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

Abstract

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.

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

“…Thus, today's environments are chaotic, and nurses are committed to therapeutic work, yet they struggle to balance it with the new demands of management (Kingston & Greenwood, 2020). In addition, barriers such as lack of time, communication problems (Harris & Panozzo, 2019a), the physical structures of the units, the ratios or the cultures of care are external factors that limit the therapeutic relationship (Tolosa-Merlos et al, 2021). If nurses are unable to become aware of how they respond to time pressure, frustration or unclear care policies, there is a risk that these barriers will become entrenched, new ones will be created and the patient will perceive their actions as lacking care, presence or involvement (Harris & Panozzo, 2019b).…”

Understanding organisational and nursing behaviour changes associated with a therapeutic engagement improvement tool in acute mental health inpatient settings: A qualitative analysis

“…Their efforts included reflective sessions and workshops with registered mental health nurses, which generated ideas such as using more service user-centred language. Reflective practice has been shown to help change nursing attitudes in the context of therapeutic relationships ( Tolosa-Merlos et al, 2023a ). Additionally, in a few sites, ward managers also identified and championed changes.…”

Generating therapeutic spaces to improve the nurse-patient relationship in mental health inpatient units: The Reserved Therapeutic Space

“…Consequently, the burden of care may transform the nurse-pa�ent rela�onship into an aspect that is perceived as a luxury rather than an essen�al component of care. Evidence also points to environmental factors such as unit regula�ons and, above all, a lack of adequate space (Tolosa-Merlos et al, 2023).…”