Therapeutic engagement is perceived as the crux of mental health nursing, but prior to the development of the Therapeutic Engagement Questionnaire (TEQ) there was no metric to measure this objectively in acute inpatient mental health settings.

Mental health nurse with patient

Development and validation of the TEQ

The development of the TEQ was led by Mary Chambers, Professor of Mental Health Nursing, Kingston University. and ARC South London's theme lead for patient and public involvement research. 

The TEQ was developed in 2019 in partnership with mental health service users for use in an acute setting to measure the impact of mental health nurses on service users’ recovery, and to support staff to engage therapeutically with patients, with a view to delivering improved outcomes.

The questionnaires are based on available literature, data collected from interviews with service users and a workshop focusing on how to measure the contribution of mental health nurses to service user recovery The TEQ was developed and validated across 26 NHS mental health trusts in England to measure therapeutic engagement in adult acute inpatient healthcare settings in two contexts – the general therapeutic environment and one-to-one interactions with service users. Following validation, the TEQ was piloted on two wards in South West London and St George’s Mental Health NHS Trust.

The TEQ’s national and international impact

TEQ is now being implemented into routine clinical practice in England and internationally

Introducing the NHS guidance on reducing harm from ligatures, Hannah Cadogan, lecturer in nursing at Roehampton University, and representative for lived experience at the Royal College of Nursing, said: 

Therapeutic engagement is spoken about first in this guidance for a reason: from my experience it was a massive factor that not only in a moment stopped me from actively trying to take my own life, but it ultimately lead to me managing my distressing thoughts without self harming.

Hannah Cadogan, lecturer in nursing at Roehampton University, and representative for lived experience at the Royal College of Nursing

How the TEQ is being used

The TEQ has highlighted the role of registered mental health nurses in therapeutic engagement activity and in identifying practice variations within wards. The implementation sites are using TEQ data in a variety of ways, for example: to support nursing strategy, inform quality improvement, and to introduce new ways of working with the objective to increase the quality-of-service user experience and nurses job satisfaction.

Other impacts from use of the TEQ include:

  • Identified variation in practice between how service users and registered mental health nurses are involved in collaborating to create a care plan
  • Trusts are initiating nursing practice improvements to help increase service user engagement
  • Barriers and obstacles highlighted to registered mental health nurses delivering perceived appropriate and valued therapeutic activities; as a result of being made aware of these problems, managers and nurses have been able to institute supportive and remedial actions.

Examples of quality improvements in practice resulting from TEQ findings include:

  • Registered nurses carrying out enhanced level observations and reviewed daily
  • Service users meet with both their named nurse and junior doctors to discuss and agree their care plan
  • Named/primary nurse introduces themselves to the service user at each nurse handover (twice-daily)
  • Highly skilled nurses lead and coach healthcare assistants and agency staff.

The TEQ helped develop a partnership between the patients and the staff. This didn’t need any extra funding, it only needed us to focus on the patient's expectations […] and respecting that they are experts in their recovery

Collen Baffana, manager of an adult mental health ward at Queen Mary’s Hospital in Roehampton.

Professor Chambers and Francesca Taylor, research project manager at Kingston University, gave a presentation on embedding research into practice in acute mental health settings: barriers and enablers to the implementation of the  TEQ at the Royal College of Nursing International Research conference in Manchester on 6 September 2023.

There are also plans to develop a TEQ App prototype for evaluation and to explore its potential use in other care settings.

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