Assessing therapeutic engagement of mental health nursing through the Therapeutic Engagement Questionnaire (TEQ)

Researchers from Kingston University have developed a tool in collaboration with nurses and mental health service users to assess therapeutic engagement from the perspectives of both groups. 

Therapeutic engagement, that is, the ability to engage and communicate effectively with people who use mental health services, is fundamental to mental health nursing. The lack of a tool to objectively measure therapeutic engagement prompted Professor Mary Chambers from Kingston's Centre for Public Engagement and a team of national and international academic researchers, service users and registered mental health nurses to develop a short and simple tool to quantify therapeutic engagement in mental health settings caring for acute inpatients.

Professor Chambers and her team conducted six studies of service users and registered mental health nurses in acute inpatient settings.

The efforts of the team culminated in the development of the Therapeutic Engagement Questionnaire (TEQ), the first tool to be collaboratively co-produced by nurses and service users to assess therapeutic engagement from the perspectives of both groups.

TEQ was validated with the help of in-depth research involving 714 service users and 611 registered mental health nurses across 26 NHS Mental Health Trusts in England. The findings corroborated TEQ as a psychometrically sound and valid measurement tool.

Presently, TEQ has been implemented both nationally and internationally as a reliable tool for use in acute inpatient mental health settings. The data obtained using the TEQ has helped inform nursing staff about the current nature of therapeutic engagement activity and how service users perceive it. These developments have resulted in changes in national policy and have a significant impact on nursing practice in the UK and internationally.

In the UK, NHS England has promoted the use of TEQ in its Atlas of Shared Learning, which is based on case studies demonstrating instances where nursing staff changed their practice, resulting in improved patient outcomes. NHS England also emphasises the importance of the tool in supporting the delivery of the NHS Long Term Plan. Additionally, TEQ is an adopted project of the NIHR South London Applied Research Collaboration (ARC).

Four out of 54 of the NHS Mental Health Trusts in England have implemented TEQ and three more are in the process of doing so. Feedback from registered mental health nurses, nurse managers and Directors of Nursing has confirmed TEQ's value. TEQ has also highlighted barriers that impede the nurses' ability to deliver appropriate therapeutic activities to service users, enabling managers and nurses to develop ways to address them.

TEQ is included in the SW London and St George's NHS Mental Health Trust Quality Improvement and Innovation (QII) initiative.

The Trusts' Director of Nursing and Quality reported that TEQ continues "to have a positive impact on the care we provide [...] as the results have already been used to influence and inform wider pieces of work in the organisation." 

Thanks to the widespread significance of TEQ in mental health nursing and patient-nurse engagement, Professor Chambers was invited to give the Eileen Skellern Memorial Lecture in 2017,which recognises remarkable advances in mental health and mental health nursing. As of 2021, the TEQ has been implemented internationally in Slovenia, Finland, Malta and Jordan. An app version of TEQ is also currently being developed based on the evidence gathered from over 30 national and international workshops.

With the establishment of TEQ, Professor Chambers and her team have been successful in shedding light on the role of registered mental health nurses in therapeutic engagement and identifying their support and training needs.

Professor Chambers wishes to acknowledge the invaluable support of Francesca Taylor, who works with her on the TEQ.

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