Exploring the use of Triple-C in mental healthcare through nurses' experiences: An explorative descriptive qualitative study

Abstract

ABSTRACT Background: Triple-C is a person-centred care method increasingly used in long-term mental healthcare for patients with severe and persistent mental illness (SPMI). It focuses on understanding the causes of patients’ behaviour and addressing their needs. To date, its use by Mental-Healthcare Nurses (MHNs) remains largely unexplored. Gaining insight into their experiences is important to inform training programmes and ensure adequate support for using Triple-C in daily patient care. Aim: To explore and describe the experiences of MHNs working with Triple-C in long-term mental healthcare for patients with SPMI. Methods: A qualitative, descriptive, and explorative design was used. Semi-structured interviews were conducted with twelve MHNs from various wards within a Dutch mental healthcare organisation. Thematic analysis was applied to identify themes. Results: Analysis revealed five themes: 1) Adopting a different perspective on patients and their problematic behaviours, 2) Observing different interpretations and applications of Triple-C principles, 3) Feeling uncertain at times about the competent use of Triple-C, 4) Reverting to familiar ways of working, 5) Working within systemic constraints. With the introduction of Triple-C, MHNs adopted a different perspective on patients and their problematic behaviours, one that aligns more closely with person-centred care. However, they also encountered challenges that hindered the consistent and effective use of Triple-C. Conclusion: MHNs generally have positive experiences with Triple-C, highlighting its value in adopting a different perspective on patients and their problematic behaviours. However, Triple-C cannot be introduced or sustained in isolation. Its consistent, effective, and sustainable use requires alignment at multiple levels, team, organisational, and systemic, along with continuous investment in training programmes and adequate support. Practical implications: To support the consistent and effective use of Triple-C, healthcare organisations should invest in ongoing training, regular patient discussions, interprofessional case discussions, and align team practices and organisational policies with Triple-C principles.