Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study

Tolosa-Merlos, Diana; Poyato, Antonio R. Moreno; González‐Palau, Francesca; Pérez‐Toribio, Alonso; Casanova‐Garrigós, Georgina; Hito, Pilar Delgado

doi:10.1111/jocn.16223

Cited by 20 publications

(15 citation statements)

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“…As in other nursing contexts, the findings point to the importance of awareness as a starting point for change (Bekkema et al, 2021 ; Cusack et al, 2018 ). This awareness allows the participants to improve their attitude and knowledge about the phenomenon of concern (Tolosa‐Merlos et al, 2021 ). This, together with the support received from the group, improves team relations, increasing motivation and satisfaction in the work environment (Afshar et al, 2020 ; Chen et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

A systematic review on the use of action research methods in mental health nursing care

Poyato

Subias-Miquel

Tolosa-Merlos

et al. 2022

Journal of Advanced Nursing

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Aims:To identify and synthesize evidence on the use of action research methods in mental health nursing care.Design: Systematic review.Data Sources: CINAHL, Web of Science, PubMed and Scopus databases were searched in January 2021.Review Methods: Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Two reviewers independently conducted the study selection, and quality appraisal using Joanna Briggs Institute Critical Appraisal Checklist for Q ualitative Research, data extraction and data analysis procedures.Results: Sixteen studies, half of which used participatory action research, were included in this review. Nurses, along with other stakeholders, were an active part of the action research process. The main topics of interest addressed were categorized as improving the adoption of a person-centred approach to care and improving decisionmaking procedures. The use of action research helped the participants to identify the meaning they attached to the topic of interest to be improved. Moreover, this method helped to identify needs and strategies for improving care. The studies concurred that the use of action research enabled participants to gain awareness, improve attitudes and acquire knowledge. In addition, it enabled participants to gain confidence and security in the group context, as key aspects of their empowerment. Conclusion:This review shows the usefulness of action research in any mental health nursing context, contributing to the improvement of care at both the individual and collective levels.Impact: This paper demonstrates the use of the action research method in the field of mental health nursing. Its use has improved the clinical practice of nurses as well as that of teams in both community and hospital settings, addressing issues of the person-centred approach to care and decision-making procedures.

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Section: Discussionmentioning

confidence: 99%

A systematic review on the use of action research methods in mental health nursing care

Poyato

Subias-Miquel

Tolosa-Merlos

et al. 2022

Journal of Advanced Nursing

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“…This was recorded by means of an observation script prepared by the same team, which included a description of the physical structure, the nursing teams and the nurse–patient relationship in each of the units (Tolosa‐Merlos et al, 2021). The reflective diaries of the participating nurses were the main data collection tool used in both PAR cycles (Tolosa‐Merlos et al, 2023). The objective was to individually monitor the expected process of change, based on the nurses' reflection and understanding of their clinical practice (Price, 2017).…”

Section: Methodsmentioning

confidence: 99%

“…The reflective diaries of the participating nurses were the main data collection tool used in both PAR cycles (Tolosa-Merlos et al, 2023).…”

Section: Data Collectionmentioning

confidence: 99%

“…Once these guidelines were designed, the first support group (SG1) was held at each unit where the coordinators informed the nurses how they should carry out the self‐observation of clinical practice. To this end, they were provided with a guidance document on how to carry out the observation and how to record the data using a reflexive diary (RD) (Tolosa‐Merlos et al, 2023).…”

Section: Cyclementioning

confidence: 99%

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The therapeutic relationship at the heart of nursing care: A participatory action research in acute mental health units

Tolosa-Merlos

Poyato

González‐Palau

et al. 2022

Journal of Clinical Nursing

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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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“…Establishing an appropriate therapeutic relationship is associated with better health outcomes for patients, improving the effectiveness of interventions in inpatient mental health care and enhancing the well-being and experience of patients as well as nurses [ 7 , 8 ]. For this reason, it is important to make nurses aware of the importance of maintaining a quality relationship with patients [ 9 ]. A relationship based on a solid bond that enables understanding of the patient’s needs and helps the relationship process to reach an agreement on the objectives and interventions to be carried out with the patient [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Transcultural adaptation and assessment of psychometric properties of the Spanish version of the Scale for the Evaluation of Staff-Patient Interactions in Progress Notes

et al. 2023

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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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Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 20 publications

References 59 publications

A systematic review on the use of action research methods in mental health nursing care

A systematic review on the use of action research methods in mental health nursing care

The therapeutic relationship at the heart of nursing care: A participatory action research in acute mental health units

Transcultural adaptation and assessment of psychometric properties of the Spanish version of the Scale for the Evaluation of Staff-Patient Interactions in Progress Notes

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