J Nurs Stud 2020; 110:103692. [PMID: 32682109 DOI: 10.1016/j.ijnurstu.2020.103692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND In contemporary healthcare, both community and inpatient mental health and emergency services are important help-seeking avenues for persons with suicidal ideation and behaviour. Regarding nursing practice in these services, there is a strong focus on assessing and managing suicide risk. Within this clinical context, the perspectives of persons with suicidal ideation and behaviour are often overlooked. OBJECTIVE To synthesise the literature examining the perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. DESIGN Review of qualitative and quantitative studies within a data-based convergent synthesis design. DATA SOURCES A systematic search of electronic databases (until January 2020) in PubMed, Web of Science, Embase, and PsycARTICLES. Additional articles were identified through hand searching reference lists. REVIEW METHODS The methodological quality was assessed using the Critical Appraisal Skills Programme for qualitative studies and the QualSyst tool for quantitative studies. Thematic analysis was used to identify the key themes and subthemes. RESULTS In total, 26 studies were selected for analysis. Most studies were qualitative and focused on inpatient mental health services. The studies reflected a spectrum of positive and negative perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. Three key themes were identified: being cared for and acknowledged as a unique individual, giving voice to myself in an atmosphere of connectedness, and encountering a nurturing space to address my suicidality. CONCLUSIONS This systematic review provides insights that can be used to encourage nurses to contribute to suicide prevention and treatment as part of an approach in which they care for, connect, and collaborate with persons experiencing suicidal ideation and behaviour as unique individuals.
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Seney V, Insana J, Alberto A, Hay J. Opioid training development: Cultivating nurse competence through education. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2020; 33:141-147. [PMID: 32506588 DOI: 10.1111/jcap.12281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
TOPIC Mental illness and substance use have become areas of concern throughout society. One of the greatest concerns affecting the United States is the increased prevalence of opioid use and accidental overdose. The opioid epidemic not only impacts adults, it also affects the nation's most vulnerable youth. Children and adolescents are at high risk for substance abuse due to multiple risk factors including negative life events, family dysfunction, and parental substance abuse. PURPOSE Pediatric nurses must be prepared to care for children and families who experience opioid addiction and overdose. The aim of the quality improvement project was to improve the skill set of nurses working with children and adolescents with substance use disorders (SUDs) in a pediatric psychiatric hospital. SOURCES USED Nurses attended a 2-hr workshop focused on nursing interventions related to SUD utilizing Orlando's Nursing Theory and Brief Intervention Therapy. Following the workshop, nurses reported their perceived competence in caring for individuals at risk for or identified with SUD increased. CONCLUSION The workshop appeared to be effective in increasing nurses' competence and confidence if working with youth and their families dealing with substance use issues.
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Affiliation(s)
- Valerie Seney
- College of Nursing and Health Sciences, University of Massachusetts Dartmouth, Dartmouth, Massachusetts, USA
| | - Jacqueline Insana
- Nursing Department, Bradley Hospital, East Providence, Rhode Island, USA
| | - Allison Alberto
- School Nurses Department, Dighton Elementary School, Dighton, Massachusetts, USA
| | - Jessica Hay
- College of Nursing and Health Sciences, University of Massachusetts Dartmouth, Dartmouth, Massachusetts, USA
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35
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Rodríguez Nogueira O, Botella-Rico J, Martínez González MC, Leal Clavel M, Morera-Balaguer J, Moreno-Poyato AR. Construction and content validation of a measurement tool to evaluate person-centered therapeutic relationships in physiotherapy services. PLoS One 2020; 15:e0228916. [PMID: 32119676 PMCID: PMC7051061 DOI: 10.1371/journal.pone.0228916] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This study sought to develop a tool for evaluating person-centered therapeutic relationships within physiotherapy services, and to examine the content validity of the same. METHODS A mixed qualitative and quantitative study was performed in three distinct phases: 1) the items were generated based on a literature review and a content analysis of focus groups of patients and physiotherapists; 2) an e-Delphi survey process was performed based on three rounds to select and refine the proposed questionnaire; 3) two rounds of cognitive interviews were conducted to evaluate the comprehension of items, the clarity of language and the appropriateness and relevance of content. RESULTS Thirty-one items were generated based on the seven domains identified after the analysis of four focus groups of physiotherapists and four patient focus groups. Nine experts participated in the e-Delphi survey. Fifty-five patients participated in the two rounds of the cognitive pre-tests. Participating patients were from public and private physical therapy services. Based on the participants' suggestions, four items were removed, and four were added, whereas 16 were reworded. CONCLUSIONS The final tool comprised 31 items divided into seven domains. The response format was based on a 5-point Likert frequency scale. The response options ranged from "strongly agree" to "strongly disagree".
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Affiliation(s)
- O. Rodríguez Nogueira
- University of León, Health Sciences School, Nursing and Physical Therapy Department, Ponferrada León, Spain
| | - J. Botella-Rico
- Universidad Cardenal Herrera-CEU, CEU Universities, Physical Therapy Department, Plaza Reyes Católicos, Elche, Alicante, Spain
| | - M. C. Martínez González
- Universidad Cardenal Herrera-CEU, CEU Universities, Medicine Department, Plaza Reyes Católicos, Elche, Alicante, Spain
| | - M. Leal Clavel
- Universidad Cardenal Herrera-CEU, CEU Universities, Nursing Department, Plaza Reyes Católicos, Elche, Alicante, Spain
| | - J Morera-Balaguer
- Universidad Cardenal Herrera-CEU, CEU Universities, Physical Therapy Department, Plaza Reyes Católicos, Elche, Alicante, Spain
- * E-mail:
| | - A. R. Moreno-Poyato
- Universitat de Barcelona, Escola d'Infermeria, Departament d'Infermeria de Salut Pública, Salut Mental i MaternoInfantil, Facultat de Medicina i Ciències de la Salut, Campus Bellvitge Pavelló de Govern, c/ Feixa Llarga, L'Hospitalet de Llobregat Barcelona, Spain
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Chambers M, McAndrew S, Nolan F, Thomas B, Watts P, Grant R, Kantaris X. The Therapeutic Engagement Questionnaire (TEQ): a service user-focused mental health nursing outcome metric. BMC Psychiatry 2019; 19:384. [PMID: 31796008 PMCID: PMC6892151 DOI: 10.1186/s12888-019-2326-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Therapeutic engagement (TE) has been described as the crux of mental health nursing but despite its perceived importance, to date, there is no measurement tool that captures it. As a result, there is no way of determining the contribution of mental health nursing interaction to service user recovery, in acute inpatient mental health settings or the wider care quality agenda. METHODS To develop and validate a TE measurement tool in partnership with Service Users (SUs) and Registered Mental Health Nurses (RMHNs). The TEQ was developed in 3 stages: 1) item generation (and pre-testing), 2) item reduction using Principal Component Analysis (PCA), and 3) validation across Mental Health Trusts in England. RESULTS The final questionnaire has two versions, (SU and RMHN version), each scored within two contexts (1-1 SU-RMHN interactions and overall environment and atmosphere of the ward) and includes 20 items with two sub-scales (care interactions and care delivery). Psychometric evaluation of the TEQ shows high inter-scale correlations (0.66-0.95 SU; 0.57-0.90 RMHN), sound sub-scale internal consistency (> 0.95), concurrent validity (> 0.60) and adequate score variability for both versions of the TEQ. In summary, the TEQ behaves well as a measurement tool. CONCLUSIONS The TEQ can determine the collaborative and empathic nature of RMHN-SU interactions, capture if SUs are treated with dignity and respect and recognise that the principles of the recovery approach are being respected. The TEQ can also provide robust monitoring of nursing activity, offer opportunity for transparency of activity, feed into healthcare organizations' key performance indicators and provide reassurance about the nature and quality of nurses' work.
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Affiliation(s)
- Mary Chambers
- Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, St George’s Campus, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 0RE UK
| | - Sue McAndrew
- School of Nursing, Midwifery, Social Work & Social Sciences, University of Salford, Salford, Greater Manchester, M6 6PU UK
| | - Fiona Nolan
- Camden and Islington NHS Foundation/University College London, Centre for Outcomes Research and Effectiveness, 1-19, Torrington Place, London, WC1E 7HB UK
| | - Ben Thomas
- Department of Health, Strategy and External Relations Directorate, 79 Whitehall, London, SW1A 2NS UK
| | - Paul Watts
- Somerset Partnership NHS Foundation Trust, Community Mental Health Nursing, 2nd Floor Mallard Court, Express Park, Bristol Road, Bristol, TA4 4RN UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, St George’s Campus, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 0RE UK
| | - Xenya Kantaris
- Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, St George’s Campus, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 0RE UK
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Roviralta-Vilella M, Moreno-Poyato AR, Rodríguez-Nogueira Ó, Duran-Jordà X, Roldán-Merino JF. Relationship between the nursing practice environment and the therapeutic relationship in acute mental health units: A cross-sectional study. Int J Ment Health Nurs 2019; 28:1338-1346. [PMID: 31609540 DOI: 10.1111/inm.12648] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 02/03/2023]
Abstract
The therapeutic relationship constitutes the central axis of mental health nursing. The clinical practice environment has been empirically related to the quality of care. However, the relationship between the two constructs is unknown in the setting of mental health units. We aimed to examine whether the practice environment and nurses' characteristics influence the therapeutic relationship in mental health units. Through a cross-sectional design, data were collected via an online form completed by nurses in 18 mental health units. Linear regression was used to examine the relationship between the clinical practice environment and the therapeutic relationship. Questionnaires were completed by 198 participants. The mean age was 33.8 (SD 9.1) years, 71.7% were women, and only 20.2% had a specialist qualification in mental health. The therapeutic relationship was better when there was a more favourable practice environment (B: 3.111; 95% CI: 1.46-4.75). The most influential environment-related factor was the nursing foundations for quality of care (B: 2.124; 95% CI: 0.17-4.07). The factors associated with a high-quality therapeutic relationship were a more favourable practice environment and the presence of more foundations for quality nursing care, coupled with higher academic attainment and longer nursing experience. Institutions should take into account the importance of the nursing practice environment in mental health units. Aspects related to the quality of nursing foundations, such as training, the use of nursing language and taxonomy, and the existence of a common nursing philosophy, are influential for a high-quality therapeutic relationship.
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Affiliation(s)
| | - Antonio R Moreno-Poyato
- Escola Superior d'Infermeria del Mar, Parc de Salut Mar, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Óscar Rodríguez-Nogueira
- Nursing and Physical Therapy Department, Health Sciences School, Universidad de León, Ponferrada León, Spain
| | | | - Juan F Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
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Hartley S, Raphael J, Lovell K, Berry K. Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. Int J Nurs Stud 2019; 102:103490. [PMID: 31862531 PMCID: PMC7026691 DOI: 10.1016/j.ijnurstu.2019.103490] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/30/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
Background Therapeutic alliance is a core part of the nursing role and key to the attainment of positive outcomes for people utilising mental health care services. However, these relationships are sometimes difficult to develop and sustain, and nursing staff would arguably benefit from evidence-based support to foster more positive relationships. Objectives We aimed to collate and critique papers reporting on interventions targeted at improving the nurse–patient therapeutic alliance in mental health care settings. Design Systematic literature review. Data sources The online databases of Excerpta Medica database (Embase), PsycINFO, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched, eligible full text paper references lists reviewed for additional works and a forward citation search conducted. Review methods Original journal articles in English language were included where they reported on interventions targeting the nurse–patient therapeutic relationship and included a measure of alliance. Data were extracted using a pre-determined extraction form and inter-rater reliability evaluations were conducted. Information pertaining to design, participants, interventions and findings was collated. The papers were subject to quality assessment. Results Relatively few eligible papers (n = 8) were identified, highlighting the limitations of the evidence base in this area. A range of interventions were tested, drawing on diverse theoretical and procedural underpinnings. Only half of the studies reported statistically significant results and were largely weak in methodological quality. Conclusions The evidence base for methods to support nursing staff to develop and maintain good therapeutic relationships is poor, despite this being a key aspect of the nursing role and a major contributor to positive outcomes for service users. We reflect on why this might be and make specific recommendations for the development of a stronger evidence base, with the hope that this paper serves as a catalyst for a renewed research agenda into interventions that support good therapeutic relationships that serve both staff and patients.
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Affiliation(s)
- Samantha Hartley
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M139PL, United Kingdom; Pennine Care NHS Foundation Trust, Ashton-under-Lyne OL6 7SR, United Kingdom.
| | - Jessica Raphael
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M139PL, United Kingdom
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M139PL, United Kingdom
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M139PL, United Kingdom
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Abstract
Traditional ideas of mental health nursing are challenged in contemporary healthcare settings by developments focussed on more partnership and collaboration with people using mental health services. Yet service users have reported limited involvement in planning their own care. The purpose of this research was to explore accounts from multiple perspectives about service user involvement in mental health nursing processes. Qualitative research interviews and focus groups with mental health nursing students (n = 18), qualified nurses (n = 17) and service users (n = 13) were conducted, audio-recorded and transcribed verbatim. Participants' transcribed talk was thematically analysed to examine understandings about service user involvement and mental health nursing. Nursing work was often described as task-focussed, with limited collaboration with service users in areas like care planning. Service user involvement was seldom mentioned by nurses themselves, indicating it did not form an important part of mental health nursing processes. Mental health nurses appear to be complicit in care processes that do not include involvement of service users and may discourage novice practitioners from attempts at engagement.
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Acford E, Davies J. Exploring therapeutic engagement with individuals with a diagnosis of personality disorder in acute psychiatric inpatient settings: A nursing team perspective. Int J Ment Health Nurs 2019; 28:1173-1182. [PMID: 31286646 DOI: 10.1111/inm.12629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 01/19/2023]
Abstract
Individuals with a diagnosis of personality disorder (PD) face negative attitudes and are often deemed harder to care for than individuals with other diagnoses. To improve care and engagement with services, it is essential to understand the ways general psychiatric nursing staff approach this client group. This research aims to examine the ways inpatient psychiatric nursing staff therapeutically engage with individuals with a diagnosis of PD. Focus groups were conducted with Registered Mental Health Nurses (n = 7) and Health Care Assistants (formally known as nursing assistants; n = 12) who care for individuals with a diagnosis of PD in a general psychiatric inpatient setting. A thematic analysis indicated six themes: the right frame of mind, knowing the service user, knowing when to engage, service user input, a unified approach, and structured admissions. The findings highlight what non-PD specialist inpatient nursing staff do in order to engage therapeutically with this group of service users and areas that require improvement. Supporting good practice could improve staff confidence when caring for this client group, lower stigma around the diagnosis, and promote a more positive experience of care for individuals with a diagnosis of PD who are using general inpatient mental health services.
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Affiliation(s)
- Emma Acford
- Department of Psychology, College of Human and Health Sciences, Vivian Tower, Swansea University, Swansea, UK
| | - Jason Davies
- Department of Psychology, College of Human and Health Sciences, Vivian Tower, Swansea University, Swansea, UK
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Greer B, Newbery K, Cella M, Wykes T. Predicting Inpatient Aggression in Forensic Services Using Remote Monitoring Technology: Qualitative Study of Staff Perspectives. J Med Internet Res 2019; 21:e15620. [PMID: 31538943 PMCID: PMC6754691 DOI: 10.2196/15620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/25/2023] Open
Abstract
Background Monitoring risk of imminent aggression in inpatient forensic mental health services could be supported by passive remote monitoring technology, but staff attitudes toward the relevance and likelihood of engagement with this technology are unknown. Objective This study aimed to explore staff views, specifically potential benefits and implementation barriers, on using this technology for monitoring risk of inpatient aggression. Methods We conducted semistructured focus groups with nurses in an inpatient forensic mental health service. We used thematic analysis with two independent raters to identify themes and subthemes related to staff attitudes toward passive remote monitoring. We subsequently checked with members to ensure the validity of the themes identified by the raters. Results From January to March 2019, a total of 25 nurses took part in five focus groups. We identified five main themes, one of which concerned the potential benefits that passive remote monitoring could provide for monitoring risk of aggression. Staff suggested it could provide an early warning of impending aggression and enable support to be provided earlier. The remaining themes concerned implementation barriers, including risks to the users’ physical and mental well-being; data security concerns and potential access by third parties; the negative impact of a constant stream of real-time data on staff workload; and design characteristics and user awareness of the benefits of passive remote monitoring. Conclusions Passive remote monitoring technology could support existing methods of monitoring inpatient aggression risk, but multiple barriers to implementation exist. Empirical research is required to investigate whether these potential benefits can be realized, and to identify ways of addressing these barriers to ensure acceptability and user engagement.
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Affiliation(s)
- Ben Greer
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katie Newbery
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Myklebust KK, Bjørkly S. The quality and quantity of staff-patient interactions as recorded by staff. A registry study of nursing documentation in two inpatient mental health wards. BMC Psychiatry 2019; 19:251. [PMID: 31412803 PMCID: PMC6694476 DOI: 10.1186/s12888-019-2236-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/08/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Therapeutic staff-patient interaction is fundamental in psychiatric care. It is recognized as a key to healing in and of itself, or a premise to enhance psychiatric treatment adherence. Still, little is known about how these interactions are recorded in nursing documentation. The purpose of the study was to assess the quality and quantity of staff-patient interactions as recorded in progress notes in nursing documentation. METHODS The study has an observational registry study design. A random sample of 3858 excerpts was selected from progress notes in 90 patient journals on an acute psychiatric unit and an open inpatient district psychiatric centre (DPC) in Norway. The Scale for the Evaluation of Staff-Patient Interactions in progress notes (SESPI) was used to assess the progress note excerpts. It is developed to assess the quality and quantity in excerpt descriptions of staff-patient interactions in terms of empathic attunement. Descriptive statistics were calculated for the total sample and for each ward separately. Ordinal and multinomial logistic regression were used to estimate control for shift type, staff education level, and type of hospital ward. RESULTS Only 7.6% of the total number of excerpts (N = 3858) described staff-patient interactions sufficiently to analyze them in terms of attunement. Compared to the DPC, the acute ward reported more staff-patient interactions. The evening excerpts reported more successful types of attunement than those from the night shifts. Education level did not contribute significantly to our models. CONCLUSION These findings present a unique insight into the quality and quantity of mental health nursing documentation regarding staff-patient interactions. Therapeutic interactions where staff tried to attune to the patients were rarely described. However, this is the first study measuring nursing documentation with the SESPI, and more studies are required to validate the scale and our findings. One potential clinical implication of this research is the development of a scale that personnel in psychiatric wards can have for evaluation of the quality of their reporting practice with emphasis on staff-patient interactions. By regular use this may help keeping up emphasis on emphatic attunement in milieu treatment contexts.
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Affiliation(s)
- Kjellaug K. Myklebust
- 0000 0004 0434 9525grid.411834.bFaculty of Health Sciences and Social Care, Molde University College, Box 2110, 6402 Molde, Norway
| | - Stål Bjørkly
- 0000 0004 0434 9525grid.411834.bFaculty of Health Sciences and Social Care, Molde University College, Box 2110, 6402 Molde, Norway ,0000 0004 0389 8485grid.55325.34Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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Vandewalle J, Beeckman D, Van Hecke A, Debyser B, Deproost E, Verhaeghe S. Contact and communication with patients experiencing suicidal ideation: A qualitative study of nurses’ perspectives. J Adv Nurs 2019; 75:2867-2877. [DOI: 10.1111/jan.14113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Joeri Vandewalle
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Research Foundation‐Flanders (FWO) Brussels Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- School of Health Sciences Örebro University Orebro Sweden
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Dublin Ireland
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Nursing Department Ghent University Hospital Ghent Belgium
| | - Bart Debyser
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Department of Nursing VIVES University College Roeselare Belgium
- Centre for Psychiatry and Psychotherapy Clinic St Joseph Psychiatric Hospital Pittem Belgium
| | - Eddy Deproost
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Centre for Psychiatry and Psychotherapy Clinic St Joseph Psychiatric Hospital Pittem Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- Department of Nursing VIVES University College Roeselare Belgium
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Fletcher J, Hamilton B, Kinner SA, Brophy L. Safewards Impact in Inpatient Mental Health Units in Victoria, Australia: Staff Perspectives. Front Psychiatry 2019; 10:462. [PMID: 31354541 PMCID: PMC6635577 DOI: 10.3389/fpsyt.2019.00462] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/12/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction: Mental health professionals working in acute inpatient mental health wards are involved in a complex interplay between an espoused commitment by government and organizational policy to be recovery-oriented and a persistent culture of risk management and tolerance of restrictive practices. This tension is overlain on their own professional drive to deliver person-centered care and the challenging environment of inpatient wards. Safewards is designed to reduce conflict and containment through the implementation of 10 interventions that serve to improve the relationship between staff and consumers. The aim of the current study was to understand the impact of Safewards from the perspectives of the staff. Methods: One hundred and three staff from 14 inpatient mental health wards completed a survey 12 months after the implementation of Safewards. Staff represented four service settings: adolescent, adult, and aged acute and secure extended care units. Results: Quantitative results from the survey indicate that staff believed there to be a reduction in physical and verbal aggression since the introduction of Safewards. Staff were more positive about being part of the ward and felt safer and more connected with consumers. Qualitative data highlight four key themes regarding the model and interventions: structured and relevant; conflict prevention and reducing restrictive practices; ward culture change; and promotes recovery principles. Discussion: This study found that from the perspective of staff, Safewards contributes to a reduction in conflict events and is an acceptable practice change intervention. Staff perspectives concur with those of consumers regarding an equalizing of staff consumer relationships and the promotion of more recovery-oriented care in acute inpatient mental health services.
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Affiliation(s)
- Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bridget Hamilton
- Centre for Psychiatric Nursing, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Stuart A. Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Heidelberg, VIC, Australia
- Mater Research Institute-UQ, University of Queensland, Brisbane, QLD, Australia
- Griffith Criminology Institute, Griffith University, Mt Gravatt, QLD, Australia
| | - Lisa Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
- Mind Australia Limited, Heidelberg, VIC, Australia
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Duxbury J, Baker J, Downe S, Jones F, Greenwood P, Thygesen H, McKeown M, Price O, Scholes A, Thomson G, Whittington R. Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme (‘REsTRAIN YOURSELF’). Int J Nurs Stud 2019; 95:40-48. [DOI: 10.1016/j.ijnurstu.2019.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 11/16/2022]
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Myklebust KK, Bjørkly S. Development and reliability testing of the Scale for the Evaluation of Staff-Patient Interactions in Progress Notes (SESPI): An assessment instrument of mental health nursing documentation. Nurs Open 2019; 6:790-798. [PMID: 31367401 PMCID: PMC6650683 DOI: 10.1002/nop2.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/30/2022] Open
Abstract
AIM To develop and test the reliability of the Scale for the Evaluation of Staff-Patient Interactions in Progress Notes (SESPI). Therapeutic nurse-patient interactions are fundamental in mental health nursing. However, little is known about how these interactions are recorded in nursing documentation and there is no instrument available for collecting this type of information for quantitative analysis. DESIGN Instrument development and reliability testing. METHODS The development of the SESPI was based on qualitative analyses of progress notes retrieved from patient records in two mental health services. A self psychological attunement perspective guided the analyses. SESPI was tested for internal consistency and inter-rater reliability after 22 nurses independently scored 10 progress notes. RESULTS Cronbach's alpha for the entire instrument was 0.977, indicating that the raters' scores had very high internal consistency. ICC was 0.770. The alpha and ICC values for each step were high, varying between 0.970 and 0.992.
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Affiliation(s)
| | - Stål Bjørkly
- Faculty of Health Sciences and Social CareMolde University CollegeMoldeNorway
- Centre for Forensic PsychiatryOslo University HospitalOsloNorway
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White MR, Stein-Parbury J, Orr F, Dawson A. Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia. Int J Ment Health Nurs 2019; 28:605-615. [PMID: 30556954 DOI: 10.1111/inm.12566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2018] [Indexed: 11/29/2022]
Abstract
Mental health consumers who hear voices frequently experience distress and express a desire to discuss their voice-hearing experience. Nurses do not regularly demonstrate a willingness to engage in such discussions. With the introduction of educational strategies that develop empathy and an understanding of voice-hearing experiences, it is anticipated that early career nurses will be able to translate such understanding into their professional nursing practice. To explore early career nurses' understanding of providing care to mental health consumers who hear voices, a qualitative exploratory descriptive study was conducted in which nine early career Registered Nurses were interviewed regarding their experiences of caring for people who hear voices. Thematic analysis was employed to analyse the data and generate themes. Participants reported difficulty in developing relationships with consumers who hear voices, due to a workplace culture that was focussed on risk and lacking professional support. Nurses need specific education to develop the skills necessary to respond to consumers who hear voices and engage in dialogue that assists consumers to relate to the voices in a meaningful way. However, for this to succeed in practice, changes need to be supported by addressing the cultural barriers, such as risk-focussed environments, that prevent nurses implementing best practice.
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Affiliation(s)
- Melanie R White
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fiona Orr
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Molin J, Graneheim UH, Ringnér A, Lindgren BM. Patients' experiences of taking part in Time Together - A nursing intervention in psychiatric inpatient care. Int J Ment Health Nurs 2019; 28:551-559. [PMID: 30501013 DOI: 10.1111/inm.12560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 02/01/2023]
Abstract
This qualitative study aimed to illuminate patients' experiences of taking part in the nursing intervention Time Together. The data were drawn from 11 individual semi-structured interviews with patients and analysed with qualitative content analysis using an inductive approach. The results show that patients taking part in Time Together felt confirmed and participated on equal terms; thus, they experienced being seen as humans among other humans. Time Together offered patients a break, and they felt strengthened, which contributed to their hopes for recovery. Furthermore, when Time Together was absent patients felt disconfirmed, which fostered feelings of distance from staff. The results support the effectiveness of the intervention, indicating that Time Together may be a tool to facilitate patients' personal recovery. However, the success of the intervention depends on staff compliance with the predetermined structure of the intervention in combination with engagement.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden
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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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Moreno‐Poyato AR, Delgado‐Hito P, Leyva‐Moral JM, Casanova‐Garrigós G, Montesó‐Curto P. Implementing evidence‐based practices on the therapeutic relationship in inpatient psychiatric care: A participatory action research. J Clin Nurs 2019; 28:1614-1622. [DOI: 10.1111/jocn.14759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/31/2018] [Accepted: 12/05/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Antonio R. Moreno‐Poyato
- Escola Superior d’Infermeria del Mar Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
| | - Pilar Delgado‐Hito
- School of Nursing, L'Hospitalet del Llobregat University of Barcelona Barcelona Spain
| | - Juan M. Leyva‐Moral
- Department of Nursing, Faculty of Medicine Universitat Autònoma de Barcelona Cerdanyola del Vallès, Barcelona Spain
| | - Georgina Casanova‐Garrigós
- Fundació Pere Mata Terres de l'Ebre Amposta, Tarragona Spain
- School of Nursing Universitat Rovira i Virgili Tarragona Catalunya Spain
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