Nurses’ perspective on fostering therapeutic relationships whilst coping with patients’ disruptive behavior during admittance in a center for intensive treatment: a qualitative study.

Abstract

The inability of care professionals to meet the complex needs of patients with severe mental illnesses, can cause patients to display disruptive behavior. Care disruption occurs when disruptive behavior jeopardizes the therapeutic relationship and causes treatment to stagnate. Care disruption increases the patients' distrust in healthcare, frustrates their subsequent therapeutic relationships and prolongs their need for care. In the Netherlands, care providers dealing with care disruption can refer patients to centers for intensive treatment (CITs). Observations from clinical practice show that CIT-nurses foster therapeutic relationships despite the high level of disruptive behavior they face. Evidently, they possess specific skills and knowledge to manage challenging therapeutic relationships that in turn can be useful for other care professionals to adopt in order to prevent the occurrence of care disruption. This study aimed to describe the nurses’ perspective on fostering therapeutic relationships whilst coping with patients’ disruptive behavior. Qualitative research was performed by means of semi-structured interviews and a focus group with CIT-nurses. Data were analyzed thematically. ‘Perseverance despite disruption’ emerged as the superordinate theme, comprised of two subthemes – nurses’ vision and nurses’ behavior. The nurses' shared vision of the therapeutic relationship, patients, themselves and other nurses determines their ability to and the way in which they cope with, discuss and manage the patients’ disruptive behavior. In conclusion, this study describes the behavior and underlying shared vision of nurses specialized in fostering therapeutic relationships whilst coping with disruptive behavior. Subsequently, the study recommends the creation of and compliance with a well-considered shared vision of care in order to effectively cope with disruptive behavior.