Aims and objectives: To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units.Background: In mental health units, the therapeutic relationship is especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care.Design: Action and observation stages of a participatory action research project.Methods: Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used.Results: The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice.Conclusions: This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse–patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice.Relevance to clinical practice: These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day‐to‐day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.

Although the use of verbal de‐escalation in nursing has been shown to be an effective tool for controlling agitation and avoiding mechanical restraint, there is scarce evidence supporting the use of de‐escalation by nurses and factors related to the patients who ultimately receive mechanical restraint. This retrospective study sought to examine the relationship between the use of verbal de‐escalation by nurses and the clinical profile of patients who had received mechanical restraint at an acute mental health unit. This study analysed the records of patients who had received mechanical restraint between the years 2012 and 2019. A bivariate analysis was initially performed, followed by multiple logistic regression analysis. A total of 493 episodes of restraint were recorded. Of these, in almost 40% of cases, no prior use of verbal de‐escalation was noted. The factors associated with the use of verbal de‐escalation by nurses were patients with a history of restraint episodes and patients who previously had been administered medication. Furthermore, episodes of mechanical restraint that occurred later during the admission were also associated with the use of de‐escalation. These findings confirm the relevance of early nurse interventions. Consequently, it is important to establish an adequate therapeutic relationship from the start of hospitalization to facilitate getting to know the patient and to enable the timely use of verbal de‐escalation, thus avoiding the use of mechanical restraint.

Aims. (i) To evaluate the scope and quality of nurse‐patient interactions recorded in the clinical notes of inpatient mental health units and (ii) to identify nursing interventions recorded in the context of the nurse‐patient relationship in the clinical notes of inpatient mental health units. Design. A multimethod approach was use. Methods. Employing a quantitative cross‐sectional design for the first aim, and a qualitative content analysis design of secondary data for the second aim. In total, 1,714 clinical notes were examined from 44 randomly selected patients who were hospitalized in five mental health units over the years 2022‐2023. Results. The patient’s experience of the interaction was present in 69.9% (n = 1,198) of the notes. However, only 12.0% (n = 205) of the notes reached a sufficient standard of quality in terms of describing the nurse‐patient interactions. Specifically, more than half of the notes did not reflect any type of nursing intervention (n = 723; 60.4%). Thirty interventions compatible with the nursing intervention classification were identified, of which more than 70% corresponded to domains in the physiological area. Conclusion. This study shows that the quantity and scope of patients’ clinical notes in mental health units do not sufficiently reflect the interventions performed by nurses, nor the quality or impact of these interventions in the context of the nurse‐patient therapeutic relationship. Implications for the Profession and/or Patient Care. Improving the quality of clinical notes by integrating interventions and their impact can increase the quality of nursing care. Impact. The use of standardized nursing terminologies would contribute to the understanding of the extent and quality of nurse‐patient interactions recorded in clinical notes. Thus, standardized documentation would also help to improve these interactions and their recording, which will facilitate decision‐making. Reporting Method. Findings were reported using COREQ and STROBE guidelines. Patient or Public Contributions. There were no patient or public contributions.

Aims and Objectives: To explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse–patient therapeutic relationship.Design: Participatory Action Research.Methods: Ninety‐six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used.Results: The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change.Conclusions: This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar.Relevance to Clinical Practice: The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units.No Patient or Public Contribution: Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice.

BACKGROUND: The practice environment influences the quality of care and the nursing outcomes achieved in their workplaces. OBJECTIVE: To examine the perception of the clinical practice environment among nurses working in mental health units in the context of their participation in an action research study aimed at improving the nurse–patient relationship. METHOD: An explanatory sequential mixed methods study was designed. The data were collected in three phases in 18 mental health units (n = 95 nurses). Quantitative data were collected through the Practice Environment Scale of the Nursing Work Index, and qualitative data were collected through reflective diaries and focus groups in the context of participatory action research. RESULTS: The nurses’ assessment of their practice environment shifted from positive to negative. Nurse manager leadership was the aspect that worsened the most. In addition, the perception of their participation in the affairs of the center and nursing foundations for quality of care decreased. The nurses considered it essential to be able to influence decision-making bodies and that the institution should promote a model of care that upholds the therapeutic relationship in actual clinical practice. CONCLUSIONS: Nurses perceived that they should be involved in organizational decisions and required more presence and understanding from managers. Furthermore, nurses stated that institutions should promote nursing foundations for quality of care. This study contributes to understanding how nurses in mental health units perceive their work environment and how it affects the improvement of the nurse–patient relationship in clinical practice.