Implementing evidence-based practices on the therapeutic relationship in inpatient psychiatric care: a participatory action research

Abstract

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.