The Effects of a Participatory Intervention in Mental Health Units on Nurses’ Perceptions of the Practice Environment: A Mixed Methods Study

Abstract

BACKGROUND: The practice environment influences the quality of care and the nursing outcomes achieved in their workplaces. OBJECTIVE: To examine the perception of the clinical practice environment among nurses working in mental health units in the context of their participation in an action research study aimed at improving the nurse–patient relationship. METHOD: An explanatory sequential mixed methods study was designed. The data were collected in three phases in 18 mental health units ( n = 95 nurses). Quantitative data were collected through the Practice Environment Scale of the Nursing Work Index, and qualitative data were collected through reflective diaries and focus groups in the context of participatory action research. RESULTS: The nurses’ assessment of their practice environment shifted from positive to negative. Nurse manager leadership was the aspect that worsened the most. In addition, the perception of their participation in the affairs of the center and nursing foundations for quality of care decreased. The nurses considered it essential to be able to influence decision-making bodies and that the institution should promote a model of care that upholds the therapeutic relationship in actual clinical practice. CONCLUSIONS: Nurses perceived that they should be involved in organizational decisions and required more presence and understanding from managers. Furthermore, nurses stated that institutions should promote nursing foundations for quality of care. This study contributes to understanding how nurses in mental health units perceive their work environment and how it affects the improvement of the nurse–patient relationship in clinical practice.

Hemşirelerin Hemşirelik İlişkisine Yönelik Bakış Açıları: Deneyimlerin Nitel Çalışması

“…The nurses stated that factors such as education level, age, and the attitude of patient relatives affect the nursing relationship. When the patient's relatives fail to contact and communicate with healthcare personnel, this creates a negative interaction between the nurse, the patient, and the patient's relatives, which in turn creates an obstacle between the nurse and the patient, adversely affecting nursing practices (27). The fact that nurses define patient relatives as one of the factors affecting the nursing relationship in the findings of our study suggests that they can consider the patients along with those near to them.…”