Development and psychometric properties of the Therapeutic Relationship Assessment Scale-Nurse

Staff Observational Differences Between Depressive Disorders and Personality Disorders

INTRODUCTION

Distinguishing those with a personality disorder from those with major depressive disorder (MDD) can be challenging, but establishing the correct diagnosis can direct appropriate management.

AIM

To identify whether behavioural themes differ between those with personality disorders from those with MDD, and how those differences might relate to a clinical team's perception of diagnosis.

METHOD

An observational study identifying all inpatients presenting with symptoms of depression. At discharge, patients (n = 60) underwent a structured diagnostic interview and were grouped according to diagnosis. Qualitative data was analysed to determine whether behavioural themes differed between those with MDD and those with a personality disorder (with or without MDD).

RESULTS

Ward staff perceptions of diagnosis aligned in all cases of personality disorder, but they also attributed that diagnosis to 54% of patients who had only MDD. Several behavioural themes were evident in those with a personality disorder but not those with MDD. Many behavioural themes were observed in both groups, and it is likely these that drove differences in diagnostic views.

IMPLICATIONS FOR PRACTICE

Certain behavioural themes may be determinants of the perception of diagnosis held by inpatient staff, and when present in acute episodes in MDD, may risk diagnostic misattribution.

Development and Psychometric Properties of the Therapeutic Relationship Assessment Scale-Patient (TRAS-Patient)

The therapeutic relationship plays a crucial role in nursing care for people with mental illness. Adopting a systemic and person-centred approach that considers the individual experiences and needs of the person is paramount. However, no instruments were found in the literature designed to evaluate the nurse-patient therapeutic relationship from the perspective of a person with mental illness. This study aimed to develop and evaluate the psychometric properties of an instrument for assessing the quality of the nurse-patient therapeutic relationship from the patient's perspective. An e-Delphi study was conducted to develop the assessment tool, and a psychometric study was carried out to examine its psychometric properties. The sample comprised 240 adults with mental illness. Internal consistency was assessed using Cronbach's alpha and the Omega coefficient. The final structure of the assessment instrument included 24 items distributed across two factors, explaining 64.2% of the variance. Cronbach's alpha was 0.94, and the Omega coefficient was 0.96. The intraclass correlation coefficient was 0.84 (95% CI: 0.66-0.92). The therapeutic relationship assessment scale (TRAS-Patient) shows good psychometric properties. This is a relevant tool for assessing the quality of the nurse-patient therapeutic relationship from the patient's perspective, thus promoting a patient-centred approach and responding to the patient's needs. Mental health nurses can access a tool for evaluating the nurse-patient therapeutic relationship centred on disciplinary knowledge. This enables patient involvement in care, enhanced care and person-centred practice.

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

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.

Psychometric properties of the Turkish version of the therapeutic relationship assessment scale for nurses

Background

It is essential for nurses who care for individuals diagnosed with mental illness to establish a therapeutic relationship. There is no measurement tool available in Türkiye to assess the therapeutic relationship between patient and nurse.

Aim

The objective of this study is to perform a validity and reliability study of the Turkish version of a scale that enables the evaluation of the quality of the therapeutic relationship established between nurses and patients.

Methods

140 nurses were included in this study. The data were analysed using the exploratory and confirmatory analyses.

Results

The scale consists of 25 items and four sub-dimensions. In confirmatory factor analysis (CFA), all factor loads were >0.30. As a result of CFA, all fit indices were >0.85 and the root mean square approximation was <0.080. Cronbach alpha was 0.93 for the whole scale.

Conclusion

The Turkish version of the TRAS-Nurse scale and its original version were compatible with each other and gave similar results. This scale can be used to determine the therapeutic relationship of nurses who care for psychiatric patients in Türkiye and can be a useful measurement tool when evaluating the factors that may be effective in improving the therapeutic relationship.

Forensic mental health nurses' experiences of rebuilding the therapeutic relationship after an episode of physical restraint in forensic services in Ireland: A qualitative study

Few studies have explored how forensic mental health nurses can rebuild the therapeutic relationship following an episode of physical restraint in the acute forensic setting. In this study, we aimed to redress this gap in the literature by exploring with forensic mental health nurses the factors that enable or hinder the rebuilding of the therapeutic relationship following an episode of physical restraint. A qualitative study design was used to capture participants' experiences, views and perceptions of the therapeutic relationship following an episode of physical restraint in the acute forensic setting. Data were collected through individual interviews with forensic mental health nurses (n = 10) working in an acute forensic setting. Interviews were audio recorded, and transcribed verbatim and accounts were analysed using thematic analysis. Four themes were identified: 'Building a Recovery Focused Therapeutic Relationship'; 'Authoritarian Role'; 'Inevitable Imbalance'; 'Rebuilding the Therapeutic Relationship'; plus two sub-themes 'Facilitators to rebuilding' and 'Barriers to rebuilding'. Findings suggest that an inevitable imbalance exists in building a recovery-focused therapeutic relationship and at times, is hindered by the authoritarian role of the forensic mental health nurse. Recommendations for changes in clinical practice and in upcoming policies should incorporate a dedicated debrief room and protected time for staff to debrief effectively following restraint. Routine post-restraint-focused clinical supervision would also be beneficial to mental health nursing staff.