Development of a Psychotherapeutic Intervention Model in Nursing
Doutorando no Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto
PhD, Escola Superior de Enfermagem do Porto
Lluch Canut, Teresa
PhD, Escola d’Infermeria de la Universitat de Barcelona
Only few mental health nursing models (e.g. “The Tidal Model”1 and “The Relationship-Based Model for Psychiatric Nursing Practice”2) are to be found in literature and although all of them seem to be models related to caring in psychiatric nursing, they do not aim specifically to guide nursing psychotherapeutic interventions in the clinical practice. Hence, the development of a psychotherapeutic intervention model in nursing can be extremely important for nurses to be allowed to perform psychotherapeutic interventions in the clinical practice, as opposed to what happens in several countries like Lithuania, some cantons of Switzerland, Italy and Russia3.
Research Problem / Question: What structure and contents should be presented in a psychotherapeutic intervention model in nursing?
Aim: To develop a psychotherapeutic intervention model in nursing.
Methods: Narrative review utilising MEDLINE, PsycINFO, CINAHL, the Web of Science, Psychology and Behavioral Sciences Collection, and MedicLatina computerised databases for the period from 2003-2013; two focus group meetings, which took place in Portugal and Spain, with the participation of 15 intentionally selected nursing professionals; modified e-Delphi method, in which participated 42 intentionally selected experts (nurses and nursing professors), by means of three rounds of online questionnaires.
Results: According to the narrative review that was carried out, the usual length of nursing psychotherapeutic interventions varies between 5-16 weeks, in a total of 5-12 sessions of 45-60 minutes. The mechanisms of change are heterogeneous, but the therapeutic relationship between the nurse and the client seems to be the most important positive predictive factor of these interventions. The effectiveness of nursing psychotherapeutic interventions has been widely demonstrated in many studies. However, the need of further studies to prove its cost effectiveness is evident4. According to the experts who participated in the focus group meetings, it seems clear that Peplau’s theory should be the keystone for the model. They also considered that NANDA-I/ICNP - NIC - NOC should be on the basis of the model structure and that it should feature brief to medium-term psychotherapeutic intervention5. In the modified e-Delphi study panelists achieved consensus over the conclusion that a psychotherapeutic intervention model in nursing should be fully based on the autonomous scope of practice, i.e., it should commence with an assessment to allow identification of nursing diagnoses (e.g. anxiety, impaired coping, situational low self-esteem) and, subsequently, adopting psychotherapeutic intervention strategies to those nursing diagnoses using NIC interventions. Finally, experts also deemed that the model should follow the principles of integrative psychotherapy6.
Conclusion: The research that has been conducted allowed to develop a systematized psychotherapeutic intervention model in nursing, which can in its turn be useful to demonstrate that nursing psychotherapeutic interventions are autonomous nursing interventions as they can be entirely based on nursing’s body of knowledge. Evaluation of the effectiveness of the model in the clinical practice should now take place, by means of the conduction of a randomized controlled trial, for instance.
Keywords: cuidados de enfermagem, enfermagem, modelos de enfermagem, psicoterapia, terapia
1Barker P, Buchanan-Barker P. The Tidal Model: a guide for mental health professionals. East Sussex: Routledge; 2005.
2Wheeler K. A relationship-based model for psychiatric nursing practice. Perspect Psychiatr Care. 2011 Jul;47(3):151-9.
3Horatio: European Psychiatric nurses. Psychiatric/Mental Health Nursing and Psychotherapy: the position of Horatio: European Psychiatric Nurses [Internet]. 2012 [citado 27 Jan 2016]. Disponível em: http://www.horatio-web.eu/downloads/Psychotherapy_position_paper.pdf
4Sampaio F, Sequeira C, Lluch Canut T. Nursing psychotherapeutic interventions: a review of clinical studies. J Clin Nurs. 2015 Aug 24;24(15-16):2096105.