Exploring therapeutic engagement in Finnish adult acute inpatient mental health settings.

Why you should read this article: • To consider what constitutes effective therapeutic engagement between mental health nurses and service users • To understand how therapeutic engagement can have a positive effect on the overall ward environment and service users’ dignity, as well as providing them with a voice regarding their care pathway • To appreciate the value of collaborative care plans that can support service users when they become unwell. Background: Effective therapeutic engagement between mental health nurses and service users is associated with enhanced service user satisfaction and clinical outcomes and reduced rehospitalisation rates, and is essential to support service users’ recovery. Aim: To measure therapeutic engagement in adult acute inpatient wards in Finland from the perspectives of service users and nurses using the Therapeutic Engagement Questionnaire (TEQ) and to identify areas where the quality of this engagement may be enhanced. Method: Nurses (n =47) and service users (n=123) from 13 acute inpatient wards in two healthcare organisations in Finland – Helsinki University Hospital (which oversees 23 hospitals in different locations) and Aurora Hospital, a municipal psychiatric hospital in Helsinki – completed the TEQ. The TEQ is designed specifically for use in acute mental health inpatient settings to objectively measure nurses’ therapeutic contribution to service users’ recovery, as perceived by both groups, and to give service users an active voice regarding their care pathway. Respondents rate a series of statements, two on a visual analogue scale and 40 on a four-point Likert scale. Higher scores indicate better therapeutic engagement. Statements with the greatest number of ‘strongly disagree’ responses indicate potential areas for improvement. Results: Both groups of respondents highly rated the effects of nursing staff and named nurses on service users’ recovery through therapeutic engagement, overall ward environment and atmosphere, preserving service users’ dignity and nurses’ professional behaviour. Low ratings were awarded by both groups to nursing staff’s and named nurses’ support with planned care risks and stepping out of their (service users’) comfort zone, and fostering service users’ confidence to create practical and realistic care plans for achieving their goals. Statements with the greatest number of ‘strongly disagree’ ratings by service users included that ‘[my named nurse] works with me to plan my care in advance of me being unwell’ and ‘[the nursing staff] help me to have control over my care plan’. Conclusion: Service users and nurses regard therapeutic engagement as important in supporting service users’ recovery. However, nurses should be supported to develop collaborative, practical and realistic care plans that support service users with planned care risks, expand their care comfort zone and incorporate advance care planning should the service user become unwell. [ABSTRACT FROM AUTHOR]