Introduction: In Portugal, the performance of nursing psychotherapeutic interventions is regulated as a specific competence of mental health nurses. However, these nurses face several difficulties in their clinical practice in order to perform this type of interventions, as there are significant gaps regarding their structure, content and systematisation. In literature, professional helping relationship can be considered as a nursing intervention. However, it is important to know its characteristics, contents and procedures, in order to validate it as a nursing psychotherapeutic nursing based on nursing knowledge and feasible by mental health nurses.
Aims: To develop and evaluate the content validity of the professional helping relationship as a nursing psychotherapeutic intervention, and to develop the tools which are the foundation for further evaluation of the effectiveness of the professional helping relationship in a clinical setting.
Methods: This research was divided into four studies. The first study was a scoping review, which was carried out recurring to online databases, such as MEDLINE with full text (via EBSCOhost), CINAHL Plus with full text (via EBSCOhost), Web of Science Core Collection (via Web of Science), Scopus (via b-on), ScienceDirect (via b-on), and consultation of the references of the included papers. The data extraction tool was developed having on its basis the model recommended by the Joanna Briggs Institute. The second study was a modified e-Delphi study, in which data were collected between January and May 2018 through two rounds of online questionnaires. The third study was a psychometric study, in which cultural adaptation and evaluation of the psychometric properties of the Nursing Outcome Classification (NOC) outcome "Cognition" were carried out in a sample of Portuguese adults with mental illness. The fourth study aimed to develop a scale for evaluating the quality of the therapeutic relationship, from the perspective of the nurse, through a literature review and subsequent group of experts’ meeting, also comprising the evaluation of the scale's psychometric properties in a sample of 221 mental health nurses. The reliability of the scale was assessed by internal consistency and its construct validity was assessed by exploratory factor analysis, Classic Horn’s Parallel Analysis, and Pure Exploratory Bifactor. Finally, grounded on all the results of the aforementioned studies, a manual for operationalising the helping relationship as a nursing intervention was prepared.
Results: In the first study, 729 papers were found and 13 additional records were identified. After analysing the literature, data related to the aim of the professional helping relationship were gathered, and those data suggested its aim is to train a person to solve a problem. Stress, guilt, mood changes, low self-esteem, suicidal ideation, body image disturbance, and the inability to interact satisfactorily with oneself or with the environment that surrounds the patient were the main problems that the professional helping relationship could address. Regarding the nurse's skills and attitudes, unconditional acceptance, empathy and the ability to not judge others were highlighted. Finally, this study also revealed that the professional helping relationship takes place in a set of phases, which are composed by several activities. The second study made it possible to agree on the aim of the professional helping relationship, its assumptions and the key competences associated with the nurse for its performance, having been reached perfect consensus on empathy, understanding, the ability to not judge, honesty and the ability to listen. It also made it possible to consensualise the nursing focuses that can lead to nursing diagnoses liable to the prescription of professional helping relationship. The focuses that were more consensual were self-esteem, grief and anxiety. Finally, the procedures / contents / activities to be carried out in each session of the intervention were also assessed by the experts. They emphasised the active listening, the clarification of the nursing diagnosis, the identification of the patient's resources, and the identification and training of strategies for problem-solving. In the third study, the final version in European Portuguese of the NOC outcome “Cognition”, composed by 13 items, presented good psychometric properties, and the exploratory factor analysis carried out identified only one factor. In the fourth study the Therapeutic Relationship Assessment Scale - Nurse was developed, and it presented a total internal consistency (Cronbach's alpha) of .93, ranging from .78 to .88 for each of the factors. The scale presented a good temporal stability (ICC = .86), as well as a good adjustment both to a four-factor structure and to a one-factor structure. Finally, the manual allowed the compilation of all the results of the studies that were previously carried out.
Conclusion: Reaching consensus on the content and procedures of the professional helping relationship, assumed as a nursing psychotherapeutic intervention, seems to be important to guide mental health nurses’ practice on the performance of nursing psychotherapeutic interventions, as well as to allow this intervention to be a useful tool in empowering patients to solve, mostly, emotional problems.