Investigations into patient and nursing staff experiences of acute adult inpatient mental health units

Abstract

Section A
Background: Adult inpatient care has changed considerably over the last sixty years. The multiple failings of the inpatient system are well documented, and countless studies have shown that inpatient care is often experienced as inadequate by patients. There is a need for understanding what high-quality inpatient mental health care looks like in order to improve care for patients.

Aims: To conduct a systematic review of the literature base in order to understand experiences of acute adult inpatient mental health care and what the ingredients of high-quality care are from a patient perspective.

Method: A systematic search of three online databases (MEDLINE, PsychINFO, CINAHL) was carried out. Primary research published between 2017 and 2024 was screened against inclusion and exclusion criteria. Study quality was appraised. A narrative synthesis was carried out and key themes were identified.

Results: Fourteen studies were included in the review. Four key themes were identified: therapeutic relationships; patient-centred care and involvement; coercive practices; the physical inpatient environment.

Conclusion: The identified themes confirm findings from previous systematic reviews. Patients frequently described adverse experiences of coercive practices ranging from restraint to ward rules. High quality inpatient care included therapeutic relationships, involvement in one’s care, and access to activities and psychological therapies. A key message across all studies was the fundamental importance of high-quality therapeutic relationships to recovery. The review adds to a body of evidence that can be used to guide improvements in inpatient care.

Section B
Background: Meaningful nurse-patient relationships are of fundamental importance to the quality of acute adult inpatient mental health care and recovery. Despite recognition of the value of relationships, inpatients tend to be critical of their care and the quality of their relationships with nursing staff, highlighting the need to understand how nurse-patients relationships develop, and how they might be facilitated.

Aims: To develop an explanatory theory and model of the social processes involved in the development of therapeutic relationships between nursing staff and patients on acute adult inpatient mental health units.

Method: Semi-structured interviews were conducted with six current inpatients and seven members of the nursing team from two acute adult inpatient mental health units in an inner-city London borough. A grounded theory methodology was used to identify key concepts across the interviews.

Results: The analysis produced eight categories, which formed a preliminary model depicting the process of developing meaningful therapeutic relationships between patients and nursing staff. Relationships were conceptualised as a temporal, relational process unfolding across overlapping phases.

Conclusion: The findings contribute to an under-researched area and offer a preliminary model of nurse-patient relationship development that can guide further research, service development, and training. The study highlights the often-overlooked value of relational work undertaken by nursing staff, and the challenges they face in forming and managing relationships.

Date of Award	2025
Original language	English