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Engagement as an Element of Safe Inpatient Psychiatric Environments

BACKGROUND: The American Psychiatric Nurses Association (APNA) Institute for Safe Environments (ISE) has focused on key elements that affect safety in psychiatric treatment environments; one of these key elements is patient engagement. An ISE workgroup discussed and reviewed the literature on engagement and safety in inpatient psychiatric settings. This article presents what we have learned about the role that engagement plays in inpatient treatment of severely mentally ill individuals and evidence that links nurse–patient engagement to safety. OBJECTIVES: To describe, using supporting literature, the role that nurse–patient engagement plays in creating safe, therapeutic environments for individuals with severe mental illness. DESIGN: (1) Define engagement and describe why it is an important element of safe treatment environments; (2) identify what helps and what hinders patients in their engagement with nurses, and nurses in their engagement with patients; (3) describe how engagement may improve unit safety; and (4) propose recommendations and set future directions for practice, research, and education. CONCLUSION: Engagement may provide the foundation for safe, therapeutic, and recovery-oriented treatment. In the future, APNA’s ISE plans to build upon this foundation by developing a clinical model of nurse–patient engagement and safety by drawing together emerging research and practice models.