The Therapeutic Relationship in Inpatient Psychiatric Care: A Narrative Review of the Perspective of Nurses and Patients

Poyato, Antonio R. Moreno; Montesó‐Curto, Pilar; Delgado‐Hito, Pilar; Suárez-Pérez, Raquel; Aceña-Domínguez, Rosa; Carreras-Salvador, Regina; Leyva‐Moral, Juan M.; Lluch‐Canut, Teresa; Roldán‐Merino, Juan

doi:10.1016/j.apnu.2016.03.001

Cited by 74 publications

(116 citation statements)

References 52 publications

(105 reference statements)

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“…There are many reasons for examining staff–patient interactions from this perspective. First, patients from acute psychiatric units have demanded more empathic understanding from staff (Bee et al., ; Hopkins, Loeb, & Fick, ; Moreno‐Poyato et al., ). Stewart et al.…”

Section: Discussionmentioning

confidence: 99%

Development and reliability testing of the Scale for the Evaluation of Staff‐Patient Interactions in Progress Notes (SESPI): An assessment instrument of mental health nursing documentation

Myklebust

Bjørkly

2019

Nursing Open

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Aim To develop and test the reliability of the Scale for the Evaluation of Staff‐Patient Interactions in Progress Notes ( SESPI ). Therapeutic nurse–patient interactions are fundamental in mental health nursing. However, little is known about how these interactions are recorded in nursing documentation and there is no instrument available for collecting this type of information for quantitative analysis. Design Instrument development and reliability testing. Methods The development of the SESPI was based on qualitative analyses of progress notes retrieved from patient records in two mental health services. A self psychological attunement perspective guided the analyses. SESPI was tested for internal consistency and inter‐rater reliability after 22 nurses independently scored 10 progress notes. Results Cronbach's alpha for the entire instrument was 0.977, indicating that the raters' scores had very high internal consistency. ICC was 0.770. The alpha and ICC values for each step were high, varying between 0.970 and 0.992.

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Section: Discussionmentioning

confidence: 99%

Development and reliability testing of the Scale for the Evaluation of Staff‐Patient Interactions in Progress Notes (SESPI): An assessment instrument of mental health nursing documentation

Myklebust

Bjørkly

2019

Nursing Open

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“…165 In a recent narrative review of the perspectives of mental health nurses and service users on the therapeutic relationship in inpatient psychiatric care, 166 it was reported that this was perceived similarly by both nurses and patients. Both felt that the therapeutic relationship consisted of 'interpersonal interaction between the two, with one party wishing to help and the other wishing to be helped.…”

Section: Recovery Therapeutic Relationships and Care Planningmentioning

confidence: 99%

“…The relationship rests on trust and respect, establishing a framework in which nurses can care for patients in any number of ways based on various theoretical models, and using a variety of interventions'. 166 Service users described the ideal nurse for the therapeutic relationship as one who is 'respectful, empathetic, honest, friendly, and available'. 166 They wanted to be treated as equals and hoped to be empowered to manage their illness and their care.…”

Section: Recovery Therapeutic Relationships and Care Planningmentioning

confidence: 99%

“…166 Service users described the ideal nurse for the therapeutic relationship as one who is 'respectful, empathetic, honest, friendly, and available'. 166 They wanted to be treated as equals and hoped to be empowered to manage their illness and their care. At the heart of this is the need for mutual respect but service users reported often feeling that they were treated as 'problems to be solved, and they also feel that their opinions are not taken into account' and that nurses could be 'paternalistic and protectionist'.…”

Section: Recovery Therapeutic Relationships and Care Planningmentioning

confidence: 99%

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Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

Simpson

Coffey

Hannigan

et al. 2017

Health Serv Deliv Res

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BackgroundMental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing their care. Care planning processes should be personalised and focused on recovery, with goals that are specific to the individual and designed to maximise their achievements and social integration.Objective(s)We aimed to ascertain the views and experiences of service users, carers and staff to enable us to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving 19 mental health wards in six NHS sites in England and Wales included a metanarrative synthesis of policies and literature; a survey of service users (n = 301) and staff (n = 290); embedded case studies involving interviews with staff, service users and carers (n = 76); and a review of care plans (n = 51) and meetings (n = 12).ResultsNo global differences were found across the sites in the scores of the four questionnaires completed by service users. For staff, there was significant difference between sites in mean scores on recovery-orientation and therapeutic relationships. For service users, when recovery-orientated focus was high, the quality of care was viewed highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Across all sites, staff’s scores were significantly higher than service users’ scores on the scale to assess therapeutic relationships. Staff across the sites spoke of the importance of collaborative care planning. However, the staff, service user and carer interviews revealed gaps between shared aspirations and realities. Staff accounts of routine collaboration contrasted with service user accounts and care plan reviews. Definitions and understandings of recovery varied, as did views of the role of hospital care in promoting recovery. ‘Personalisation’ was not a familiar term, although there was recognition that care was often provided in an individualised way. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.ConclusionsOur results suggest that there is positive practice taking place within acute inpatient wards, with evidence of widespread commitment to safe, respectful, compassionate care. Although ideas of recovery were evident, there was some uncertainty about and discrepancy in the relevance of recovery ideals to inpatient care and the ability of people in acute distress to engage in recovery-focused approaches. Despite the fact that staff spoke of efforts to involve them, the majority of service users and carers did not feel that they had been genuinely involved, although they were aware of efforts to keep them safe.Future workFuture research should investigate approaches that increase contact time with service users and promote personalised, recovery-focused working; introduce shared decision-making in risk assessment and management; and improve service user experiences of care planning and review and the use of recovery-focused tools during inpatient care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…This is particularly striking in the inpatient arena where nurses are commonly depicted as too busy for engagement and patients as disappointed in the quality of staff interactions (Cutcliffe, Santos, Kozel, Taylor, & Lees, 2015;Moreno-Poyato et al, 2016). This is particularly striking in the inpatient arena where nurses are commonly depicted as too busy for engagement and patients as disappointed in the quality of staff interactions (Cutcliffe, Santos, Kozel, Taylor, & Lees, 2015;Moreno-Poyato et al, 2016).…”

mentioning

confidence: 99%

Underestimating or overestimating the power of therapeutic nurse–patient interactions

Delaney

2018

Child Adoles Psych Nursing

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The Therapeutic Relationship in Inpatient Psychiatric Care: A Narrative Review of the Perspective of Nurses and Patients

Abstract: 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.

Cited by 74 publications

References 52 publications

Development and reliability testing of the Scale for the Evaluation of Staff‐Patient Interactions in Progress Notes (SESPI): An assessment instrument of mental health nursing documentation

Development and reliability testing of the Scale for the Evaluation of Staff‐Patient Interactions in Progress Notes (SESPI): An assessment instrument of mental health nursing documentation

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

Underestimating or overestimating the power of therapeutic nurse–patient interactions

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