Views of nurses working in Maltese community psychiatric teams about the nurse-patient relationship which develop during home visits

Abstract

Community psychiatric nursing in Malta is still in development with limited local research (Mifsud, 2009). Other countries' experience suggested that inpatient psychiatric nurse-patient interactions may need to be adapted for use within patients' homes (Magnusson, Severinsson, & Lutzen, 2003). Yet, trusting nurse-patient relationships are essential to provide the supportive basis for community psychiatric nurses (Barker, 2001a; McNaughton, 2005). This qualitative study aimed to explore the views of nurses working in Maltese community psychiatric teams about the nurse-patient relationship which develops during home visits. The set objectives targeted various areas, central to which lay the perceived factors that characterise the development of therapeutic relationships, surrounded by other issues such as the time taken to build the relationship and outcomes. The purposive sample consisted of all the nurses having more than two years experience working m community psychiatric teams (n=8). All accepted to participate. Data were collected via face-to-face, in-depth semi-structured interviews and were analysed qualitatively, using thematic analysis to capture the participants' meaning assigned to the subject under investigation. The main findings revealed that the patient's home, as his I her own natural environment is an ideal location with some very special features to facilitate a trusting nurse-patient relationship. Patients feel more relaxed and in control, ensuring that the relationship is genuine and 'open'. The nurse may need to be more diplomatic in confronting patients about their behaviour in their home and may also experience more distractions than in a clinical setting. However, the relationship based on reciprocal respect allows nurses to work collaboratively with patients in their own homes and is related to improved patient outcomes and facilitates a rich, continuous, flexible and context-sensitive assessment of the patient's unique needs. The findings support the present policy shift from hospital-based to community mental health care and the current practice considering the nurse-patient relationship in the patient's home as the psychiatric nurses' main 'tool' in nursing education and practice. Additional practical training in family-centred home visiting accompanied by further research exploring the perceptions of the relatives /carers may also help empower nurses to get relatives' collaboration with patient care plans