The impact of a participatory intervention on the therapeutic relationship in mental health nurses: A multicentre study

Abstract

Aims: To evaluate the effects of an intervention aimed at improving the therapeutic relationship, using the participatory-action research method, in terms of improving the quality of the nurse-patient therapeutic relationship. Design: A single-group pre-post research design. Methods: Quantitative data were collected between January 2018 and June 2019 using an online form completed by nurses from 18 mental health units (N = 95). Data were collected before and after the intervention, which consisted of the design, implementation and evaluation of strategies to improve the therapeutic relationship through participatory-action research involving nurses. The Working Alliance Inventory-Short, Interpersonal Reactivity Index, Evidence-Based Practice Questionnaire and Practice Environment Scale of the Nursing Work Index were used. The Wilcoxon rank-sum test was used together with the Spearman's correlation coefficient. Two multiple linear regressions models were constructed.Results: Overall, the intervention improved the nurse-patient therapeutic relationship. In addition, the results revealed that, above all, the improvement in evidencebased practice along with a decrease in nurses' personal distress were the factors associated with the improvement of the nurse-patient therapeutic relationship. Conclusion:In mental health units, the therapeutic nurse-patient relationship can be improved through participatory interventions that include the implementation of evidence-based practices.Impact: This research examined the effects of an intervention aimed at improving the therapeutic relationship among nurses working at mental health units using participatory action research. The results show that the therapeutic relationship can be improved through participatory methods where evidence-based practice is implemented and enhanced among nurses, since a better therapeutic relationship along with reduced staff discomfort are determining factors that influence the quality of the therapeutic relationship. Institutional managers should promote participatory group interventions to enable nurses to develop evidence-based aspects of the therapeutic relationship together with expanding personal aspects and self-knowledge.

Impact of the ‘reserved therapeutic space’ nursing intervention on patient health outcomes: An intervention study in acute mental health units

“…In this sense, other important environmental factors that have traditionally been identified as barriers to establishing quality relationships in the units are the lack of time on behalf of the nurses, either due to administrative tasks or due to a low nurse–patient ratio (Kingston & Greenwood, 2020 ). In addition, nurses consider the lack of leadership and support from supervisors to be an important limiting factor (Moreno‐Poyato, Rodríguez‐Nogueira, et al, 2021 ; Moreno‐Poyato, Roviralta‐Vilella, et al, 2021 ). Moreover, it should be considered that many units maintain outdated regulations and have structures that do not favour spaces for the relationship with the public (Adler, 2020 ; Tolosa‐Merlos et al, 2021 ).…”

“…In recent years, different strategies have been implemented to improve the nurse–patient therapeutic relationship in mental health hospitalization units (McAllister et al, 2021 ; Molin et al, 2018 ; Moreno‐Poyato et al, 2018 ; Moreno‐Poyato, Rodríguez‐Nogueira, et al, 2021 ; Moreno‐Poyato, Roviralta‐Vilella, et al, 2021 ). Spaces for joint activities have been designed and implemented in the unit in a group setting to facilitate therapeutic engagement between nurses and patients (Molin et al, 2018 ).…”

“…Consequently, as a result of a participatory project with nurses from two mental health units, a nursing intervention was designed, implemented and evaluated, to enhance individualized encounters with their patients, obtaining excellent quantitative and qualitative results in the improvement of the therapeutic relationship (Moreno‐Poyato et al, 2018 , 2019 ). Subsequently, 198 nurses from 18 mental health units participated in a new study in which they agreed on, implemented and evaluated a very similar intervention, which they called ‘reserved therapeutic space’ (RTS), emerging as part of one of the strategies to improve the therapeutic relationship of nurses with their patients (Moreno‐Poyato, Rodríguez‐Nogueira, et al, 2021 ; Moreno‐Poyato, Roviralta‐Vilella, et al, 2021 ). However, given the recommendations to design and validate the intervention with those people who will later form a relevant part of the intervention, a new study was carried out.…”