Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.

Accessible summary What is known on the subject? Empathy is one of the main attributes for establishing the nurse–patient therapeutic relationship. Davis (1983) identified four components on an empathic response: perspective taking, fantasy, empathetic concern and personal distress. It is essential to deepen our knowledge on the influence of the dimensions of empathy for the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship. What the paper adds to existing knowledge? A significant association exists between the dimensions of empathy and the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship between nurses and patients in mental health units. This study shows that the nurses' perspective on the patient's situation improves the bond, and therefore, this skill is especially useful in the first phase or orientation phase of the therapeutic relationship. However, for the second phase or working phase of the therapeutic relationship, a greater empathic concern among nurses, together with less personal distress, improves collaborative goal setting with patients. What are the implications for practice? It is important for mental health nurses to be aware of the importance of personal self‐awareness and the emotional management of empathy for the construction and development of therapeutic relationships of quality with patients. Knowledge of the relationship between each of the dimensions of empathy in the different stages of the therapeutic relationship is useful for the design of educational programmes, by including training on empathic strategies. Abstract IntroductionEmpathy and its dimensions (perspective taking, empathic concern, personal distress and fantasy) are essential for establishing the nurse–patient therapeutic relationship. It is important to know how this influences the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship. AimTo examine whether the dimensions of empathy influence the nurse–patient therapeutic relationship within mental health units. MethodA cross‐sectional design was used to collect data to measure the therapeutic alliance and the different dimensions of empathy via an online form completed by nurses working at 18 mental health units. Linear regressions were used in the analysis. ResultsA total of 198 participants completed the questionnaires. Nurses established a greater therapeutic alliance with patients when they were able to adopt their patient's perspective and experience concern. DiscussionNurses’ perspective taking is an influential factor impacting the nurse–patient bond in the orientation phase, whereas experiencing greater concern and decreased emotional distress were associated with improved therapeutic alliance in the working phase. Implications for practiceThese findings may help gain awareness among nurses of the importance of empathy in the nurse–patient relationships,...

Aims and objectives To produce changes in the therapeutic relationship between clinical practice nurses and patients in psychiatric units by implementing evidence‐based practices through participatory action research. Background The therapeutic relationship is the cornerstone of nursing care in psychiatric units. The literature suggests that theoretical knowledge alone is insufficient to establish the therapeutic relationship in practice. Therefore, strategies are needed to adequately establish the therapeutic relationship in psychiatric units. Design Participatory action research. Methods Participants consisted of nurses from two psychiatric units of a university hospital. Data were collected through focus groups and reflective diaries, which were analysed using the content analysis method. The COREQ guidelines were followed to ensure rigour. Results Nurses conceptualised the therapeutic relationship in their practice, identifying facilitating elements and limitations. They were able to compare their clinical practice with the recommendations of scientific evidence and constructed three evidence‐based proposals to improve the therapeutic relationship: (a) a customised nurse intervention space, (b) knowledge updating and (c) reflective groups, which they subsequently implemented and evaluated. Conclusions This study shows that nurses in psychiatric units can generate changes and improvements in the therapeutic relationship. The process of implementing evidence‐based practice enhanced participants’ awareness of their clinical practice and allowed them to make changes and improvements. Relevance to clinical practice The process confirmed that the implementation of evidence‐based practice through participatory methods, such as participatory action research, is valid and produces lasting changes. This study also reveals the need to rethink nurses’ functions and competencies in current psychiatric units.

The therapeutic relationship constitutes the central axis of mental health nursing. The clinical practice environment has been empirically related to the quality of care. However, the relationship between the two constructs is unknown in the setting of mental health units. We aimed to examine whether the practice environment and nurses’ characteristics influence the therapeutic relationship in mental health units. Through a cross‐sectional design, data were collected via an online form completed by nurses in 18 mental health units. Linear regression was used to examine the relationship between the clinical practice environment and the therapeutic relationship. Questionnaires were completed by 198 participants. The mean age was 33.8 (SD 9.1) years, 71.7% were women, and only 20.2% had a specialist qualification in mental health. The therapeutic relationship was better when there was a more favourable practice environment (B: 3.111; 95% CI: 1.46–4.75). The most influential environment‐related factor was the nursing foundations for quality of care (B: 2.124; 95% CI: 0.17–4.07). The factors associated with a high‐quality therapeutic relationship were a more favourable practice environment and the presence of more foundations for quality nursing care, coupled with higher academic attainment and longer nursing experience. Institutions should take into account the importance of the nursing practice environment in mental health units. Aspects related to the quality of nursing foundations, such as training, the use of nursing language and taxonomy, and the existence of a common nursing philosophy, are influential for a high‐quality therapeutic relationship.

The results confirm the possibility of measuring and improving the therapeutic relationship in psychiatric care.

BackgroundPsychiatric nurses are aware of the importance of the therapeutic relationship in psychiatric units. Nevertheless, a review of the scientific evidence indicates that theoretical knowledge alone is insufficient to establish an adequate therapeutic alliance. Therefore, strategies are required to promote changes to enhance the establishment of the working relationship. The aims of the study are to generate changes in how nurses establish the therapeutic relationship in acute psychiatric units, based on participative action research and to evaluate the effectiveness of the implementation of evidence through this method.Methods/DesignThe study will use a mixed method design. Qualitative methodology, through participative action research, will be employed to implement scientific evidence on the therapeutic relationship. A quasi-experimental, one-group, pre-test/post-test design will also be used to quantitatively measure the effectiveness of the implementation of the evidence. Participants will consist of nurses and patients from two psychiatric units in Barcelona. Nurses will be selected by theoretical sampling, and patients assigned to each nurses will be selected by consecutive sampling. Qualitative data will be gathered through discussion groups and field diaries. Quantitative data will be collected through the Working Alliance Inventory and the Interpersonal Reactivity Index. Qualitative data will be analysed through the technique of content analysis and quantitative data through descriptive and inferential statistics.DiscussionThis study will help to understand the process of change in a nursing team working in an inpatient psychiatric ward and will allow nurses to generate knowledge, identify difficulties, and establish strategies to implement change, as well as to assess whether the quality of the care they provide shows a qualitative improvement.

The practice environment is a key element that influences the quality of psychiatric–mental health nursing care; however, little is known about it. For the current study, to explore the evidence on environmental factors influencing nursing practice in psychiatric inpatient units, a scoping review of primary research published between 2009 and 2019 was performed. PubMed, Web of Science, Scopus, and CINAHL databases were searched. Eleven articles were included. Main findings were: (a) the biomedical approach limits the development of the nursing model; (b) lack of opportunities, representation, and recognition of nurses in the organization; (c) greater support from managers for a greater perception of nurses' competence and therapeutic commitment; and (d) the need for a feeling of belonging to the team and the perception of emotional exhaustion, workload, and administrative tasks. Although psychiatric nurses have a slightly positive view of their practice environment, certain factors limit quality of care. The current review points to the need for nurses to have greater organizational support and the importance of promoting effective teamwork. Implications for mental health services include the need for support and recognition by managers, as well as the existence of a nursing model within the units. [ Journal of Psychosocial Nursing and Mental Health Services, 59 (11), 33–40.]

Background and aim Western countries share an interest in evaluating and improving quality of care in the healthcare field. The aim was to develop and examine the psychometric properties and factor structure of the Spanish version of the Quality in Psychiatric Care–Inpatient (QPC-IP) instrument. Methods A psychometric study was conducted, translating the QPC-IPS instrument into Spanish, revision of the instrument by a panel of experts, and assessing its psychometric properties. 150 psychiatric inpatients completed the QPC-IP. Test-retest reliability was assessed by re-administering the questionnaire to 75 of these patients. Results After conducting pilot testing and a cognitive interview with 30 inpatients, it was determined that the QPC-IPS was adequate and could be self-administered. A Cronbach’s alpha of 0.94 was obtained for the full instrument and values of 0.52–0.89 for the various dimensions of the questionnaire. Test re test reliability: The Intraclass Correlation Coefficient for the full questionnaire was 0.69, while for the individual dimensions values between 0.62 and 0.74 were obtained, indicating acceptable temporal stability. Convergent validity was analysed using 10-point numerical satisfaction scale, giving a positive correlation (0.49). Confirmatory factor analysis revealed six factors consistent with the original scale. The Spanish version yielded adequate results in terms of validity and reliability. Conclusion Our findings provide evidence of the convergent validity, reliability, temporal stability and construct validity of the Spanish QPC-IP for measuring patient quality in psychiatric care in Spanish hospitals. Hospital administrators can use this tool to assess and identify areas for improvement to enhance quality in psychiatric care.