Psychological perspectives in the acute inpatient setting

Abstract

BACKGROUND: The acute inpatient setting provides short-term intensive care during times of mental health crisis. Psychological perspectives including trauma-informed practice, and the delivery of psychological interventions, are recommended in the acute setting. The effective integration of psychological perspectives may support improvements to the quality of acute inpatient care.

AIMS: The current portfolio contributes to the growing evidence supporting the integration of psychological perspectives into the acute setting. The thesis is divided into two parts. The first section is a qualitative study of mental health nurses' experiences as they integrated trauma-informed practice into the acute setting. The second section is a systematic review of group-based psychological interventions in the acute setting.

METHOD: The qualitative study involved eight semi-structured interviews and used Interpretative Phenomenological Analysis (IPA). The systematic review involved a systematic search of databases Embase, MEDLINE, CINAHL Plus, and PsycINFO. Findings were reviewed using narrative synthesis, and comparison of effects for studies involving intent-to-treat analyses.

RESULTS: The qualitative study identified two themes, ‘A Welcome Shift: We are Trying’, and ‘The Person Behind the Nurse’. A tension was identified between trauma-informed principles, and the dominant risk-management paradigm. Accounts of work-based trauma, moral distress, and stigma were considered. The systematic review identified 18 quantitative studies of variable and predominantly low-quality designs. Consideration was given to adaptations, effectiveness, and feasibility. Moderate quality designs and controlled studies involving intent-to-treat analyses were prioritised.

CONCLUSION: The qualitative study suggested that trauma-informed practice has been well-received by nurses in the acute setting, but highlighted practical and conceptual challenges facing its uptake. Recommendations were made regarding the delivery of context-specific training, staff wellbeing, and improved access to psychological perspectives. Findings from the review pointed to tentative but inconclusive evidence in support of the use of group-based approaches in the acute inpatient setting. Groups were largely seen as a feasible way from which to deliver psychological interventions. Further controlled research involving treatment-as-usual controls and ITT analysis is needed to establish these preliminary findings, and better understand the circumstances under which improved outcomes might be achieved.