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Woods K. Nurse-Client Engagement: A Concept Analysis Through a Spiritual Lens. J Christ Nurs 2024; 41:32-37. [PMID: 35394975 DOI: 10.1097/cnj.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Engaging clients is central to nurses' work across all practice settings. This concept analysis seeks to better understand engagement as seen by the participants. Data from 15 qualitative studies conducted between 1982 and 2020 illustrate engagement from the perspective of nurse and client. Five defining attributes emerged: genuine concern and hopeful persistence, authenticity, trusting, time, and mutuality. The purpose of this concept analysis is to make the process of engagement visible, quantifiable, and valid.
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Affiliation(s)
- Katie Woods
- Katie Woods, MSc.N, RN (EC), NP-PHC , is a nurse practitioner at the Kingston Community Health Centre in Kingston, Ontario, Canada, practicing primary healthcare. She also provides preceptorship for nurse practitioner students through Queens University, Kingston, ON
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Henderson P, Fisher NR, Ball J, Sellwood W. Mental health practitioner experiences of engaging with service users in community mental health settings: A systematic review and thematic synthesis of qualitative evidence. J Psychiatr Ment Health Nurs 2020; 27:807-820. [PMID: 32171046 DOI: 10.1111/jpm.12628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Engagement is regarded as important and beneficial for service users and mental health services A universal definition of engagement is not yet fully agreed upon. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Based upon their experience, mental health staff use varied engagement approaches to fit with the changeable and unique needs of people who use services (service users). Mental health staff demonstrate qualities such as persistence and adaptability to successfully engage with service users. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Irrespective of professional background, the role of community mental health staff is not restricted to any single approach. Practical help and social support are as seen as important as clinical treatment to establish successful engagement. Little is known about the engagement experiences of mental health staff working in early intervention settings as most studies in this review focused on the perspectives of staff based in assertive outreach or community mental health teams. There is a need to further understand staff experiences of engagement with service users in early intervention settings. Role descriptions and expectations of community mental health workers should account for the wide-ranging flexible approach required in order to deliver appropriate interventions. This may involve a focus on engagement in training programmes. ABSTRACT: Introduction Effective mental health care is dependent on engaging service users, but some individuals do not actively attend appointments, and may stop engaging with mental health services. Quantitative studies reveal some salient factors that seem to predict engagement, but these studies miss the nuances of good clinical practice in this area. A number of qualitative studies of health professionals' experiences and understanding of effective engagement have been published. Aim This review aimed to systematically identify, evaluate and synthesize results from these studies with a view to informing effective practice in this area. Methods Electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (www.crd.york.ac.uk/prospero/; ID CRD42017083976). Of 799 records, ten papers met the inclusion criteria. All papers were subjected to quality appraisal based on the CASP checklist and data systematically extracted. A thematic synthesis of included studies examining mental health practitioners' experiences of engagement in community mental health settings was conducted. Results Mental health practitioners see engaging service users as depending upon complex, multi-dimensional phenomena which should include individualized person-centred approaches as well as practical, social and clinical support. Mental health practitioners demonstrate qualities such as determination and adaptability to establish and maintain engagement with service users. Implications for practice As a core aspect of nurse education, registered mental health nurses and other professionals would benefit from systematic guidance regarding engagement strategies. Most studies in this review focused on assertive outreach or community mental health teams, more clarification is needed of practitioner's engagement experiences in early intervention settings.
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Affiliation(s)
- Paul Henderson
- Division of Health Research, Lancaster University, Lancaster, UK.,Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | | | - Judith Ball
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | - William Sellwood
- Division of Health Research, Lancaster University, Lancaster, UK
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Gullick J, Wu J, Reid C, Tembo AC, Shishehgar S, Conlon L. Heideggerian structures of Being-with in the nurse-patient relationship: modelling phenomenological analysis through qualitative meta-synthesis. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:645-664. [PMID: 32894396 DOI: 10.1007/s11019-020-09975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
Heideggerian philosophy is frequently chosen as a philosophical framing, and/or a hermeneutic analytical structure in qualitative nursing research. As Heideggerian philosophy is dense, there is merit in the development of scholarly resources that help to explain discrete Heideggerian concepts and to uncover their relevance to contemporary human experience. This paper uses a meta-synthesis methodology to pool and synthesise findings from 29 phenomenological research reports on Being-with in the nurse-patient relationship. We firstly considered and secured the most relevant Heideggerian elements to nurse-patient Being-with (Dasein-with, circumspection, solicitude, and discourse). Under these deductive codes, we then inductively developed sub-themes that seemed to explain the multifaceted nature of Being-with, through a secondary analysis and synthesis of published data from 417 patient, carer and nurse participants. Dasein-with was enhanced when nurses had first-hand experience with a phenomenon. Nurses moved between the inauthentic they-mode (task-orientated busyness, existential abandonment, rough handling and deficient modes of concern in potentially violent encounters), and the authentic self-mode (seeking connection [knowing], and openness [unknowing], which exposed their emotional vulnerability). Through circumspection (making room for, deseverance and directionality), technology and people were encountered environmentally feeding into nursing attention, assessment and communication. Nursing as a social arrangement (solicitude) was expressed through either leaping-in care (also perceived as 'power over') or leaping-ahead care (moving the patient towards independence). There was a place for both inauthentic (idle talk) and authentic discourse (including non-verbal and spiritual discourse) that nurses wove through the ontic everydayness of nursing tasks.
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Affiliation(s)
- Janice Gullick
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia.
| | - John Wu
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
- University of Sydney (Sydney Conservatorium of Music and University Library), Sydney, NSW, Australia
| | - Cindy Reid
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
| | - Agness Chisanga Tembo
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
- Maitland Hospital (Intensive Care Unit), Maitland, NSW, Australia
| | - Sara Shishehgar
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Lisa Conlon
- University of Sydney (Susan Wakil School of Nursing & Midwifery, Faculty of Medicine & Health), Sydney, NSW, Australia
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Tindall RM, Allott K, Simmons M, Roberts W, Hamilton BE. The missing voice of engagement: an exploratory study from the perspectives of case-managers at an early intervention service for first-episode psychosis. BMC Psychiatry 2019; 19:312. [PMID: 31651268 PMCID: PMC6814013 DOI: 10.1186/s12888-019-2315-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A key component of case-management in early intervention services for first-episode psychosis is engaging a person with the service and building a relationship from which therapy and treatment can be facilitated. The aim of this study was to understand how case-managers at an early intervention service experience the process of engagement and working with varying levels of attendance and participation. METHODS Qualitative interviews were conducted with the case-managers of nine young people treated at an early intervention service for first-episode psychosis within 6 months of treatment entry. Interviews discussed the process of working with the young person and factors that influenced service engagement. Interviews were analyzed using thematic analysis. RESULTS Case-managers described a range of influences on engagement which were grouped under the themes: young person and caregiver influences on engagement, case-manager influences on engagement, and influences of the early intervention service system on engagement. The experience of engagement was described as relational, however it occurred in the context of broader influences, some of which were unable to be changed or challenged by the case-manager (e.g., resource allocation, models of treatment, young person demographics). CONCLUSION This study illustrates the challenges that case-managers face when working with young people with first-episode psychosis, and the direct influence this has on engagement with treatment. Understanding these challenges and addressing them in policy and service design may lead to improvements in young peoples' recovery from first-episode psychosis and increase case-manager job satisfaction.
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Affiliation(s)
- Rachel M. Tindall
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia ,0000 0001 2179 088Xgrid.1008.9Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Magenta Simmons
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Winsome Roberts
- 0000 0001 2179 088Xgrid.1008.9Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Bridget E. Hamilton
- 0000 0001 2179 088Xgrid.1008.9Department of Nursing, The University of Melbourne, Melbourne, Australia
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Newberry K, Terrington C. Engaging the hard to engage: What contribution could occupational therapy make to an interdisciplinary approach? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.8.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Karen Newberry
- Senior lecturer in occupational therapy, College of Health and Social Care, University of Derby, UK
| | - Claire Terrington
- Senior occupational therapist in assertive outreach, Birmingham and Solihull Mental Health Foundation Trust, UK
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"Sometimes What They Think is Helpful is Not Really Helpful": Understanding Engagement in the Program of Assertive Community Treatment (PACT). Community Ment Health J 2016; 52:882-890. [PMID: 26335712 DOI: 10.1007/s10597-015-9934-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
Abstract
This exploratory study recruited a purposive sample of twelve clinical staff from a Program of Assertive Community Treatment (PACT) team in central Virginia to understand the perceptions and experiences related to assertive engagement. The researchers coded the transcribed data initially as twenty-three sub-themes and further refined the data into four overarching themes: characteristics of assertive engagement, PACT engagement strategies and engagement strategies for difficult to engage clients. Further analysis emphasized that PACT team members emphasized the importance of the therapeutic relationship for engagement, which proves challenging for hard-to-engage clients.
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Procter N, Ferguson M, Backhouse J, Cother I, Jackson A, Murison J, Reilly JA. Face to face, person to person: Skills and attributes deployed by rural mental health clinicians when engaging with consumers. Aust J Rural Health 2015; 23:352-8. [DOI: 10.1111/ajr.12204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nicholas Procter
- School of Nursing and Midwifery; University of South Australia; Port Pirie South Australia Australia
| | - Monika Ferguson
- School of Nursing and Midwifery; University of South Australia; Port Pirie South Australia Australia
| | - Julia Backhouse
- Outer Southern Community Mental Health; Port Pirie Regional Health Service; Port Pirie South Australia Australia
| | - Ingrid Cother
- Eastern Community Mental Health Centre; Port Pirie Regional Health Service; Port Pirie South Australia Australia
| | - Adrian Jackson
- Eastern Community Mental Health Centre; Port Pirie Regional Health Service; Port Pirie South Australia Australia
| | - Julie Murison
- Country Health SA Local Health Network; Port Pirie Regional Health Service; Port Pirie South Australia Australia
| | - Julie-Anne Reilly
- Mental Health Directorate; Central Adelaide Local Health Network; SA Health; Adelaide
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Procter N, Backhouse J, Cother I, Ferguson M, Fielder A, Jackson A, Murison J, Reilly JA. Engaging consumers in the Australian emergency mental health context: a qualitative perspective from clinicians working in the community. HEALTH & SOCIAL CARE IN THE COMMUNITY 2015; 23:428-436. [PMID: 25471007 DOI: 10.1111/hsc.12156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 06/04/2023]
Abstract
Successfully engaging with consumers is seen as an essential component of mental healthcare, yet doing so can be challenging and little is understood about the unique engagement skills and attributes employed by mental health clinicians working in the emergency community context. Consequently, this qualitative study explored the engagement experiences of clinicians to identify the attributes used when engaging with consumers in this unique setting. We conducted two semi-structured focus groups in July and August 2011 with 16 clinicians employed at one metropolitan mental health organisation in South Australia. Using thematic analysis, we identified two key themes pertaining to the skills and attributes used for successful consumer engagement: (i) building trust, through communication style, an honest approach, facilitating choice and locating trust networks; and (ii) portraying genuine care, through showing respect, offering practical assistance and taking the least restrictive pathway. These findings highlight the unique nature of engagement in the emergency community mental health setting, as well as the flexibility and resourcefulness required to facilitate it.
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Affiliation(s)
- Nicholas Procter
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Julia Backhouse
- Outer Southern Community Mental Health, SA Health, Adelaide, South Australia, Australia
| | - Ingrid Cother
- Eastern Community Mental Health Centre, SA Health, Adelaide, South Australia, Australia
| | - Monika Ferguson
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Andrea Fielder
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Adrian Jackson
- Eastern Community Mental Health Centre, SA Health, Adelaide, South Australia, Australia
| | - Julie Murison
- Country Health SA Local Health Network, Port Pirie Regional Health Service, Port Pirie, South Australia, Australia
| | - Julie-Anne Reilly
- Mental Health Directorate, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
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Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use. Int J Ment Health Syst 2014; 8:40. [PMID: 25389446 PMCID: PMC4226907 DOI: 10.1186/1752-4458-8-40] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use. METHODS Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses. RESULTS The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients' own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment. CONCLUSIONS The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients' contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client's quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment.
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Bright FAS, Kayes NM, Worrall L, McPherson KM. A conceptual review of engagement in healthcare and rehabilitation. Disabil Rehabil 2014; 37:643-54. [DOI: 10.3109/09638288.2014.933899] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Wright N, Callaghan P, Bartlett P. Mental health service users' and practitioners' experiences of engagement in assertive outreach: a qualitative study. J Psychiatr Ment Health Nurs 2011; 18:822-32. [PMID: 21985685 DOI: 10.1111/j.1365-2850.2011.01733.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Assertive outreach services have been central to community mental health policy within the UK. These multidisciplinary teams were established to engage with service users who have severe and enduring mental health problems and have found traditional community services unable to meet their needs. Mental health nurses have a pivotal role in these multidisciplinary teams, yet the nature of these relationships from the perspective of those who work in and receive care is poorly understood. This study set out to explore the nature and meaning of engagement for practitioners and service users within assertive outreach services. A qualitative approach, informed by philosophical hermeneutics, underpinned the study. Participants were recruited from a single assertive outreach team in the UK. To be eligible for the study, mental health practitioners needed to be employed within the assertive outreach team. All service users residing in the community and receiving care from the team were also eligible for inclusion. In total 14 interviews were conducted with mental health practitioners and 13 with service users. Data analysis was informed by Turner's method. Four themes emerged from the data; contact, dialogue, transformation and shared understanding. Meaningful engagement was found to manifest itself through experiences such as providing and receiving practical assistance, having a genuine two-way conversation and valuing the experiences and personal attributes of the other person. The findings indicate that engagement is an active, dynamic and skilled process, which leads practitioners and service users to transform together to create a new relationship.
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Affiliation(s)
- N Wright
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK.
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Abstract
Aim: The purpose of this study was to describe the experience and meaning of engagement for staff and clients of assertive outreach teams. Method: Interpretative phenomenological analysis was selected for its flexibility and transparency. Data were collected by semi-structured interviews from a sample of five client and five staff participants (n = 10). The interviews were analysed idiographically, inductively and interrogatively. Findings: Four themes identified by both staff and client participants emerged: engagement as an interpersonal relationship, engagement in and through time, enabling and disabling factors and engagement in occupation. In addition, clients developed a theme around engagement as a means to self-actualisation. Staff also raised a specific theme around the role of engagement in mental health services. Conclusion: Staff and clients experienced engagement in broadly similar ways, but with differing emphases. Although all participants described it as both an invisible ‘means’ and a visible ‘end’, the staff related engagement only to mental health services whereas the clients experienced it in the context of both mental health services and occupations. Relevance: This study is relevant to all occupational therapists who work with people experiencing mental health problems.
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Abstract
The active engagement of clients in mental health services offers far greater chances of successful outcomes. When clients do not actively engage in treatment, their risk of becoming part of the population of 'high users' is greater. The 'high users' consume a disproportionate share of health resources, which may prevent other potential clients from accessing services. Engagement can be particularly challenging in crisis situations, which is how many clients attracting psychotic diagnoses first enter the service. New Zealand Māori bring a transcendent quality to the idea of 'respect for Other', which would make it sacrilegious to overpower Other in most situations. This paper reviews a growing body of literature indicating how we might integrate an enhanced respect or reverence of Other into clinical practice. This includes the idea of engaging more frequently with the social network when building rapport with an individual is particularly challenging. There is some evidence that services adopting this kind of approach are more economical.
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Affiliation(s)
- Nick Drury
- Mental Health and Addiction Services, Hawke's Bay District Health Board, Hastings, New Zealand.
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McAdam M, Wright N. A review of the literature considering the role of mental health nurses in assertive outreach. J Psychiatr Ment Health Nurs 2005; 12:648-60. [PMID: 16336589 DOI: 10.1111/j.1365-2850.2005.00889.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A review of the literature considering the role of mental health nurses in assertive outreach Assertive outreach teams are a central component of the UK government vision for Mental Health. The general aim of such services is to engage with clients who for one reason or another lose contact with traditional services and require a more flexible approach to care. Researchers and the Government recognize that nurses who work within Assertive Outreach need specialist skills, knowledge and personal attributes to carry out their work. A comprehensive review of the literature was carried out via computer search engines, an Internet search and a hand search of pertinent references. Two screens were applied to the literature to make sure only the highest quality information was evaluated. The results of the literature search were presented in tabular format and three key themes were identified as being important for mental health nurses working in assertive outreach services. These themes were clinical knowledge and skills, successful outcomes for assertive outreach services and personal attributes of practitioners. Multidisciplinary working within assertive outreach services allows for some of the ethical dilemmas to be resolved. However, the competing demands placed on nurses, including risk assessment verses engagement, may lead to high stress levels and burnout. Research studies highlight that without experienced and knowledgeable staff the provision of an assertive outreach model is in jeopardy. The Government and service providers need to ensure that practitioners within assertive outreach services receive sufficient training, managerial and clinical supervision, in order to do the best for a very challenging and chaotic client group.
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Affiliation(s)
- M McAdam
- Clinical Governance and Risk Management Department, Nottinghamshire Health Care NHS Trust, Duncan MacMillan House, Mapperley, UK.
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