title: Rapid realist review of the evidence: achieving lasting change when mental health rehabilitation staff undertake recovery-oriented training.
abstract: OBJECTIVE
  The aim of this study was to identify the factors contributing to lasting change in practice following a recovery-based training intervention for inpatient mental health rehabilitation staff.
  
  
  BACKGROUND
  Staff training may help nurses and other staff groups in inpatient mental health rehabilitative settings to increase their recovery-oriented practice. There are no published reviews on the effectiveness of such training and few long-term evaluations. This review informed a realist evaluation of a specific intervention (GetREAL).
  
  
  METHODS
  Rapid realist review methodology was used to generate and prioritize programme theories.
  
  
  METHODS
  ASSIA, CINAHL, Cochrane Library, Medline, PsycINFO, Scopus, Web of Science and grey literature searches were performed in September 2014-March 2015 with no date restrictions. Stakeholders suggested further documents. GetREAL project documentation was consulted.
  
  
  METHODS
  Programme theory development took place iteratively with literature identification. Stakeholders validated and prioritized emerging programme theories and the prioritized theories were refined using literature case studies.
  
  
  RESULTS
  Fifty-one relevant documents fed into 49 programme theories articulating seven mechanisms for lasting change. Prioritized mechanisms were: staff receptiveness to change; and staff feeling encouraged, motivated and supported by colleagues and management to change. Seven programme theories were prioritized and refined using data from four case studies.
  
  
  CONCLUSIONS
  Lasting change can be facilitated by collaborative action planning, regular collaborative meetings, appointing a change agent, explicit management endorsement and prioritization and modifying organizational structures. Conversely, a challenging organizational climate, or a prevalence of 'change fatigue', may block change. Pre-intervention exploration may help identify any potential barriers to embedding recovery in the organizational culture.
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, UK.
authors.forename: Melanie
authors.identifier: http://orcid.org/0000-0001-9149-4314
authors.initials: M
authors.lastname: Gee
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, UK.
authors.forename: Sadiq
authors.initials: S
authors.lastname: Bhanbhro
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cook
authors.affiliation: Rehabilitation Psychiatry, Division of Psychiatry, University College London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Killaspy
mesh_terms: D001291:Attitude of Health Personnel; D004739:England; D006760:Hospitalization; D006801:Humans; D007318:Inservice Training / Q000379:methods; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008505:Medical Staff, Hospital / Q000193:education*; D001523:Mental Disorders / Q000451:nursing / Q000534:rehabilitation; D010347:Patient Care Planning; D011364:Professional Practice / Q000592:standards*; D000067250:Psychiatric Rehabilitation / Q000193:education*
keywords: in-service training; lasting change; multidisciplinary teams; nursing; psychiatric nursing; psychiatric rehabilitation; rapid realist review; recovery; staff training