Journal of Psychiatric and Mental Health Nursing最新文献

Introduction: A strong nurse-patient therapeutic relationship is crucial in acute mental health care yet remains challenging, potentially affecting outcomes and perceived quality of care. Interventions that foster structured, person-centred encounters may address these challenges effectively.

Aim: To evaluate the effects of the 'Reserved Therapeutic Space' intervention in terms of its impact on the improvement of the nurse-patient therapeutic relationship, the quality of care, perceived coercion and humiliation and length of stay.

Methods: A multicentre quasi-experimental trial design in twelve acute mental health units compared the Reserved Therapeutic Space to standard care. Participants completed validated instruments assessing the therapeutic relationship, perceived quality of care and coercion. Mixed-effects models and survival analyses evaluated intervention effects.

Results: Participants receiving the Reserved Therapeutic Space reported stronger nurse-patient relationships, higher quality of care ratings and lower coercion scores compared to those receiving standard care. Survival analysis indicated significantly shorter hospitalizations in the intervention group.

Implications: Findings suggest that dedicating structured time for nurse-patient engagement enhances therapeutic relationships, reduces negative experiences and potentially improves both satisfaction and resource use. Providing structured therapeutic encounters can advance person-centred, collaborative mental health nursing practices in acute settings. Future research should explore long-term outcomes of this intervention.

Introduction: Efforts to reduce restrictive practices in acute mental health units require more than operational reform; they also need to give voice to clinicians who implement these changes.

Aim: This paper forms part of a broader evaluation of the Safe Steps for De-escalation, which was aimed at investigating the impact of the Safe Steps implementation on the perceived professional quality of life of the nurse participants. This paper also presents a qualitative assessment of the process, aimed at identifying the factors that influence the successful implementation of the Safe Steps from the perspective of the nurse participants.

Methods: Safe Steps is a structured approach for de-escalation, intended to reduce restrictive practices and promote the development and maintenance of therapeutic relationships, as well as individuals' self-management. It was implemented in three adult inpatient units in New South Wales, Australia, from March 2024 to April 2025. This paper was nested within a mixed concurrent control study and was informed by a pragmatic and complex intervention research framework. Nurse focus group discussions were analysed using reflexive thematic analysis. Paired measures of compassion satisfaction, burnout, and compassion fatigue before and after one-year implementation were compared.

Results: Scores after implementation indicated a decline in compassion satisfaction and an increase in burnout, compared to the baseline. Two superordinate themes were identified from seven focus groups, with twenty-six nurse participants: (i) de-escalation is a relational, adaptive, and collective nursing practice, and (ii) ecological pressures shape the practice of de-escalation. These superordinate themes were developed from seven subordinate themes.

Discussion: A cautious interpretation of the quantitative measures is warranted, given the challenges of obtaining follow-up responses in busy, under-resourced inpatient units. The thematic findings suggest that successful implementation depends on the organisational and relational contexts in which interventions are deployed.

Recommendations: Future evaluations of the Safe Steps need to consider extending beyond nurses' relational capabilities to encompass the relational responsiveness of multidisciplinary teams.

Background: Suicidality is frequently examined through psychiatric or epidemiological lenses, with culture treated as a secondary factor or explanatory variable. This essay advances an alternative view, positioning culture as the lived horizon through which suffering is interpreted, narrated, and acted upon.

Aim: To examine how culturally grounded systems of meaning shape suicidal experience and to translate these insights into practical guidance for nursing suicide risk assessment and care.

Approach: Drawing on cross-cultural suicidology, narrative identity theory, and ethically constructed clinical illustrations, the essay explores suicidal meaning making across Indigenous, Japanese, and Muslim minority contexts. Suicide risk is framed as a narrative crisis in which a person's life story constricts towards a single perceived ending while avoiding cultural essentialism.

Key findings: Across contexts, cultural worlds shape how distress is voiced, which forms of disclosure feel permissible, and what protective anchors remain accessible. Clinically salient meanings include duty, shame, exile, faith, and belonging. Protective resources often emerge through land, language, ritual, creativity, spirituality, and community relationships.

Implications for nursing practice: Rather than offering causal explanations, the essay provides practice-oriented guidance for nurses. This includes culturally attuned listening, documentation of cultural resources alongside standard risk elements, collaboration with Elders or faith leaders when appropriate and with consent, and the use of relational and family-centred pathways of support.

Conclusion: Centring culture as the medium of meaning allows suicide assessment and care to become more accurate, humane, and responsive to patients' lived worlds, supporting narrative reopening rather than symptom management alone.

Introduction: Patient experiences of recovery-oriented nursing practices in psychiatric inpatient care are understudied. Steps Towards Recovery (STR) is a nursing-led programme developed to promote personal recovery through empowering each patient's ability to identify resources, find solutions and gain control over one's life.

Aim: The aim was to evaluate patients' experiences of participating in STR.

Method: Interviews with 18 patients participating in STR group sessions at a psychiatric inpatient clinic. Data were inductively analysed with applied thematic analysis.

Results: Three themes were identified. STR group sessions, with the manual-based contents, seem beneficial for taking the first steps towards a personal recovery process. Participants described an increased ability to see things from different angles, could focus their thoughts more positively, and underlined the importance of maintaining these strategies after discharge. Group leaders' skills related to psychiatric inpatient care were also reflected on.

Discussion: STR seems to promote personal recovery. Psychiatric inpatient care requires group leaders trained in STR with competence to manage advanced psychiatric nursing care.

Limitations: Data were collected at one clinic, decreasing transferability.

Implications: Recovery-oriented programmes in psychiatric wards can support patients' first steps towards recovery.

Recommendations: Nursing-led programmes supporting personal recovery should be implemented in psychiatric wards.

Background: Discharge planning should be considered for all individuals attending mental health services from the first visit and should involve the individual, whenever possible. However, despite this ideal and evidence for planned discharge, many services still carry out this process in silos, away from the individual it impacts most.

Purpose: This paper aims to reflect on Will's experience of discharge during his time with Child and Adolescent Mental Health Services (CAMHS) in order to demonstrate the importance of discharge planning in such services.

Method: This is a first person narrative weaved with input from the academic literature in order to examine discharge planning within CAMHS.

Findings: As demonstrated through this lived experience piece, when discharge is planned efficiently and with the person involved throughout, then the overall experience of the service and of the discharge process, particularly in CAMHS, is a positive one. However, as noted in this narrative, unfortunately, this ideal is often not met, and despite the good that is achieved from accessing services, discharge when unplanned and not considered in the unique context of the person can lead to a return to unwellness. In essence, this narrative advocates for a recovery-oriented, person-centred approach to discharge planning and execution in CAMHS so that a person, like Will, can live a life of their choosing, free from unwellness.