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.

Aims: To explore nurses' experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective.Design: Qualitative meta-synthesis. Data sources:Comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019. Review methods:The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method.Results: Seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: 'Understanding suicidal behaviour as a consequence of suffering', 'Nurses' personal distress in suicide care', 'The presence of the nurse as the axis of suicide care' and, 'Improving nurses' relational competences for a better therapeutic environment'. Conclusion:Further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care. Impact:This review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour.

Aims To examine the relationship between the dimensions of evidence‐based practice and the therapeutic relationship and to predict the quality of the therapeutic relationship from these dimensions among nurses working in mental health units. Design A cross‐sectional design. Methods Data were collected between February–April 2018 via an online form completed by nurses working at 18 mental health units. Multiple linear regressions were used to examine the relationship between the dimensions of evidence‐based practice and therapeutic relationship. Questionnaires were completed by 198 nurses. Results Higher levels of evidence‐based practice were a significant predictor of a higher‐quality therapeutic relationship (β: 2.276; 95% CI: 1.30–3.25). The evidence‐based practice factor which most influenced an improved therapeutic relationship was the nurses’ attitude (β: 2.047; 95% CI: 0.88–3.21). The therapeutic relationship dimension which was most conditioned by evidence‐based practice dimensions was agreement on tasks, which was most favourable with a better attitude (β: 0.625; 95% CI: 0.09–1.16) and greater knowledge and skills for evidence‐based practice (β: 0.500; 95% CI: 0.08–0.93). Conclusion In mental health settings, the therapeutic nurse–patient relationship is positively enhanced by evidenced‐based practice and the nurse's level of experience, with a great influence on shared decision‐making. Impact This research sought to examine the relationship between the evidence‐based practice and the therapeutic relationship in mental health nursing. This study demonstrates that an improved attitude and knowledge of evidence‐based practices of mental health nurses increases shared decision‐making with patients, which is a basic requirement for person‐centred care. Because the therapeutic relationship is considered the backbone of nursing practice in mental health units, this research will have an impact on both mental health nurses and mental health unit managers.

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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.