A systematic review on the use of action research methods in mental health nursing care.

AIMS: To identify and synthesize evidence on the use of action research methods in mental health nursing care. DESIGN: Systematic review. DATA SOURCES: CINAHL, Web of Science, PubMed and Scopus databases were searched in January 2021. REVIEW METHODS: Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Two reviewers independently conducted the study selection, and quality appraisal using Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, data extraction and data analysis procedures. RESULTS: Sixteen studies, half of which used participatory action research, were included in this review. Nurses, along with other stakeholders, were an active part of the action research process. The main topics of interest addressed were categorized as improving the adoption of a person-centred approach to care and improving decision-making procedures. The use of action research helped the participants to identify the meaning they attached to the topic of interest to be improved. Moreover, this method helped to identify needs and strategies for improving care. The studies concurred that the use of action research enabled participants to gain awareness, improve attitudes and acquire knowledge. In addition, it enabled participants to gain confidence and security in the group context, as key aspects of their empowerment. CONCLUSION: This review shows the usefulness of action research in any mental health nursing context, contributing to the improvement of care at both the individual and collective levels. IMPACT: This paper demonstrates the use of the action research method in the field of mental health nursing. Its use has improved the clinical practice of nurses as well as that of teams in both community and hospital settings, addressing issues of the person-centred approach to care and decision-making procedures.

The therapeutic relationship at the heart of nursing care: A participatory action research in acute mental health units.

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.

Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study.

AIMS AND OBJECTIVES: To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units. BACKGROUND: In mental health units, the therapeutic relationship is especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care. DESIGN: Action and observation stages of a participatory action research project. METHODS: Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used. RESULTS: The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice. CONCLUSIONS: This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse-patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice. RELEVANCE TO CLINICAL PRACTICE: These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day-to-day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.

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

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.

[Reflections on therapeutic relationship and its clinical practice in mental health nursing]. / Reflexiones sobre la relación terapéutica y su práctica asistencial en enfermería de salud mental.

The purpose of this paper is to unravel the theoretical concepts behind therapeutic relationship for careful consideration. The therapeutic or helping relationship is the pillar on which is built the mental health nursing. It is based on an efficient and accurate communication and management relational skills on the part of the nurse. However, and despite the theoretical knowledge of these skills in the field of mental health nursing, there is enough evidence to believe that they are not applied within suitable quality standards. Theoretical concepts such as empathic attitude, unconditional acceptance and active listening become real with the daily exercise of the nursing profession. In the same way, practice also creates conceptual differences, prejudices, fears, and self-protection mechanisms that limit the relationship and they put distance between patient and nurse.

Percepción del uso del humor por parte de enfermeras y pacientes en los servicios de salud mental / Perception of the use of humour by nurses and patients at Mental Health Units

Objetivo: conocer, en función de la literatura disponible, el significado del sentido del humor entre enfermeras y pacientes en el contexto de servicios de salud mental, así como determinar los factores que facilitan o dificultan el uso del sentido del humor en las unidades de salud mental. Métodos: se llevó a cabo una revisión narrativa en el periodo 2022-2023. Las búsquedas se realizaron en Pubmed, PsycINFO, LILACS y CINAHL, usando los descriptores: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, "psychiatric nursing”. Se incluyeron todo tipo de documentos que abordaran el tema según los objetivos, publicados desde 2012 hasta noviembre de 2022 en inglés, español o portugués. Se añadió un artículo traducido del coreano por su relevancia. Resultados: se incluyeron 10 manuscritos en la revisión. Los hallazgos sugieren que el sentido del humor se percibe como una herramienta esencial para fortalecer la relación entre enfermeras y pacientes en entornos psiquiátricos. No obstante, se destaca la existencia de factores que podrían conducir a un uso inapropiado del humor, llevando a la deshumanización de la atención y la posible ruptura del vínculo terapéutico. Conclusiones: es importante considerar cuidadosamente el empleo del humor en el contexto de la salud mental, para garantizar su efectividad sin comprometer la calidad asistencial. (AU)

Objective: based on the literature available, to understand the meaning of sense of humour between nurses and patients in the setting of Mental Health Units, as well as to determine the factors that facilitate its use, o make it difficult. Methods: a narrative review was conducted during the 2022-2023 period. Searches were conducted in Pubmed, PsycINFO, LILACS and CINAHL, using the descriptors: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, “psychiatric nursing”. All type of documents addressing this matter according to the objectives were included, published from 2012 until November 2022 in English, Spanish or Portuguese. An article translated from Korean was added due to its relevance. Results: ten (10) manuscripts were included in the review. Findings suggested that sense of humour was perceived as an essential tool in order to strengthen the relations between nurses and patients in psychiatric settings. However, it was highlighted that there are factors which could induce an inadequate use of humour, leading to dehumanization in care and a potential breach in the therapeutic link. Conclusions: it is important to carefully consider the use of humour in the mental health setting, in order to guarantee its effectiveness without compromising the quality of care. (AU)

La relación terapéutica como eje de los cuidados enfermeros en las unidades de agudos de salud mental: análisis del contexto en Cataluña / A relação terapêutica como núcleo central dos cuidados de enfermagem em unidades de saúde mental aguda: análise do contexto na Catalunha / The therapeutic relationship as the core of nursing care in acute mental health units: analysis of the context in Catalonia

Múltiples factores de tipo individual y contextual condicionan la calidad de la relación terapéutica en unidades de salud mental. El objetivo fue describir las características de estructura, de equipo, de normativa y de dinámica de cuidados que intervienen en el establecimiento de la relación terapéutica en las unidades de salud mental de Cataluña. El estudio forma parte un proyecto multicéntrico que incluye 18 unidades de salud mental de Cataluña y que pretende mejorar la relación terapéutica a través de una Investigación-Acción Participativa. Este trabajo es la primera etapa en la cual se realizó un análisis del contexto de estudio. Los datos se recogieron a través de guías observacionales cumplimentadas por las enfermeras coordinadoras de cada centro. Los resultados se agruparon en 3 temas: i) estructura de las unidades y dimensión de las plantillas, ii) normativa y dinámica de las unidades y iii) indicadores de calidad de los cuidados. La principal conclusión del estudio es la gran variabilidad observada en las unidades en relación con su estructura, ratios y normativas. Debido a estos factores del entorno, los cuidados que se brindan y, en consecuencia, la relación terapéutica; es considerablemente distinta en función del área en la que reside cada paciente.(AU)

Multiple individual and contextualfactors influence the quality of thetherapeutic relationship in mental healthunits. The objective was to describe the characteristics of structure, teamwork, wardrules and care dynamics that intervene in theestablishment of the therapeutic relationshipin mental health units in Catalonia. Thestudy is part of a multi-centre project thatincludes 18 mental health units in Catalonia,and which aims to improve the therapeuticrelationship through Participatory Action-Research. This work is the first stage inwhich an analysis of the study context wascarried out. The data were collected throughobservational guides filled in by thecoordinating nurses of each centre. Theresults were grouped into 3 themes: i)structure of the units and size of theteamworks, ii) rules and dynamics of theunits and iii) indicators of quality of care.The main conclusion of the study is the greatvariability observed in the units in relation totheir structure, ratios and rules. Due to theseenvironmental factors, the care providedand, consequently, the therapeuticrelationship, is considerably differentdepending on the area in which each patientresides.(AU)

Vários fatores individuais econtextuais condicionam a qualidade darelação terapêutica nas unidades de saúdemental. O objetivo foi descrever ascaracterísticas da estrutura, trabalho emequipa, regulamentação e dinâmica decuidados que intervêm no estabelecimentoda relação terapêutica em unidades de saúdemental na Catalunha. O estudo faz parte deum projeto multicêntrico que inclui 18unidades de saúde mental na Catalunha e quevisa melhorar a relação terapêutica atravêsda Investigação-Ação Participativa. Estetrabalho é a primeira etapa em que foirealizada uma análise do contexto do estudo.Os dados foram recolhidos através de guias observacionais preenchidos pelosenfermeiros coordenadores de cada centro.Os resultados foram agrupados em 3 temas:i) estrutura das unidades e tamanho dosgabaritos, ii) regulamentação e dinâmica dasunidades e iii) indicadores de qualidade daatenção. A principal conclusão do estudo é agrande variabilidade observada nas unidadesem relação á sua estrutura, relações eregulamentos. Devido a estes fatoresambientais, os cuidados prestados e,consequentemente, a relação terapêutica, sãoconsideravelmente diferentes dependendoda área em que cada paciente reside

Viaje de ida y vuelta: Reflexiones sobre la enfermería psiquiátrica penitenciaria / Travel back and forth: Reflections on prison psychiatric nursing / Viajar e para trás: Reflexões sobre a prisão de enfermagem psiquiátrica

OBJETIVO: Describir las dificultades a la hora de poder aplicar la Relación Terapéutica en el cuidado de pacientes que padecen una enfermedad mental, ingresados en un Centro Psiquiátrico Penitenciario. MÉTODO: La narratividad como instrumento para redimensionar y reflexionar sobre la práctica asistencial enfermera, des de la perspectiva de la relación de ayuda en el cuidado de pacientes con enfermedad mental. RESULTADOS: La elaboración de este relato en primera persona ha contribuido a mostrar que los profesionales de enfermería en Centros Psiquiátricos Penitenciarios trabajan para lograr visibilidad y evitar ser institucionalizados. CONCLUSIONES: Mediante la narrativa se ha alcanzado el propósito inicial de describir las diferentes dificultades a la hora de poder aplicar la Relación Terapéutica en el cuidado de pacientes que padecen una enfermedad mental, ingresados en un Centro Psiquiátrico Penitenciario. La narrativa constituye un instrumento pertinente para la reflexión sobre la práctica de la enfermería especialista en Salud Mental. | OBJECTIVE: To describe the difficulties in applying the Therapeutic Relationship in the care of patients suffering from mental illness, admitted to a Prison Psychiatric Center. METHOD: Narrativity as an instrument to resize and reflect on nursing care practice, from the perspective of the relationship of help in the care of patients with mental illness. RESULTS: The elaboration of this first-person account has contributed to show that the nursing professionals in Penitentiary Psychiatric Centers work to achieve visibility and avoid being institutionalized. CONCLUSIONS: Through the narrative the initial purpose of describing the different difficulties in the application of the Therapeutic Relationship in the care of patients suffering from mental illness, admitted to a Prison Psychiatric Center, has been reached. The narrative constitutes a pertinent instrument for the reflection on the practice of the nursing specialist in Mental Health

OBJECTIVE: To describe the difficulties in applying the therapeutic relationship in the care of patients suffering from mental illness, admitted to a Prison Psychiatric Center. METHOD: Narrativity as an instrument to resize and reflect on nursing care practice, from the perspective of the relationship of help in the care of patients with mental illness. RESULTS: The elaboration of this first-person account has contributed to show that the nursing professionals in Penitentiary Psychiatric Centers work to achieve visibility and avoid being institutionalized. CONCLUSIONS: Through the narrative the initial purpose of describing the different difficulties in the application of the Therapeutic Relationship in the care of patients suffering from mental illness, admitted to a Prison Psychiatric Center, has been reached. The narrative constitutes a pertinent instrument for the reflection on the practice of the nursing specialist in Mental Health

OBJETIVO: Descrever as dificuldades podem aplicar a relação terapêutica no tratamento de pacientes que sofrem de doença mental internado em uma clínica psiquiátrica prisão. MÉTODO: Narratividade como uma ferramenta para redimensionar e refletir sobre a enfermeira prática assistencial, des do ponto de vista da relação de ajuda no cuidado de pacientes com a doença mental. RESULTADOS: O desenvolvimento deste relato em primeira pessoa ajudou a mostrar que os enfermeiros trabalham em prisões Centros psiquiátricos para alcançar visibilidade e evitar a institucionalização. CONCLUSÕES: Através da narrativa atingiu o objetivo inicial de descrever as várias dificuldades podem aplicar a relação terapêutica no tratamento de pacientes que sofrem de doença mental internado em uma clínica psiquiátrica prisão. A narrativa é um reflexo relevante sobre a prática de instrumento especialista em enfermagem de saúde mental

Reflexiones sobre la relación terapéutica y su práctica asistencial en enfermería de salud mental / Reflections on therapeutic relationship and its clinical practice in mental health nursing

El propósito de este trabajo es deshilvanar los conceptos teóricos de la relación terapéutica para poder considerarlos detenidamente. La relación terapéutica o de ayuda constituye el pilar sobre el que se ha construido la enfermería de salud mental. Se fundamenta en una comunicación eficaz y precisa, y en el manejo de habilidades y competencias relacionales por parte del profesional de enfermería. No obstante, a pesar del conocimiento teórico de dichas competencias en el ámbito mencionado, existen indicios suficientes para pensar que no se llevan a cabo con el nivel de calidad idóneo. Conceptos teóricos como la actitud empática, la aceptación incondicional y la escucha activa se tornan reales a la hora de ejercer en el día a día el rol de la profesión enfermera. De la misma forma, también se crean diferencias conceptuales, prejuicios, miedos y mecanismos de autoprotección que limitan la relación y ponen distancia entre el paciente y el profesional (AU)

The purpose of this paper is to unravel the theoretical concepts behind therapeutic relationship for careful consideration. The therapeutic or helping relationship is the pillar on which is built the mental health nursing. It is based on an efficient and accurate communication and management relational skills on the part of the nurse. However, and despite the theoretical knowledge of these skills in the field of mental health nursing, there is enough evidence to believe that they are not applied within suitable quality standards. Theoretical concepts such as empathic attitude, unconditional acceptance and active listening become real with the daily exercise of the nursing profession. In the same way, practice also creates conceptual differences, prejudices, fears, and self-protection mechanisms that limit the relationship and they put distance between patient and nurse (AU)