Understanding barriers and facilitators to therapeutic relationships in state psychiatric hospitals

Keefe, Kristen; Cardemil, Esteban V.; Thompson, Matthew

doi:10.1002/jclp.22866

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…Nurses spending time building therapeutic relationships with consumers is an investment in consumers' recovery (Keefe, Cardemil, & Thompson, 2020), leading to improved clinical outcomes and consumer satisfaction (Hartley, Raphael, Lovell, & Berry, 2020). Research exploring consumers' perceptions of how therapeutic relationships with nurses enhance consumers' recovery is ongoing and will add to knowledge in this area (Chambers et al., 2019).…”

Section: Discussionmentioning

confidence: 99%

Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study

Cutler

Sim

Halcomb

et al. 2020

Journal of Clinical Nursing

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Aims and objectives: To explore how nurses influence the perceptions and experience of safety among consumers who have been admitted to an acute mental health unit. Background: Safety is a priority in acute mental health inpatient units, yet consumers do not always experience acute units as safe. Despite being primary stakeholders, little is known about what safety means for consumers in acute mental health units. Design: A qualitative descriptive study informed by naturalistic enquiry was conducted and is reported using the COREQ checklist. Methods: Fifteen consumers with experience of mental illness participated in semistructured individual interviews. These interviews explored what safety meant for them during their acute mental health unit admissions. Thematic analysis was used to analyse the data. Findings: The theme Influence of Nurses reflected that the way nurses engaged in acute mental health units had a profound impact on participants' sense of safety. Three sub-themes emerged as follows: (a) Availability: "It's about nurses spending time with you"; (b) Being responsive: "They would listen if you had a concern"; and (c) Caring: "Little acts of kindness." Conclusions: These findings challenge the dominant discourse around safety in mental health organisations, in which nursing practice is often oriented towards the management of risk, rather than the promotion of safety. The findings demonstrate that, through their clinical practice, nurses can enhance consumers' feelings of safety in the acute mental health unit. Relevance to clinical practice: Nurses play a key role in providing care within acute mental health units. It is vital that the behaviours and actions nurses can enact in order to promote feelings of safety among consumers in this setting are enabled at individual, unit and organisational levels.

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Section: Discussionmentioning

confidence: 99%

Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study

Cutler

Sim

Halcomb

et al. 2020

Journal of Clinical Nursing

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“…Short appointment times and lack of continuous care are common barriers to SMI patients receiving appropriate physical healthcare(8). Primrose-A addressed these barriers by providing longer regular appointments, which has previously been suggested to aid in building positive therapeutic relationships (32). Primary care services operate with limited resources and time, preventing patients receiving mental health and cardiovascular care in one appointment (33).…”

Section: Discussionmentioning

confidence: 99%

An integrated primary care service to reduce cardiovascular disease risk in people with severe mental illness: Primrose-A. Thematic analysis of its acceptability, feasibility, and implementation.

Shaw

Mifsud

Osborn

et al. 2023

Preprint

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Background Cardiovascular disease among patients with severe mental illness in England is a major preventable contributor to premature mortality. To address this, a nurse and peer-coach delivered service (Primrose-A) was implemented in three London general practices from 2019 (implementation continued during COVID-19). This study aimed to conduct interviews with patient and staff to determine the acceptability of, and experiences with, Primrose-A. Methods Eight patients who had received Primrose-A, and 3 nurses, 1 GP, and 1 peer-coach who had delivered Primrose-A in three London-based GP surgeries. Semi-structured audio-recorded interviews were conducted. Reflexive thematic analysis was used to identify themes from the transcribed interviews. Findings Overall, Primrose-A was viewed positively by patients and staff, with participants describing success in improving patients’ mental health, isolation, motivation, and physical health. Therapeutic relationships between staff and patients, and long regular appointments were important facilitators of patient engagement and acceptance of the intervention. Several barriers to the implementation of Primrose-A were identified, including training, administrative and communication issues, burden of time and resources, and COVID-19. Conclusions Intervention acceptability could be enhanced by providing longer-term continuity of care paired with more peer-coaching sessions to build positive relationships and facilitate sustained health behaviour change. Future implementation of Primrose-A or similar interventions should consider: 1) training sufficiency (covering physical and mental health, including addiction), 2) adequate staffing to deliver the intervention, 3) facilitation of clear communication pathways between staff, and 4) supporting administrative processes.

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“… 91 In people with SMI, regular contact is reported to provide a sense of continuity of care and an opportunity to facilitate a high‐quality therapeutic alliance with a healthcare professional. 92 This may be important for this group when engaging in any treatment option, not just those related to weight loss. 93 …”

Section: Discussionmentioning

confidence: 99%

Identifying effective characteristics of behavioral weight management interventions for people with serious mental illness: A systematic review with a qualitative comparative analysis

et al. 2021

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People with serious mental illness (SMI) have identified barriers to engaging in behavioral weight management interventions (BWMIs). We assessed whether BWMIs that addressed these barriers were more effective. First, we systematically reviewed qualitative literature and used a thematic analysis to identify the characteristics of BWMIs that promote engagement for adults with SMI. Second, we systematically reviewed randomized controlled trials (RCTs) of BWMIs in adults with SMI. Data on the characteristics that promoted engagement and weight outcomes were extracted. We then used a crisp-set qualitative comparative analysis (CsQCA) to identify which characteristics were associated with weight loss. For the qualitative review, 20 studies in 515 people with SMI were analyzed and nine characteristics were reported to promote engagement in BWMIs. For the systematic review, 34 RCTs testing 36 interventions in 4305 participants were included. The active interventions resulted in more weight loss (mean = À4.37 to +1 kg at 6 weeks to 18 months follow-up) compared with controls (À1.64 to +3.08 kg). The CsQCA showed BWMIs that offered regular contact, tools to support enactment, and tailored materials were associated with effectiveness. As these are all supplementary strategies, it may be possible to augment BWMIs available for the general population to engage people with SMI.

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Understanding barriers and facilitators to therapeutic relationships in state psychiatric hospitals

Cited by 6 publications

References 29 publications

Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study

Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study

An integrated primary care service to reduce cardiovascular disease risk in people with severe mental illness: Primrose-A. Thematic analysis of its acceptability, feasibility, and implementation.

Identifying effective characteristics of behavioral weight management interventions for people with serious mental illness: A systematic review with a qualitative comparative analysis

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