Nursing responses and interventions for episodes of adolescent distress in an acute child and adolescent mental health inpatient unit: an interpretive descriptive study

Adolescents who experience acute mental health problems are often admitted to acute child and adolescent mental health inpatient units for care and treatment. Nurses, at times, are required to respond to episodes of distress that adolescents experience during the admission period. Nurses engage with young people who exhibit maladaptive and often high-risk behaviours that require appropriate interventions to help alleviate their distress. The majority of research conducted on child and adolescent mental health has focussed on quantitative methodologies examining the demographic and diagnostic characteristics of young people, treatment outcome measures, or the rate of coercive interventions such as seclusion, physical restraint, and pm medication. There are numerous contextual factors that influence nursing practice. This study aimed to understand which nursing responses and interventions were most helpful in resolving distress for adolescents admitted to an acute child and adolescent mental health inpatient unit. An interpretive descriptive study was undertaken to explore the contextual and experiential components of providing nursing responses and interventions for episodes of adolescent distress. This approach is suited to the subtle but complex nature of the clinical setting and understanding the interactions between nurses and adolescents. Following a review of the relevant literature, and documentation of the researcher’s assumptions, two methods were used to collect data. Non-participant observations focussing on interactions between adolescents (aged 13-17) experiencing episodes of distress and nurses who responded to them were conducted. The second-stage of data collection, semi-structured interviews (n = 10) were conducted with nurses working in the inpatient unit. Both data sets were analysed using Thorne’s three-stage interpretive descriptive method. The open, axial and selective coding process produced themes and sub-themes that provided a deeper understanding of how adolescents experience episodes of distress in the acute inpatient mental health setting, and the cultural and contextual factors that not only trigger these episodes, but also on the nurses who provide care for them at these times. Young people experienced and displayed their distress in numerous ways and nurses used a range of responses and interventions to assist them. The importance of a person-centred approach was evident and there were multiple cultural and contextual factors that influenced both the young people’s experiences during the admission, and nursing practices. An observation model of responding to adolescent distress, and a clinical tool that integrates findings from both data sets were developed as a result of this study. These will provide the impetus for education and training, policy and organisational change, and future research in this area of mental health nursing care.