Environmental Influences on the Therapeutic Relationships of Nurses Working in Mental Health

Tuesday, July 12, 2011: 10:30 AM

Michael A. Roche, RN, PhD, MHSc, BHSc, DipAppSc, CertMHN
Centre for Health Services Management, Faculty of Nursing Midwifery & Health, University of Technology, Sydney, Broadway, Australia
Christine Duffield, RN, PhD
Centre for Health Services Management, University of Technology, Sydney, Sydney, Australia

Learning Objective 1: Identify the characteristics of the practice environment that impact on nurses working in acute inpatient mental health settings.

Learning Objective 2: Understand the amount of influence each of the identified factors have on the nurse's ability to engage in therapeutic relationships with patients.

Purpose: The therapeutic relationship is considered the central focus of nursing work in mental health and has been linked to patients’ involvement in care and patient outcomes (Horvath, 2005). Therefore, factors that may improve or impeded the nurse’s ability to engage effectively in this relationship have the potential to have a corresponding influence on the patient and their outcomes. Studies in mental health and other nursing domains have identified a range of environmental factors that have an influence on nurses (Aiken, et al., 2008; Hanrahan et al., 2008, 2010). This study investigated the impact of characteristics of the work environment on the willingness and ability of nurses to engage in therapeutic relationships.

Methods: Data were collected on six mental health wards in 5 public general acute hospitals in Australia between 2005 and 2006. In addition to ward staffing and skill mix data, all nurses on the participating wards were asked to complete a survey that included the Practice Environment Scale of the Nursing Work Index (Lake, 2002), and the Mental Health Problems Perception Questionnaire (Lauder, et al., 2000). Reponses were received from 76 nurses (51% response). Analyses were conducted using a modelling approach in order to identify the most influential factors. 

Results: Experienced nurses who perceived themselves to be competent and supported were more likely to express a willingness to engage therapeutically with patients. Environmental factors associated with these perceptions included access to continued education, career development, opportunities to participate in hospital affairs and clinical supervision.

Conclusion: Positive hospital practice environments can improve the capacity of nurses working in mental health to engage therapeutically with patients. Specific approaches include access to preceptorship, continued education and career development opportunities, together with clinical supervision, improved continuity of care, and the involvement of mental health nurses in the governance of the hospital.