Role of therapeutic relationship within mental health nursing

Role of remediation kind at bottom noetic health nursingRe face is a meaningful component of the gentilityal process and is essential for current and future master key nursing charge (Tingen, 2009). To describe what nursing look is, Tingen (2009) uses a commentary by Polit and Beck (2006, p4) who describe it as aSystematic inquiry intentional to develop knowledge virtually issues of importance to nurses, including nursing practice, nursing education and nursing administration.Without research, nurses would non be able to practice licence base anguish, the importance of which is verbalise within the economy of Conduct (Nursing and Midwifery Council 2008). sufferingonize to Haynes and Haines (1998) evidence found practice aims to integrate current best evidence from research with clinical policy and practice.It is principal(prenominal) to critic onlyy evaluate e truly research exact to establish the signifi corporationce and worth of each one-on-one publication ( Hek, 1996). For the innovation of this assignment I forget use a universal critical appraisal tool that fire be use to evaluate any type of research, which can be located in adjunct 1. It has been adapted and devised use appraisal tools from Hawker et al (2002) and the faultfinding Appraisal Skills Programme (CASP) (Public wellness Resource Unit, 2007).BackgroundI stool chosen to retread the topic of therapeutic relationships within the survey of mental health nursing. I feel this is a vital component in the nursing role, and or sothing every mental health nurse should be dexterous in. Literature states that the therapeutic relationship is a central element of c ar through which many aspects of mental health nursing is carried out (Priebe and McCabe, 2006). look for strategyMy question is what role does the therapeutic relationship learn within mental health nursing? I carried out my literature search using the Cinahl entropybase. Although at that place be a variety of infobase choices, Cinahl produced ample results so opposite infobase searches were non required. card 1 summarises my literature search results.Table 1 literature search strategy infobase namekey voice communication/phrases utilizedatabase headings applysearch limits (inclusions/exclusions)no. resultsCinahl(Search was conducted on 1st April 2011)therapeutic relationship and mental healthnonePrimary researchside languagePeer reviewed64Therapeutic relationship and psychiatricNonePrimary researchEnglish languagePeer reviewed68I searched the terms mental health and psychiatric separately b argonly in conjunction with the words therapeutic relationship to ensure a much in-depth search as both terms ar used interchangeably within literature. The collar motifs I have selected to review atomic number 18 Johansson and Eklund (2003), Scanlon (2006) and Forchuk et al. (2005). They were chosen so that both qualitative and quantitative research is include and that differing pers pectives on the therapeutic relationship were researched. A summary of the relevant education from each article can be found in a critical appraisal grid in Appendix 2. Elements of the summary entrust be referred to in the following treatment.Critical Review interrogation aims some(prenominal) research paper should make elapse the purpose of the weigh organism reported so that the reader can establish whether or not it is relevant to them (Couchman and Dawson, 1990). It is suggested that an abstract or summary is a good focus to ground a brief overview of the matter of the paper (Couchman and Dawson, 1990). Greenhalgh (2010) recommends that the introductory conviction of a research paper should state the background to the research. All three highlighted text file distinctly set out their aims and elapse background breeding as to the importance of their canvas and why it has been chosen. The Forchuk et al. (2005) learn aims to replicate a successful pilot shoot conduc ted several long time earlier, but patently on a larger scale. interrogation approach/designWhen assessing the methodological quality and approach of a paper Greenhalgh (2010) proposes five key questions. They are was the study original, whom was it about, was it well intentional, was systematic bias avoided and was it large enough and proceed for long enough to make the results credible (Greenhalgh, 2010). Johansson and Eklund (2003) give good rule for the research design using literature as evidence. Both authors are subsistd in the field of psychiatry, but the first author conducted all audiences, which helped to maintain consistency and credibility.Scanlon (2006) appears to have spent time designing her study, using established literature as well as her profess experience to develop an interrogate guide which was piloted to ensure its suitability. The Forchuk et al. (2005) study describes a make and concise research design using cluster randomisation. The study had a con trol group to compare to a group receiving the model used in the aforementioned pilot study. respectable issuesAny research involving military man participants and animal materials or specimens is subject to ethical review, whether it is clinical, biomedical or amicable research, including the secondary use (Sheffield Hallam University, 2011). Literature regarding ethical considerations varies in the areas they discuss but in general, there are four main areas of ethical perplexity where the rights and dignity of the participant must be preserved, namely ensuring take cake of harm protecting confidentiality (Behi and Nolan, 1995 Marion, 2004) and that the research process provides more benefit than harm (Behi and Nolan, 1995).The study by Johansson and Eklund (2003) was initiated by the ethics committee of the county council, so it is imitation they were recruited to complete the study, although no study is given otherwise than the authors had no collaborationism with eithe r of the two settings used to recruit participants. Although written consent was sought-after(a) it is not stated as to whether the participants understood the aims of the study. Both Scanlon (2006) and Forchuk et al. (2005) provide itsy-bitsy information other than ethical principles organism followed.SamplingFor any study to take place, the subjects must be selected, and this is called consume. The process used to select a group of people, events, behaviours or situations must ensure that the subjects are representative of the race being studied (Burns and Grove, 2007), or the research impart not be credible. The population being studied will guide what process will be used to complete the sampling process (Burns and Grove, 2007). Johansson and Eklund (2003) give in-depth and indite reasoning for their chosen sampling process. that their attempts at ensuring maximum var. can be representd to have failed with only 9 participants recruited.In contrast, petty information is given by Scanlon (2006) as to her sampling process, but there is a clear inclusion criterion for the sample of six participants. The sampling process used by Forchuk et al. (2005) appears to be in-depth with attempts to reduce any voltage limitations or barriers. A large sample size of 390 participants partook in the study, which was a year long. A dropout rate of 36% resulted in 249 completing the study. data assemblageBurns and Grove (2007) define data collection as the precise, systematic gathering of information relevant to the research purpose or the specific objectives, questions, or hypotheses of a study. The choice of data collecting proficiency used will be determined by the type and purpose of the study being conducted (Burns and Grove, 2007). The data collection method utilised in the Johansson and Eklund (2003) study was an open-ended in-depth interview with a clear focus. The interview was achieve written during discussion with no other recording equipment used. They themselves admit that this can introduce bias and the potential for data to be missed using this process. To maintain consistency the interviewer was the same mortal for all interviews, but the person transcribing is not stated.Other than developing a piloted interview guide, Scanlon (2006) does not give particular proposition about the data collection technique, other than semi-structured interviews being conducted. The interview guide is attached as an appendix. Data collection methods in the Forchuk et al. (2005) study would appear to be very thorough involving 5 tools, 3 of which were designed solely for this research.Data summaryAfter the data is collated, the research will be of no use to anyone if it is not analysed as it will have no meaning or explanation (McMichael, 2007). Analysis transforms the data roll up into new knowledge (Thorne, 2000) and with its primary purpose being to impose some order to data so that conclusions can be made and communicated (Massey, 1995) . The analysis process in the Johansson and Eklund (2003) study would appear to be very thorough. However the interviewer was one of the researchers categorising, so the transcripts were known and analysis may have been affected. Scanlons (2006) research provides a good example of thorough data analysis, using a recognised coding procedure comprising of three sets of coding. In contrast Forchuk et al. (2005) give little information regarding their data analysis providing only one elegant paragraph explaining how t-tests were used to test hypothesis.FindingsThe findings or results of any study should be presented in a way that advises the reader of any significant outcomes (Burns and Grove, 2007). It is suggested that tables and discussion are separate to as to avoid confusion (Couchman and Dawson, 1990). Johansson and Eklund (2003) give a good example of separating the ways in which the data is presented, with an in-depth discussion about each category. Sub categories were created to provide further clarity and quotes from interview are used to emphasise points. However the table gives little information other than the headings for each category and brings little value to the report.Scanlon (2006) uses an in-depth discussion to relay her findings, with quotes from participants accompaniment literature on the topic area. The studys aims have clearly been achieved. fenceing the extent of data collected, the findings are surprisingly sparse in the Forchuk et al. (2005) paper. Baseline data is presented in a table, but little information is available as the findings did not support the hypothesis.Generalisability/transferabilityGeneralisability refers to the extent to which research findings are valid and relevant to other settings (Pibouleau, 2009) and how useful they are (Altman and Bland, 1998). Pibouleau (2009) explains how poor reporting of generalisability can be a barrier to research findings being introduced to clinical practice. If findings are not gen eralisable consequently they will not be suitable to be implemented into clinical practice. The refined scale of the study by Johansson and Eklund (2003) indicates that it is weak and that its generalisability is limited. They attempt to argue that due to having no contrasting findings that it gives rise to a certain tip of representativeness, but their conclusion contradicts this by stating there was some variation, the culprit being a patient with psychosis. Scanlon (2006) reports her study to not be generalisable due to its small scale. However, it does discuss how therapeutic relationships fit in with the role of psychiatric nursing, so the study can be argued to be transferable to the wider population. The Forchuk et al. (2005) study failed to witness its aims, so is not generalisable in any way. This is despite it being based on a successful pilot study conducted some years previously.Implications for practiceThe research by Johansson and Eklund (2003) heads very little i mplication for practice other than to offer issues that should be turn to in future uniform studies. The study is flawed, and has limitations and contradictions within the discussion. Both authors have previous experience in research in the topic area which is evident in the referencing of their own work, so it raises concerns that these issues have not been addressed in previous work. In contrast Scanlon (2006) recognises all flaws in her study, and gives several recommendations for future research. The fact that the interview guide is included and the findings discussed in such depth allows the study to be replicated. Very little can be gained from the Forchuk et al. (2005) research with regards to enhancing practice, but recommendations are made for future study, almost as a token gesture. However, the paper does highlight factors to consider when planning the discharge process to ensure success, so cannot be completely dismissed.DiscussionConsidering the substance of therapeu tic relationships within the field of mental health and the importance it plays within the role of the nurse, the analysis of the highlighted cover is disappointing. The Johansson and Eklund (2003) paper is flawed offering nothing significant for clinical practice. The Forchuk et al. (2005) study failed to meet its aims and as a result provided very little information other than the importance of providing support in the transition from hospital to community. Although very valid, this is does not compensate for the complete failure of the research which was based on a successful pilot. It can be argued that the only paper critiqued that can offer anything to clinical practice is that published by Scanlon (2006), but whence her conclusions infer the opposite. Despite the fact that her study can easily be replicated and recommendations for future research are offered, she casts doubt by having a prohibit focus on her findings.ConclusionThis critical review has little to offer to a ddress my question, but the background research and literature reviews within the reviewed papers does offer a rich source of secondary information. Despite that none of the studies have generalisability they do highlight issues that future researchers should be aware of. From this review it seems that a qualitative approach is best suited to a study in this topic area. It is recommended that the flaws and limitations highlighted in the above research designs are used to establish an effective method for evaluating the role of the therapeutic relationship in mental health nursing.ReferencesALTMAN, D.G. and BLAND, J.M. (1998). Generalisation and extrapolation. online. British medical exam ledger, 317 (7155), 409-410. Article from British Medical Journal last accessed 1 April 2011 at http//www.bmj.com.lcproxy.shu.ac.uk/content/317/7155/409.full.pdfBEHI, R. and NOLAN, M. (1995). Ethical issues in research. British Journal of Nursing, 4 (12), 712-716.BURNS, N. and GROVE, S.K. (2007). Understanding Nursing Research Building an evidence-based practice. fourth ed., China, Saunders Elsevier.COUCHMAN, W. and DAWSON, J. (1990). Nursing and health-care research. London, Scutari Press.FORCHUK, C. et al. (2005). Therapeutic relationships from psychiatric hospital to community. online. Journal of psychiatric and Mental wellness Nursing, 12 (5), 556-564. Article from Ebscohost last accessed 1 April 2011 at http//web.ebscohost.com.lcproxy.shu.ac.uk/ehost/pdfviewer/pdfviewer?sid=f3dd7acd-4bbe-4931-88aa-e5fbf505b948%40sessionmgr14vid=2hid=10GREENHALGH, T. (2010). How to read a paper The basics of evidence-based medicine. 4th ed., West Sussex, Wiley-Blackwell.HAWKER, S. et al. (2002). Appraising the Evidence Reviewing Disparate Data Systematically. online. Qualitative Health Research, 12 (9), 1284-1299. Article from Sage last accessed 1 April 2011 at http//qhr.sagepub.com.lcproxy.shu.ac.uk/content/12/9/1284.full.pdf+htmlHAYNES, B. and HAINES, A. (1998). Barriers and bridges t o evidence based clinical practice. British Medical Journal, 317 (7153), 273-276.HEK, G. (1996). Guidelines of conducting critical research evaluation. Nursing Standard, 11 (6), 40-43.JOHANSSON, H. and EKLUND, M. (2003). Patients suasion on what constitutes good psychiatric care. online. Scandinavian Journal of Caring Sciences, 17 (4), 339-346. Article from Ebscohost last accessed 1 April 2011 at http//web.ebscohost.com.lcproxy.shu.ac.uk/ehost/pdfviewer/pdfviewer?sid=c7e46787-eb49-4138-85ac-a8a551792d91%40sessionmgr11vid=2hid=10MARION, R. (2004). Ethics in research. online Last accessed 1 April2011 at http//www.sahs.utmb.edu/pellinore/intro_to_research/wad/ethics.htmMASSEY, V.H. (1995). Nursing research. Pennsylvania, Springhouse Corporation.MCMICHAEL, C. (2007). Qualitative data analysis. online. Last accessed 2 April 2011 at http//www.latrobe.edu.au/publichealth/Units/phe6/phe6hrb/Week%206%202007%20Analysis.pdfNURSING and MIDWIFERY COUNCIL (2008). The Code in Full. online. Last a ccessed 1 April 2011 at http//www.nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/standardPIBOULEAU, L. (2009). Applicability and generalisability of published results of randomised controlled trials and non-randomised studies evaluating four orthopaedic procedures methodological systematic review. online. British Medical Journal, 339 (b4538), 1-8. Article from British Medical Journal last accessed 1 April 2011 at http//www.bmj.com/content/339/bmj.b4538.fullPOLIT, D.F. and BECK, C.T. (2006). Essentials of nursing research Methods, appraisal, and utilization. 6th ed., Philadelphia, Lippincott Williams and Wilkins.PRIEBE, S. and MCCABE, R. (2006). The therapeutic relationship in psychiatric settings. online. Acta Psychiatrica Scandinavica, 113 (s429), 69-72. Article from Wiley last accessed 1 April 2011 at http//onlinelibrary.wiley.com.lcproxy.shu.ac.uk/doi/10.1111/j.1600-0447.2005.00721.x/pdf worldly concern HEALTH RESOURCE UNIT (2007). Appraisal Tools. Online. Last accessed 1 April 2011 at http//www.phru.nhs.uk/Pages/PHD/resources.htmSCANLON, A. (2006). Psychiatric nurses perceptions of the constituents of the therapeutic relationship a grounded theory study. online. Journal of Psychiatric and Mental Health Nursing, 13 (3), 319-329. Article from Ebscohost last accessed 1 April 2011 at http//web.ebscohost.com.lcproxy.shu.ac.uk/ehost/pdfviewer/pdfviewer?sid=476f44a1-8cff-4a3c-a40f-c96bc336d3c3%40sessionmgr14vid=2hid=10SHEFFIELD HALLAM UNIVERSITY (2011). Research ethics 1. Research involving human participants. online. Last accessed 1 April 2011 at http//students.shu.ac.uk/rightsrules/resethics1.htmlTHORNE, S. (2000). Data analysis in qualitative research. Evidence base Nursing, 3 (3), 68-70.TINGEN, M.S. et al. (2009). The importance of nursing research. Journal of Nursing Education, 48 (3) 167-170.Appendix 1A Universal Critical Appraisal Tool alter from HAWKER, Sheila et al (2002) Appraising the Evidence Reviewing Disparate Data Systematically. Qualita tive Health Research, 12 (9), 1284-1299 and the Critical Appraisal Skills Programme (CASP) appraisal tools http//www.phru.nhs.uk/Pages/PHD/CASP.htm1 Research aims and research question Is there a clear statement of aims and a research question?ConsiderIs the goal of the research clearly stated? ar reasons given for why the research is relevant or distinguished?2 Research approach/design Is the approach appropriate and clearly explained?ConsiderIs the research approach/design justified?Is an explanation offered as to why it was chosen?3 Ethics have ethical issues been addressed and was necessary ethical approval obtained?ConsiderAre issues of confidentiality, sensitivity and consent addressed?Are research governance processes clearly expound?4 Sampling Is the sampling strategy appropriate to address the research aims?ConsiderIs how the participants were recruited, selected or allocated explained?Are details provided (e.g. race, gender, age, context) of who was studied?Is the sample size for the study justified?5 Data collection Are the methods of data collection appropriate and clearly explained?ConsiderIs it clear how the data were collected and are the methods chosen justified?6 Data analysis Is the translation of the data analysis sufficiently rigorous?ConsiderIs there a clear description of how analysis was done Qualitative Is there a description of how themes or concepts were derived?Quantitative Are reasons for the statistical tests selected described and statistical significance discussed?7 Findings Is there a clear description of the findings?ConsiderAre findings explicit, easy to understand and in logical progression?Are tables, if present, explained in the text?Do results relate directly to the aims?Are sufficient data presented to support the findings?8 Transferability or generalisability Are the findings of this study transferable, or generalisable to a wider population?ConsiderAre the context and setting of the study described sufficiently to allow comparison with other contexts and settings?Is there sufficient detail provided about the sample (as in section 4)?9 Implications and usefulness How important are these findings to policy and/or practice?ConsiderDo the findings pass something new and/or different in terms of understanding, insight or perspective?Are ideas for further research suggested?Are implications for policy and/or practice suggested?