Received: 29 April 2022 | Revised: 24 August 2022 | Accepted: 1 October 2022 DOI: 10.1111/jan.15463 Q U A L I TAT I V E M E TA S Y N T H E S I S A systematic review on the use of action research methods in mental health nursing care Antonio R. Moreno-­Poyato1 | Martí Subias-­Miquel2,3 | Diana Tolosa-­Merlos3,4 | Ana Ventosa-­Ruiz3,5 | Alonso Pérez-­Toribio3,6 | Kadhija EL Abidi3 | Raquel Navarro-­Maldonado7,8 | Raquel Suárez-­Pérez9 | Rosario Valera-­Fernández4 | Maria Romeu-­Labayen1,10 | Teresa Lluch-­Canut1 | Juan Roldán-­Merino11 | 1 Montserrat Puig-­Llobet 1 Department of Public Health, Mental Health and Maternal and Child Health Abstract Nursing, Nursing School, Universitat de Aims: To identify and synthesize evidence on the use of action research methods in Barcelona, L'Hospitalet de Llobregat, Spain 2 Community Mental Health Center mental health nursing care. (CMHC) Ciutat Vella, Parc Sanitari Sant Design: Systematic review. Joan de Déu, Sant Boi de Llobregat, Spain 3 Data Sources: CINAHL, Web of Science, PubMed and Scopus databases were Nursing and Health Doctoral Programme, Nursing School, Universitat de Barcelona, searched in January 2021. Barcelona, Spain Review Methods: Data were selected using the updated Preferred Reporting Items for 4 Institut de Neuropsiquiatria i Addiccions, Systematic Reviews and Meta-­Analysis framework. Two reviewers independently con- Hospital del Mar, Barcelona, Spain 5 Hospital Benito Menni Complejo ducted the study selection, and quality appraisal using Joanna Briggs Institute Critical Asistencial, Sant Boi de Llobregat, Spain Appraisal Checklist for Qualitative Research, data extraction and data analysis procedures. 6 Unitat de Salut Mental de l'Hospitalet, Results: Sixteen studies, half of which used participatory action research, were in- Servei d'Atenció Primària Delta de Llobregat, Direcció d'Atenció Primària cluded in this review. Nurses, along with other stakeholders, were an active part of the Costa de Ponent, Institut Català de la action research process. The main topics of interest addressed were categorized as Salut, L'Hospitalet de Llobregat, Spain 7 Gynecology and Obstetrics Unit, Hospital improving the adoption of a person-­centred approach to care and improving decision-­ Can Misses, Ibiza, Spain making procedures. The use of action research helped the participants to identify the 8 Nursing and Health Doctoral Programme, meaning they attached to the topic of interest to be improved. Moreover, this method Nursing Department, Faculty of Nursing, Universitat Rovira i Virgili, Tarragona, helped to identify needs and strategies for improving care. The studies concurred that Spain the use of action research enabled participants to gain awareness, improve attitudes 9 Centro de Salud de Zarracina, Servicio de and acquire knowledge. In addition, it enabled participants to gain confidence and atención primaria, Servicio de Salud del Principado de Asturias (SESPA), Oviedo, security in the group context, as key aspects of their empowerment. Spain 10 Conclusion: This review shows the usefulness of action research in any mental health AFIN Research Group and Outreach Centre, Autonomous University of nursing context, contributing to the improvement of care at both the individual and Barcelona, Cerdanyola del Vallès, Spain collective levels. 11 Campus Docent Sant Joan de Déu Impact: This paper demonstrates the use of the action research method in the field Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain of mental health nursing. Its use has improved the clinical practice of nurses as well as that of teams in both community and hospital settings, addressing issues of the Correspondence Antonio R. Moreno-­Poyato, Department person-­centred approach to care and decision-­making procedures. of Public Health, Mental Health and This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd. 372 |  wileyonlinelibrary.com/journal/jan J Adv Nurs. 2023;79:372–384. MORENO-­POYATO et al. | 373 Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, KEYWORDS L'Hospitalet de Llobregat, Spain. action research, mental health, nursing care, systematic review Email: amorenopoyato@ub.edu 1 | I NTRO D U C TI O N development but also to facilitate practitioner understanding and user and professional engagement (Waterman et al., 2001). More Action research is a research method that facilitates under- recently, Cordeiro and Soares (2018) conducted a scoping review of standing and improving the world by transforming it (Kemmis & the international literature to explore how action research had also Mctaggart, 2008). Traditionally, this type of approach has been been applied in studies framed in the general health context. These used in the social sciences (Rowell et al., 2017), although in recent authors concluded that action research was useful in any context years it is also been successfully used internationally in the area of where there were organizational and/or political problems, as well health sciences (Cordeiro & Soares, 2018) and, specifically, in the as for addressing gaps in health education at the collective and indi- field of nursing (Effendy et al., 2022). In fact, action research has vidual levels (Cordeiro & Soares, 2018). been shown to be useful for implementing evidence-­based practice Specifically, in the area of nursing, nurses are constantly con- (Munten et al., 2010) in the area of nursing education or for improv- cerned about the difficulties related to the gap between theory, ing nursing practices in intensive care (Soh et al., 2011). However, no research and practice, therefore, it is necessary to translate these evidence has been found to demonstrate its use and utility, specifi- theoretical concepts into practice through research (Greenway cally in the field of mental health nursing. et al., 2019). In this sense, Munten et al. (2010) evaluated the use of action research in the implementation of Evidence-­Based Practice. The authors concluded that action research was a prom- 1.1 | Background ising method in what appears to be a useful way to bridge the gap between nursing research and practice (Munten et al., 2010). More The action research method relies on inquiry to understand and specifically, a review was published on the use of action research improve the practices in which one participates and the situa- in the intensive care units. (Soh et al., 2011). In this study, the au- tions in which one finds oneself (Baum et al., 2006; Kemmis & thors also concluded that action research was a promising method Mctaggart, 2008). This method includes a family of related ap- to address the improvement of clinical practice in the intensive care proaches that integrate theory and action, approaches that are units, although they detected shortcomings in the reviewed studies adapted to the broad and complex contexts and problems addressed in terms of clinical outcome assessment (Soh et al., 2011). Likewise, (e.g., participatory action research; collaborative action research; Cusack et al. (2018) studied the value of action research in public cooperative inquiry; feminist participatory action research; rural health nursing practice, concluding that action research should be participatory research and critical participatory action research) the method of choice for examining complex and deeply rooted (Bradbury, 2015). The action research process consists of a continu- nursing issues in the profession. In any case, most of the reviews ous and cyclical interaction where each cycle comprises different point to the lack of publications about the use of action research stages, such as action, reflection and evaluation (Rowell et al., 2017). and the lack of synthesis about the methodology used (Cordeiro This process enables a better understanding of the nature of prac- & Soares, 2018; Cusack et al., 2018; Soh et al., 2011; Waterman tices, their purpose and the necessary conditions to modify these, et al., 2001). ultimately resulting in social transformation (Bradbury et al., 2019). This is also the case in mental health nursing. Over the last few The process can be individual or collective and can modify or pro- years, multiple published studies have used the action research duce changes at the level of the individual, collective or organization method with different methodological approaches aimed at im- (Kemmis & Mctaggart, 2008; Rowell et al., 2017). proving different aspects of clinical practice, such as patient safety It is evident that the nature of the action research process con- (Kanerva et al., 2017), mental health nursing skills (Kelly et al., 2019), tributes to its potential as a method for improving work practices in self-­harm in young people (Bailey et al., 2019) or mental health care complex contexts such as healthcare. Thus, there are some reviews programs (Lin et al., 2018; Rezaie & Phillips, 2020). There is great het- in the international literature that have sought to examine the use erogeneity in the studies to date about the description of the meth- of action research in the healthcare context. Waterman et al. (2001) odological approaches and the results obtained (Bailey et al., 2019; conducted a systematic review aimed at identifying research proj- Kanerva et al., 2017; Kelly et al., 2019; Rezaie & Phillips, 2020). To ects in the healthcare field of the UK. The authors concluded that our knowledge, no studies have performed a comprehensive anal- action research had the potential to be useful, not only in areas such ysis and synthesis of the use of action research in mental health as innovation development, healthcare improvement and knowledge nursing. Therefore, it is necessary to compile the available evidence. 374 | MORENO-­POYATO et al. These findings could provide new knowledge to aid future research b. Types of intervention(s)/phenomena of interest: Studies that aiming to use this method to transform and improve mental health used action research as a research method and aimed to improve nursing practice. and/or change care and/or management in the context of mental health nursing, both community and hospital settings. c. Types of studies: qualitative primary research that illustrated the 2 | TH E R E V I E W action research methodology and methods used, the research process and the results or findings (e.g., knowledge creation, 2.1 | Aims problem-­solving, action and others). Studies that reported only one phase or incomplete reports about the action research pro- The objective of this systematic review was to locate and describe cess were not considered. the best available evidence related to the form and content in which the action research method has been applied in the context of mental health nursing. Hence, this review aimed to answer the 2.4 | Search outcomes following questions: The preliminary search yielded 538 records. Subsequently, 133 du- a. What is the type of action research methodology used in mental plicate records were removed, leaving 405 records to be filtered health nursing and who participated in the research? based on their titles and abstracts. In total, 75 full-­text articles were b. What are the main dimensions addressed as a focus for change assessed for eligibility and subsequently, of which 59 records were or improvement in studies that have used the action research excluded. Of those excluded at this stage, 13 did not pertain to men- method? tal health nursing, 9 were not directed to the clinical or management c. What new knowledge and plans for action or social change do setting, 8 did not pertain to the action research method, 26 failed the studies provide? to capture the entire process and three did not present qualitative data. As a result, 16 articles met the criteria and were included in this review. Figure 1 illustrates the search method and the selection 2.2 | Design process. A systematic review and thematic synthesis of qualitative studies were performed. This review is presented following The Preferred 2.5 | Quality appraisal Reporting Items for Systematic Reviews and Meta-­Analyses (PRISMA) guidelines. The revision was registered with PROSPERO Prior to analysis, the selected articles were assessed using the on March 25, 2021, with registration number CRD42021238794. Joanna Briggs Institute Critical Appraisal Checklist (JBI-­QARI) to evaluate the quality of individual studies. Two reviewers assessed the studies independently. Disagreements between the two review- 2.3 | Search methods ers were resolved by consensus or by consulting a third reviewer when necessary. Although some studies did not report all the items The following steps were followed in this review. After a preliminary collected in the JBI-­QARI, the team decided not to exclude any of search to locate any existing or planned systematic reviews on this them since the purpose of the quality assessment was to follow a topic, the first step was a limited search of the PubMed and CINAHL systematic and standardized process that would highlight the quality databases using terms related to action research and mental health of the available evidence on the study phenomenon (Vanderspank-­ nursing. An analysis of the text words contained in the title, abstract Wright et al., 2018). The results of the quality assessment are and index terms used to describe the articles retrieved during the included in Data S2. search was then performed. Based on this, an adapted search strat- egy was designed for all other databases in which searches were performed using database-­specific keywords and subject headings, 2.6 | Data abstraction where appropriate. The search strategies can be found in Data S1. The searches were limited to studies published in English from 2009 Initially, a standardized data extraction form was developed that to 2020. The following databases were searched: CINAHL, Web of included the following fields: Author, years and source origin, Science, PubMed and Scopus. The inclusion criteria were: Objective/s, Participants, Concept/Context, Method/Cycles and stages/Collection techniques/Duration, Knowledge building and a. Types of participants: Nurses in clinical or management roles Social change. Using this form, two authors independently extracted and/or patients or health care recipients who had participated in data. Disagreements were resolved by consensus or by consulting a action research. third reviewer. MORENO-­POYATO et al. | 375 F I G U R E 1 PRISMA flow diagram. Identification of new studies via databases and registers Identification Records removed before screening: Records identified from: Duplicate records (n = 133) Databases (n = 4) Records marked as ineligible by Registers (n = 538) automation tools (n = 0) Records removed for other reasons (n = 0) Records screened Records excluded (n = 405) (n = 330) Screening Reports sought for retrieval Reports not retrieved (n = 0) (n = 0) Reports excluded: Not mental health nursing (n = 13) Reports assessed for eligibility Not clinical or namagement (n = 9) (n = 75) Not include the entire process (n = 26) Not qualitative data (n = 3) Not method (n = 8) Included New studies included in review (n = 16) 2.7 | Synthesis et al., 2014) and there was mixed participation of users and nurses in only five studies (Chambers et al., 2013; Chandley et al., 2014; The data were analysed using thematic content analysis (Crowe Kidd et al., 2015; Larkin et al., 2015; Onnela et al., 2014). As for et al., 2015). During the first stage, the text obtained was frag- the number of participants, this ranged from eight to 45 people mented into descriptive codes that were assigned according to in most studies. However, one study mentions the collaboration their semantic content. In the second stage, these codes were of over 150 people (Larkin et al., 2015), whereas two of the stud- grouped into more analytical sub-­t hemes, classifying the codes ies did not specify the number of participants (Hyde et al., 2009; according to the meaning of the linguistic units and their combina- Onnela et al., 2014). tions. Finally, in a third hierarchical stage, the semantic analysis of the previous subthemes was considered, and the codes were classified deductively according to the research questions of the 3.2 | Use of action research in mental study. health nursing The majority of the studies included in the review claimed to use 3 | R E S U LT S either action research (k = 4) (Chambers et al., 2013; Chandley et al., 2014; Crouche & Williamson, 2013; Hyde et al., 2009) or 3.1 | Characteristics of included studies participatory action research (k = 8) (Clements, 2012; Hutchinson & Lovell, 2013; Lange, 2011; Larkin et al., 2015; Moreno-­Poyato The characteristics of the 16 included studies are shown in et al., 2019; Onnela et al., 2014; Salzmann-­Erikson, 2017; Vantil Table 1. Many of the included studies were conducted in the et al., 2020). Other studies also employed collaborative action-­ United Kingdom (k = 6), followed by Australia (k = 2), whereas research (k = 1) (Lakeman & Glasgow, 2009), practitioner-­b ased only one study was included from the following countries: USA, action research (k = 1) (Barrett & Roberts, 2010) and action re- Canada, Ireland, Norway, Sweden, Finland, Spain and Brazil. About search applying a cooperative inquiry perspective (k = 2) (Borg the setting in which the studies were carried out, nine were con- et al., 2010; Kidd et al., 2015). Most studies described the cycles ducted in inpatient care, and seven in community care. In terms of and stages of the action research process that guided the pro- the participants, 14 of the studies involved nurses on their own or cess. Thus, the different approaches described in the studies were together with other professionals and patients. However, only half grouped into four stages: (1) Exploring and identifying the prob- of the studies reviewed involved patients (Chambers et al., 2013; lem, (2) Planning action, (3) Implementing action and (4) Evaluating Chandley et al., 2014; Clements, 2012; Hutchinson & Lovell, 2013; (Table 2). However, in six of the studies, no explicit reference was Kidd et al., 2015; Lange, 2011; Larkin et al., 2015; Onnela made to research cycles and stages (Borg et al., 2010; Chandley TA B L E 1 Action research studies in mental health nursing care 376 | Author, years and source Method/cycles and stages/ origin Objective/s Participants Concept/context collection techniques/duration Knowledge building Social change Hyde et al. (2009) To develop and implement a N = n. a. Nurses of two acute Decision-­making Action-­research/4 cycles of ‘plan, The only factor that was identified as Improved seclusion records. The manager was Australia clinical decision-­making inpatient wards (from in the use of do, study, act’/Workshops, influencing the decision to seclude involved in the review and follow-­up of framework around the use of nurse unit manager to the seclusion Discussion groups/Duration a patient was safety. Two decision seclusion cases seclusion enrolled nurse) Inpatient care not specified flowcharts were developed for the decision to confine and the decision to release Borg et al. (2010) Norway To examine the nature of N = 12 Crisis Resolution/Home Evolution of clinicians Action research applying A new model of clinical practice was Unclear practice models that are Treatment team (one using an open a cooperative inquiry conceptualized. The importance of being developed in a Crisis psychologist, two social dialogue method perspective. /No cycles or being in the users' home environment Resolution/Home Treatment workers and nine mental Community care stages are specified/Focus and assessing the crisis situation there team incorporating the health nurses) group/Duration not specified together with the individual and his philosophy of open dialogue or her family network by keeping the and the open lifeworld dialogue open, tolerating uncertainty approach and nurturing daily life issues Barret and To improve the care of people N = 8 Five ward nurses, an Interventions by Practitioner-­based action research/ The need to improve the care of users Users changed their attitude about discussing Roberts (2010) with a dual diagnosis in one academic with experience nurses to Problem identification, action with the dual diagnosis was identified. substance use with nurses when previously United Kingdom acute mental health care in dual diagnosis training, persons with planning, implementing Specific learning needs and specific they shied away from it. Nurses felt more ward a service user trainer and dual diagnosis. learning and reflection/Group skills to engage more effectively able to rationalize their opposition to a nurse consultant (the Inpatient care sessions/Duration not specified were identified. The difficulty of staff intoxicated patients and to successfully author) shortages was detected. The effort challenge the stance of some physician to apply learning in practice was colleagues who had advised them to ban reflected on; different methods were individuals from admission until sober proposed Chambers and To translate into practice a N = 33 19 detained service Training program Action research/First action Patient needs were identified. An A greater sense of competence and confidence Borschmann (2013) deeper, more evidence-­based users, 14 staff members designed to research cycle: phase educational intervention was in interacting with service users was United Kingdom understanding of the ‘lived (five nurses, five health optimize the 1 exploratory; Phase designed for the staff. The reported; also increased awareness of experience of service users’ care assistants, two hospitalization 2—­intervention; Phase participants found the training course themselves and the needs of others, both detained under the Mental activity coordinators, one experience 3—­evaluation/Semi-­s tructured motivating and valuable for their daily service users and peers. Improved team Health Act occupational therapist inpatient care interviews, focus group and clinical practice. ‘a good refresher’ relationships and one assistant surveys/27 months neighbourhood manager) Lackeman and To develop, implement and N = 10 Psychiatric nurses Peer-­group clinical Collaborative action research/ Participants reported a greater number Participants reported feeling more satisfied Glasgow (2009) undertake an initial supervision/ The first phase addressed of roles that they had identified with with their work. Most participants thought Ireland evaluation of a model of peer-­ Inpatient care establishing collaborative or enacted since they began peer that peer experience in group supervision group clinical supervision for relationships with the group supervision. These included contributed to improvements in the care use in routine practice service and participants and teacher, counsellor, advisor, advocate, provided. All participants agreed that they establishing the need and negotiator and protector. felt more supported by their colleagues preferred form of clinical through group participation. Participants supervision. The second reported that they were more aware of addressed the commissioning taking on replacement roles and provision of education and the initiation of supervision groups. The third phase involved the implementation and adaptation of supervision groups and the initial evaluation/Focus groups/5 months MORENO-­POYATO et al. TA B L E 1 (Continued) Author, years and source Method/cycles and stages/ origin Objective/s Participants Concept/context collection techniques/duration Knowledge building Social change Onnela et al. (2014) To develop a professional N = n. a. Steering group Mental health Participatory action research/Nine Interventions were developed at three Group interventions improved bullying Finland practice model of mental (directors and coordinators promotion cycles of reflection, action and levels: (a) universal level, targeting the prevention, increased student knowledge health nurses in mental in the health sector) to Community care-­ observation Workshops and entire school community. (b) selective and participation, improving the school health promotion in a follow and evaluate the Scholar nursing reflective Journal Duration not level, focused on selected classrooms and classroom environment. Developing MORENO-­POYATO et al. comprehensive school development process specified and groups. (c) indicated level, aimed interventions in collaboration with environment Mental health nurses to at individual students with a low level stakeholders increases community-­ help evaluate the model of symptoms and their families wide mental health promotion and as the operators of the knowledge. Collaboration improves the interventions School staff, implementation of interventions and parents and students supports the inculcation of interventions as part of the school function Larkin et al. (2015) United To understand, and then N = 21 (research phase) Six Improving the Participatory action research, Action plans were identified: 1. pathways Improvements that were relatively easy Kingdom improve, the experience of service users, six parents experience of adapted Experience-­Based in and out. 2. Provide staff with a to implement were already underway hospitalization during early and nine inpatient staff. hospitalization Co-­D esign One cycle of eight rewarding and well-­supported role in the first audit. Less progress was psychosis N = over 150 (Co-­design in people with stages in two phases: research 3. Communication with families and made on improvements that involved phase) Stakeholders: early psychosis phase and Co-­design phase/ service users 4. Recovery-­focused contributions from other departments inpatient staff, community Inpatient care in-­depth interviews, feedback practice 5. Creating a positive or that involved strategic, budgetary mental health staff, NHS groups/ Duration not specified environment for everyone 6. or staffing commitments. The lack of managers, family members Recognize and share good practices continuity in high-­level support meant that or service users across professions and services responsibility for making improvements fell on a small group of individuals who were progressively more pressured and had little ‘empowerment’ when it was time to implement change Chandley et al. (2014) To explore the concept, and N = 40 20 patients 20 nurses Improving recovery-­ Action research and ethnography/ The limitations and contradictions There was an awareness of a trajectory from United Kingdom application, of ‘recovery’ focused care No cycles or stages are involved in employing recovery the past, to the present and into the future, in the care and clinical inpatient care specified/Focus groups/3 years principles in forensic care were although there was no single shared time management of patients identified. Recovery resides in: safe axis. They spoke of trajectories from detained in one UK high-­ contexts and in the relationships ‘being a criminal to going straight’, from security hospital in the courtroom. A definition of ‘being a victim to becoming a survivor’, recovery in the forensic context from ‘exclusion to inclusion’, and from was identified. Factors influencing ‘evil to redemption’, whilst very few recovery in high-­secure care: Set A: conceptualized themselves as ‘sick’ protective factors; Set B: cultural factors; Set C: proactive approaches Set D: individual characteristics Hutchinson and To discuss the process of N = 36 Six service users as The impact of mental Participatory action research/ No Aspects of identity and its transformation Exclude disease labels and work history. The Lovell (2013) United working with people who researchers 30 service illness on a cycles or stages are specified/ process were identified: connection, group began to think and act differently, Kingdom use statutory mental health users as interviewees person's identity Training workshops, discussion recognized definitions of self and creating a shared language. Encourage services Community care group/peer support, semi-­ reciprocity teamwork as well as enhancing individual structured interviews/3 years and group identities. Transform their identities, increase social experiences and regain control over one's own life | 377 TA B L E 1 (Continued) 378 | Author, years and source Method/cycles and stages/ origin Objective/s Participants Concept/context collection techniques/duration Knowledge building Social change Moreno-­Poyato To produce changes in the N = 9 Nurses, 4 men and 5 Improve the Participatory action research/ Barriers to establishing a therapeutic The nurses became aware of the theory in et al. (2019) Spain therapeutic relationship women nurse–­patient 2 cycles with 4 stages each one relationship were identified, such as practice. The change in practice enhanced between clinical practice therapeutic Focus groups and reflective organization, lack of time in clinical patient empowerment, involving the nurses and patients in relationship/ journals/6 months practice, lack of motivation and job patient in the treatment objectives and psychiatric units Inpatient care dissatisfaction. Strategies for change tasks to be performed. The improvement were identified: (a) A personalized and unification of the objectives for the nursing intervention space, (b) whole team. Knowledge updating (c) Reflection groups, which were subsequently implemented and evaluated Croucher and To introduce a new system of risk N = 11 Team Leader, Mental health risk Action Research/ Look, Think and A traffic light system was designed to The traffic light was useful for better report Williamson (2013) assessment, based on traffic Community Psychiatric assessment and Act phases/ Focus groups/ assess and monitor risk that the team writing, bringing clarity and guidance United Kindom lights, into a community Nurses, Social Worker, monitoring/ Duration not specified could easily use at planning meetings about risk levels mental health team Occupational Therapist, Community care and resource allocation. It served as a Housing Officer Support historical record too as well. The traffic Worker light improved risk allocation if needed in collaboration with the care coordinator. This support to the care coordinator can reduce restrictions to care by introducing—­ when safe—­positive risk elements, which can empower patients Kidd et al. (2015) To explore the meaning of the N = 11 Six consumers Four Recovery process Cooperative enquiry/No cycles or Systemic barriers in the recovery process Not identified Australia term recovery to people clinicians One career meaning / stages are specified/Group were identified. The meaning of with experience providing Community care Meetings/12 months recovery as an ongoing quest in and receiving mental health life was also identified, although services. it reflected variations for each participant. Salzmann-­Erikson (2017) To describe the process of a N = 26 One unit manager, 11 Improve ward rules/ Participatory Action Research/ More than 100 specific warding rules The ward rules were relaunched in favour of Sweden team development project male staff (two of whom Inpatient care Four phases: problem were identified. A framework was adopting the new principles. The working considering ward rule issues, were registered nurses and identification, planning, developed that embraced the (1) model reminded staff of the principles, and to develop a working nine psychiatric aides) and action and reflection / Group Safety Principle, (2) Structure empowered their professional decision model to empower staff 14 women (Eight of whom discussions, observations and Principle and (3) Interaction making, decreased collegial conflicts due to in their daily in-­patient were registered nurses and field notes/9 months Principle. The principles were greater acceptance of individual decisions, psychiatric nursing practices six psychiatric aides) linked to normative guidelines and and generally improved well-­being at work. applied ethical theories: deontology, In addition, the work model also enabled consequentialism and ethics of care staff to find support for their decisions based on the principles grounded in the ethics of totality Vantil et al. (2020) Brazil To describe risk management N = 13 Five nurses, two Improving patient Participatory Action Research / 12 Priority identification and the risk Better organization of the practice, implementation in the safety social workers, three safety/Inpatient phases: I. Exploratory phase; II. factors that involved the safety of guaranteeing the professional that actions of patients with mental psychologists, one speech care Research topic; III. Locating the patients with mental disorders 7 were standardized based on the principles disorders through action therapist, one pharmacist problem; IV. Theory placement; protocols were developed: 1. Patient of patient safety. Greater satisfaction research and one physician V. Hypothesis; VI. Seminars; Correct Identification; 2. Hand for the nursing team and patient, as well VII. Field observation, Hygiene; 3. Violence Prevention; 4. as greater safety in the performance sampling and qualitative Prescription and Safe Administration of procedures, reducing risks for representativeness; VIII. Data of Medications; 5. Patient Evasion professionals and patients collection; IX. Learning; X. Prevention; 6. Preventing Restraint Informal/formal knowledge; Injury; and 7. Fall Prevention. the XI. Action plan; XII. External textual proposal of software for MORENO-­POYATO et al. reporting/ Group meetings internal management of incident (8 in group A, 8 in group B, 1 reports consensus)/6 months MORENO-­POYATO et al. | 379 et al., 2014; Clements, 2012; Hutchinson & Lovell, 2013; Kidd Williamson (2013) et al., 2015; Lange, 2011). Croucher and Concerning the research methods, in all 16 studies group meet- ings were held in the form of focus groups, workshops and other Think Look denominations. However, in four of the studies, interviews were also Act conducted (Chambers et al., 2013; Clements, 2012; Hutchinson & Lovell, 2013; Larkin et al., 2015) and in two cases reflective journals Observation were used (Moreno-­Poyato et al., 2019; Onnela et al., 2014). Other Reflecting Onnela et al. (2014) data collection methods and techniques used included photographs Action and text pieces (Clements, 2012) or observations and field notes (Salzmann-­Erikson, 2017). Chambers et al. (2013) and Evaluation/Divulgation 3.3 | Topics of interest for improving mental health nursing care through action research Vantil et al. (2020) Intervention Two categories were identified: improving the adoption of a Exploring person-­centred approach to care and improving decision-­making procedures (Figure 2). The category improving the adoption of a person-­centred approach to care included topics of studies that Barret and Roberts (2010), Moreno-­Poyato et aimed to improve care from the people's experience. In this category, recovery-­focused care was the most addressed topic (Chandley al. (2019) andSalzmann-­Erikson (2017) et al., 2014; Clements, 2012; Kidd et al., 2015; Lange, 2011). For example, in the study by Kidd et al. (2015), systemic barriers in the recovery process were identified by people with experience in pro- viding and receiving mental health services. Another topic of inter- Problem identification est was to improve care by understanding the lived experience of Implementing/action service users (Chambers et al., 2013; Hutchinson & Lovell, 2013; Action planning Larkin et al., 2015). In this regard, the study by Hutchinson and Lovell (2013) is noteworthy, as users acted as interviewers of Reflection other users to identify the impact of the mental disorder on the person's identity. In this same category, we also identified papers aimed at improving other topics such as the nurse–­patient thera- Hyde et al. (2009) and Lackeman peutic relationship (Moreno-­Poyato et al., 2019), the evaluation of TA B L E 2 Stages of action research in mental health nursing studies the open dialogue model (Borg et al., 2010) and the promotion of mental health in the school setting (Onnela et al., 2014). The cat- egory improving decision-­making procedures included those topics and Glasgow (2009) that sought to improve more specific aspects of mental health care Study and act and that responded to the attempt to structure and operational- ize procedures for decision-­making. In this sense, risk management and assessment of mental health were dealt with in two studies Plan Do (Crouche & Williamson, 2013; Vantil et al., 2020). Here, the con- tribution made by Crouche and Williamson (2013) stands out, by Implementing action identifying the introducing a new risk assessment system in a community mental Planning action health team. Other topics included in this category were the use of Exploring and problem seclusion (Hyde et al., 2009), ward rules (Salzmann-­Erikson, 2017) Evaluating Stages of action research and peer-­group clinical supervision (Lakeman & Glasgow, 2009). For both categories, all studies reviewed aimed to either improve nursing care (Barrett & Roberts, 2010; Chandley et al., 2014; Hyde et al., 2009; Moreno-­Poyato et al., 2019; Onnela et al., 2014) or process Reflection improve the clinical practice of teams (Borg et al., 2010). About the improvement of nursing care, the study by Moreno-­Poyato et al. (2019), which implemented an evidence-­based intervention 380 | MORENO-­POYATO et al. F I G U R E 2 Topics of interest for improving mental health nursing care Recovery Use of seclusion through action research. Nurse-patient therapeutic Ward rules relationship Improving the adoption of Topics of interest for Improving decision-making a person centered action research studies procedures approach to care in mental health nursing Open dialogue Peer-group clinical supervision Lived experience of service users’ Risk management and assesment to improve the nurse–­patient therapeutic relationship in mental greater capacity and competence in relation to the phenomenon they health units, should be highlighted. Borg et al. (2010) were able to were trying to change (Barrett & Roberts, 2010; Chambers et al., 2013; conceptualize a new model of clinical practice in a home treatment Lakeman & Glasgow, 2009; Moreno-­Poyato et al., 2019; Onnela team centred on open dialogue. et al., 2014). Changes in teamwork were also identified. Participants felt more supported and relationships in the team were improved (Chambers et al., 2013; Lakeman & Glasgow, 2009; Moreno-­Poyato 3.4 | Action research as a source of knowledge in et al., 2019; Salzmann-­Erikson, 2017), involving managers (Crouche & mental health nursing Williamson, 2013; Hyde et al., 2009) and improvements in the con- sensus of objectives (Hutchinson & Lovell, 2013; Hyde et al., 2009; In all the studies included in the review, it was possible to clearly identify Moreno-­Poyato et al., 2019). In this sense, the process has been the knowledge generated. In this regard, the first aspect highlighted in all found to generate motivation and satisfaction (Chambers et al., 2013; the articles was that the method made it possible to identify the mean- Moreno-­Poyato et al., 2019; Vantil et al., 2020), providing security and ing that the participants gave to the study phenomenon to be improved. empowering the participants in the project (Barrett & Roberts, 2010; Thus, in most cases, the participants' needs and priorities were identified Clements, 2012; Kidd et al., 2015; Moreno-­Poyato et al., 2019; (Barrett & Roberts, 2010; Chambers et al., 2013; Chandley et al., 2014; Salzmann-­Erikson, 2017; Vantil et al., 2020). Hyde et al., 2009; Lakeman & Glasgow, 2009; Lange, 2011; Moreno-­ Poyato et al., 2019; Vantil et al., 2020) together with the difficulties and barriers they encountered in practice (Barrett & Roberts, 2010; Chandley 4 | DISCUSSION et al., 2014; Kidd et al., 2015; Moreno-­Poyato et al., 2019). Additionally, most of the studies described specific, adapted and efficient strategies The purpose of this review was to locate and describe the available to improve the topic of interest (Barrett & Roberts, 2010; Chambers evidence related to the use of the action research method in the et al., 2013; Chandley et al., 2014; Hyde et al., 2009; Larkin et al., 2015; context of mental health nursing. First, it should be noted that it is a Moreno-­Poyato et al., 2019; Onnela et al., 2014). Other studies also method used to improve aspects related to mental health nursing in identified new practice models, such as the incorporation of the open both inpatient and community care settings. These findings confirm dialogue in a home treatment team model (Borg et al., 2010) or the devel- that action research is useful in any context that aims to improve opment of a professional practice model for mental health nurses work- aspects of health (Cordeiro & Soares, 2018). In addition, it is impor- ing in mental health promotion in a school setting (Onnela et al., 2014). tant to point out that it has the capacity to converge stakeholders in the phenomenon to be improved. This fact is especially relevant in current international health research policies, where the active 3.5 | Action research as a driver of change in participation of citizens in all steps of the research process is pro- mental health nursing moted, both in the development of projects and in the involvement of citizens in the dissemination and consumption of science (Vohland The first aspect that stands out in most of the studies as a prod- et al., 2021). However, in the case of mental health nursing, only half uct of change is the participants' awareness of the topic of interest of the studies included users. This is also the case in other contexts, (Barrett & Roberts, 2010; Borg et al., 2010; Chambers et al., 2013; where there are still a small number of studies in which equal groups Chandley et al., 2014; Clements, 2012; Hyde et al., 2009; Lakeman are formed between researchers and other stakeholders, not only in & Glasgow, 2009; Moreno-­Poyato et al., 2019). In addition, the par- the design of the study but also in the selection of participants and ticipants improved their attitude and level of knowledge, acquiring data collection and analysis (Effendy et al., 2022; Wiles et al., 2022). MORENO-­POYATO et al. | 381 From a methodological perspective, it is important to empha- may have limited the scope of the identified articles. However, the size that although there are different approaches to action research list of search terms was constructed in an elaborate, multistep pro- (Rowell et al., 2017), the results of the review indicate that in the cess. Third, the articles included were of varying quality. In this re- field of mental health nursing the most commonly used method is gard, the team decided not to remove any articles to be able to more Participatory Action Research. This may be due to the need to work precisely analyse and report these limitations in the use of action re- in a participatory fashion, with researchers and stakeholders side by search. Nonetheless, this may have had an impact on the reliability side to address a shared concern which is the driver of the process of the results obtained in relation to other issues analysed. Fourth, of change (Kemmis & Mctaggart, 2008). Another outstanding aspect only articles that presented results from the entire action research of the results from a methodological point of view was that most of process were included. This may have meant that projects that have the studies described the cyclical designs used and this made it pos- not published articles with complete results could not be reviewed. It sible to elaborate a classification of the common stages identified. is important to consider that many action research projects are rep- However, over one-­third of the studies did not specifically describe resented in several articles; a single article may aim to highlight only the cyclical process of the research, whereas some did so in a vague one phase of the project, rather than all phases. However, the claims manner, although one of the characteristics of action research is the of the review were to provide knowledge about the use of action re- cyclical nature of the design and process (Casey et al., 2022; Rowell search in mental health nursing as a whole. Given the transformative et al., 2017). This finding may explain why, in many of the studies, the nature of the method used in the included studies, the results ob- results related to the change produced were not clearly identified. In tained may be transferable to similar contexts and populations. this sense, the lack of description of the stages of action research is an important limitation for assessing the quality of the study report (Casey et al., 2022; Waterman et al., 2001). 5 | CO N C LU S I O N The results indicate two major foci for which the action research method has been used in the area of mental health nursing: improv- This review has identified and synthesized the available evidence on ing person-­centred models of care and improving decision-­making the use of action research in the context of mental health nursing. procedures. As in other contexts of nursing practice, heterogeneous The findings demonstrate that Participatory Action Research is the group participation allows issues of collective concern to be ad- most widely used action research method and that it is useful for en- dressed (Cordeiro & Soares, 2018; Cusack et al., 2018), whether it hancing models of care and improving decision-­making procedures, deals with issues related to the care model (Blackwell et al., 2017; both in the hospital and community settings. Action research can Rönnerhag et al., 2019), or if it focuses on improving more specific improve aspects of nursing practice and team dynamics. However, aspects related to day-­to-­day decision making (Cerulus et al., 2021; it should be noted that the quality assessment of action research Jokiniemi et al., 2021). articles is complex and requires further research. As a source of knowledge, the results of the review point to In light of the findings of this review, three key points are iden- the usefulness of action research for exploring the meaning of the tified to improve the effectiveness and quality of the use of action phenomenon of interest, making it easier for participants to iden- research on mental health nursing care: tify what they need to improve and how they can improve it more efficiently (Casey et al., 2022). Thus, action research is a driver for • The perspective of different stakeholders should be incorporated change and improvement in the practice of mental health nurses. throughout the research process, from project design to the re- As in other nursing contexts, the findings point to the importance porting of results. Action research includes the participation of of awareness as a starting point for change (Bekkema et al., 2021; different stakeholders and, therefore, incorporates a collabora- Cusack et al., 2018). This awareness allows the participants to im- tive approach both in the identification of the problem and in the prove their attitude and knowledge about the phenomenon of con- actions to foster change. In this sense, it allows all stakeholders cern (Tolosa-­Merlos et al., 2021). This, together with the support to become aware of the issue of interest, directly applying knowl- received from the group, improves team relations, increasing moti- edge in practice and obtaining satisfaction and empowerment. vation and satisfaction in the work environment (Afshar et al., 2020; However, still, in the context of mental health nursing, stakehold- Chen et al., 2021). Throughout the process, participants gain confi- ers are not representatively included in all projects and all their dence and security, key aspects for the empowerment of participants phases. (Alomari et al., 2020; Bekkema et al., 2021; Cusack et al., 2018). • It is necessary to provide a detailed description of the cycles and stages of the whole process, together with the objectives to be achieved for each of them. The use of action research, as a 4.1 | Limitations method of a cyclical and transformative nature, requires that spe- cial attention be paid not only to the end results of the method This review has some limitations. First, including the English lan- but also to the results produced in the process. It is important that guage filter as an inclusion criterion may have resulted in studies that researchers adequately describe both the stepwise design carried could not be reviewed. Second, it is possible that the search terms out and the results obtained during the process. 382 | MORENO-­POYATO et al. • Clear reporting is warranted on the knowledge generated and Barrett, P., & Roberts, S. (2010). Enhancing dual diagnosis capacities the change produced throughout the action research process. in acute inpatient nurses: A practitioner-­based action research project. Advances In Dual Diagnosis, 3(2), 24–­31. https://doi. Although the purpose of action research is to promote change, org/10.5042/add.2010.0385 in some studies, the impact is not clearly reflected in the results Baum, F., MacDougall, C., & Smith, D. (2006). Participatory action re- section. search. Journal of Epidemiology and Community Health, 60(10), 854–­ 857. https://doi.org/10.1136/jech.2004.028662 Bekkema, N., Niemeijer, A., Frederiks, B., & Schipper, C. (2021). Exploring AU T H O R C O N T R I B U T I O N S restrictive measures using action research: A participative observa- Made substantial contributions to conception and design, acquisition tional study by nursing staff in nursing homes. Journal of Advanced of data, or analysis and interpretation of data: ARMP, DTM, AVR, APT, Nursing, 77(6), 2785–­2795. https://doi.org/10.1111/jan.14825 KE, RNM, RSP, RVF. Involved in drafting the manuscript or revising it Blackwell, R. W. n., Lowton, K., Robert, G., Grudzen, C., & Grocott, P. (2017). Using experience-­based Co-­design with older patients, critically for important intellectual content: ARMP, MSM, MRL, TLLC, their families and staff to improve palliative care experiences in JRM, MPLL. Given final approval of the version to be published. Each the emergency department: A reflective critique on the process author should have participated sufficiently in the work to take pub- and outcomes. International Journal of Nursing Studies, 68, 83–­94. lic responsibility for appropriate portions of the content: ARMP, DTM, https://doi.org/10.1016/j.ijnur​stu.2017.01.002 Borg, M., Karlsson, B., & Suzie Kim, H. (2010). Double helix of research AVR, APT, KE, RNM, RSP, RVF, MSM, MRL, TLLC, JRM, MPLL. Agreed and practice—­Developing a practice model for crisis resolu- to be accountable for all aspects of the work in ensuring that questions tion and home treatment through participatory action research. related to the accuracy or integrity of any part of the work are appro- International Journal of Qualitative Studies on Health and Well-­Being, priately investigated and resolved: ARMP, DTM, AVR, APT, KE, RNM, 5(1), 4647. https://doi.org/10.3402/qhw.v5i1.4647 Bradbury, H. (2015). The SAGE handbook of action research. SAGE RSP, RVF, MSM, MRL, TLLC, JRM, MPLL. Publications Ltd. https://doi.org/10.4135/97814​73921290 Bradbury, H., Waddell, S., O' Brien, K., Apgar, M., Teehankee, B., & FUNDING INFORMATION Fazey, I. (2019). A call to action research for transformations: None. The times demand it. Action Research, 17(1), 3–­10. https://doi. org/10.1177/14767​50319​829633 Casey, M., Coghlan, D., Carroll, A., & Stokes, D. (2022). Is action research C O N FL I C T O F I N T E R E S T just about telling a good story? Journal of Advanced Nursing, 78(3), None. e46–­e 48. https://doi.org/10.1111/jan.15108 Cerulus, M., Bossuyt, I., & Vanderhaeghen, B. (2021). An integrative lit- PEER REVIEW erature review of the implementation of advance care planning in hospital settings. Journal of Clinical Nursing, 30(21–­22), 3099–­3110. The peer review history for this article is available at https://publo​ https://doi.org/10.1111/jocn.15835 ns.com/publo​n/10.1111/jan.15463. Chambers, M., Gillard, S., Turner, K., & Borschmann, R. (2013). Evaluation of an educational practice development programme for staff DATA AVA I L A B I L I T Y S TAT E M E N T working in mental health inpatient environments. Journal of Psychiatric and Mental Health Nursing, 20(4), 362–­373. https://doi. The data that support the findings of this study are available from org/10.1111/j.1365-­2850.2012.01964.x the corresponding author upon reasonable request. Chandley, M., Cromar-­Hayes, M., Mercer, D., Clancy, B., Wilkie, I., & Thorpe, G. (2014). The development of recovery based nursing in a ORCID high-­security hospital: Nurturance and safe spaces in a dangerous world? Mental Health and Social Inclusion, 18(4), 203–­214. https:// Antonio R. Moreno-­Poyato https://orcid. doi.org/10.1108/MHSI-­0 8-­2014-­0 024 org/0000-0002-5700-4315 Chen, S., Liu, J., Bai, X., Yue, P., & Luo, S. (2021). Providing targeted psy- Juan Roldán-­Merino https://orcid.org/0000-0002-7895-6083 chological support to frontline nurses involved in the management Montserrat Puig-­Llobet https://orcid.org/0000-0002-3893-4488 of COVID-­19: An action research. Journal of Nursing Management, 29(5), 1169–­1179. https://doi.org/10.1111/jonm.13255 Clements, K. (2012). Participatory action research and photovoice in a REFERENCES psychiatric nursing/clubhouse collaboration exploring recovery Afshar, M., Sadeghi-­Gandomani, H., & Masoudi Alavi, N. (2020). A study narrative. Journal of Psychiatric and Mental Health Nursing, 19(9), on improving nursing clinical competencies in a surgical depart- 785–­791. https://doi.org/10.1111/j.1365-­2850.2011.01853.x ment: A participatory action research. Nursing Open, 7(4), 1052–­ Cordeiro, L., & Soares, C. B. (2018). Action research in the healthcare 1059. https://doi.org/10.1002/nop2.485 field. JBI Database of Systematic Reviews and Implementation Reports, Alomari, A., Wilson, V., & Lewis, J. (2020). Action research: A mechanism 16(4), 1003–­1047. https://doi.org/10.11124/​JBISR​IR-­2016-­0 03200 for active engagement of clinical nurses in a program of research. Crouche, S., & Williamson, G. R. (2013). Risk assessment in mental Nursing & Health Sciences, 22(3), 539–­547. https://doi.org/10.1111/ health: Introducing a traffic light system in a community men- nhs.12690 tal health team. The Open Nursing Journal, 7, 82–­88. https://doi. Bailey, D., Kemp, L., Wright, N., & Mutale, G. (2019). Talk about self-­harm org/10.2174/18744​3 4620​13052​9004 (TASH): Participatory action research with young people, GPs and Crowe, M., Inder, M., & Porter, R. (2015). Conducting qualitative re- practice nurses to explore how the experiences of young people search in mental health: Thematic and content analyses. Australian who self-­harm could be improved in GP surgeries. Family Practice, & New Zealand Journal of Psychiatry, 49(7), 616–­623. https://doi. 36(5), 621–­626. https://doi.org/10.1093/fampr​a/cmz006 org/10.1177/00048​67415​582053 MORENO-­POYATO et al. | 383 Cusack, C., Cohen, B., Mignone, J., Chartier, M. J., & Lutfiyya, Z. (2018). Rönnerhag, M., Severinsson, E., Haruna, M., & Berggren, I. (2019). A Participatory action as a research method with public health qualitative evaluation of healthcare professionals' perceptions of nurses. Journal of Advanced Nursing, 74(7), 1544–­1553. https://doi. adverse events focusing on communication and teamwork in ma- org/10.1111/jan.13555 ternity care. Journal of Advanced Nursing, 75(3), 585–­593. https:// Effendy, C., Margaretha, S. E. P. M., & Probandari, A. (2022). The utility of doi.org/10.1111/jan.13864 participatory action research in the nursing field. Creative Nursing, Rowell, L. L., Bruce, C. D., Shosh, J. M., & Riel, M. M. (2017). In L. L. 28(1), 54–­60. https://doi.org/10.1891/CN-­2021-­0 021 Rowell, C. D. Bruce, J. M. Shosh, & M. M. Riel (Eds.), The Palgrave Greenway, K., Butt, G., & Walthall, H. (2019). What is a theory-­practice international handbook of action research. Palgrave Macmillan US. gap? An exploration of the concept. Nurse Education in Practice, 34, https://doi.org/10.1057/978-­1-­137-­4 0523​- ­4 1–­6. https://doi.org/10.1016/j.nepr.2018.10.005 Salzmann-­Erikson, M. (2017). Using participatory action research to de- Hutchinson, A., & Lovell, A. (2013). Participatory action research: velop a working model that enhances psychiatric Nurses' profes- Moving beyond the mental health “service user” identity. Journal of sionalism: The architecture of stability. Administration and Policy in Psychiatric and Mental Health Nursing, 20(7), 641–­6 49. https://doi. Mental Health and Mental Health Services Research, 44(6), 888–­903. org/10.1111/jpm.12001 https://doi.org/10.1007/s1048​8-­017-­0 806-­1 Hyde, S., Fulbrook, P., Fenton, K., & Kilshaw, M. (2009). A clinical improve- Soh, K. L., Davidson, P. M., Leslie, G., & Rahman, A. B. A. (2011). Action ment project to develop and implement a decision-­making framework research studies in the intensive care setting: A systematic review. for the use of seclusion. International Journal of Mental Health Nursing, International Journal of Nursing Studies, 48(2), 258–­268. https://doi. 18(6), 398–­408. https://doi.org/10.1111/j.1447-­0349.2009.00631.x org/10.1016/j.ijnur​stu.2010.09.014 Jokiniemi, K., Korhonen, K., Kärkkäinen, A., Pekkarinen, T., & Pietilä, A. Tolosa-­Merlos, D., Moreno-­Poyato, A. R., González-­Palau, F., Pérez-­Toribio, (2021). Clinical nurse specialist role implementation structures, pro- A., Casanova-­Garrigós, G., & Delgado-­Hito, P. (2021). Exploring the cesses and outcomes: Participatory action research. Journal of Clinical therapeutic relationship through the reflective practice of nurses Nursing, 30(15–­16), 2222–­2233. https://doi.org/10.1111/jocn.15594 in acute mental health units: A qualitative study. Journal of Clinical Kanerva, A., Kivinen, T., & Lammintakanen, J. (2017). Collaborating with Nursing, 2022, 1–­11. https://doi.org/10.1111/jocn.16223 nurse leaders to develop patient safety practices. Leadership in Health Vanderspank-­Wright, B., Efstathiou, N., & Vandyk, A. D. (2018). Critical Services, 30(3), 249–­262. https://doi.org/10.1108/LHS-­05-­2016-­0022 care nurses' experiences of withdrawal of treatment: A system- Kelly, J., Jayaram, H., Bhar, S., Jesto, S., & George, K. (2019). atic review of qualitative evidence. International Journal of Nursing Psychotherapeutic skills training for nurses on an acute aged mental Studies, 77, 15–­26. https://doi.org/10.1016/j.ijnur​stu.2017.09.012 health unit: A mixed-­method design. International Journal of Mental Vantil, F. C. S., Lima, E. d. F. A., Figueiredo, K. C., Massaroni, L., Sousa, A. I., Health Nursing, 28(2), 501–­515. https://doi.org/10.1111/inm.12555 & Primo, C. C. (2020). Safety of patients with mental disorders: A col- Kemmis, S., & Mctaggart, R. (2008). Participatory action research. In Y. lective construction of strategies. Revista Brasileira de Enfermagem, S. L. Norman & K. Denzin (Eds.), Strategies of qualitative inquiry (3rd 73(1), e20170905. https://doi.org/10.1590/0034-­7167-­2017-­0905 ed., pp. 271–­330). Sage Publications. Vohland, K., Land-­zandstra, A., Ceccaroni, L., Lemmens, R., Perelló, J., Kidd, S., Kenny, A., & McKinstry, C. (2015). The meaning of recovery in a Ponti, M., Samson, R., & Wagenknecht, K. (2021). What is citizen regional mental health service: An action research study. Journal of science? The challenges of definition. In The science of citizen science. Advanced Nursing, 71(1), 181–­192. https://doi.org/10.1111/jan.12472 Springer International Publishing. https://doi.org/10.1007/978-­3-­ Lakeman, R., & Glasgow, C. (2009). Introducing peer-­group clin- 030-­58278​- ­4_2 ical supervision: An action research project. International Waterman, H., Tillen, D., Dickson, R., & de Koning, K. (2001). Action re- Journal of Mental Health Nursing, 18(3), 204–­210. https://doi. search: A systematic review and guidance for assessment. Health org/10.1111/j.1447-­0349.2009.00602.x Technology Assessment, 5(23). https://doi.org/10.3310/hta5230 Lange, B. (2011). Cocreating a communicative space to develop a mind- Wiles, L. K., Kay, D., Luker, J. A., Worley, A., Austin, J., Ball, A., Bevan, A., fulness meditation manual for women in recovery from substance Cousins, M., Dalton, S., Hodges, E., Horvat, L., Kerrins, E., Marker, J., abuse disorders. Advances in Nursing Science, 34(3), E1–­E13. https:// McKinnon, M., McMillan, P., Pinero de Plaza, M. A., Smith, J., Yeung, doi.org/10.1097/ANS.0b013​e3182​272405 D., & Hillier, S. L. (2022). Consumer engagement in health care pol- Larkin, M., Boden, Z. V. R., & Newton, E. (2015). On the brink of genu- icy, research and services: A systematic review and meta-­analysis inely collaborative care. Qualitative Health Research, 25(11), 1463–­ of methods and effects. PLoS One, 17(1), e0261808. https://doi. 1476. https://doi.org/10.1177/10497​32315​576494 org/10.1371/journ​al.pone.0261808 Lin, L.-­E., Lo, S.-­C., Liu, C.-­Y., Chen, S.-­C., Wu, W.-­C., & Liu, W.-­I. (2018). Effectiveness of needs-­oriented hospital discharge planning for care- givers of patients with schizophrenia. Archives of Psychiatric Nursing, S U P P O R T I N G I N FO R M AT I O N 32(2), 180–­187. https://doi.org/10.1016/j.apnu.2017.10.013 Additional supporting information can be found online in the Moreno-­Poyato, A. R., Delgado-­Hito, P., Leyva-­Moral, J. M., Casanova-­ Supporting Information section at the end of this article. Garrigós, G., & Montesó-­Curto, P. (2019). Implementing evidence-­ based practices on the therapeutic relationship in inpatient psy- chiatric care: A participatory action research. Journal of Clinical Nursing, 28(9–­10), 1614–­1622. https://doi.org/10.1111/jocn.14759 Munten, G., van den Bogaard, J., Cox, K., Garretsen, H., & Bongers, I. How to cite this article: Moreno-­Poyato, A. R., Subias-­ (2010). Implementation of evidence-­based practice in nursing using Miquel, M., Tolosa-­Merlos, D., Ventosa-­Ruiz, A., Pérez-­ action research: A review. Worldviews on Evidence-­Based Nursing, Toribio, A., EL Abidi, K., Navarro-­Maldonado, R., Suárez-­ 7(3), 135–­157. https://doi.org/10.1111/j.1741-­6787.2009.00168.x Pérez, R., Valera-­Fernández, R., Romeu-­L abayen, M., Onnela, A. M., Vuokila-­Oikkonen, P., Hurtig, T., & Ebeling, H. (2014). Lluch-­C anut, T., Roldán-­Merino, J., & Puig-­Llobet, M. (2023). Mental health promotion in comprehensive schools. Journal of Psychiatric and Mental Health Nursing, 21(7), 618–­627. https://doi. A systematic review on the use of action research methods org/10.1111/jpm.12135 in mental health nursing care. Journal of Advanced Nursing, Rezaie, L., & Phillips, D. (2020). Post-­discharge needs of Iranian women 79, 372–384. https://doi.org/10.1111/jan.15463 diagnosed with severe mental illness: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 27(6), 752–­762. https://doi. org/10.1111/jpm.12634 384 | MORENO-­POYATO et al. The Journal of Advanced Nursing (JAN) is an international, peer-reviewed, scientific journal. JAN contributes to the advancement of evidence-based nursing, midwifery and health care by disseminating high quality research and scholarship of contemporary relevance and with potential to ­advance knowledge for practice, education, management or policy. JAN publishes research reviews, original research reports and methodological and ­theoretical papers. For further information, please visit JAN on the Wiley Online Library website: www.wileyonlinelibrary.com/journal/jan Reasons to publish your work in JAN: • High-impact forum: the world’s most cited nursing journal, with an Impact Factor of 2.561 – ranked 6/123 in the 2019 ISI Journal Citation Reports © (Nursing; Social Science). • Most read nursing journal in the world: over 3 million articles downloaded online per year and accessible in over 10,000 libraries worldwide (including over 6,000 in developing countries with free or low cost access). • Fast and easy online submission: online submission at http://mc.manuscriptcentral.com/jan. • Positive publishing experience: rapid double-blind peer review with constructive feedback. • Rapid online publication in five weeks: average time from final manuscript arriving in production to online publication. • Online Open: the option to pay to make your article freely and openly accessible to non-subscribers upon publication on Wiley Online Library, as well as the option to deposit the article in your own or your funding agency’s preferred archive (e.g. PubMed).