Impact of the 'reserved therapeutic space' nursing intervention on patient health outcomes: An intervention study in acute mental health units

Antonio R Moreno-Poyato, Khadija El Abidi, Teresa Lluch-Canut, Montserrat Cañabate-Ros, Montserrat Puig-Llobet, Juan F Roldán-Merino, Antonio R Moreno-Poyato, Khadija El Abidi, Teresa Lluch-Canut, Montserrat Cañabate-Ros, Montserrat Puig-Llobet, Juan F Roldán-Merino

Abstract

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.

Design: Multicentre intervention study with control group.

Methods: The study will be carried out in 12 mental health units. 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. An estimated 131 patients per group are expected to participate. Funding was granted by the Instituto de Salud Carlos III. Co-financed by the European Union (European Regional Development Fund (ERDF) (PI21/00605)) and College of Nurses of Barcelona (PR-487/2021). The proposal was approved by all the Research Ethics Committees of participating centres.

Results: This project will lead to changes in clinical practice, transforming the current models of organization and care management in mental health hospitalization units. No patient or public contribution.

Keywords: mental health; nurse-patient relationship; nursing intervention; psychiatric nursing.

Conflict of interest statement

The authors have no conflict of interest to declare.

© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
CONSORT Flow diagram RTS_MHNursing_Spain.

References

    1. Adler, R. H. (2020). Bucking the system: Mitigating psychiatric patient rule breaking for a safer milieu. Archives of Psychiatric Nursing, 243, 153057. 10.1016/j.apnu.2020.03.002
    1. Aguilera‐Serrano, C. , Guzmán‐Parra, J. , Miranda‐Paez, J. , García‐Spínola, E. , Torres‐Campos, D. , Villagrán‐Moreno, J. M. , Moreno‐Küstner, B. , García‐Sanchez, J. A. , & Mayoral‐Cleries, F. (2019). Validation of a short version of the Coercion Experience Scale (CES‐18): Psychometric characteristics in a Spanish sample. Psychiatry Research, 272(2018), 284–289. 10.1016/j.psychres.2018.12.126
    1. Andrade‐González, N. , & Fernández‐Liria, A. (2015). Spanish adaptation of the Working Alliance Inventory‐Short (WAI‐S). Current Psychology, 35(1), 169–177. 10.1007/s12144-015-9365-3
    1. Aznar‐Huerta, A. , Cardó‐Vila, G. , Vives‐Abril, T. , Valera‐Fernández, M. R. , Leyva‐Moral, J. M. , & Moreno‐Poyato, A. R. (2021). Unconditional acceptance in the nurse‐patient therapeutic relationship as a whole: An exploratory qualitative study in the context of mental health services. Revista Española de Enfermería de Salud Mental, 2021(14), 22–29.
    1. Bergk, J. , Flammer, E. , & Steinert, T. (2010). “Coercion Experience Scale” (CES) – Validation of a questionnaire on coercive measures. BMC Psychiatry, 10(1), 5. 10.1186/1471-244X-10-5
    1. Berry, K. , Haddock, G. , Kellett, S. , Roberts, C. , Drake, R. , & Barrowclough, C. (2016). Feasibility of a ward‐based psychological intervention to improve staff and patient relationships in psychiatric rehabilitation settings. The British Journal of Clinical Psychology, 55(3), 236–252. 10.1111/bjc.12082
    1. Chan, A.‐W. , Tetzlaff, J. M. , Altman, D. G. , Laupacis, A. , Gøtzsche, P. C. , Krleža‐Jerić, K. , Hróbjartsson, A. , Mann, H. , Dickersin, K. , Berlin, J. A. , Doré, C. J. , Parulekar, W. R. , Summerskill, W. S. M. , Groves, T. , Schulz, K. F. , Sox, H. C. , Rockhold, F. W. , Rennie, D. , & Moher, D. (2013). SPIRIT 2013 statement: Defining standard protocol items for clinical trials. Annals of Internal Medicine, 158(3), 200–207. 10.7326/0003-4819-158-3-201302050-00583
    1. Generalitat de Catalunya, Departament de Salut . (2017). Pla director de salut mental i addiccions: estratègies 2017–2020 .
    1. Hartley, S. , Raphael, J. , Lovell, K. , & Berry, K. (2020). Effective nurse–patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102, 103490. 10.1016/j.ijnurstu.2019.103490
    1. Horvath, A. O. , & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36(2), 223–233.
    1. Kingston, M. A. , & Greenwood, S. (2020). Therapeutic relationships: Making space to practice in chaotic institutional environments. Journal of Psychiatric and Mental Health Nursing, 27(6), 689–698. 10.1111/jpm.12620
    1. Liao, F. , & Murphy, D. (2019). Evaluation of therapeutic relationship skills training for mental health professionals: The therapeutic relationship enabling programme (TREP). MedEdPublish, 8, 112. 10.15694/mep.2019.000112.1
    1. McAllister, S. , Simpson, A. , Tsianakas, V. , & Robert, G. (2021). “What matters to me”: A multi‐method qualitative study exploring service users', carers' and clinicians' needs and experiences of therapeutic engagement on acute mental health wards. International Journal of Mental Health Nursing, 30(3), 703–714. 10.1111/inm.12835
    1. McCluskey, A. , Watson, C. , Nugent, L. , O'Connor, T. , Moore, Z. , O'Brien, N. , Molloy, L. , & Patton, D. (2022). Psychiatric nurse's perceptions of their interactions with people who hear voices: A qualitative systematic review and thematic analysis. Journal of Psychiatric and Mental Health Nursing, 29(3), 395–407. 10.1111/jpm.12829
    1. Missouridou, E. , Resoulai, Α. , Sakavara, Ι. , Fradelos, E. C. , Kritsiotakis, E. , Mangoulia, P. , Kasidi, E. , Stefanou, E. , Liapis, C. , Segredou, E. , Koutelekos, J. , & Evagelou, E. (2021). Psychiatric care in acute care units with locked doors: Nursing care providers' perceptions and experiences. Advances in Experimental Medicine and Biology, 1337, 99–106. 10.1007/978-3-030-78771-4_12
    1. Missouridou, E. , Xiarhou, P. , Fradelos, E. C. , Mangoulia, P. , Kasidi, K. , Kritsiotakis, M. , Stefanou, E. , Liapis, C. , Dimitriadis, A. , Segredou, E. , Dafogianni, C. , & Evagelou, E. (2021). Nurses' experiences of psychiatric care in acute care units with an open door policy. Advances in Experimental Medicine and Biology, 1337, 127–135. 10.1007/978-3-030-78771-4_15
    1. Missouridou, E. , Fradelos, E. C. , Kritsiotakis, E. , Mangoulia, P. , Segredou, E. , & Papathanasiou, I. V. (2022). Containment and therapeutic relationships in acute psychiatric care spaces: The symbolic dimensions of doors. BMC Psychiatry, 22(1), 2. 10.1186/s12888-021-03607-2
    1. Molin, J. , Lindgren, B. , Graneheim, U. H. , & Ringnér, A. (2018). Time together: A nursing intervention in psychiatric inpatient care: Feasibility and effects. International Journal of Mental Health Nursing, 27(6), 1698–1708. 10.1111/inm.12468
    1. Moreno‐Poyato, A. R. , Casanova‐Garrigos, G. , Roldán‐Merino, J. F. , & Rodríguez‐Nogueira, Ó. (2021). Examining the association between evidence‐based practice and the nurse‐patient therapeutic relationship in mental health units: A cross‐sectional study. Journal of Advanced Nursing, 77(4), 1762–1771. 10.1111/jan.14715
    1. Moreno‐Poyato, A. R. , Delgado‐Hito, P. , Leyva‐Moral, J. M. , Casanova‐Garrigós, G. , & Montesó‐Curto, P. (2019). Implementing evidence‐based practices on the therapeutic relationship in inpatient psychiatric care: A participatory action research. Journal of Clinical Nursing, 28(9–10), 1614–1622. 10.1111/jocn.14759
    1. Moreno‐Poyato, A. R. , Delgado‐Hito, P. , Suárez‐Pérez, R. , Lluch‐Canut, T. , Roldán‐Merino, J. F. , & Montesó‐Curto, P. (2018). Improving the therapeutic relationship in inpatient psychiatric care: Assessment of the therapeutic alliance and empathy after implementing evidence‐based practices resulting from participatory action research. Perspectives in Psychiatric Care, 54(2), 300–308. 10.1111/ppc.12238
    1. Moreno‐Poyato, A. R. , El Abidi, K. , Lluch‐Canut, T. , & Puig‐Llobet, M. (2021). Espacio Terapéutico Reservado: Una intervención enfermera para unidades de agudos de salud mental. Guía breve de implementación . Dipòsit Digital de la Universitat de Barcelona.
    1. Moreno‐Poyato, A. R. , El Abidi, K. , Rodríguez‐Nogueira, Ó. , Lluch‐Canut, T. , & Puig‐Llobet, M. (2021). A qualitative study exploring the patients' perspective from the ‘reserved therapeutic space’ nursing intervention in acute mental health units. International Journal of Mental Health Nursing, 30(3), 783–797. 10.1111/inm.12848
    1. Moreno‐Poyato, A. R. , Montesó‐Curto, P. , Delgado‐Hito, P. , Suárez‐Pérez, R. , Aceña‐Domínguez, R. , Carreras‐Salvador, R. , Leyva‐Moral, J. M. , Lluch‐Canut, T. , & Roldán‐Merino, J. F. (2016). The therapeutic relationship in inpatient psychiatric care: A narrative review of the perspective of nurses and patients. Archives of Psychiatric Nursing, 30(6), 782–787. 10.1016/j.apnu.2016.03.001
    1. Moreno‐Poyato, A. R. , Rodríguez‐Nogueira, Ó. , Casanova‐Garrigos, G. , El Abidi, K. , & Roldán‐Merino, J. F. (2021). The impact of a participatory intervention on the therapeutic relationship in mental health nurses: A multicentre study. Journal of Advanced Nursing, 77(7), 3104–3115. 10.1111/jan.14835
    1. Moreno‐Poyato, A. R. , Roviralta‐Vilella, M. , Abidi, K. E. , Bordera‐Antequera, S. , Triviño‐Briones, S. R. , Olives, C. U. , Lluch‐Canut, T. , & Puig‐Llobet, M. (2021). Nursing practice environment in psychiatric units: A scoping review. Journal of Psychosocial Nursing and Mental Health Services, 59(11), 33–40. 10.3928/02793695-20210526-01
    1. Raphael, J. , Price, O. , Hartley, S. , Haddock, G. , Bucci, S. , & Berry, K. (2021). Overcoming barriers to implementing ward‐based psychosocial interventions in acute inpatient mental health settings: A meta‐synthesis. International Journal of Nursing Studies, 115, 103870. 10.1016/j.ijnurstu.2021.103870
    1. Rio, J. H. M. , Fuller, J. , Taylor, K. , & Muir‐Cochrane, E. (2020). A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice. International Journal of Mental Health Nursing, 29(2), 290–298. 10.1111/inm.12684
    1. Roviralta‐Vilella, M. , Moreno‐Poyato, A. R. , Rodríguez‐Nogueira, Ó. , Duran‐Jordà, X. , & Roldán‐Merino, J. F. (2019). Relationship between the nursing practice environment and the therapeutic relationship in acute mental health units: A cross‐sectional study. International Journal of Mental Health Nursing, 28(6), 1338–1346. 10.1111/inm.12648
    1. Ruud, T. , & Friis, S. (2022). Continuity of care and therapeutic relationships as critical elements in acute psychiatric care. World Psychiatry, 21(2), 241–242. 10.1002/wps.20966
    1. Sanchez‐Balcells, S. , Lluch‐Canut, M.‐T. , Domínguez del Campo, M. , Moreno‐Poyato, A. R. , Tomás‐Jiménez, M. , Lundqvist, L.‐O. , Schröder, A. , Puig‐Llobet, M. , & Roldan‐Merino, J. F. (2021). A Spanish adaptation of the quality in psychiatric care—Inpatient (QPC‐IP) instrument: Psychometric properties and factor structure. BMC Nursing, 20(1), 191. 10.1186/s12912-021-00710-3
    1. Schröder, A. , Wilde Larsson, B. , & Ahlström, G. (2007). Quality in psychiatric care: An instrument evaluating patients' expectations and experiences. International Journal of Health Care Quality Assurance, 20(2), 141–160. 10.1108/09526860710731834
    1. Spanish Ministry of Health . (2022). Mental health strategy of the National Health System. Period 2022–2026. Ministry of Health, Spanish Government.
    1. Tolosa‐Merlos, D. , Moreno‐Poyato, A. R. , & Delgado‐Hito, P. (2021). La relación terapéutica como eje de los cuidados enfermeros en las unidades de agudos de salud mental: análisis del contexto en Cataluña. Cultura de Los Cuidados, 25(59), 132–143. 10.14198/cuid.2021.59.14
    1. Tolosa‐Merlos, D. , Moreno‐Poyato, A. R. , González‐Palau, F. , Pérez‐Toribio, A. , Casanova‐Garrigós, G. , & Delgado‐Hito, P. (2022). Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study. Journal of Clinical Nursing, 2021, 1–11. 10.1111/jocn.16223
    1. Wasserman, D. , Apter, G. , Baeken, C. , Bailey, S. , Balazs, J. , Bec, C. , Bienkowski, P. , Bobes, J. , Ortiz, M. F. B. , Brunn, H. , Bôke, Ö. , Camilleri, N. , Carpiniello, B. , Chihai, J. , Chkonia, E. , Courtet, P. , Cozman, D. , David, M. , Dom, G. , … Vahip, S. (2020). Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries. European Psychiatry, 63(1), e82. 10.1192/j.eurpsy.2020.79
    1. Zugai, J. S. , Stein‐Parbury, J. , & Roche, M. (2015). Therapeutic alliance in mental health nursing: An evolutionary concept analysis. Issues in Mental Health Nursing, 36(4), 249–257. 10.3109/01612840.2014.969795

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