The therapeutic role of mental health nurses in psychiatric intensive care: A mixed-methods investigation in an inner-city mental health service

INTRODUCTION: Despite indications that therapeutic interaction is beneficial for patients and for nurses' job satisfaction in acute psychiatric care, research shows a small amount of nurses' time is spent on such activity.

AIMS: This study investigated the actual and potential therapeutic role of the mental health nurse in psychiatric intensive care, where admission is due to violence or aggression.

METHODS: In a mixed-methods concurrent triangulation design, clinician and patient activity was observed using a structured measurement tool, and qualitative interviews were conducted with four practitioners and six patients. Findings were generated using thematic analysis and descriptive statistics.

RESULTS: Of the directly observed 234 clinician and 309 patient activities, 20.9% and 15.9% respectively were classified as therapeutic engagement. Interviews revealed that both clinicians and patients wanted more therapeutic contact, but whereas nurses wanted longer time to spend in individual sessions, patients preferred brief but more frequent interaction with nurses.

DISCUSSION: This study shows disparity between actual and desirable levels of therapeutic interaction. Apart from organisational constraints, a fundamental problem is the lack of definition or established practices of therapeutic engagement.

IMPLICATIONS FOR PRACTICE: There should be more emphasis on therapeutic engagement in nurse education, ward management and clinical supervision. This article is protected by copyright. All rights reserved.