Mount Isa Mental Health Service, Mount Isa Hospital, Mount Isa, Queensland, Australia.
Waikato Institute of Technology, Hamilton, New Zealand.
J Psychiatr Ment Health Nurs. 2020 Dec;27(6):689-698. doi: 10.1111/jpm.12620. Epub 2020 Feb 27.
WHAT IS KNOWN ABOUT THE SUBJECT?: While therapeutic relationships remain core to mental health nursing practice and patient recovery, increased managerialism and focus on risk has impacted nurses' therapeutic practice with patients. While there is anecdotal evidence of the impact there has been little research that demonstrates nurses experience of therapeutic engagement within the current context. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper reports on qualitative research that highlights nurses' strong attempts to create the space for therapeutic engagement with clients. This research provides evidence of the constraints on practice imposed by new managerial processes and suggests potential means of responding to them. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses are committed to working therapeutically but struggle to balance this against new managerial demands imposed across many OECD countries. The New Zealand government has recently reported on positive changes to mental health provision but does not suggest changes to the structures that impede good practice. This research indicates that structural change is essential to therapeutic engagement. ABSTRACT: Introduction Increasing managerialism, driven in part by notions of risk, compromises the mental health nurses therapeutic engagement with clients potentially impacting their recovery. While the importance of therapeutic relationships in mental health recovery is acknowledged, there is little evidence about how managerial processes encroach on this relationship. Aim To explore mental health nurses experience of engaging in therapeutic relationships within the current practice environment. Method This paper utilized an interpretive phenomenological approach, using interviews with mental health nurses. Results Managerial processes significantly impacted the practice of nurses who struggled to make space for therapeutic relationships within a chaotic milieu. The chaos is associated with increasing austerity within the health system; this has resulted in high staff turnover and staff shortages. Discussion Managerial demands dominate the practice field at the expense of therapeutic engagement between nurses and clients ultimately affecting client recovery. While nurses' integrity means they desperately try to make space for the therapeutic work, they often become burnt out and disheartened. Implications for practice While nurses are often blamed for failures in the system, the structures that disable nurses in their attempts to practice therapeutically require urgent responses, strengthening professional organizations and engaging in democratic partnerships with consumer groups.
已知信息：尽管治疗关系仍然是精神健康护理实践和患者康复的核心，但日益增多的管理主义和对风险的关注已经影响了护士与患者的治疗实践。虽然有一些轶事证据表明存在这种影响，但几乎没有研究表明护士在当前背景下体验到治疗性参与。
文献新增信息：本文报告了一项定性研究，该研究强调了护士们强烈试图为与客户进行治疗性接触创造空间。这项研究提供了实践中受到新管理流程限制的证据，并提出了应对这些限制的潜在方法。
对实践的影响：精神健康护士致力于进行治疗性工作，但努力在这方面与许多经合组织国家强加的新管理要求保持平衡。新西兰政府最近报告了精神健康服务的积极变化，但并未提出改变阻碍良好实践的结构。这项研究表明，结构性变革对于治疗性参与至关重要。
摘要：引言 部分由风险观念驱动的管理主义的增加，损害了精神健康护士与患者建立治疗性关系的能力，可能会影响他们的康复。虽然治疗关系在精神健康康复中的重要性得到了认可，但关于管理流程如何侵犯这种关系的证据很少。
目的：探讨精神健康护士在当前实践环境中参与治疗性关系的经验。
方法：本文采用了一种解释性现象学方法，对精神健康护士进行了访谈。
结果：管理流程对那些在混乱环境中努力建立治疗性关系的护士的实践产生了重大影响。这种混乱与卫生系统内日益紧缩的情况有关；这导致了高员工离职率和人员短缺。
讨论：管理需求主导着实践领域，而牺牲了护士与患者之间的治疗性接触，最终影响了患者的康复。虽然护士的诚信意味着他们拼命地为治疗性工作创造空间，但他们往往会疲惫不堪，灰心丧气。
对实践的影响：尽管护士经常因系统故障而受到指责，但使护士无法进行治疗性实践的结构需要紧急回应，需要加强专业组织，并与消费者团体进行民主合作。
