Nurse-Patient Relations, Psychiatric Hospitalization
Conditions
Keywords
Nurse-Patient therapeutic relationship, Quality of psychiatric care, Mental health nursing, Acute psychiatric care
Brief summary
Aims: To evaluate the effectiveness of the Reserved Therapeutic Space intervention for improving the nurse-patient therapeutic relationship in acute mental health units in Spain, as well as its impact in terms of quality of care and patients' perceptions of coercion. Design: Multicenter intervention study with control group. Methods: The study will be carried out in 12 mental health units in Spain. Given the conditions of evaluation in real clinical practice, paired randomization will be performed to assign centers to intervention and control groups. The Reserved Therapeutic Space intervention to be tested has been co-designed and validated by both nurses and patients. The quality of the therapeutic relationship, the care received, and perceived coercion among patients will be assessed at baseline and at discharge using instruments validated in our context. An estimated 131 patients per group are expected to participate. Funding was granted in July 2021 by the Institute of Health Carlos III (PI21/00605, Ministry of Science and Innovation) and in October 2021 by the College of Nurses of Barcelona (PR-487/2021). The proposal was approved by all the Research Ethics Committees of participating centers. Discussion: This study is expected to demonstrate the effectiveness of a specific nursing intervention on patient health outcomes including the level of the therapeutic relationship, the quality of care, the level of coercion and other specific indicators for acute mental health units. Impact: This project will lead to changes in clinical practice, transforming the current models of organization and care management in mental health hospitalization units, promoting the quality of the therapeutic relationship and, ultimately, the quality of person-centered care.
Interventions
BEHAVIORALReserved Therapeutic Space
The main objective of the 'Reserved Therapeutic Space' intervention is to enhance the therapeutic bond of trust, to enable the agreement of objectives and interventions in a shared manner in relation to their recovery process in the unit. The intervention is carried out through individual meetings between the nurse and the patient in a comfortable and intimate space, where there are no interruptions and which is also chosen by the person who is hospitalized. The content of the spaces must be constructed individually according to the patients' concerns at each moment of the process.
Sponsors
Campus docent Sant Joan de Déu-Universitat de Barcelona
Hospital Universitario Fundación Alcorcón
Hospital Regional de Malaga
Hospital Gil Casares de Santiago de Compostela
Hospital Universitario Infanta Leonor
Hospital Virgen de los Lirios de Alcoi
Hospital Universitari de Bellvitge
Hospital de Galdakao
Hospital de Mataró
Hospital del Mar
Complejo Hospitalario Universitario de Vigo
Hospital Universitario San Juan de Alicante
Instituto de Salud Carlos III
Colegio Oficial de Enfermeras y Enfermeros de Barcelona
Hospital Clínico Universitario de Valencia
University of Barcelona
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults hospitalized in mental health inpatient units who voluntarily consent to participate in the study
Exclusion criteria
* Adults hospitalized in mental health inpatient units who present a language barrier, mechanical restraint, contraindication by the clinical referent, cognitive impairment, or intellectual disability at the time of recruitment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline Nurse-patient therapeutic alliance at discharge assessed by WAI-Short patient version | At baseline and at discharge from the inpatient unit (an average of 16 days) | The Working Alliance Inventory Short Questionnaire (WAI-S), patient version. This is an instrument for measuring the working alliance, and therefore, the therapeutic relationship between professional and patient (Horvath & Greenberg, 1989). Scores range from 12-84 with higher scores indicating greater levels of therapeutic alliance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline Quality in Psychiatric Care at discharge assessed by QPC | At baseline and at discharge from the inpatient unit (an average of 16 days) | The Quality in Psychiatric Care scale (QPC: Schröder et al., 2007) assesses the quality of care and is the best suited to evaluate the quality of care in psychiatric units. Scores range from 30-120 with higher scores indicating greater levels of quality in psychiatric care. |
| Experience of coercion assessed by CES-18 | At discharge from the inpatient unit (an average of 16 days) | The Coercion Experience Scale (CES-18: Bergk et al., 2010). This scale assesses the subjective experience of coercion during psychiatric hospitalization. Scores range from 18-90 with higher scores indicating greater levels of coercion experience. |
Countries
Spain
Outcome results
None listed