Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain.
Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.
J Clin Nurs. 2023 Jan;32(1-2):253-263. doi: 10.1111/jocn.16223. Epub 2022 Jan 24.
To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units.
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.
Action and observation stages of a participatory action research project.
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.
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.
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.
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.
通过急性心理健康病房护士的反思实践，探索治疗关系。
在精神卫生病房，治疗关系对于提高护理干预的有效性尤为重要。反思实践被认为是改善护理的一个重要方面。
参与式行动研究项目的行动和观察阶段。
通过为实践互动的指导描述和反思而设计的反思日记来收集数据，这些互动与治疗关系有关，并应用内容分析。共有来自 18 个急性心理健康病房的 152 名护士参与。使用了 COREQ 指南。
结果分为以下三类：(i)护理态度作为治疗关系的核心。对于护士来说，态度因素是治疗关系的关键。(ii)对治疗关系至关重要的护理实践。护士确定了一些实践，例如营造有利的环境、使用适当的语言方式、提供帮助以及与患者合作，这些都是在实践中建立治疗关系的必要条件。(iii)影响治疗关系的情境因素。护士认为患者的病情、病房的护理动态及其规定、以及病房的结构和环境是涉及在日常临床实践中建立适当治疗关系的情境因素。
本研究提供了基于精神卫生病房护士对自身实践的反思，了解护士态度在护患治疗关系中的重要性和作用的知识。
这些发现有助于护士提高意识，并根据自己的知识和日常困难制定改进策略。此外，管理者可以评估促进激励和促进护士参与以改善与患者的治疗关系的策略。
