Doctor of Nursing Practice (DNP)
First Committee Member
Second Committee Member
Third Committee Member
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Over 46 million adults in the United States (U.S.) live with a mental illness. Locally in Nevada, the psychiatrist to patient ratio is approximately 700:1, and patients are seen primarily in the inpatient setting, if seen at all, due to the wait average of 85 hours in the hospital emergency rooms for access into mental health hospitals or specialty units of a general hospital. Moreover, costs for mental health mood disorders alone are estimated at over seven million dollars annually. The Institute of Medicine (IOM) opined the need for change in healthcare to redesign practice and clinical communication with patients in all healthcare settings; however, more is still needed in mental health. Therapeutic communication is essential to meet the patient's physical and psychological needs while establishing the nurse-patient trusting relationship. Clinical outcomes in mental health settings remain poor, with non-therapeutic communication resulting in poor patient outcomes. A leading cause of inadequate treatment includes non-therapeutic communication during pre- and post-discharge treatment.
It is not well described in the literature what role nurses play, nationally or locally, in ensuring the safe transition of mental health patients from an emergency room to a specialty unit. Mental health nurses are expected to complete clinical assessments on admitted clients, including effective therapeutic interpersonal communication techniques and psychosocial intervention skills to provide safety, trust, collaboration with rapport, respect, genuineness with the caring emphasis, and empathy. Nurses may be able to decrease adverse events within mental health settings, in part, by practicing therapeutic communication; unfortunately, evidence shows that nurses are often unprepared in mental health to incorporate therapeutic communication and relationship building among their patients. Expected knowledge of, and competence in therapeutic communication would seem to be a logical requirement for mental health nurses; however, Nevada's current practice does not require demonstrated knowledge and competency in therapeutic communication between mental health nurses and patients in hospital settings. Competency development may guide nurses to develop critical thinking skills to practice and support psychiatric patients to achieve optimal outcomes.
The lack of required knowledge and competency related to therapeutic communication is the underlying impetus for this Doctor of Nursing Practice (DNP) project. The purpose of this DNP project was to develop, implement, and evaluate an educational module for mental health nurses and staff to improve knowledge and competency in therapeutic communication with their patients. The TeamSTEPPS® Program was adapted to develop a mental health-specific educational module focused on therapeutic communication to accomplish this purpose. The educational module was implemented online due to Covid-19 Pandemic, and this intervention was evaluated using four previously validated TeamSTEPPS® instruments.
Fifty-two participants were included in this project. Results indicated a statistically significant change in knowledge and competency pre- compared to the post-intervention with the educational module. Based on the results of this project, one may conclude that implementing additional mental health education for nurses may improve their knowledge and competency related to therapeutic communications with their patients, as was demonstrated in this project.
Communication; Mental health; Outpatient; Psychiatric; Safety; Therapeutic communication
Communication | Mental and Social Health | Nursing
University of Nevada, Las Vegas
Nill, Patricia A., "Improving Therapeutic Communication in Mental Health Nursing: A Quality Improvement Project" (2021). UNLV Theses, Dissertations, Professional Papers, and Capstones. 4177.
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