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Chambers M, McAndrew S, Nolan F, Thomas B, Watts P, Kantaris X. Measuring therapeutic engagement in acute mental health inpatient environments: the perspectives of service users and mental health nurses. BMC Psychiatry 2021; 21:547. [PMID: 34749690 PMCID: PMC8576955 DOI: 10.1186/s12888-021-03561-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A key component of caring for service users (SUs) in acute mental health inpatient environments is Therapeutic Engagement (TE). To that end, the Therapeutic Engagement Questionnaire (TEQ) was developed and validated. The TEQ measures TE between SUs and registered mental health nurses (RMHNs) from the perspective of both parties and can quantify and recognise how nurses engage with SUs and monitor this activity as well as its enhancement of SU care and recovery. The aim of this study was to explore the views of SUs and RMHNs in relation to the TEQ and how it could be adopted into clinical practice within an acute inpatient environment. METHODS As part of the validation stage of the development of the TEQ, the views of 628 SUs and 543 RMHNs were collected using a qualitative approach by way of free text at the end of the questionnaire. Two questions required free text response: - 'what do you think of the TEQ?', and 'how can it be utilised?' RESULTS Following thematic analysis, it was found that both sets of participants stated that such a tool could be utilised to improve the service, could help nurses with reflective practice, be utilised as part of clinical supervision and to aid nurses' professional development. The nurse participants also stated that such a tool would help track SU participation and enablement in their care. Furthermore, the nurses noted that the tool would help to reinforce the core 'caring' value of nursing and the overall goal of recovery. The SUs added that the TEQ would recognise the work of mental health nurses and provide them with a clear opportunity to express their views in relation to nursing staff. CONCLUSIONS Therapeutic engagement (TE) has been identified as part of the repertoire of mental health nursing and both groups of participants identified how a tool to assess this construct may be utilised in day-to-day clinical practice to the benefit of each group.
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Affiliation(s)
- M. Chambers
- grid.4464.20000 0001 2161 2573Kingston University and St George’s, University of London, Faculty of Health, Social Care and Education, St George’s Campus, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 0RE UK
| | - S. McAndrew
- grid.8752.80000 0004 0460 5971University of Salford, School of Health and Society, Salford, Greater Manchester, M6 6PU UK
| | - F. Nolan
- grid.5115.00000 0001 2299 5510Anglia Ruskin University, Faculty of Health, Education, Medicine and Social Care, Bishop Hall Lane, Chelmsford, Essex CM1 1SQ UK
| | - B. Thomas
- London Southbank University, 103 Borough Road, London, SE1 0AA UK
| | - P. Watts
- Formerly of Somerset Partnership NHS Foundation Trust, Community Mental Health Nursing, 2nd Floor Mallard Court, Express Park, Bristol Road, Bristol, TA4 4RN UK
| | - X. Kantaris
- grid.4464.20000 0001 2161 2573Kingston University and St George’s, University of London, Faculty of Health, Social Care and Education, St George’s Campus, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 0RE UK
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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: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Delaney KR, Shattell M, Johnson ME. Capturing the Interpersonal Process of Psychiatric Nurses: A Model for Engagement. Arch Psychiatr Nurs 2017; 31:634-640. [PMID: 29179832 DOI: 10.1016/j.apnu.2017.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 12/30/2022]
Abstract
Staff members' engagement with patients is a critical element of inpatient psychiatric care, essential to safety, the hospitalization experience and the development of a culture of care. Currently broad concerns exist around the amount of time inpatient psychiatric nurses expend in patient engagement and the quality of these interactions. In this paper we present a model of engagement that clarifies necessary skills to support the engagement process. The model is based on Peplau's theory of interpersonal relations, patients' ideas on healing elements of psychiatric hospitalization and research on inpatient therapeutic relationships. We are currently using this model for a web-based teaching/learning course to cultivate interpersonal engagement, and to explicate how through operationalizing their inpatient role, nurses support patients in the development of their mental health and well-being.
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Affiliation(s)
- Kathleen R Delaney
- Department of Community, Systems and Mental Health Nursing, Rush University, College of Nursing, 600 S. Paulina St, Chicago, IL 60612, United States.
| | - Mona Shattell
- Department of Community, Systems and Mental Health Nursing, Rush University, College of Nursing, 600 S. Paulina St, Chicago, IL 60612, United States.
| | - Mary E Johnson
- Department of Community, Systems and Mental Health Nursing, Rush University, College of Nursing, 600 S. Paulina St, Chicago, IL 60612, United States.
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Bland MD, Birkenmeier RL, Barco P, Lenard E, Lang CE, Lenze EJ. Enhanced Medical Rehabilitation: Effectiveness of a clinical training model. NeuroRehabilitation 2017; 39:481-498. [PMID: 27689608 DOI: 10.3233/nre-161380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patient engagement in medical rehabilitation can be greatly influenced by their provider during therapy sessions. We developed Enhanced Medical Rehabilitation (EMR), a set of provider skills grounded in theories of behavior change. EMR utilizes 18 motivational techniques focused on providing frequent feedback to patients on their effort and progress and linking these to patient goals. OBJECTIVE To examine the effectiveness of a clinical training protocol for clinicians to do EMR, as measured by clinician adherence. METHODS A physical therapist, physical therapist assistant, occupational therapist, and certified occupational therapist assistant were trained in EMR. Training consisted of five formal training sessions and individual and group coaching. Adherence to EMR techniques was measured during two phases: Pre-Training and Maintenance, with an a priori target of 90% adherence by clinicians to each EMR technique. RESULTS With training and coaching, clinician adherence per therapeutic activity significantly improved in 13 out of 18 items (p < 0.05). The target of 90% adherence was not achieved for many items. CONCLUSIONS Our training and coaching program successfully trained clinicians to promote patient engagement during therapeutic service delivery, although not typically to 90% or greater adherence. Ongoing coaching efforts were necessary to increase adherence.
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Affiliation(s)
- Marghuretta D Bland
- Program in Physical Therapy, Washington University, Saint Louis, MO, USA.,Department of Neurology, Washington University, Saint Louis, MO, USA.,Program in Occupational Therapy, Washington University, Saint Louis, MO, USA
| | | | - Peggy Barco
- Program in Occupational Therapy, Washington University, Saint Louis, MO, USA
| | - Emily Lenard
- Department of Psychiatry, Healthy Mind Laboratory, Washington University, Saint Louis, MO, USA
| | - Catherine E Lang
- Program in Physical Therapy, Washington University, Saint Louis, MO, USA.,Department of Neurology, Washington University, Saint Louis, MO, USA.,Program in Occupational Therapy, Washington University, Saint Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, Healthy Mind Laboratory, Washington University, Saint Louis, MO, USA
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Nolan FM, Fox C, Cheston R, Turner D, Clark A, Dodd E, Khoo ME, Gray R. A feasibility study comparing UK older adult mental health inpatient wards which use protected engagement time with other wards which do not: study protocol. Pilot Feasibility Stud 2016; 2:7. [PMID: 27965827 PMCID: PMC5153860 DOI: 10.1186/s40814-016-0049-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/22/2016] [Indexed: 01/15/2023] Open
Abstract
Background Protected engagement time (PET) is a concept of managing staff time on mental health inpatient wards with the aim of increasing staff and patient interaction. Despite apparent widespread use of PET, there remains a dearth of evidence as to how it is implemented and whether it carries benefits for staff or patients. This protocol describes a study which is being carried out on mental health wards caring for older adults (aged over 65) in England. The study shares a large proportion of the procedures, measures and study team membership of a recently completed investigation of the impact of PET in adult acute mental health wards. The study aims to identify prevalence and components of PET to construct a model for the intervention, in addition to testing the feasibility of the measures and procedures in preparation for a randomised trial. Methods/design The study comprises four modules and uses a mixed methods approach. Module 1 involves mapping all inpatient wards in England which provide care for older adults, including those with dementia, ascertaining how many of these provide PET and in what way. Module 2 uses a prospective cohort method to compare five older adult mental health wards that use PET with five that do not across three National Health Service (NHS) Foundation Trust sites. The comparison comprises questionnaires, observation tools and routinely collected clinical service data and combines validated measures with questions developed specifically for the study. Module 3 entails an in-depth case study evaluation of three of the participating PET wards (one from each NHS Trust site) using semi-structured interviews with patients, carers and staff. Module 4 describes the development of a model and fidelity scale for PET using the information derived from the other modules with a working group of patients, carers and staff. Discussion This is a feasibility study to test the application of the measures and methods in inpatient wards for older adults and develop a draft model for the intervention. The next stage will prospectively involve testing of the model and fidelity scale in randomised conditions to provide evidence for the effectiveness of PET as an intervention. Trial registration ISRCTN31919196
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Affiliation(s)
- Fiona M Nolan
- Centre for Outcomes Research and Effectiveness (CORE), University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Chris Fox
- Department of Clinical Psychology, Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Earlham Road, Norwich, NR4 7TJ UK
| | - Richard Cheston
- Health and Social Sciences, University of the West of England, Glenside Campus, Bristol, BS16 1DD UK
| | - David Turner
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Earlham Road, Norwich, NR4 7TJ UK
| | - Allan Clark
- Department of Population Health and Primary Care, Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Earlham Road, Norwich, NR4 7TJ UK
| | - Emily Dodd
- University of the West of England, Room 2G05, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD UK
| | - Mary-Ellen Khoo
- Camden and Islington NHS Foundation Trust, 1st Floor East Wing, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE UK
| | - Richard Gray
- Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Zaitsoff S, Yiu A, Pullmer R, Geller J, Menna R. Therapeutic engagement: Perspectives from adolescents with eating disorders. Psychiatry Res 2015; 230:597-603. [PMID: 26493323 DOI: 10.1016/j.psychres.2015.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 09/16/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
This study aimed to identify factors that adolescents with eating disorders (ED) consider important for therapeutic engagement, and to examine similarities and differences in the number of identified factors considered important for therapeutic engagement based on diagnostic status and readiness and motivation to change dietary restriction behaviors. Treatment seeking adolescent females (n=34, Mage=16.33, SD=1.34) with an ED were prompted to generate responses to 4 constructs related to therapeutic engagement: (1) Trust, (2) Agreement on therapeutic goals, (3) Confidence in Ability to Change and (4) Feelings of Inclusion in therapeutic decisions. A coding scheme for each construct was developed using a random sample of responses, and each category within a construct was rated as present or absent for each participant. Frequencies and percentages of participants who reported each category within each construct are reported. Additionally, findings indicate that the top two out of three categories reported within each construct were the same between participants with AN versus EDNOS, and between participants high and low in readiness and motivation to change dietary restriction behaviors. This study is a first step in identifying aspects of therapeutic engagement that are important to adolescents with ED, which may differ from adults.
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Affiliation(s)
- Shannon Zaitsoff
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Angelina Yiu
- Department of Psychology, Temple University, Philadelphia, PA, United States.
| | - Rachelle Pullmer
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Josie Geller
- Eating Disorders Program, Saint Paul's Hospital, Vancouver, British Columbia, Canada; Department of Psychiatry, University of British Columbia, British Columbia, Canada
| | - Rosanne Menna
- Department of Psychology, University of Windsor, Ontario, Canada
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Stone TE, Levett-Jones T. A comparison of three types of stimulus material in undergraduate mental health nursing education. Nurse Educ Today 2014; 34:586-591. [PMID: 23948086 DOI: 10.1016/j.nedt.2013.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 07/09/2013] [Accepted: 07/17/2013] [Indexed: 06/02/2023]
Abstract
AIMS AND OBJECTIVES The paper discusses an innovative educational approach that compared the use of different textual forms as stimulus materials in the teaching of an introductory mental health course. BACKGROUND Practitioners in many disciplines, including nursing, appreciate the value of narratives in making sense of experiences, challenging assumptions and enhancing learning: they enable exploration of reality from different perspectives and create an emotional resonance. Narratives help nursing students to uncover embedded meanings, values and beliefs; they can include written texts, illustrated texts or picture books. PARTICIPANTS 180 students enrolled in an elective undergraduate nursing course. METHOD This project afforded students the choice of critically analysing (a) a chapter from one of two autobiographies, (b) an illustrated text, or (c) an illustration from a picture book. Each text was a narrative account from a personal or carer's perspective of the experience of mental illness. Their written submissions were then analysed by means of a qualitative descriptive approach. RESULTS In analysis of the autobiographies students tended to paraphrase the authors' words and summarise their experiences. Those choosing the illustrated text were able to link the images and text, and provide a deeper and more insightful level of interpretation, albeit influenced by the author's personal account and expressed emotions; however, those analysing a picture book illustration demonstrated a surprising level of critical and creative thinking, and their interpretations were empathetic, insightful and thoughtful. CONCLUSION The use of picture books, although not a common approach in nursing education, appears to engage students, challenge them to think more deeply, and stimulate their imagination.
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Affiliation(s)
- Teresa E Stone
- Yamaguchi University Faculty of Health Sciences, 1-1-1 Minami-Kogushi, UBE, Yamaguchi 755-8505 Japan.
| | - Tracy Levett-Jones
- The University of Newcastle, Faculty of Health, School of Nursing and Midwifery, Richardson Wing, University Drive, Callaghan, NSW 2308, Australia.
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