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 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.

Actitudes y percepciones de las enfermeras hacia la conducta suicida: Revisión sistemática de estudios cualitativos / Nurses' attitudes and perceptions towards suicidal behaviour: Systematic review of qualitative studies

Objetivo principal: Conocer las percepciones y actitudes hacia la conducta suicida por parte de las enfermeras, así como su influencia en la evaluación y abordaje de esta. Metodología: Revisión sistemática de estudios cualitativos que sigue el modelo de metasíntesis para el análisis de los resultados. Resultados: El total de artículos incluidos en el trabajo han sido trece, a través de los cuales, se han obtenido cuatro categorías temáticas que sintetizan los resultados de los estudios evaluados. Conclusiones: El trabajo aporta una visión del camino que se está recorriendo, desde una postura moralista hacia la conducta suicida, a la comprensión de la patología que se ha de evaluar, tratar y prevenir.(AU)

Main objective: To know the perceptions and attitudes towards suicidal behaviour by nurses, as well as their influence on its evaluation and approach to it. Methodology: Systematic review of qualitative studies that follows the metasynthesis model for the analysis of results. Results: The total number of articles included in this paper has been thirteen, through which, four thematic categories that summarise the results of the evaluated studies have been obtained. Conclusions: The paper provides a vision of the path that is being followed, from a moralistic stance towards suicidal behaviour, to the understanding of the pathology that has to be assessed, treated and prevented.(AU)

Las diversas caras de la enfermería durante el Nacionalsocialismo (1933-1945): una revisión narrativa / As várias faces da enfermagem durante o nacional-socialismo (1933-1945): uma revisão narrativa / he diverse faces of nursing during National Socialism (1933-1945): a narrative review

In a certain period in the history of nursing, the care and attention characteristic of theprofession coexisted with the ignorance and cruelty of a society corrupted by tragedy and hatredtowards the human being. Objective: to make known the role of the supporters of the Nazi party asnurses of the Allied side and of the resistance during National Socialism in Europe and expose thedifferences between the care they provided. Methodology: narrative review developed through thebibliographic search of books and articles in various databases, selected based on inclusion andexclusion criteria. Results: the nursing care of the time was strongly differentiated between twosides, where empathy and affection were replaced by abuse and barbarism. In addition, a type ofnursing has been discovered which was forced to help the National Socialist regime against its will.Conclusion: the actions of those nurses who worked during the time of Nazism have been reflected,for the current nursing can know what happened in the past to learn and improve for the future.(AU)

En un determinado período de la historia de la enfermería, los cuidados característicosde la profesión convivieron junto la ignorancia y la crueldad de una sociedad corrompida por latragedia, el miedo y el odio. Objetivo: dar a conocer tanto el papel de las enfermeras simpatizantesdel partido nazi como el de las enfermeras del bando aliado y de la resistencia durante el Nacionalsocialismo en Europa y exponer las diferencias entre los cuidados que prestaron. Metodología: revisión narrativa desarrollada a través de la búsqueda bibliográfica de libros y de artículos en diversas bases de datos, seleccionados a partir de unos criterios de inclusión y exclusión. Resultados: laatención enfermera de la época estuvo fuertemente diferenciada entre los dos bandos, dónde la empatía y el afecto se substituyeron por el maltrato y la barbarie. Además, se ha descubierto un tipode enfermería la cual se vio obligada a ayudar al régimen nacionalsocialista en contra de su voluntad. Conclusión: se han plasmado las actuaciones de aquellas enfermeras que trabajaron durante laépoca del nazismo, para que la enfermería actual pueda conocer lo que ocurrió en el pasado y mejorar de cara al futuro.(AU)

Num determinado período da história da enfermagem, o cuidado e a atenção característicada profissão coexistiam com a ignorância e a crueldade de uma sociedade corrompida pela tragédiae pelo ódio ao ser humano. Objectivo: dar a conhecer o papel dos apoiantes do partido nazi comoenfermeiros do lado aliado e da resistência durante o nacional-socialismo na Europa o expor as diferenças entre os cuidados que prestaram. Metodologia: revisão narrativa desenvolvida através dabusca bibliográfica de artigos em várias bases de dados, selecionados com base em critérios de inclusão e exclusão. Resultados: o cuidado de enfermagem do tempo foi fortemente diferenciado entreos dois lados, onde a empatia e o afeto foram substituídos por abuso e barbárie. Além disso, foidescoberto um tipo de enfermagem que foi forçada a ajudar o regime nacional-socialista contra suavontade. Conclusão: as ações das enfermeiras que trabalharam na época do nazismo foram reflectidas, para que a enfermagem atual possa saber o que aconteceu no passado para aprender e melhorarpara o futuro.(AU)

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.

Plan de Mejora Individual: instrumento evaluativo en las prácticas clínicas / Individual Improvement Plan: evaluative instrument in clinical practice

Objetivo: Analizar el Plan de Mejora Individual (PMI), para evaluar las prácticas clínicas en unidades de críticos del grado en enfermería, e identificar los elementos clave de aprendizaje. Método: Diseño cualitativo y descriptivo. Muestreo propositivo de 51 estudiantes matriculados en las prácticas clínicas de cuidados críticos. Se utilizó un análisis de contenido. Resultados: La estructura en seis apartados del PMI: reflexión, acción, evaluación, participación, personal, utilidad y transferencia permite la reflexión para identificar áreas de mejora. Se extrajeron seis categorías: Humanización, Comunicación, Aprendizaje, Saberes profesionales, Seguridad clínica y Complejidad. Estas conforman los elementos clave de aprendizaje. Conclusiones: El PMI se presenta como un instrumento estructurado, sumativo y evaluativo a partir del concepto de reflexión-en-la-acción, este ofrece la oportunidad de analizar y reflexionar sobre la práctica, evitando una experiencia de su prácticum que podrían devenir rutinaria y mecanizada. (AU)

Objective: To analyze the Individual Improvement Plan (IIP) as a document to evaluate the critical patient practices of the nursing degree and identify the key learning elements. Method: Qualitative and descriptive design. The sampling was purposeful 51 students enrolled in clinical practices of critical care units. It was used a content analysis. Results: The structure of the IIP: reflection, action, evaluation, participation, personnel, utility and transfer has allowed students to reflect and identify areas for improvement in critical services. It was extracted six categories: Humanization, Communication, Learning, Professional knowledge, Clinical safety and Complexity. These make up the key learning elements. Conclusions: The IIP is presented as a structured, summative and evaluative instrument based on reflection-in-action. The students have the opportunity to analyze and reflect on the practice, avoiding an experience of their practicum that could become routine and mechanized. (AU)

Influence of Pain and Discomfort in Stroke Patients on Coping Strategies and Changes in Behavior and Lifestyle.

The implementation of prevention strategies can reduce the risk of having a stroke. This prospective, longitudinal, multicenter observational study of 82 patients describes health habits, quality of life, coping strategies, and physical and neurological status at 3 months and 1 year after stroke. The EuroQoL-5D quality of life scale (EQ-5D) and the coping strategy measurement scale (COPE-28) were used to assess pain and discomfort, and behavioral and lifestyle changes. Significant differences were observed in the pain or discomfort levels of those patients with behavioral and lifestyle changes. Correlation was also found between pain or discomfort and the coping strategies associated with active emotional support at 1 year after stroke. The results of the pain or discomfort dimension were not, however, associated with better adherence to treatment. Pain and discomfort could have a predictive value in changes in lifestyles and behaviors but not for treatment adherence in patients who have had a stroke, which is significant at 1 year. In addition to important active coping strategies such as social support, these changes in behavior and lifestyle following a stroke are long-term and should therefore be assessed during the initial examination.

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

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 evidence-based 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.

Suicide care from the nursing perspective: A meta-synthesis of qualitative studies.

AIMS: To explore nurses' experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective. DESIGN: Qualitative meta-synthesis. DATA SOURCES: Comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019. REVIEW METHODS: The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method. RESULTS: Seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: 'Understanding suicidal behaviour as a consequence of suffering', 'Nurses' personal distress in suicide care', 'The presence of the nurse as the axis of suicide care' and, 'Improving nurses' relational competences for a better therapeutic environment'. CONCLUSION: Further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care. IMPACT: This review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour.

Examining the association between evidence-based practice and the nurse-patient therapeutic relationship in mental health units: A cross-sectional study.

AIMS: To examine the relationship between the dimensions of evidence-based practice and the therapeutic relationship and to predict the quality of the therapeutic relationship from these dimensions among nurses working in mental health units. DESIGN: A cross-sectional design. METHODS: Data were collected between February-April 2018 via an online form completed by nurses working at 18 mental health units. Multiple linear regressions were used to examine the relationship between the dimensions of evidence-based practice and therapeutic relationship. Questionnaires were completed by 198 nurses. RESULTS: Higher levels of evidence-based practice were a significant predictor of a higher-quality therapeutic relationship (ß: 2.276; 95% CI: 1.30-3.25). The evidence-based practice factor which most influenced an improved therapeutic relationship was the nurses' attitude (ß: 2.047; 95% CI: 0.88-3.21). The therapeutic relationship dimension which was most conditioned by evidence-based practice dimensions was agreement on tasks, which was most favourable with a better attitude (ß: 0.625; 95% CI: 0.09-1.16) and greater knowledge and skills for evidence-based practice (ß: 0.500; 95% CI: 0.08-0.93). CONCLUSION: In mental health settings, the therapeutic nurse-patient relationship is positively enhanced by evidenced-based practice and the nurse's level of experience, with a great influence on shared decision-making. IMPACT: This research sought to examine the relationship between the evidence-based practice and the therapeutic relationship in mental health nursing. This study demonstrates that an improved attitude and knowledge of evidence-based practices of mental health nurses increases shared decision-making with patients, which is a basic requirement for person-centred care. Because the therapeutic relationship is considered the backbone of nursing practice in mental health units, this research will have an impact on both mental health nurses and mental health unit managers.

Implementing evidence-based practices on the therapeutic relationship in inpatient psychiatric care: A participatory action research.

AIMS AND OBJECTIVES: To produce changes in the therapeutic relationship between clinical practice nurses and patients in psychiatric units by implementing evidence-based practices through participatory action research. BACKGROUND: The therapeutic relationship is the cornerstone of nursing care in psychiatric units. The literature suggests that theoretical knowledge alone is insufficient to establish the therapeutic relationship in practice. Therefore, strategies are needed to adequately establish the therapeutic relationship in psychiatric units. DESIGN: Participatory action research. METHODS: Participants consisted of nurses from two psychiatric units of a university hospital. Data were collected through focus groups and reflective diaries, which were analysed using the content analysis method. The COREQ guidelines were followed to ensure rigour. RESULTS: Nurses conceptualised the therapeutic relationship in their practice, identifying facilitating elements and limitations. They were able to compare their clinical practice with the recommendations of scientific evidence and constructed three evidence-based proposals to improve the therapeutic relationship: (a) a customised nurse intervention space, (b) knowledge updating and (c) reflective groups, which they subsequently implemented and evaluated. CONCLUSIONS: This study shows that nurses in psychiatric units can generate changes and improvements in the therapeutic relationship. The process of implementing evidence-based practice enhanced participants' awareness of their clinical practice and allowed them to make changes and improvements. RELEVANCE TO CLINICAL PRACTICE: The process confirmed that the implementation of evidence-based practice through participatory methods, such as participatory action research, is valid and produces lasting changes. This study also reveals the need to rethink nurses' functions and competencies in current psychiatric units.

Violence and depression in a community sample.

AIMS AND OBJECTIVES: To understand the relation between the experience of violence and sociodemographic and clinical factors, and to determine whether diagnosed depression and the presence of anxiety and stress are related to having experienced workplace and domestic violence in different genders and age groups. BACKGROUND: Previous studies indicate that domestic and workplace violence increase the risk of suffering from depression. However, no studies have evaluated these two types of violence in a same cohort. DESIGN AND METHODS: We designed a descriptive cross-sectional study from 317 individuals randomly selected from the population in southern Catalonia (Spain). Sociodemographic and Goldberg anxiety-depression questionnaires were administered by telephone survey to 160 men and 157 women in December 2008. The data obtained were analysed by a logistic regression model. RESULTS: A quarter of the individuals had suffered from violence: 48·29% of them had experienced domestic violence and 32·9% had experienced workplace violence. Nearly half of the individuals with depression had experienced violence. No statistical difference has been observed between domestic and workplace violence regarding diagnosed depression. Women were twice as likely as men to have suffered from violence. People working outside their home and those who claimed to have no social support had a greater risk of suffering from violence. A greater consumption of medication, above all of psychotropic drugs, is associated with experiencing violence and with greater comorbidity. Predictive factors for suffering from depression are being women, having experienced violence, having suffered stress or anxiety, having little or no social support, having overload of task or having no secondary education and no tertiary education. CONCLUSIONS: This study suggests that when considering depression, anxiety and stress, especially in women, we must take into account whether an individual has suffered violence. RELEVANCE TO CLINICAL PRACTICE: Identifying violence can help health professionals, managers and researchers improve care and reduce suffering in families and communities.