Abstract
Patients with mood disorders admitted to inpatient units experience severe emotional distress. Psychiatric nurses are responsible for offering patients with mood disorders therapeutic interventions. Group therapy has been highlighted as an effective treatment modality for patients with mood disorders. Psychiatric nurses are uniquely positioned to facilitate group therapy for patients with mood disorders, enabling them to cope with life stressors, existential factors, trauma and losses. However, this is rarely the case. In fact, little is known about group therapy being facilitated for patients with mood disorders by psychiatric nurses. Patients‟ experiences of group therapy facilitated by psychiatric nurses and a lack of knowledge and skills among psychiatric nurses fulfilling this role resulted in the following research question being formulated: “What can be done to assist psychiatric nurses in facilitating constructive group therapy for patients with mood disorders?”
The researcher‟s minor dissertation explored the lived experiences of patients with mood disorders attending group therapy facilitated by psychiatric nurses. They reported positive and negative psychological experiences in attending group therapy, indicating the need for psychiatric nurses‟ facilitation of constructive group therapy to enhance positive experiences and limit negative ones. Guidelines for psychiatric nurses‟ facilitation of constructive group therapy for patients with mood disorders were consequently formulated.
The purpose of this study was to develop a model to assist psychiatric nurses in facilitating constructive group therapy for patients with mood disorders. The researcher used a qualitative, exploratory, descriptive, contextual and theory-generating design and conducted this study following the four steps of model development. Step 1 entailed concept analysis, consisting of two phases. The researcher‟s minor dissertation was used to identify the central concept, namely the “facilitation of constructive group therapy”. The definition of the central concept was obtained by identifying essential attributes from dictionaries and subject literature. The defined central concept was then classified according to Dickoff, James and Wiedenbach‟s survey list. In Step 2, the concepts were placed into relationships.
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Step 3 focused on developing and describing the model, followed by an evaluation of the model by a panel of experts. The panel of experts consisted of seven participants who were selected using purposive sampling. The panel of experts had to be conversant and knowledgeable in model development and experienced in qualitative research. The model was deemed applicable, clear, simple, general and accessible. In Step 4, the model was implemented for three months and evaluated in the clinical field of psychiatric nursing practice using a phenomenological approach.
The model‟s implementation evolved over two phases. The first phase entailed the preparation of the workshop. The workshop was then conducted based on the model as a frame of reference to assist psychiatric nurses in facilitating constructive group therapy for patients with mood disorders, acting as a stepping-stone for the implementation phase. The target population consisted of psychiatric nurses working with patients with mood disorders. Six participants attended the workshop, which consisted of three phases: the relationship phase, the working phase and the termination phase. During the second phase, an external field worker conducted in-depth interviews with the psychiatric nurses about their experiences implementing the model. Purposive sampling was used in selecting the participants, who were invited to participate in the study voluntarily. While six participants were interviewed directly after the workshop, four participants participated in the implementation phase and were subsequently interviewed after this process. The central question posed to the participants was: “How did the implementation of the model work for you?” The four in-depth interviews were conducted one month after the model‟s implementation and again three months later. An independent coder with experience in qualitative research assisted with the data collection process until no new themes and sub-themes emerged and data saturation was reached. The independent coder and researcher had a consensus discussion on emerged themes and sub-themes.
The central storyline emerging from the data collection process reflected that the psychiatric nurses experienced the model as a supportive tool, which assisted and empowered them to facilitate constructive interactions among patients with mood disorders. The psychiatric nurses found the model created a safe space for patients with mood disorders to share and deal with their challenges. The psychiatric nurses reported that the model assisted them in facilitating patients‟ optimal functioning
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outside the hospital setting and helped psychiatric nurses improve their professional and personal skills.
The recommendations from the study‟s findings indicated that the model was relevant to the unit and patients with mood disorders. It also came to light that the model could be used in other clinical settings with different groups of patients, and the model‟s implementation had the potential to promote positive patient outcomes. The model could also be used to enhance nurse-patient relationships in units for patients with mood disorders, and it would be useful in other disciplines.
The model opened additional avenues for further research related to the experiences of nurses and different groups of patients in various clinical settings. The model also seemed relevant and beneficial for inclusion in undergraduate and postgraduate training and could be used to evaluate sound nurse-patient relationships, therapeutic communication skills and enhance competency in the facilitation of therapeutic interventions for patients with mood disorders.
The following criteria of trustworthiness were applied throughout the study: credibility, transferability, dependability, confirmability and authenticity. Ethical principles were adhered to during the study, and these included autonomy, non-maleficence, beneficence and justice.
The development, implementation and evaluation of the model to assist psychiatric nurses in facilitating constructive group therapy for patients with mood disorders is an original contribution to the theory of clinical psychiatric nursing practice. The model can assist psychiatric nurses in empowering patients with mood disorders to cope with life stressors, existential factors, trauma and losses, and enhance therapeutic growth and personal change by facilitating constructive group therapy. This study also makes an original contribution to the empowerment of psychiatric nurses, creating self-awareness related to working with patients with mood disorders.