Virtual Healing: Exploring How Psychiatric Mental Health Nurse Practitioners Experience Therapeutic Alliance while Using Telepsychiatry

Abstract

Background: While evidence suggests that tele-mental health (TMH) is diagnostically non-inferior to in-person care, it is unclear how psychiatric mental health nurse practitioners (PMHNPs) experience a therapeutic alliance (TA) compared to in-person care.Aims: Explore how PMHNPs experience TA when using TMH and identify respective barriers and facilitators. Conceptual Framework: Hildegard Peplau’s Interpersonal Relations Theory (IRT) and Media Richness Theory (MRT) were adapted as a guiding research framework. Methods: Recorded virtual interviews were conducted from 40-70 minutes with each participant and later professionally transcribed for analysis in qualitative software, MAXQDA. Husserlian phenomenology and thematic analysis was utilized to illuminate phenomenological overarching themes and subthemes. Results: 17 PMHNPs participated in this study, all of whom practiced TMH in the past 12 months, held over 29 active PMHNP licenses across 25 different American states. All participants were cis-female within the ages 30 to 75 years with mean age of 45.2 years, mean years in PMHNP practice being 10.8 years, and mean TMH experience being 2.6 years. From the interview transcripts, 1,426 individual codes, five major themes with 16 respective subthemes were discovered. Major themes were titled “Skills are Skills; There is No Place Like Home…or Tele-Mental Health in the Wild; Virtual Divide or Digital Connection; Individual Patient & Provider Considerations; and Provider Ambivalence.” Conclusions: Overall, PMHNPs could build TA over TMH using inherent interpersonal skills that had to be adapted to TMH. Adaptions included working with patient environmental factors, individual considerations, and technological observation shifting observation and communication patterns needed for building TA. However, experiential aspects of TA created during in-person care could not be replaced with TMH while there were unparalleled aspects of TMH that allowed for a fuller clinical picture and logistical convenience to see patients more often with ease, concluding that a hybrid care model would enhance TA for most patients.