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Changing nurses’ views of the therapeutic environment: randomised controlled trial

  • Emese Csipke (a1), Til Wykes (a2), Stephen Nash (a3), Paul Williams (a4), Leo Koeser (a5), Paul McCrone (a6), Diana Rose (a7) and Tom Craig (a8)...

Abstract

Background

Although patients value evidence-based therapeutic activities, little is known about nurses' perceptions.

Aims

To investigate whether implementing an activities training programme would positively alter staff perceptions of the ward or be detrimental through the increased workload (trial registration: ISRCTN 06545047).

Method

We conducted a stepped wedge cluster randomised trial involving 16 wards with psychology-led nurse training as the intervention. The main outcome was a staff self-report measure of perceptions of the ward (VOTE) and secondary outcomes measuring potential deterioration were the Index of Work Satisfaction (IWS) and the Maslach Burnout Inventory (MBI). Data were analysed using mixed-effects regression models, with repeated assessments from staff over time.

Results

There were 1075 valid outcome measurements from 539 nursing staff. VOTE scores did not change over time (standardised effect size 0.04, 95% CI –0.09 to 0.18, P = 0.54), neither did IWS or MBI scores (IWS, standardised effect size 0.02, 95% CI –0.11 to 0.16, P = 0.74; MBI standardised effect size –0.09, 95% CI –0.24 to 0.06, P = 0.24). There was a mean increase of 1.5 activities per ward (95% CI –0.4 to 3.4, P = 0.12) and on average 6.3 more patients attended groups (95% CI –4.1 to 16.6, P = 0.23) following training. Staff feedback on training was positive.

Conclusions

Our training programme did not change nurses' perceptions of the ward, job satisfaction or burnout. During the study period many service changes occurred, most having a negative impact through increased pressure on staffing, patient mix and management so it is perhaps unsurprising that we found no benefits or reduction in staff skill.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Emese Csipke, University College London, Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. Email: e.csipke@ucl.ac.uk

Footnotes

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These authors are joint first authors.

Footnotes

References

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Changing nurses’ views of the therapeutic environment: randomised controlled trial

  • Emese Csipke (a1), Til Wykes (a2), Stephen Nash (a3), Paul Williams (a4), Leo Koeser (a5), Paul McCrone (a6), Diana Rose (a7) and Tom Craig (a8)...
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