Exploring the person-centred care practice patterns of mental health nurses: a concurrent mixed methods study

Isler, Chantille Irene (2024) Exploring the person-centred care practice patterns of mental health nurses: a concurrent mixed methods study. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Aim: To understand the person-centred care practice patterns of mental health nurses in one Atlantic Canadian province. Background: There is emphasis on person-centred care within mental health services, yet, person-centred care is often poorly understood and operationalized by health care professionals. Mental health nurses’ person-centred practices remain unclear, as there is limited research on their practices. Design: The Person-centred Practice Framework (McCormack & McCance, 2016), comprising of 17 constructs spanning three domains essential for implementing person-centred care, was the theoretical framework for this concurrent mixed methods study. The quantitative portion of the study was a descriptive cross-sectional design and both interviews and participant observation comprised the qualitative portion. Interpretive description, a nursing methodology, guided the qualitative components of the study. In the integration phase, the analytic technique of merging established the alignment among complementary data within the three sets of study findings. Methods: Seventy Registered Nurses across one Atlantic Canadian province completed the survey package consisting of: 1) the person-centred practice inventory (Slater et al., 2017), 2) the person-centred climate questionnaire (Edvardsson et al. 2010), and 3) 13 demographic and work-related questions. Interviews occurred with eight individuals who had received recent inpatient mental health care in the province. Thirty-six hours of participant observation were conducted on three adult inpatient mental health units. The Pillar Integration Process, a four-stage procedure designed to integrate qualitative and quantitative data using joint display tables, guided the integration. Results: Three patterns were developed from the integrated data that described how nurses conduct and navigate their practice within the care environment: 1) mental health nurses maintain a separation from patients and often deliver nursing care from a distance, 2) mental health nurses practice in an organizational culture that supports the status quo, which is not person-centred care, and 3) when mental health nurses and individuals co-engage in person-centred moments, the results are inspiring and foster hope. The results of each component of the study are presented throughout the dissertation. Conclusion: Nurses face organizational and personal barriers in their delivery of person-centred care. Although person-centred moments were infrequent, they are valued by those who receive care. Advancing beyond discrete moments of person-centred care requires a sustained commitment from both health care professionals and the organization within which they work. Organizations should evaluate current practices and structures to ensure nurses are optimally positioned to provide person-centred care.

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