Therapeutic relationships, risk, and mental health practice

Felton, Anne; Repper, Julie; Avis, Mark

doi:10.1111/inm.12430

Cited by 40 publications

(76 citation statements)

References 42 publications

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“…Therefore, there is a need to establish optimal conditions that guarantee protected spaces encouraging high-quality interaction between nurses and patients (Gerace et al 2018;Molin et al 2018. One of the factors most frequently cited in the literature as hampering the establishment of an adequate TR is the clinical practice environment (Copanitsanou et al 2017;Felton et al 2018;Moreno-Poyato et al 2016). The 'practice environment' is defined by Lake (2002) as all the organizational factors that facilitate or hamper nursing practice.…”

Section: Introductionmentioning

confidence: 99%

Relationship between the nursing practice environment and the therapeutic relationship in acute mental health units: A cross‐sectional study

Roviralta‐Vilella¹,

Poyato

Rodríguez‐Nogueira

et al. 2019

Int J Mental Health Nurs

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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.

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Section: Introductionmentioning

confidence: 99%

Relationship between the nursing practice environment and the therapeutic relationship in acute mental health units: A cross‐sectional study

Roviralta‐Vilella¹,

Poyato

Rodríguez‐Nogueira

et al. 2019

Int J Mental Health Nurs

View full text Add to dashboard Cite

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“…However, two participants demonstrated engagement with service users’ subjective experiences, although they still maintained a link with risk. The experiences of these participants are discussed in Felton, Repper, and Avis ().…”

Section: Resultsmentioning

confidence: 99%

“…Our application of Hilgartner's () work offers new insight into the preoccupation with risk and the process by which people with mental health problems are defined as risky. Displacement from the position of risk object occurs when there is a severing between the association with harm or the object is no longer understood as one (Felton et al., ). Rediscovering a relational focus within mental health care and engaging with people's subjective experiences is a must for professionals to enable this to take place.…”

Section: Resultsmentioning

confidence: 99%

“…Participants’ loss of connection with individuals’ subjective experiences resulting in a process of objectification is counter to a recovery philosophy and suggests that despite appearances recovery‐orientated practices are limited at the study site. Objectification contributes to the conditions where people with mental health problems can be constructed as dangerous and therefore as “risky” other and contradicts the relational focus of mental health nursing (Felton & Stickley, ; Felton et al., ). It forms one key aspect of a process which enables service users to be defined as risk objects (Hilgartner, ).…”

Section: Discussionmentioning

confidence: 99%

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The construction of people with mental health problems as risk objects: Findings of a case study inquiry

Felton

Repper

Avis

2018

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Risk assessment and management in mental health services are contested and perceived as problematic by both professionals and service users. There is substantial emphasis on risk as a core component of professional practice. However, recovery for people with mental health problems emphasizes self‐determination which seems to conflict with risk management. A critique is emerging of risk assessment and management. However, there is a lack of empirical evidence which seeks to explore how professionals manage the conflicts between recovery orientated practice and risk management. What the paper adds to existing knowledge? The paper reports on qualitative research which highlights people with mental health problems are objectified and frequently associated with the potential for harm. Risk dominates the work of mental health professionals and undermines individualized care. Service users are subject to increased surveillance and medication as a result. What are the implications for practice? Service users’ subjective experiences need to be prioritized in mental health care by renewed focus on the relationship between professionals and service users. Mental health professionals should question the centrality of risk to their practice. Abstract IntroductionThe emergence of recovery, alongside significant focus on risk management, creates potential for conflicting influences in mental health care. Although evidence has critiqued risk assessment, there is a lack of research that seeks to explore how professionals make decisions within these apparently incompatible agendas. AimTo explore how practitioners, experience potential tensions arising from delivering recovery‐orientated care and enforcing containment. MethodThis paper reports on a case study inquiry, using interviews with mental health professionals and observations in an acute ward and an assertive outreach team. ResultsRisk governed the practice of mental health professionals to such an extent it defined how service users were understood and treated. Service users were constructed as objects of risk, first by being objectified and secondly by creating a link between that object and harm. DiscussionHilgartner's (1992, Organizations, uncertainties and risk (pp. 39–53). Boulder, CO: Westview Press) theory of risk explains how risk dominates the identity of people with mental health problems at the cost of recovery. This results in increased monitoring, surveillance and medication to enact control. Implications for practiceTo undermine the dominance of risk, professionals should reconnect with the subjective experiences of people with mental health problems and challenge the acceptance of risk as central to their role.

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“…communication, risk assessment, risk management, safety and security, therapeutic relationships is echoed in policy, in that promoting safety is not only an endpoint of risk management, but patients feel safe to engage in its practices (DH, 2009). The therapeutic relationship between patients and clinician is therefore crucial to foster patient opportunities, in the exploration of what risks are, and ways to feel safe (Felton, Repper, & Avis, 2018b). That said, participatory approaches are not always evident with risk management.…”

Section: Introductionmentioning

confidence: 99%

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

Deering

Pawson

Summers

et al. 2019

Psychiatric Ment Health Nurs

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Accessible Summary What is known about the subject? Risk in psychiatry involves harm to self or others owing to mental health difficulties, for example iatrogenic effects of treatment, self‐harm, suicide and violence. Risk management is a framework to minimize risks, comprising of risk assessment, generation of risk management plans and evaluation of interventions. Literature has extensively explored risk management and presented a critique that its practices can lead to patient harm. However, there is a paucity of literature about what patients identify as helpful risk management practices, despite the potential for such patient views to ameliorate harm and improve mental health care. What this paper adds to existing knowledge Interpersonal relationships with clinicians, and communication that keeps patients involved and informed of management processes, were found to be central to beneficial risk management practices, while patients having agency and autonomy to influence their participation was also important. Beneficial interpersonal relationships and connectivity in the form of patients’ wider community of support were found to be influential in aiding risk management. Meaningful relationships, and particularly peer support, that maintained personal and collective identities were prevalent in the literature. What are the implications for practice? Rendering risk management more visible and accessible in practice might cultivate an openness that promotes patient participation. This includes drawing on a wider network of support, for example the patient’s friends and family, as well as having advocacy utilizing peer support. AbstractIntroductionMinimizing the harm that patients pose to themselves and others, due to mental health difficulties, is a central component of risk management in psychiatry. However, risk management itself can cause patient harm, but despite this and the potentially informative value of lived experience, little is known about what patients want or expect from risk management.AimTo review research and explore what patients consider beneficial in risk management practice.MethodA mixed studies systematic review utilizing PRISMA guidelines, alongside a convergent qualitative design to categorize findings.ResultsTwelve papers were identified, generating two categories of beneficial practices: interpersonal relationships and communication with clinicians; coupled with patient agency in their own risk management.DiscussionConnectivity appears important. Particularly patients feeling involved, and their voices being heard in both the identification of risks and then shaping risk management practice. Moreover, this included involvement of friends, family and peers to widen input and supportive networks beyond clinical relationships.Implications for PracticeRisk management needs to be an accessible part of care, which is more inclusive of patient views and needs. The latter might also be aided by drawing on the patient's wider community in order to provide more effective support and r...

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Therapeutic relationships, risk, and mental health practice

Cited by 40 publications

References 42 publications

Relationship between the nursing practice environment and the therapeutic relationship in acute mental health units: A cross‐sectional study

Relationship between the nursing practice environment and the therapeutic relationship in acute mental health units: A cross‐sectional study

The construction of people with mental health problems as risk objects: Findings of a case study inquiry

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

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