The therapeutic role of mental health nurses in psychiatric intensive care: A mixed‐methods investigation in an inner‐city mental health service

Abstract

Introduction Despite indications that therapeutic interaction is beneficial for patients and for nurses' job satisfaction in acute psychiatric care, research shows a small amount of nurses' time is spent on such activity. Aims This study investigated the actual and potential therapeutic role of the mental health nurse in psychiatric intensive care, where admission is due to violence or aggression. Methods In a mixed-methods concurrent triangulation design, clinician and patient activity was observed using a structured measurement tool, and qualitative interviews were conducted with four practitioners and six patients. Findings were generated using thematic analysis and descriptive statistics. Results Of the directly observed 234 clinician and 309 patient activities, 20.9% and 15.9%, respectively, were classified as therapeutic engagement. Interviews revealed that both clinicians and patients wanted more therapeutic contact, but whereas nurses wanted longer time to spend in individual sessions, patients preferred brief but more frequent interaction with nurses. Discussion This study shows disparity between actual and desirable levels of therapeutic interaction. Apart from organizational constraints, a fundamental problem is the lack of definition or established practices of therapeutic engagement. Implications for Practice There should be more emphasis on therapeutic engagement in nurse education, ward management and clinical supervision.

Time Together: A nursing intervention in psychiatric inpatient care: Feasibility and effects

“…The observational findings in this study, the enabling factors identified, point in the same direction and thereby add to these conclusions. McAllister and McCrae () state that therapeutic engagement cannot be enforced by rule. Our standpoint is that TT itself, with its emphasis on togetherness, both enables TT and brings out engagement in patients and staff – indeed a circular feedbacking process.…”

“…This design was chosen based on the conviction that quality interactions, with their potential benefits for both patients and staff, were needed for the systems as a whole and not only for certain individuals. This conviction is confirmed by McAllister and McCrae () who describe units as ecosystems where interactions, relationships, and the organization directly influence patient and staff engagement. Any change in one of these components has the potential to positively or negatively influence the level of engagement within the system.…”

A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice

“…With the acute focus on symptom reduction and with a very unwell consumer, attention to nurse–consumer therapeutic engagement may not be the immediate priority, particularly if workloads are high (McAllister & McCrae ; Pazargadi et al . ; Snell, Crowe & Jordan ).…”

“…With the acute focus on symptom reduction and with a very unwell consumer, attention to nurse-consumer therapeutic engagement may not be the immediate priority, particularly if workloads are high (McAllister & McCrae 2017;Pazargadi et al 2015;Snell, Crowe & Jordan 2009). With high workloads, professional mental health nursing practice has been described as crisis management that prevents nurses from fulfilling their own role expectations and from meeting the needs of the consumer (Hummelvoll & Seversinsson 2001;Cleary 2003Cleary , 2004Fourie et al 2005).…”

Understanding the nature of mental health nursing within CAMHS PICU: 1. Identifying nursing interventions that contribute to the recovery journey of young people

“…The body of research evidence in relation to adult PICU is much better established (Gwinner & Ward 2013). However, several studies have concluded that there remains no evidence regarding the efficacy of treatment approaches in PICU environments and there is an absence of clearly articulated principles and practices of nursing care in these environments (Bowers 2012;Gwinner & Ward 2013;McAllister & McCrae 2017).…”