Title : The nursing contribution to palliative-psychological care in inpatient psychiatry: A qualitative expert study towards an integrative, interdisciplinary model
Abstract:
Mental health nursing is central to the daily care of people with severe and persistent mental illness (SPMI), yet inpatient psychiatry remains largely oriented toward cure and symptom remission. For people with treatment-resistant schizophrenia, severe mood disorders, personality disorders and dementia, this focus often falls short, and quality of life, dignity and autonomy receive too little attention. Palliative-psychological care, which transfers palliative principles such as comfort, meaning and holistic support into mental health, addresses these needs but is barely established in psychiatry. This study explored how such an approach could be defined for inpatient care, what role nursing plays within it, and how an integrative, interdisciplinary concept could be developed. A qualitative, exploratory design was used. Eight semi-structured expert interviews with professionals from psychiatry, psychology, nursing and hospice care, together with a family caregiver, were analysed using Mayring's qualitative content analysis with a combined deductive and inductive category system, intercoder checks and communicative validation. Palliative-psychological approaches were barely established, fragmented and conceptually unclear, with palliative often equated with end-of-life care only. Nurses emerged as central to the success factors identified: continuity and relationship-based care, family integration, daily structure, and psychosocial interventions such as biography work and music-based activities that protect identity and dignity. Barriers included staff shortages, financing and placement gaps, professional resistance, and ethical dilemmas around autonomy, advance directives and chronic suicidality. Findings informed a seven-module integrative concept spanning structured indication, existential and psychotherapeutic support, family integration, daily structure and continuity, spiritual and cultural support, interdisciplinary teamwork with supervision, and cross-sector transition management. The concept positions mental health nurses as central, coordinating contributors and offers a basis for participatory piloting and evaluation.
