Towards evidence-based nursing in psychiatric inpatient care : Attitudes and experiences among patients and staff

Sammanfattning: Nursing in psychiatric inpatient care is shadowed by a strong medical perspective and roles and responsibilities within nursing are unclear. Implementation of nursing research and theories through evidence-based practice (EBP) is crucial to high-quality nursing. Steps Towards Recovery (STR) is a nursing programme focusing on the individual recovery process, a key theoretical basis for nursing in psychiatric and mental health care. The overall aim of this thesis was to explore aspects of nursing in connection to implementation of STR in psychiatric inpatient wards. A descriptive, comparative study (Study I) of patients’ and staff members’ experiences of STR and implementation of the programme was conducted in Dalarna, where STR was initially implemented. According to the results, patients were mostly positive and experienced that STR contributed positively to their care. Staff members were also positive towards STR and considered the programme to contribute to positive development of nursing care. Study II explored staff members’ understandings of nursing in psychiatric inpatient care. Results showed that nursing was understood in qualitatively different ways, with varying degrees of connection to the theoretical basis of nursing. Staff members’ experiences of stress, quality of care and satisfaction with nursing care and work were explored in a quasi-experimental study (Study III) comparing ratings between reference wards and STR wards, before and after STR implementation. Higher ratings in two dimensions of quality of care were found in the STR group after implementation. Positive experiences of the programme were reported from staff at the STR wards. Attitudes towards and experiences of EBP and STR were explored in a mixed method study (Study IV), with results indicating that although attitudes were positive, EBP was insufficiently implemented in clinical nursing care and the responsibility for EBP was unclear. In summary, nursing in psychiatric inpatient care can be understood in a variety of ways. Even so, attitudes towards EBP in nursing were positive, but EBP implementation in clinical nursing work was considered to be lacking. STR is an example of EBP in nursing and the programme was positively received by patients, staff and nurse managers.