TY - JOUR
T1 - The nature of the therapeutic alliance between nurses and consumers with Anorexia Nervosa in the inpatient setting
T2 - A mixed-methods study
AU - Zugai, Joel S.
AU - Stein-Parbury, Jane
AU - Roche, Michael
N1 - Funding Information:
The conduct of this study was guided by the National Statement on Ethical Conduct in Human Research (National Health and Medical Research Council 2007) and by the Declaration of Helsinki (World Medical Association 2013). Ethical considerations for this project were of particular importance, given the vulnerability of consumers with AN. Participation in this project was voluntary, and fully informed consent was sought from all participants, as well as parental consent for interviews with adolescent consumers under the age of 18. Prior to gaining consent from consumers, the treating team verified that the consumer was cognitively and medically stable to the degree that consent and participation was viable. The PI was a PhD student experienced in qualitative research and was overseen by experienced supervisors. Confidentiality was maintained by removing identifiable information in the interview transcripts and through the use of pseudonyms in reporting the results. Ethical approval was attained from the participating hospitals and the relevant university.
Publisher Copyright:
© 2017 John Wiley & Sons Ltd
PY - 2018
Y1 - 2018
N2 - Aims and objectives: To develop a greater understanding of the nature of the inpatient therapeutic alliance between nurses and consumers with Anorexia Nervosa (AN). Background: Consumers with AN value interpersonal relationships with nurses, finding these relationships meaningful and therapeutic. It is established that the therapeutic alliance enhances outcomes for consumers with AN. However, establishing the therapeutic alliance in the inpatient setting is considered challenging. Design: This study employed a two-phase mixed-method explanatory sequential design. An initial quantitative survey, phase one, was followed by the collection and analysis of qualitative data, phase two. Methods: Phase one employed validated survey instruments, measuring the perceived degree of therapeutic alliance and elements of ward milieu. Phase two involved semi-structured interviews that focused on therapeutic relationships between nurses and consumers, with specific exploration of the results from phase one. Data collection commenced May 2014 and concluded February 2015. Results: The therapeutic alliance involved interpersonal engagement and a balanced application of authority. In a therapeutic alliance, nurses cared for consumers with interpersonal finesse, whilst maintaining clear distinction between the consumer as an individual and AN as an illness. Nurses also developed a therapeutic alliance by occupying their position of power with consistent yet individualised expectations and by maintaining appropriate professional boundaries. Conclusions: The therapeutic alliance between nurses and consumers with AN is not developed through negotiation of equal partners. Rather, the therapeutic alliance is dependent on nurses' capacity to maintain their position of power, whilst demonstrating their trustworthiness to the consumer. In trusting nurses, consumers felt safer in investing in a new concept of well-being. Relevance to Clinical Practice: By understanding the nature of the therapeutic alliance as it is described in this study, nurses have an enhanced capacity to develop effective therapeutic alliances with consumers. A maternalistic nursing style emerged as a viable approach.
AB - Aims and objectives: To develop a greater understanding of the nature of the inpatient therapeutic alliance between nurses and consumers with Anorexia Nervosa (AN). Background: Consumers with AN value interpersonal relationships with nurses, finding these relationships meaningful and therapeutic. It is established that the therapeutic alliance enhances outcomes for consumers with AN. However, establishing the therapeutic alliance in the inpatient setting is considered challenging. Design: This study employed a two-phase mixed-method explanatory sequential design. An initial quantitative survey, phase one, was followed by the collection and analysis of qualitative data, phase two. Methods: Phase one employed validated survey instruments, measuring the perceived degree of therapeutic alliance and elements of ward milieu. Phase two involved semi-structured interviews that focused on therapeutic relationships between nurses and consumers, with specific exploration of the results from phase one. Data collection commenced May 2014 and concluded February 2015. Results: The therapeutic alliance involved interpersonal engagement and a balanced application of authority. In a therapeutic alliance, nurses cared for consumers with interpersonal finesse, whilst maintaining clear distinction between the consumer as an individual and AN as an illness. Nurses also developed a therapeutic alliance by occupying their position of power with consistent yet individualised expectations and by maintaining appropriate professional boundaries. Conclusions: The therapeutic alliance between nurses and consumers with AN is not developed through negotiation of equal partners. Rather, the therapeutic alliance is dependent on nurses' capacity to maintain their position of power, whilst demonstrating their trustworthiness to the consumer. In trusting nurses, consumers felt safer in investing in a new concept of well-being. Relevance to Clinical Practice: By understanding the nature of the therapeutic alliance as it is described in this study, nurses have an enhanced capacity to develop effective therapeutic alliances with consumers. A maternalistic nursing style emerged as a viable approach.
KW - Anorexia Nervosa
KW - consumer perspectives
KW - mental health nursing
KW - mixed methods
KW - nurse–patient relations
KW - psychiatric therapeutic process
KW - therapeutic alliance
KW - therapeutic relationships
UR - http://www.scopus.com/inward/record.url?scp=85030326967&partnerID=8YFLogxK
U2 - 10.1111/jocn.13944
DO - 10.1111/jocn.13944
M3 - Article
C2 - 28677200
AN - SCOPUS:85030326967
SN - 0962-1067
VL - 27
SP - 416
EP - 426
JO - Journal of Clinical Nursing
JF - Journal of Clinical Nursing
IS - 1-2
ER -