title: Implementation of evidence on the nurse-patient relationship in psychiatric wards through a mixed method design: study protocol.
abstract: BACKGROUND
  Psychiatric nurses are aware of the importance of the therapeutic relationship in psychiatric units. Nevertheless, a review of the scientific evidence indicates that theoretical knowledge alone is insufficient to establish an adequate therapeutic alliance. Therefore, strategies are required to promote changes to enhance the establishment of the working relationship. The aims of the study are to generate changes in how nurses establish the therapeutic relationship in acute psychiatric units, based on participative action research and to evaluate the effectiveness of the implementation of evidence through this method.
  
  
  METHODS
  The study will use a mixed method design. Qualitative methodology, through participative action research, will be employed to implement scientific evidence on the therapeutic relationship. A quasi-experimental, one-group, pre-test/post-test design will also be used to quantitatively measure the effectiveness of the implementation of the evidence. Participants will consist of nurses and patients from two psychiatric units in Barcelona. Nurses will be selected by theoretical sampling, and patients assigned to each nurses will be selected by consecutive sampling. Qualitative data will be gathered through discussion groups and field diaries. Quantitative data will be collected through the Working Alliance Inventory and the Interpersonal Reactivity Index. Qualitative data will be analysed through the technique of content analysis and quantitative data through descriptive and inferential statistics.
  
  
  CONCLUSIONS
  This study will help to understand the process of change in a nursing team working in an inpatient psychiatric ward and will allow nurses to generate knowledge, identify difficulties, and establish strategies to implement change, as well as to assess whether the quality of the care they provide shows a qualitative improvement.
authors.affiliation: Escola Superior d'Infermeria del Mar, Parc de Salut Mar (Pompeu Fabra University associated center), Aiguader, 80, 08860 Barcelona, Spain.
authors.forename: Antonio R
authors.identifier: 0000-0002-5700-4315
authors.initials: AR
authors.lastname: Moreno-Poyato
authors.affiliation: School of Nursing, University of Barcelona, Feixa Llarga s/n. 08907 L'Hospitalet del Llobregat, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Delgado-Hito
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Pg. Marítim, s/n. 08860, Barcelona, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Suárez-Pérez
authors.affiliation: School of Nursing, Autonomous University of Barcelona, Avda. Can Domenech, Edifici M. 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Leyva-Moral
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Pg. Marítim, s/n. 08860, Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Aceña-Domínguez
authors.affiliation: Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Pg. Marítim, s/n. 08860, Barcelona, Spain.
authors.forename: Regina
authors.initials: R
authors.lastname: Carreras-Salvador
authors.affiliation: Campus Docent Fundació Privada Sant Joan de Déu. School of Nursing, University of Barcelona, Santa Rosa, 39-57, 08950 Esplugues de Llobregat, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Roldán-Merino
authors.affiliation: School of Nursing, University of Barcelona, Feixa Llarga s/n. 08907 L'Hospitalet del Llobregat, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Lluch-Canut
authors.affiliation: School of Nursing, Rovira i Virgili University, Avda Remolins 13-15, Tortosa, 43500 Tarragona Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Montesó-Curto
keywords: Mixed method design; Nursing care; Participatory action research; Psychiatric nursing; Quality of care; Therapeutic Relationship