Effective nurse-patient relationships in mental health care: a systematic review of interventions to improve the therapeutic alliance

Background

Therapeutic alliance is a core part of the nursing role and key to the attainment of positive outcomes for patients utilising mental health care services. However, these relationships are sometimes difficult to develop and sustain, and nursing staff would arguably benefit from evidence-based support to foster more positive relationships

Objectives

We aimed to collate and critique papers reporting on interventions targeted at improving the nurse-patient therapeutic alliance in mental health care settings.

Design

Systematic literature review

Data sources

The online databases of Excerpta Medica database (Embase), PsycINFO, Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched, eligible full text paper references lists reviewed for additional works and a forward citation search conducted.

Review methods

Original journal articles in English language were included where they reported on interventions targeting the nurse-patient therapeutic relationship and included a measure of alliance. Data was extracted using a pre-determined extraction form and inter-rater reliability evaluations were conducted. Information pertaining to design, participations, interventions and findings was collated. The papers were subject to quality assessment.

Results

Relatively few eligible papers (n=8) were identified, highlighting the limitations of the evidence base in this area. A range of interventions were tested, drawing on diverse theoretical and procedural underpinnings. Only half of the studies reported statistically significant results and were largely weak in methodological quality.

Conclusions

The evidence base for methods to support nursing staff to develop and maintain good therapeutic relationships is poor, despite this being a key aspect of the nursing role and a major contributor to positive outcomes for service users. We make specific recommendations for the developments of a stronger evidence base and hope that this paper serves as a catalyst for a renewed research agenda into interventions that support good therapeutic relationships that serve both staff and patients.