An interpretive phenomenological study of nursing insights into the formation of the therapeutic nurse patient relationship within acute psychiatric wards

Fieldhouse, Christopher John

Abstract

This study has concerned itself with the therapeutic nature of the relationship between psychiatric nurses and the inpatients of acute psychiatric wards. In particular it sought the insights that those nurses held in relation to their strategic endeavour to form such a relationship. Existing theory was considered and a comprehensive review of the literature was undertaken; this identified a paucity of research and theory into how therapeutic relationships are formed between nurse and patient within a contemporary acute psychiatric ward.

In order to answer the research question, this study adopted an interpretive phenomenological methodology. The convergent interview; with its inter-interview analytical process (Dick, 2017) was utilised as the method. The research was undertaken across four wards that make up the acute inpatient facilities of a single NHS site. A maximum variance sample was sought and seventeen interviews were conducted. Six major themes emerged from the responses of the participants: making a connection and relating to one another; the utilisation of values; appraising the situation and manoeuvring; using and working with boundaries; managing the challenges and pressures of acute psychiatric work; and work as a team.

Themes were re-reviewed in the light of theory, literature and contemporary commentary and then conclusions and recommendations are made. The study concluded that the endeavour to form a therapeutic relationship is a boundaried, reflective, and altruistic driven social endeavour. One that utilises the opportunities that arise out of the relational intensity of sharing a living space, whilst one party experiences an episode of acute psychiatric illness. Such intensity requires nurses to engage in self-sustaining strategies, and to adopt a team approach if their endeavours are to be successful.

The study made recommendations for recruitment practices that enable the identification of individuals with pre-existing social skill, altruistic values, an ability for personal reflection and a degree of personal resilience. Recommendations are also made for training that supports an examination of the relational impacts of power imbalances, psychiatric symptoms, professional boundaries and professional values.

Additionally, the study presents it is the establishment of a relational bond alone, which most closely resembles acute psychiatric nurses’ understanding of therapeutic relationship. Hence a recommendation is made to rethink the framing of future research or measurement of the phenomena based on the tri-partite definition of bond, goal and task agreement that defines psychotherapy understandings of therapeutic relationship (Bordin, 1979). The study also makes recommendations for both further research and theoretical development.

Citation

Fieldhouse, C. J. (2022). An interpretive phenomenological study of nursing insights into the formation of the therapeutic nurse patient relationship within acute psychiatric wards. (Thesis). Keele University

• Thesis Type: Thesis
• Publicly Available Date: May 30, 2023
• Award Date: 2022-12