Skip navigation

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

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

Csipke, Emese, Wykes, Til, Nash, Stephen, Williams, Paul, Koeser, Leo, McCrone, Paul ORCID: 0000-0001-7001-4502, Rose, Diana and Craig, Tom (2019) Changing nurses’ views of the therapeutic environment: randomised controlled trial. BJPsych Open, 5 (1):e17. ISSN 2056-4724 (Online) (doi:

PDF (Open Access Article)
25867 McCRONE_Changing_Nurses_Views_Of_The_Therapeutic_Environment_(OA)_2019.pdf - Published Version
Available under License Creative Commons Attribution.

Download (240kB) | Preview


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

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).

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.

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.

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.

Item Type: Article
Uncontrolled Keywords: nursing, in-patient, therapeutic, evidence based, psychological
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Faculty / School / Research Centre / Research Group: Faculty of Education, Health & Human Sciences
Last Modified: 16 Mar 2020 09:57

Actions (login required)

View Item View Item


Downloads per month over past year

View more statistics