Development of Nursing Practice in Mental Health Setting for Physical Health of Patients

Priority Area of the Fifth National Mental Health Plan

Question:

Discuss about the Mental Health.

Nurses in mental health setting require skills and expertise in order to provide mental health care. However, nurses in mental health setting need to further develop in order to provide effective care. The fifth National Mental Health Plan is the collaborative government action. It focuses on seven priority areas for national action. This paper focuses particularly on the priority area- “Physical health of people living with mental health issues”. In the context of this priority area the paper critically discusses the how nursing practice has and needs to further develop in order to effectively reflect the values expressed. The rationale for selecting this priority area for the paper is the rich literature that showed poor physical heath in the people with the mental illness. Due to poor heath these people are twice as likely to die as the general population (Crawford et al., 2014).

Nurses have good communication skills to communicate with people from different cultural backgrounds. However, there is a need of eliminating the stigmatizing attitude among nurses. Even when patients with mental illness arrive with physical symptoms in emergency department, nurses overlook and judge the patient as “psycho or schizophrenia” (Shefer et al., 2014). In most cases the nurses would perform only one set of observation for mentally ill patients in ED. On the other hand those without mental illness were subjected to two-three sets of observations. The attitude of stigma and discrimination needs to be changes. There is a need of development programs for nurses to eliminate this attitude to address the physical health of the patients in addition to the emotional concerns. Nurses if continue to have this attitude will lead to diagnostic overshadowing and misdiagnosis of people. Although not all the misdiagnosis cases are caused by this attitude, it is still considered a part of the problem. It implies for training of nurses in ED that is focused on the parallel assessment of both teams (psychiatric and emergency team). The psychiatric nurses must learn how to enhance and structure the communication channels between the two departments. There is a need to overcome the disagreements over responsibilities between the two teams by fuller operationalisation for example to prevent delay in capacity assessments (Crawford et al., 2014).

According to Happell et al., (2013) it is important for the mental health hospitals to mandate “screening as essential for good practice”. Diagnosis can be clarified by regular screening and monitoring of physical health. It is essential as clinical symptoms of anti-psychotic medication develop over time. The rationale for the need is to prevent the prioritization of the mental health over physical health due to stigma. I would like to relate this with the comments of one of my colleague which – “it is better to perform screening at six months interval as annual screening may be too late to modify risks as antipsychotics changes physical heath drastically”. Therefore, mandating may help every nurse to involve in regular screening.  

The patients with mental illness have poor judgment and are highly likely to engage in sexual behavior that gives poor health outcomes such as HIV. The mental health nurses are in prime position to engage in discussion in patients regarding contraception, early detection of symptoms and need of sexual health checkups (Glasper 2016). However, psychiatric nurses fail to incorporate the “sexual health as part of comprehensive nursing assessment” and identify the individual’s level of understanding. Nurses need intense training on importance of sexual reproductive health for physical wellbeing of people with mental illness and eliminate reluctance to raise such conversation with the patients (Crawford et al., 2014). As a nurse I myself felt the need of assistance to discuss the reproductive health with the patient.

Stigma and Discrimination in Mental Health Nursing

The study executed by Glasper (2016), showed that nurse perceive training needs for management in the area of cardiovascular health, nutrition and diabetes to provide effective care for patients with mental illness. As a nurse I did sometimes felt lack of confidence in technical skills such as resuscitation. Most of my friends including me believe that the only barriers in delivering effective physical health care was own workload and patient’s motivation. The mental health nurses in UK perceived training needs in the same areas mentioned above (Robson et al., 2013). As a nurse there were instances where I was in dilemma as to how to achieve therapeutic relationship with the client in order to encourage to quit smoking. I believed that the patients should be banned to quit smoking in the premises. On the other hand my colleagues suggested that nurses too should smoke along with the patients to ensure successful therapeutic relationship with the patients. This signifies that the nurses have a positive attitude towards delivery of physical of care of mentally ill patients. However, there is a lack of structured ways or protocol to initiate the care in the general areas. Consequently, there is lesser contribution paid to management of diabetes, sexual health advice  and smoking cessation where are all the three domains significantly affect the physical health of the patients with mental illness.

People suffering from schizophrenia and bipolar disorders are highly likely to have sedentary habits with obesity (Glasper, 2016). Nurses should encourage such patients to engage in physical activity and assess the same during assessment. However, most nurses do not consider this as their responsibility. It is my personal experience where I felt that patients should be referred to physical trainer for this purpose instead of taking entire responsibility on my shoulders. There is a need of  guidelines for many other nurses like me to take action  in this area instead of merely educating the benefits of it to the patients. This is possible only when the nurse’s need of work hour flexibility is handled. There is a need of hospitals to overcome staff shortage issues. Otherwise, nurses would focus only on mental health concerns and not on the physical health considering as additional burden. Poor dental and oral health is highly common in the people suffering from mental illness. Nurses do not incorporate the dental health assessment in screening and monitoring. Nurses are not aware that the medications for psychosis also effect dental health in addition to smoking and substance abuse. Therefore, nurses screen dental health only in substance users. This again indicates lack of awareness of what aspects to be included in screening and monitoring (Varcarolis, 2016).

Patient fall is the other major significant physical health issue that is unmet by mental health nurses. Fall impacts the life of the patients and increases the hospital costs. However, nurses implement fall prevention for older age group ignoring the fact that some antipsychotic medication triggers fall such cholinesterase inhibitors, which may also happen with young men and women with mental illness (Hamaideh, 2016). I failed to prevent fall despite adequate training. I felt the need of support and assistance from multidisciplinary team which in most case is not available (Thongsai et al., 2016). This inhibits fall preventions and this area is overlooked by the organization I worked previously. 

Importance of Screening for Physical Health of Patients

According to Robson et al. (2013) training in areas where nurses need to learn specific protocol or awareness on particular health concerns can be provided. Nurses who have “post-registration in physical health care training” and experience of work in inpatient setting showed greater involvement in meeting physical health needs. There is need of innovative strategies to establish therapeutic relationship with clients having substance dependency. However, the study says that no specific training can be provided to change the attitude of the nurses or reluctance to address the physical health needs of the patients. According to Gray and Brown (2016) nurses did not consider physical health a priority for the service users and some greatly ignore the adverse effects of antipsychotic medication. This can be dealt by implementing stringent policies such as cancelling the licenses of the nurses showing discriminatory attitude towards patients or reluctant to encourage patient to quit addiction. This will trigger fear and motivation to work hard among nurses who are well trained but tend to avoid delivery of appropriate care as a result of prejudgment. Positive attitude of the nurses is imperative in effecting outcome of care. Therefore, this is a key target of future research and training initiatives argued (Gray & Brown, 2016).

One of my batch mate identified the gap between the “screening policy and the practice” in various mental health hospitals in Australia. For example there were instances where I was told to manage crisis or address immediate event and it worked against the screening of physical heath. There is need to keep basic checks in place in addition to policies.  The organization must clarify nurses about legal liability in cases where nurses fail to screen and follow up the same within specific time. It is needed because without following up screening would not be of any benefit to the client (Emerson et al., 2016).

Conclusion:

Nurses in mental health setting pay significant role in improving physical health of people suffering from mental health disorders. Based on the literature review and personal experience there is a need to overcome the barriers in physical care by addressing the nurse’s liability concerns, roles and responsibility issues and need of training and development in the area to allow nurses to be more certain about the involvement in the cancer screening, dental and eye health checks, sexual health promotion and providing cardiac health and nutrition advice. In addition to training initiatives there is a need of implementing stringent nursing practice for mental health nurses to eliminate reluctant attitude and multidisciplinary team support. This will allow them to have better awareness of their roles and responsibilities.

References:

Crawford, M. J., Jayakumar, S., Lemmey, S. J., Zalewska, K., Patel, M. X., Cooper, S. J., & Shiers, D. (2014). Assessment and treatment of physical health problems among people with schizophrenia: national cross-sectional study. The British Journal of Psychiatry, 205(6), 473-477.

Emerson, T., Williams, K., & Gordon, M. (2016). Physical health screening for patients with severe mental illness. Mental Health Practice, 20(1), 21-25.

Glasper, A. (2016). Improving the physical health of people with mental health problems. British Journal of Nursing, 25(12), 696-697.

Gray, R., & Brown, E. (2016). What does mental health nursing contribute to improving the physical health of service users with severe mental illness? A thematic analysis. International Journal of Mental Health Nursing.

Hamaideh, S. H. (2016). Mental health nurses’ perceptions of patient safety culture in psychiatric settings. International Nursing Review.

Happell, B., Scott, D., Nankivell, J., & Platania?Phung, C. (2013). Screening physical health? Yes! But…: nurses’ views on physical health screening in mental health care. Journal of clinical nursing, 22(15-16), 2286-2297.

Robson, D., Haddad, M., Gray, R., & Gournay, K. (2013). Mental health nursing and physical health care: A cross?sectional study of nurses' attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness. International Journal of Mental Health Nursing, 22(5), 409-417.

Shefer, G., Henderson, C., Howard, L. M., Murray, J., & Thornicroft, G. (2014). Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms–a qualitative study. PloS one, 9(11), e111682.

Thongsai, S., Gray, R., & Bressington, D. (2016). The physical health of people with schizophrenia in Asia: baseline findings from a physical health check programme. Journal of psychiatric and mental health nursing, 23(5), 255-266.

Varcarolis, E. M. (2016). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care. Elsevier Health Sciences.