Espacio Terapéutico Reservado: impacto de una intervención ENFERMERA de Salud Mental sobre los resultados de salud de los usuarios: un estudio de intervención no aleatorizado para mejorar la relación terapéutica en las unidades de salud mental [documento de trabajo]

Darrera modificació: Novembre 2019L'Espai Terapèutic Reservat (ETR) és una intervenció que portaran a terme les infermeres d'unitats d'hospitalització de salut mental al costat dels usuaris hospitalitzats dels quals siguin referents. La intervenció es coproduirà i validarà en dues fases. Una primera fase des de la perspectiva de les infermeres i una segona fase des de la perspectiva dels usuaris amb experiència en primera persona

Um dia na unidade de internação psiquiátrica

Se presenta el relato de la que podría ser la experiencia vivida por una persona hospitalizada en una unidad de psiquiatría cualquiera. Los datos se generan mediante la observación no participante, entrevistas informales y la propia experiencia asistencial de los autores. La persona protagonista está hospitalizada de forma involuntaria en una unidad de agudos de psiquiatría, ha recibido del “sistema” la etiqueta diagnóstica de psicosis. A través de su mirada, los autores reflexionan en torno a las percepciones y vivencias que le acontecen en relación con el devenir cotidiano del hospital, y por supuesto con el cuidado recibido por las enfermeras de la unidad.We present the story of what could be the experience of a hospitalized person in whatever psychiatric unit. The data are generated by non-participant observation and care experience of the authors. The protagonist person is involuntarily admitted in a psychiatric acute unit; he has received the diagnostic label of psychosis by the “system”. Through his eyes, the authors reflect about perceptions and experiences that happen him in relation to the daily workings of the hospital, and of course with the care received by nurses in the unit.Nós apresentamos a história do que poderia ser a experiência de uma pessoa internada em qualquer unidade psiquiátrica. Os dados são gerados pela observação não participante e experiência de cuidado dos autores. A pessoa protagonista é involuntariamente internado em uma unidade psiquiátrica aguda; ele recebeu o rótulo diagnóstico de psicose pelo “sistema”. Através de seus olhos, os autores refletem sobre as percepções e experiências que lhe suceder em relação aos trabalhos diários do hospital, e, claro, com o cuidado recebido por enfermeiras da unidade

Reflections on therapeutic relationship and its clinical practice in mental health nursing

El propósito de este trabajo es deshilvanar los conceptos teóricos de la relación terapéutica para poder considerarlos detenidamente. La relación terapéutica o de ayuda constituye el pilar sobre el que se ha construido la enfermería de salud mental. Se fundamenta en una comunicación eficaz y precisa, y en el manejo de habilidades y competencias relacionales por parte del profesional de enfermería. No obstante, a pesar del conocimiento teórico de dichas competencias en el ámbito mencionado, existen indicios suficientes para pensar que no se llevan a cabo con el nivel de calidad idóneo. Conceptos teóricos como la actitud empática, la aceptación incondicional y la escucha activa se tornan reales a la hora de ejercer en el día a día el rol de la profesión enfermera. De la misma forma, también se crean diferencias conceptuales, prejuicios, miedos y mecanismos de autoprotección que limitan la relación y ponen distancia entre el paciente y el profesional

The therapeutic relationship, beyond the aptitude

La relación que se establece entre el profesional de enfermería y el binomio paciente-familia se considera terapéutica ya que forma parte del concepto de 'profesión'. Se fundamenta en una comunicación eficaz que favorezca una relación en la cual una persona ayuda a otra; una comunicación en la que el paciente es el eje central y el profesional el último responsable de su efectividad. Evidentemente, la comunicación entre las personas depende de las habilidades comunicativas que tengan. Por tanto, el profesional debe ser empático, respetuoso, concreto, tener capacidad de escuchar receptiva y reflexivamente y, sobretodo, debe ser auténtico. La relación terapéutica está presente durante todo el proceso asistencial, desde el momento en que el paciente llega por primera vez y tiene el primer contacto con cualquier profesional hasta la última atención del último dispositivo. Cómo se establezca esta relación será la base de cualquier intervención posterior

Significant socio-emotional learning and improvement of empathy in physiotherapy students through service learning methodology: a mixed methods research

Background: research into service learning (SL) in education has increased since the 1990s. In higher education physiotherapy programmes, this technique is used to achieve real practical learning and to grasp how to recognize and manage emotions, to be concerned for others and to take decisions in clinical contexts. Objectives: to create a community experience through SL methodology for physiotherapy university students and to analyse their perceptions of the learning experience and changes in empathy. Design: a mixed research method, a quasi-experimental quantitative approach with pre- and post-measurements of a single group and a qualitative approach through reflective diaries subjected to a contents analysis. Participants: 29 students of the Faculty of Health Sciences (Department of Nursing and Physiotherapy) designed and put into practice a workshop for promoting physical activity in 277 children from the first and the sixth year of compulsory primary education. Methods: the project was divided into three phases: planning, performing and reflecting on the service. At the start, participants completed a questionnaire to determine their scale of empathy on the Interpersonal Reactive Index (IRI). One week after performing the service they handed over reflective diaries and completed a second IRI scale survey. An analysis was carried out of the contents of the reflective diaries. Results: twenty-nine students agreed to participate. These learners consolidated their skills in the subject, indicating their satisfaction with the significant learning they achieved. The IRI scale showed a significant improvement in the Personal Distress dimension (p = 0.002). Conclusions: active learning in the context of processes of a participatory and reflective type implies greater understanding of the phenomenon studied. It allows an enhance awareness of the importance of inclusivity and involvement of users in the context of clinical practice. It also provides socio-emotional learning, improving interpersonal abilities and the capacity to face up to stressful situations

A qualitative study exploring adolescents' perspective about Mental Health First Aid Training Programmes promoted by nurses in upper secondary schools

ABSTRACT:Mental Health First Aid Training Programmes are educational interventions thataim to disseminate basic first aid skills in the community. Adolescents in the context of theirsecondary school education are a particularly appropriate population for literacy promotioninterventions. This study explores adolescents’ perspectives on Mental Health First Aid TrainingProgrammes promoted by nurses in Portuguese upper secondary schools. A qualitative andexploratory study was conducted. Data were collected through semi-structured interviews with 12adolescents who participated voluntarily and with the consent of their parents. Data wereanalysed using content analysis. Fourteen themes were identified around three main areas: (i)Relevance of training programmes, (ii) Content of training programmes and (iii) Interventionmethods of training programmes. The results obtained indicate that adolescents consider MentalHealth First Aid Training Programmes in school relevant and necessary. Adolescents identified thecontent they deemed most appropriate and how it could be taught. These results can guide thedevelopment of training programmes. Nurses should take the lead in implementing these interventions in schools. Adolescents can take a more active role in mental health issues byimproving their literacyinfo:eu-repo/semantics/publishedVersio

Nurses' promotion of Mental Health First Aid Training Programmes for upper secondary students: a modified Delphi approach

Background: Mental Health First Aid Training Programmes can be carried out by nurses in schools. Adolescents have reported the importance of these interventions, the contents to be addressed, and intervention strategies that should be used. Mental health nurses have also discussed the characteristics of these training programmes. This study sought to create a consensus on the features of Mental Health First Aid Training Programmes promoted by nurses aimed at upper secondary students. Methods: A descriptive mixed method study was developed using the modified e-Delphi technique. Original statements on the topic were drawn from the results section of previous studies with nurses and adolescents. The statements were included in a structured online questionnaire. An expert panel of 78 mental health nurses participated in the two-rounds online survey from October to December 2021. Absolute and relative frequencies of responses were analysed. The experts' comments were also considered. Results: In the first round, experts suggested 4 new ideas about training programmes. Experts took a position on a total of 59 declarations. At least 75% of participants agreed with 58 statements about training programmes, namely about facilitators, intervention foci, evaluation methodology, participants, the implementation context, period and regularity, intervention strategies and content. The experts' opinions differed only in one statement that expressed the impaired sexual behaviour as a mental health problem to be addressed in the training programmes. Conclusions: Mental health nurses can lead the delivery of training programmes in upper secondary schools, improving adolescent competencies in mental health. Several educational approaches can be used to teach about mental health, related problems and actions underlying these conditions. Valid and appropriate assessment methods must be used. Our findings guide the planning, implementation and evaluation of these interventions in upper secondary schools and encourage nurses to explore these programmes and include them in their educational curricula

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

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 (β: 2.276; 95% CI: 1.30-3.25). The evidence-based practice factor which most influenced an improved therapeutic relationship was the nurses' attitude (β: 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 (β: 0.625; 95% CI: 0.09-1.16) and greater knowledge and skills for evidence-based practice (β: 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