Therapeutic Nurse-patient Relationship Research Articles

“This is part of the body” – Student nurses' de-sexualisation of intimate care for patients

BackgroundEffective intimate care can significantly impact the clinical outcomes of patients. However, conducting intimate care, which involves exposing and touching sexually sensitive areas of the body, presents challenges and anxieties for student nurses, particularly when providing care for patients of the opposite sex. ObjectivesThis study aims to identify the challenges and struggles encountered by student nurses when providing intimate care for patients of the opposite sex, as well as to explore the coping strategies employed by the students. DesignA constructivist grounded theory research approach. SettingsThe study was conducted in Macau, a Special Administrative Region of China. ParticipantsTwenty-six student nurses across various stages of their education, and three clinical mentors. MethodsPurposive and theoretical sampling techniques were utilized to recruit participants. Semi-structured interviews were conducted. The data analysis was in line with the principles of constructivist grounded theory research. ResultsA two-stage adaptation model was established, demonstrating a dynamic pathway of student nurses toward intimate care. The first stage ‘gendered confinement in intimate care’ was characterized by student nurses' negative feelings and lack of nurse-patient interactions; the second stage ‘emancipation to gendered confinement’ was characterized by the development of constructive therapeutic nurse-patient relationships. The successful transfer was achieved through students' reconstructing the meaning of intimate care and nursing profession in three interplayed types: objectification of patients' body, moral authority of nursing care, and legitimisation of nursing profession. While the transfer process involved the students' intentional efforts to de-sexualize intimate care, clinical mentors facilitated the process. ConclusionStudent nurses' adaption to intimate care is a dynamic process which enhances the construction of the nursing professional identity. Support from nursing educators can facilitate student nurses' coping with intimate care-related challenges.

Perceived usefulness of the nurse-patient therapeutic relationship in the rehabilitation journey of people with urinary incontinence: A mixed-methodstudy.

Despite various studies on the impact of incontinence on patients'lives, the existing literature has not investigated the contribution of nursing care during rehabilitation in terms of quality of life. Fewer data, therefore, exist on the characteristics and perceived impact of the therapeutic relationship as part of the rehabilitation program. To investigate the characteristics of the nurse-patient therapeutic relationship and its impact throughout the rehabilitation program; to describe the levels of patient burden on everyday activities. A monocentric, retrospective, multimethod descriptive studywas conducted in the nurse-led continence clinic of a major teaching hospital in Northern Italy. A phenomenological approach with semistructured interviews was adopted after 6 weeks of rehabilitation, following the method of phenomenological enquiry by Giorgi. The short form 12 questionnaire was administered upon admission of patients to the clinic, after 6 weeks, and during the last consultation to investigate the impact of urinary incontinence (UI) on daily activities and physical and psychological quality of life. Ninety-one adult patients of both genders presenting for nonneurogenic nonpostpartum UI were consecutively enrolled. Physical scores (PCS-12) and MCS-12 scores significantly increased over time. Psychological scores showed great variability upon admission, which was reduced halfway through the rehabilitation program. The thematic analysis highlighted four categories based on data saturation: the impact of UI on daily activities, strategies to face the problem, feelings, and the role of nurses. This mixed-method investigation suggests the importance of therapeutic nursing relationships, clinical expertise, and rehabilitative skills. Quality of life is arguably related to the positive results of the rehabilitation program but also to the environment, patients perceive in terms of support, honesty, and trust.

Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes.

The Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated. This study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient's preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment, determining language preference, and establishing scheduling availability (including evenings and weekends). DTM were provided with a tablet which allowed for self-paced education through videos and weekly video visits. The research team and Community Advisory Board identified appropriate educational video content, which was incorporated in diabetes educational topics. Video visits allowed us to assess patient involvement, motivation, and nonverbal communication. Communicating in Spanish, and awareness of diverse Hispanic/Latino backgrounds was critical, as using relevant and commonly-used terms can increase adherence and improve outcomes. Shared decision-making was encouraged to make realistic health care choices. Key elements discussed above provide a framework for future dissemination of an evidence-based DTM intervention to meet the needs of underserved Hispanic/Latino people living with T2D.

The effect of multimodal care based on Peplau’s interpersonal relationship theory on postoperative recovery in lung cancer surgery: a retrospective analysis

BackgroundLung cancer remains a major global health concern due to its high incidence and mortality rates. With advancements in medical treatments, an increasing number of early-stage lung cancer cases are being detected, making surgical treatment the primary option for such cases. However, this presents challenges to the physical and mental recovery of patients. Peplau known as the “mother of psychiatric associations” has formulated a theory of interpersonal relationships in nursing. Through effective communication between nurses and patients over four periods, she has established a good therapeutic nurse-patient relationship. Therefore, this study aimed to explore the effect of perioperative multimodal nursing based on Peplau’s interpersonal relationship theory on the rehabilitation of patients with surgical lung cancer.MethodsWe retrospectively analyzed 106 patients with non-small cell lung cancer who underwent thoracoscopic lobectomy at our department between June 2021 and April 2022. Patients were categorized into two groups according to the different nursing intervention techniques. The Peplau’s group comprised 53 patients who received targeted nursing interventions, and the control group comprised 53 patients who received conventional nursing care. We observed the patients’ illness uncertainty, quality of life, and clinical symptoms in both groups.ResultsPatients in the Peplau’s group had significantly lower illness uncertainty scores and a significantly higher quality of recovery than those in the control group. However, there were no significant differences in length of post-anesthesia care unit stay, complication rates, and visual analog scores between both groups.ConclusionThe multimodal perioperative nursing based on Peplau’s interpersonal relationship theory not only reduces the illness uncertainty of patients with lung cancer surgery and improves their QoR but also expands the application of this theory in clinical practice, guiding perioperative nursing of patients with lung cancer.ImplicationsThese findings provide practical information for standardized care in a hectic anesthetic care setting.ImpactThe assessed anesthesia nursing model helps reduce uncertainty and promote early recovery in patients with cancer at various stages of their disease, which expands the scope of therapeutic practice and existing theories. It also serves as a guide for care in the anesthesia recovery room.Reporting methodWe adhered to the relevant Equator guidelines and the checklist of items in the case–control study report.Patient or public contributionPatients cooperated with medical staff to complete relevant scales.

Explore Gaps in Therapeutic Communication and Therapeutic Nurse - Patient Relationship at Tertiary Care Hospital

Background: Effective communication in nursing is fundamental to quality patient care. The nurse-patient relationship is a vital aspect of healthcare, particularly in tertiary care hospitals, where the complexity of care is higher. Previous studies have highlighted gaps in therapeutic communication, impacting patient satisfaction and care outcomes. Objective: This study aimed to explore the gaps in therapeutic communication and the therapeutic nurse-patient relationship at a tertiary care hospital from the nurses' perspective. Methods: A cross-sectional, descriptive study was conducted at Liaquat University Hospital Hyderabad/Jamshoro. The study involved 116 nurses, selected through non-probability convenient sampling. Participants were included based on criteria such as willingness to participate, age between 25-60 years, and at least one year of work experience. Data was collected using structured questionnaires, focusing on demographic details and perceived communication gaps. SPSS version 21 was utilized for data analysis, with frequency, percentage, and mean ± SD calculated for categorical and numerical variables. Chi-square tests were applied to determine significance. Results: The mean age of the participants was 38.92 ± 9.672 years. Work experience ranged widely, with 21.9% having 2-5 years, and 2.1% having 31-35 years of experience. The major work areas included the Cardiac Ward (20.8%) and Gynea Ward (14.4%). Significant barriers identified were workload (87.5%), lack of respect (56.9%), and unfamiliar hospital environment for patients (55.5%). The study also found gaps in nurses' knowledge regarding therapeutic communication (33.4%), age difference barriers (31.9%), and lack of interest (22.3%). Conclusion: The study reveals substantial gaps in therapeutic communication and nurse-patient relationships in a tertiary care setting. Addressing these gaps requires targeted interventions to enhance nurses' communication skills, reduce workload, and improve the hospital environment.

Promoting person-centred care at the end of life.

Providing person-centred care that takes into account each patient's individual needs and priorities is crucial at the end of life. Nurses need to be aware of the main aspects of person-centred care, such as supporting shared decision-making, developing therapeutic nurse-patient relationships, and considering the patient's physical, psychological, social and spiritual needs. This article discusses the concept of person-centred care in the context of providing end of life care to patients and their families. It explains the benefits and barriers to providing person-centred end of life care, and outlines some of the areas that nurses and other healthcare professionals need to consider to promote effective care.

Virtual Reality Simulation's Influence on Nursing Students' Anxiety and Communication Skills With Anxious Patients: A Pilot Study

BackgroundAnxiety is the most prevalent mental health disorder in the United States and globally. Nurses do not feel adequately prepared to care for anxious patients, citing a lack of education in effective communication skills. Ineffective communication can negatively influence the therapeutic nurse-patient relationship and patient outcomes. Simulation methods such as high-fidelity simulation and standardized patients have decreased nursing students’ anxiety levels in caring for anxious patients. The use of full immersion virtual reality simulation as an education modality has demonstrated success in nonhealthcare and medical education but is limited in nursing education. SampleThirty-three nursing students from two accredited registered nurse programs. MethodsA quasi-experimental design implementing an anxious patient scenario in full immersion virtual reality simulation was utilized. Spielberger's short-form State Anxiety Inventory assessed students’ anxiety levels, while the simulation's analytics dashboard evaluated their communication skills. ResultsA statistically significant decrease in students’ anxiety levels over time was found. Participants’ communication scores did not demonstrate significance. ConclusionFull immersion VRS demonstrated a decrease in students’ anxiety levels. This study was the first to utilize the simulation's analytics dashboard to evaluate communication skills.

Transcultural adaptation and psychometric properties of the spanish version of the therapeutic relationship Assessment Scale-Nurse

BackgroundThe nurse-patient therapeutic relationship is considered a pillar of mental health nursing, contributing to improved person-centered care and shared decision making with the patient. Given the importance of the nurse-patient therapeutic relationship, appropriate evaluation instruments are required to assess its quality. The aim of this study was to adapt and validate the Spanish version of the Therapeutic Relationship Assessment Scale-Nurse.MethodsA translation and back-translation of the scale was carried out. To analyze the psychometric properties, the scale was administered to 213 nurses working in the field of mental health care. Temporal stability or test-retest was examined by means of the intraclass correlation coefficient (ICC) in a sample of 100 nurses.ResultsConfirmatory Factor Analysis revealed a four-factor structure identical to the original version, with some poor model fit indices. The ordinal alpha values for the total scale and the four factors were 0.939, 0.654, 0.798, 0.801, and 0.866, respectively. The intraclass correlation coefficient was 0.928 (95% CI: 0.893–0.952).ConclusionsThe results show that the Spanish version of the Therapeutic Relationship Assessment Scale-Nurse is reliable for determining the quality of the therapeutic relationship that mental health nurses can establish with their patients. However, more studies are needed to analyse the model fit of the instrument’s factor structure in the Spanish population.

The Therapeutic Nurse-Patient Relationship in Hemodialysis: A Pilot Mixed-Method Study on the Perceived Quality of Nurses' Attitudes and Caring Behaviors.

Chronic kidney disease affects many people around the world, leading those affected to replacement therapy such as hemodialysis. People who undergo hemodialysis generally undertake 2-3 treatments per week, lasting about 3-4 h each; patients spend many hours per week in contact with nurses, building a therapeutic relationship. The purpose of this work is to assess the quality of nurses' perceived caring attitudes and behaviors and to determine their perceptions regarding the importance of the therapeutic relationship with the assisted patients. A self-reported questionnaire composed of three sections was administered to nurses; the first section included sociodemographic questions, the second the Caring Nurse-Patient Interaction Scale (CNPI-23), and the third part of the questionnaire was composed of open-ended questions investigating patients' expectations according to nurses, the relevance of the therapeutic relationship on their work, and its effect on themselves and/or their own job satisfaction. Statistically significant correlations and trends have been observed between nurses' sociodemographic data and the CNPI-23 items. In the clinical care area, nurses who have a post-basic degree or more years of experience feel more competent than those in other categories; in the relational care area, women tend to feel more competent than men. No correlations were found between the humanistic and comfort care areas. According to the results, the post-basic training of dialysis nurses and the adoption of organizational strategies that encourage nurse retention should be enhanced. This study was not registered.

Recovery-oriented nursing service for people with schizophrenia in the community: An integrative review.

The recovery-oriented service concept has been recognized for its impact on mental health practices and services. As the largest group of mental healthcare providers, mental health nurses are well-positioned to deliver recovery-oriented services but face challenges due to role ambiguity and identity issues. Therefore, clarifying the role and principles of mental health nursing is essential. This study aimed to identify essential nursing practices for individuals with schizophrenia in recovery-oriented mental health services. The study utilized a five-step integrative review approach, including problem identification, literature search definition, critical analysis of methodological quality, data analysis, and data presentation. Multiple databases, such as ScienceDirect and Scopus, as well as online libraries and journals/publishers, including Sage journals, APA PsyNet, SpringerLink, PsychiatryOnline, Taylor & Francis Online, and Wiley Online Library, were searched. The search spanned from the inception of the recovery-oriented services concept in 1993 to 2022. Content and thematic analysis were employed to analyze and synthesize the findings from the included studies. Twenty-four articles met the inclusion criteria. Two themes were identified: 1) Direct nursing care, consisting of six sub-themes: therapeutic nurse-patient relationship (TNPR), psychoeducation (PE), coping skill training (CST), cognitive behavioral techniques (CBT), interventions to improve medication adherence (IMA), and social functioning (SF); and 2) Indirect nursing care. This study highlights the crucial role of nursing and nursing practices in recovery-oriented services. Mental health nurses prioritize person-centered care, therapeutic relationships, and collaboration with peer support workers to enhance treatment effectiveness. In addition, they focus on improving medication adherence, providing coping support, and promoting social capabilities, ultimately improving individuals' quality of life. Aligning actions with recovery-oriented principles, mental health nurses emphasize empowerment and holistic care. Further research in this area will enhance the healthcare system and better support individuals on their recovery journey.

Shared decision making on medication use between nurses and patients in an oncology setting: A qualitative descriptive study

(i) To explore patients' and nurses' experiences with medication-related shared decision making (SDM) (i.e., familiarity with the concept, application of medication-related SDM, barriers and facilitators towards its application) and (ii) to explore their role perceptions, respectively. A qualitative study was conducted in which seven interviews with oncological patients and a focus group interview with six nurses were performed. Prior to the interviews, observations of the application of shared decision making were conducted using the OPTION-12 scale. The observations were used exclusively to trigger the group discussion. Data were collected from November 2020 until March 2021. According to participants, the application of SDM regarding medication by nurses in oncology is limited. Barriers mentioned were health status, medication-related knowledge, the therapeutic nurse-patient relationship, time pressures and workload. Patients valued nurses' contribution to SDM regarding medication and perceived them as key persons because of their advocating, informative, facilitating and supportive role. Individual and contextual factors determined patients' desire for involvement in medication-related decisions. Participants solely concentrated on SDM concerning drug choice and management of therapeutic and adverse effects. The patients' and nurses' experiences and perceptions towards SDM in other domains of pharmaceutical care need further investigation.

Ethical Dilemmas in the Dermatology Outpatient Department in China.

Recently, sexually transmitted diseases (STDs) remain a sensitive issue within generally healthy environments. Different countries have developed various principle-based approaches to tackle the ethical issues surrounding STDs. Due to lacking any relevant laws or code of conducts to deal with the ethical issue, it has become a notable ethical problem in China. Ethical principles involve a sensitive clinical problem, this paper intends to reflect upon and discuss how nurses as moral agents deal with ethical dilemmas within Chinese culture and provided some orientations for further study. This paper briefly presented the nurses' ethical dilemma related to the issue of confidentiality and disclosure of STD patients' information via a case scenario. Based on Chinese cultural tradition, we focused on how to solve this situation as a clinical nurse with ethical principles and philosophical theories. The process of discussion provided eight steps by the Corey et al model to solve the ethical dilemma. The ability to deal with ethical dilemmas is a necessary quality for nurses. On the one hand, nurses should respect patients' autonomy and contribute positively to the relationship between confidentiality and the nurse-patient therapeutic relationship. On the other hand, nurses should combine with the current situation and make a targeted decision where necessary. Of course, professional code supported by related policies is necessary.

Impact of the 'reserved therapeutic space' nursing intervention on patient health outcomes: An intervention study in acute mental health units.

To evaluate the effectiveness of the 'reserved therapeutic space' intervention for improving the nurse-patient therapeutic relationship in acute mental health units in Spain. Multicentre intervention study with control group. The study will be carried out in 12 mental health units. The 'reserved therapeutic space' intervention to be tested has been co-designed and validated by both nurses and patients. The quality of the therapeutic relationship, the care received and perceived coercion among patients will be assessed. An estimated 131 patients per group are expected to participate. Funding was granted by the Instituto de Salud Carlos III. Co-financed by the European Union (European Regional Development Fund (ERDF) (PI21/00605))andCollege of Nurses of Barcelona(PR-487/2021). The proposal was approved by all the Research Ethics Committees of participating centres. This project will lead to changes in clinical practice, transforming the current models of organization and care management in mental health hospitalization units. No patient or public contribution.

The therapeutic relationship at the heart of nursing care: Aparticipatory action research in acute mental health units.

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. Participatory Action Research. 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. 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. 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. 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. 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.

Spanish mental health nurses' experiences of mechanical restraint: A qualitative descriptive study.

INTRODUCTION: Mechanical restraint is an intervention that causes harm to service users and nurses, yet continues to be used in many countries, including Spain. However, there is a lack of research exploring Spanish mental health nurses' experiences of using mechanical restraint. To describe the experiences of mental health nurses who have used mechanical restraint in practice. A qualitative descriptive methodology was used and a purposive sample of 10 Spanish mental health nurses were interviewed about their experiences of using mechanical restraint. Thematic analysis was then employed to analyse interview data. Participants' experiences of using mechanical restraint were mostly negative. Three main themes arose from the analysis of interview transcripts, (i) symmetrical trauma, (ii) moral injury and (iii) broken trust. The use of restrictive practices, which can be perceived as counter-therapeutic, exposes nurses to risks such as moral injury and service users to broken trust in the therapeutic nurse patient relationship. Avoiding empathy in order to use mechanical restraint is counterproductive, in the understanding that empathy is key to reducing this intervention. Reducing or eliminating use of mechanical restraints should be a policy and practice priority due to the symmetrical harms it causes both nurses and service users. The trust aspect of the therapeutic nurse-patient relationship is a significant casualty when mechanical restraint is used, therefore involving service users in co-production of post-mechanical restraint debriefing can be an avenue for restoring this trust through dialogue.

Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study.

To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units. 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. Action and observation stages of a participatory action research project. 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. 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. 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. 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.

Exploring empathy and self-efficacy in communication skills among nursing students: A cross-sectional study at two universities in the MENA region

BackgroundEmpathy is an integrated multifaceted concept that has emotional, cognitive, moral, and behavioral aspects. Nurses’ empathic attitudes convey a caring message to their patients and promote improved patient outcomes. A major challenge for student nurses is establishing a therapeutic nurse-patient relationship. This challenge should be reflected in nursing curricula. AimTo explore empathy levels and identify factors contributing to empathy perception among nursing students at Sultan Qaboos University (SQU) and Alexandria University (AU). DesignThis was a descriptive exploratory correlational study. MethodsConvenience sampling was used to recruit 500 nursing students from two public universities in Egypt and Oman. Data were collected with t a self-report three-part questionnaire that covered: 1) students’ demographic and academic characteristics; 2) the Jefferson Scale of Empathy for Nursing Students, which measures empathy among nursing students; and 3) the Communication Skills Self-Efficacy Scale, which measures healthcare professionals’ clinical communication skills self-efficacy. The present study relies mainly on Communication theory as a theoretical framework. Descriptive and analytical statistical methods were used to analyze the data. ResultsParticipating nursing students had moderate levels of empathy (AU: 92.80 ± 19.70; SQU: 84.29 ± 15.24). Communication self-efficacy, clinical score, academic level, and preference for the nursing profession were factors that significantly contributed to empathy levels (P = 0.000). ConclusionNursing students had moderate empathy levels. Use of continuous reflection and regular educational activities are recommended to improve students’ empathic attitudes and caring behaviors.

Experience of Primary Care Nurses of Sexuality Care for Persons with Disabilities: A Qualitative Study.

(1) Background: Disability is a dynamic interaction between a person’s health conditions and personal and environmental factors. Disability is an evolving concept, which can be improved by intervening in the barriers that prevent disabled people from functioning in their daily life and enjoying a satisfactory sexual life. Sexuality is an important dimension of life that affects people’s well-being. The aim was to describe and understand the experiences of primary care nurses regarding care for the sexuality of persons with disabilities. (2) Methods: A descriptive qualitative study was designed. Twenty-one in-depth interviews were conducted with nurses. A thematic analysis was used to analyse the data. (3) Results: three main themes emerged: (1) Initial assessment of the patient: competencies for a nurse-patient therapeutic relationship; (2) A comprehensive approach to nursing care for persons with disabilities: the importance of sexuality; and (3) Sex counselling in nursing consultations. (4) Conclusions: Nurses have the skills to develop a good therapeutic relationship with patients. Planning of nursing interventions is required in order to promote individual coping, emotional support, and sex education. Sex counselling is essential to promote autonomy, with the figure of the sex therapist emerging for this purpose.

Nurses' perceptions and beliefs related to the care of adults living with multimorbidity: A systematic qualitative review.

To identify and synthesise the available qualitative evidence on nurses' perceptions and beliefs related to the care of adults living with multimorbidity. The rising prevalence of adults living with multimorbidity has increased demand for health care and challenges nursing care. No review has been conducted to date of the studies of nurses' perceptions and beliefs related to the provision of care to guide policy makers, practitioners and further research to identify and deliver quality care for persons living with multimorbidity. Systematic review of qualitative studies conducted in line with the PRISMA checklist. Eight electronic publication databases and sources of grey literature were searched to identify original qualitative studies of the experience of nurses caring for adults with multiple chronic conditions with no restrictions on the date of publication or study context. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were extracted using the Joanna Briggs Institute standardised data extraction tool for qualitative research. Data synthesis was undertaken through meta-aggregation. Eleven qualitative studies were included in the review. All studies met eight or more of the 10 assessment criteria of the JBI Critical Appraisal Checklist for Qualitative Research. Four synthesised findings were generated from the aggregated findings: (i) the challenge of providing nursing care; (ii) the need to deliver holistic and person-centred nursing care; (iii) the importance of developing a therapeutic nurse-patient relationship, and (iv) delivering nursing care as part of an interprofessional care team. The complexity of multimorbidity and the predominant single-disease model of chronic care present challenges for the delivery of nursing care to adults living with multimorbidity. The nursing care of persons with multimorbidity needs to incorporate holistic assessment and person-centred care principles as part of a collaborative and interprofessional team approach. CRD42020186773.

The therapeutic relationship in the context of involuntary treatment orders: The perspective of nurses and patients.

WHAT IS KNOWN ON THE SUBJECT?: Involuntary treatment orders are increasingly being used around the world to allow the treatment of individuals living with a mental illness deemed incapable of giving consent and who are actively refusing treatment. The use of involuntary treatment orders can impact the nurse-patient therapeutic relationship, which is essential to offer quality care and promote recovery. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Nurses and patients do not agree on the possibility to develop a therapeutic relationship, with nurses believing they can build a bond with the patients despite the challenges imposed by the involuntary treatment order, and patients rejecting this possibility. Nurses caring for patients on involuntary treatment orders feel obligated to apply the conditions of this measure, even if it damages the relationship with their patients. This difficult aspect of their work leads them to question their role in relation to the management of involuntary treatment orders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need to be aware of the reasons why patients on involuntary treatment orders do not believe in the possibility of building a therapeutic relationship. Nurses need to reflect on and express their concerns about the damaging effects that managing involuntary treatment orders conditions can have on the nurse-patient therapeutic relationship. ABSTRACT: Introduction Involuntary treatment orders (ITO) can impact the nurse-patient therapeutic relationship (TR) negatively. Despite the increasing use of ITOs around the world, few studies have explored their influence on the TR from the perspectives of nurses and patients. Aim To describe the TR in the context of ITOs as reported by nurses and individuals living with a mental illness. Method Secondary data analysis of qualitative interviews with nurses (n=9) and patients (n=6) was performed using content analysis. Results Participants described the TR as fundamentally embedded in a power imbalance amplified by the ITO, which was discussed through the conflicting roles of nurses, the legal constraints imposed on patients and nurses, the complex relation between the ITO and the TR, and the influence of mental healthcare settings' context. Discussion Nurses and patients' views were opposed, questioning the authenticity of the relationship. Implications for Practice Nurses should be aware of the patients' lack of faith in the TR to ensure that they are sensitive to patients' behaviours that may falsely suggest that a relationship is established. Further studies should explore ways to alleviate the burden of the management of ITOs on nurses and allow for a trusting relationship to be build.