Implementing recovery‐oriented interventions with staff in a psychiatric hospital: A mixed‐methods study

Abstract

Accessible Summary What is known on the subject? Recovery‐oriented care is a means of providing mental health treatment, focused on the patient's individual needs and active involvement in one's own care. However, this approach presents with challenges, particularly in psychiatric hospitals, which tend to be focused on symptom reduction. What does the paper adds to existing knowledge? This study examines the influence of three different recovery‐oriented training programmes/interventions (namely, illness management and recovery, peer support, and psychiatric advance directives) on the attitudes and practice of mental health staff (including nurses) in an inpatient setting, using a mixed‐methods methodology. We quantitatively assess the knowledge, attitudes and practices developed following recovery‐oriented training, compared to staff not trained in these interventions. We interviewed staff exposed to the different interventions to learn about their personal views and characterized the benefits and challenges they experienced. Mainly, the illness management and recovery training created a positive change in the work attitude and some work‐related practices of mental health staff and the increased presence of a person‐centred approach supporting patient autonomy. However, and contrary to expectations, there was no increase in practices that support personal goals or provide individually tailored services. Peer support had an experiential impact among mental health staff, initiating a more humane, positive approach to patients. Psychiatric advance directives were reported as more challenging to implement and with limited impact. What are the implications for practice? Recovery‐oriented trainings can be internalized and implemented by staff in medical model psychiatric settings. Despite recovery‐oriented training, challenges do occur—notably, they are hardest to implement in acute wards/patient states and by psychiatric nurses. Using multiple recovery‐oriented programmes/interventions can accelerate the momentum for change in traditional settings and promote positive practice. Ongoing comprehensive mental health staff training on recovery‐oriented care programmes is essential in order to sustain change over time. Training is not enough in itself—hospital administrations need to be actively involved in promoting recovery‐oriented policies. Abstract IntroductionDeveloping person‐centred recovery‐oriented care is a challenge in mental health systems, particularly psychiatric hospitals. AimTo assess the knowledge, attitudes and practices developed following recovery‐oriented training of nurses and other staff; to identify the benefits and challenges involved in the implementation of recovery‐oriented intervention in psychiatric wards. MethodA mixed‐methods study compared recovery knowledge, attitudes and practices of 37 mental health ward staff trained in recovery‐oriented intervention, against 35 staff not trained. Fifteen staff were interviewed about their experiences, and protocols were qualitatively anal...

Undergraduate nursing students’ stigma and recovery attitudes during mental health clinical placement: A pre/post‐test survey study

“…Their positive attitudes to recovery improved (P < 0.01) on exit from placement, with consistent understandings of personal recovery also reported in the qualitative data. While there are no prior reports on recovery attitudes of undergraduate nursing students, these findings are generally consistent with the wider literature in mental health, where clinicians' recovery attitudes have been positive prior to recovery education intervention in health services (total score mean = 3.8 to 4.2), and improved further following education (mean = 4.3-4.4) (Chiba et al 2016;Deane et al 2018;Hornik-Lurie et al 2018). There are no prior studies to compare students' written understandings of personal recovery with; however, our qualitative findings indicated that on placement exit, students developed mental health literacy in terms of using more appropriate language to describe personal recovery.…”

Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review

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‘There need to be a balance’: Mental health nurses’ perspectives on medication education in university and clinical practice

“…It has been noted that mental health nurses, despite acknowledging that mental distress is influenced by social/psychodynamic factors, are often constrained by the dominance of the medical model (Carlyle et al ). Hornik‐Lurie et al () reported that mental health nurses only interact with clients for brief periods, often occurs during medication rounds, while other care professionals – such as social workers – spend more time with service users. Hornik‐Lurie et al () also found that medication was perceived as central to the role of the nurse and that other models of care were regarded as ‘fluffy’.…”

“…Hornik‐Lurie et al () reported that mental health nurses only interact with clients for brief periods, often occurs during medication rounds, while other care professionals – such as social workers – spend more time with service users. Hornik‐Lurie et al () also found that medication was perceived as central to the role of the nurse and that other models of care were regarded as ‘fluffy’. Other studies have found that mental health nurses want to enhance their knowledge around physical health care (Bolton et al ), indicating that there may be a preference for a return to a more medical approach to care, but also that there are perceived deficits in this area.…”