Nursing staff-led behavioural group intervention in psychiatric in-patient care: Patient and staff experiences

Being Open to a Process of Learning: The Meaning of Joint Activities With Patients as Narrated by Nursing Staff in Psychiatric Inpatient Care

Forming therapeutic relationships is considered important within psychiatric and mental health nursing. One way of achieving this is through social interaction when engaging in joint activities. However, introducing and using nursing interventions based on joint activities in psychiatric inpatient care has proven challenging. Since staff motivation is important, researching the meaning of engaging in joint activities from the nursing professional's point of view can provide information that is relevant in this area. This study aims to illuminate the meaning of participating in joint activities with patients as narrated by nursing professionals in psychiatric inpatient care. Narrative interviews with 14 nursing professionals with experience from psychiatric inpatient care were conducted. Data were analysed using phenomenological hermeneutics and reported following the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results illuminate that engaging in joint activities means being open to a process of learning. Four themes contributed to this understanding: Struggling with uncertainty, discovering aspects of the other, unfolding paths to self-fulfilment and sharing personhood. Being open to a process of learning means being willing to face uncertainty when engaging in activities as well as being open to learning about oneself as well as the other. Through openness to this process of learning, a sharing of personhood can be achieved, where the nursing professional and the patient approach becoming two persons. Illuminating the meaning of joint activities from the nursing professionals' perspective may provide valuable insights related to introducing and using interventions focusing on joint activities.

Participation, Confirmation and Challenges: How Nursing Staff Experience the Daily Conversations Nursing Intervention in Psychiatric Inpatient Care

Mental health nursing focuses on patients' experiences, accessed through narratives developed in conversations with nursing staff. This study explored nursing staff's experiences of using the nursing intervention Daily Conversations in psychiatric inpatient care. We used a qualitative questionnaire and received 103 responses. Qualitative content analysis of the data resulted in three themes describing both advantages and obstacles with Daily Conversations: Promotes participation, Contributes to confirming relations and Challenges previous structures. To illuminate the significance of confirming acts and make nursing staff more comfortable, the intervention could benefit from being more flexible and allowing in its structure. For the intervention to succeed, nursing staff need training in conversation, thorough preparation, shared reflections on values in mental health nursing, and structures to maintain its implementation and use.

Staff experiences related to implementation of a recovery-oriented nursing programme in psychiatric inpatient care

Nursing in psychiatric inpatient care is peripheral to a dominating biomedical model of care. Efforts are being made to implement nursing models based on core values and theories for nursing, such as recovery-oriented practices. The aim of the study was to explore experiences of a recovery-oriented nursing programme (Steps Towards Recovery, STR) among nursing staff in psychiatric inpatient care and their ratings of stress (Maslach Burnout Inventory scores), quality of care (Quality of Psychiatric Care - Inpatient staff scores) and satisfaction with nursing care (Satisfaction with Nursing Care and Work scale scores), before and after the implementation-and compare with ratings from reference wards. A quasi-experimental and prospective, pretest-post-test design was used. Specific questions about the nursing programme were answered by staff at the intervention wards. Staff reported predominantly positive experiences of the nursing programme. At follow-up, higher ratings were reported in two dimensions of quality of care in the STR group, and lower ratings in one dimension of stress were evident in the reference group. No differences in ratings between the STR and reference wards were found. Staff members' positive experiences of STR and higher ratings regarding participation and secure environment after implementation suggest that STR is a well-accepted and promising nursing programme. It is important to implement and evaluate recovery-oriented interventions in psychiatric inpatient care, where a focus on symptom relief still prevails. The results indicate that there is potential for further exploration of STR in this context.

Nursing Practice Environment in Psychiatric Units: A Scoping Review

The practice environment is a key element that influences the quality of psychiatric-mental health nursing care; however, little is known about it. For the current study, to explore the evidence on environmental factors influencing nursing practice in psychiatric inpatient units, a scoping review of primary research published between 2009 and 2019 was performed. PubMed, Web of Science, Scopus, and CINAHL databases were searched. Eleven articles were included. Main findings were: (a) the biomedical approach limits the development of the nursing model; (b) lack of opportunities, representation, and recognition of nurses in the organization; (c) greater support from managers for a greater perception of nurses' competence and therapeutic commitment; and (d) the need for a feeling of belonging to the team and the perception of emotional exhaustion, workload, and administrative tasks. Although psychiatric nurses have a slightly positive view of their practice environment, certain factors limit quality of care. The current review points to the need for nurses to have greater organizational support and the importance of promoting effective teamwork. Implications for mental health services include the need for support and recognition by managers, as well as the existence of a nursing model within the units. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Healthcare professionals' perspectives on mental health service provision: a pilot focus group study in six European countries

Background

The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it.

Methods

Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners.

Results

The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative ‘chain of care’. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence.

Conclusions

The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people’s needs throughout their lives is an essential aspect of optimal care provision.

Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review

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.