Attitudes towards people with mental illness: a cross-sectional study among nursing staff in psychiatric and somatic care

Stigma and discrimination have been identified as important obstacles to the integration of people with mental illness in society. In efforts to reduce stigma and discrimination, health professionals play an important role as they have frequent contact with and responsibility for treatment and rehabilitation of consumers. The aim of the present study was to investigate attitudes towards mental illness and people with mental illness among nursing staff working in psychiatric or somatic care. The sample consisted of 120 registered or assistant nurses who were interviewed about intimacy with mental illness and attitudes about seven different mental illnesses. The results showed that nursing staff in somatic care, to a higher degree than nursing staff in mental health, reported more negative attitudes with regard to people with schizophrenia as being more dangerous and unpredictable. In contrast, professional experience, intimacy with mental illness and type of care organization were found to be more associated with attitudes to specific mental illnesses concerning the prospect of improvement with treatment and the prospect of recovery. In conclusion, attitudes among nursing staff are in several respects comparable with public opinions about mental illness and mentally ill persons. In order to elucidate if negative attitudes about dangerousness and unpredictability of persons with specific mental illnesses are associated with realistic experiences or with prejudices further studies with a qualitative design are suggested.     

Managed care and mental health services: How we got to where we are

In September 1997, the National Alliance for the Mentally Ill issued a national report card asserting that managed care companies are falling short of their promise to deliver high-quality care to people with mental illnesses. This article traces how mental health care has evolved from the overbuilding of psychiatric facilities in the mid and late 1980s to a situation in which millions of mentally ill Americans cannot receive adequate care. It traces events that led to the unprecedented boom in psychiatric care through the 1980s to the place where health care reform has evolved. The disparity between insurance coverage of mental health care services and general medical care services is discussed, and the legislative outcome of recent mental health reform is described. Finally, implications for nursing and recommendations for action are considered.     

The family in mental health: support for clinical nursing care

This is a theoretical reflection on the clinical nursing care in mental health that is offered to the family. In view of having a family member with mental suffering, the family would delegate the care to that relative to the mental institution, thus there should be collaboration between the nursing and medical team to organize the environment and ensure family and social isolation. With the Psychiatric Reform, based on the proposal for psychosocial care, the family becomes the center of attention for health care professionals. The necessary support for clinical nursing care includes making conceptual changes in implementing health education, interdisciplinary work, and in the broadened clinic, so as to ensure comprehensiveness and subjects' autonomy. Clinical nursing care should permeate the subjects' politicalization, in which the actors militate to reach autonomy, and the practices involve dignity, creativity, welcoming, interdisciplinarity, hearing, and knowledge sharing.     

Pediatrician coordination of care for children with mental illnesses

BACKGROUND: Children with mental illnesses are seen across various service sectors, including pediatric primary care. As such, care coordination, which has been shown to improve outcomes, is especially important. Little is known about organizational and state level factors that might affect pediatricians' efforts to coordinate care for children with mental illnesses. OBJECTIVES: This study used data from a survey of primary care pediatricians to examine organizational and state level variables associated with increased care coordination for children with mental illnesses. METHODS: We undertook a cross-sectional study using data from a survey of pediatricians. A total of 1337 pediatricians in 6 states were surveyed about their care coordination and about organizational characteristics. State level data were gathered from various sources. A 5-item scale was developed for the dependent variable of past month coordination contacts (Cronbach's alpha = 0.82). RESULTS: No state level variables were associated with pediatrician coordination behaviors. Having a regular case conferencing mechanism, staff assigned to coordinate care, and a mental health specialist in the practice were associated with increased past month coordination contacts. Pediatricians in rural practices coordinated care more frequently than those in other locations. Pediatricians who screened more and those with more experience had higher rates of care coordination. CONCLUSIONS: Having a regular case conferencing mechanism, staff assigned to coordinate care, and a mental health specialist in the practice were associated with increased mental health care coordination. This information should be useful in planning ways to increase care coordination for children with mental illnesses seen in pediatric primary care.     

Reconstructing mental health nursing in home care

BACKGROUND: Psychiatric care for people in Sweden with long-term mental health problems has shifted from institutional to community and home settings. AIM: The aim of this study was to explore and describe mental health nurses' experiences of how structural changes in mental health nursing influence interaction when providing home care to patients with long-term mental health problems. METHOD: We conducted interviews with 11 mental health nurses who provided home care to people with long-term mental health problems. The constant comparative method of grounded theory was used for data collection and analysis. FINDINGS: The process of attempting to reconstruct mental health nursing by entering into the everyday reality of people with long-term mental health problems was identified as the core category. Central to this process was a change in perspective from nurse-controlled to client-centred care. This led to changes in moral values, assessment of client needs, and ways of meeting clients and establishing relationships. However, attempts to reconstruct mental health nursing according to a client-centred perspective became problematic when clients were at risk of harming themselves. In these situations, respondents felt the need to make decisions for clients, and this was experienced as burdensome and lonely. CONCLUSIONS: Our study indicates that the process of reconstructing mental health nursing in line with a client-centred perspective is incomplete. Opportunities to interact with people with mental health problems in the home environment may lead to a broader perspective on the daily lives of these people, but also to a realization that home care cannot be modelled on institutional care.     

Exploring palliative care nursing of patients with pre-existing serious persistent mental illness

Abstract

In the past, palliative care has been primarily cancer focused, and more recently the scope of care has broadened to include other life-limiting illnesses. With increasing incidence of multiple comorbidities amongst palliative care patient populations, it is less certain whether access to, and treatment within, palliative care settings are adequate for those who have pre-existing serious and persistent mental illnesses. This paper explores the key concepts of palliative care for people with serious and persistent mental illness (SPMI), the challenges present in nursing practice, and the making of end-of-life decisions, in order to consider how comprehensive, person-centred care might be given. Although some improvements have been reported over the past 14 years, this population appears to remain underserved in palliative care. The need for more specialized education for nurses in both palliative care and mental health care, and better communication and collaboration between the two specialities is needed. Greater collaboration between disciplines may ensure that these patients receive the same standard of care experienced by the general population.     

Hospitalized mental health patients and oral health

The purpose of this review of the literature is to present a contemporary perspective related to the nursing care of hospitalized mental health patients who have risk of developing oral health issues. Mental illness is a major health concern worldwide. Compounding this health issue, mental health patients/clients demonstrate avoidant behaviours related to oral health, and the symptoms of mental illness can be a compounding factor. Oral health and oral inflammatory disease are the result of lifestyle and behaviour and mental disorders affect both lifestyle and behaviour. The search used the search terms oral health AND nursing AND mental illness AND Published Date 2005 to 2010. For those who experience mental illness oral health assessment is not routinely practised by clinicians. The importance of special attention to dental problems for people with mental disorders has also been stressed by researchers since the lifespan of people with serious mental disorders is shortened compared to the general population. Oral health care is an important part of treatment. Routine oral care for hospitalized patients is imperative, and this is usually the responsibility of nurses without sufficient knowledge in oral care or comprehensive protocols to follow.     

精神科住院患者医院感染分析及护理

目的探讨精神科住院患者医院感染的特点以及寻找有效的预防措施。方法应用回顾性调查研究方法对我院2005年精神科出院2192例患者进行调查分析。结果医院感染例次数为512例次,感染率为0.20%,其中医院感染部位以上呼吸道感染最多,占35.34%,其后依次为胃肠道感染占22.18%,下呼吸道感染占20.49%,其他感染占11.65%,泌尿道感染占6.39%,皮肤软组织感染占3%,腹腔内组织感染占0.94%。结论精神科患者医院感染发病率明显低于综合性医院感染发病率,每个病区发生感染率存在差异。因此,医务人员在治疗和护理过程中应重视加强消毒隔离制度,加强住院患者的健康保健知识的宣传教育,以进一步降低医院感染的发生。     

Recent developments in psychosocial interventions for people with psychosis

The advent of drug treatments for psychotic illness in the 1950s, along with changes in social policy, heralded the move from institutionalized care to community care. Over the last decade, there have been research developments in the use of psychological techniques to manage psychotic symptomatology, particularly in the realms of cognitive behavioral therapies. There is growing evidence to suggest that psychological treatments can offer an adjunct or even an alternative to traditional medical treatments for patients with schizophrenia and other serious mental illnesses. Opportunities have arisen for mental health nurses to learn these new approaches to caring for people with enduring mental illnesses. The impact of psychological interventions in the treatment of psychosis and the implications for mental health nursing practice are discussed.     

Exploring the role of the mental health nurse in community mental health care for the aged

There is currently considerable discussion about the impact of the aging population on the demand for health care services, however there is considerably less attention paid to the impact of mental health issues on the needs of the aged population. Nurses comprise the largest professional group within the mental health workforce in Australia. The availability of a high quality mental health nursing workforce will therefore be crucial to meeting the health needs of aging clients in the future, accompanied by an increased pressure to increase the proportion of care delivered in the community. There is however, a paucity of literature on the role and contribution of community mental health nurses specialising in the aged care field. The aim of this paper is to present the findings of a project designed to examine the role of mental health nursing within aged persons' community mental health teams in Victoria, Australia, with particular emphasis on the biopsychosocial interventions used. Fifteen participants from three community mental health services in Victoria participated in a focus group interview to share their insights and experiences. Data analysis revealed two main themes, the role of the nurse, and the specific functions of the nurse. This data is presented as a beginning contribution to the paucity of literature currently available in this important area.     

Nursing considerations for dual diagnosis in mental health

It is the intention of this literature review to present suggestions for nursing practice with reference to the care of the dually diagnosed. Nursing care of the dually diagnosed client is complex. Clinicians from both drug and alcohol services and mental health services have long recognized that neither service area provides adequate clinical care to those clients who have a dual diagnosis of substance abuse and mental illness. It is now > 10 years since a ground-breaking Australian study recognized this. To ascertain whether there has been improvement in the service management of clients who have a dual diagnosis, and to determine the best practice interventions in the area of mental health nursing, we undertook a review of the literature. The databases CINAHL, MEDLINE, PsycARTICLES and PsychINFO were searched and 185 articles met the inclusion criteria. From this review, it seems that gaps still remain in the provision of services and that mental health nurses might be best placed to provide integrated care to those clients who have a dual diagnosis and present to mental health services. This requires mental health nurses to have skills in substance use detection and knowledge of potential care implications for the client in the context of their substance use.     

Integrated nursing care for people with combined mental health and substance use disorders

Many health problems arise from mental, neurological, and substance use disorders. These disorders are highly prevalent and complex and contribute to poor health outcomes, premature mortality, security risk, social isolation, and global and national economic loss. Mental health and substance use disorders are among Australia's top four causes of disease burden. Our objective was to investigate and synthesize contemporary literature regarding factors that influence nurses' delivery of integrated care to people with combined mental health and substance use disorders within mental health services. We systematically searched five electronic databases with a limit on publications from 2009 to 2021. The search yielded 26 articles. Following thematic analysis, three themes were identified: individual nursing characteristics, nursing education, and professional development characteristics, and organizational factors. This study reveals that there is a fundamental absence of adequate integrative models of care within mental health services to enable the optimal nursing care of people with combined mental health and substance use disorders. Future research is needed to determine nurses' perceptions and factors influencing their role as participants in integrative care. The results could strengthen nurses' contributions in developing/adopting integrative models of care and contribute to clinical, educational, and organizational development.     

Implications of evidence‐based practice for mental health nursing

The introduction of evidence‐based practice (EBP) and the hierarchical approach to evidence it engenders within research and evaluation has aroused controversy in the mental health professions. The aim of this paper is to present a critique of EBP with a specific relationship to mental health nursing. It will be argued that in its current form, EBP presents a potential impediment to the facilitation of consumer participation in mental health services and to the recovery model. The need for the consumer voice and the importance of the lived experience of mental illness are not readily reconciled with a strong scientific paradigm that promotes detachment and objectivity. The importance of evidence in contemporary mental health care will also be acknowledged and discussed in light of the current climate of increased consumer knowledge, fiscal constraint, and extensive social criticism of mental health‐care services. The current approach to EBP requires reconstruction to support the consumer‐focused nature of mental health nursing, and to facilitate the implementation of a recovery model for mental health care.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.     

Addressing the mental health nurse shortage: Undergraduate nursing students working as assistants in nursing in inpatient mental health settings

The population of mental health nurses is ageing and in the next few years we can expect many to retire. This paper makes an argument for the employment of undergraduate nursing students as Assistants in Nursing (AINs) in mental health settings as a strategy to encourage them to consider a career in mental health nursing. Skill mix in nursing has been debated since at least the 1980s. It appears that the use of AINs in general nursing is established and will continue. The research suggests that with the right skill mix, nursing outcomes and safety are not compromised. It seems inevitable that assistants in nursing will increasingly be part of the mental health nursing workforce; it is timely for mental health nurses to lead these changes so nursing care and the future mental health nursing workforce stay in control of nursing.     

The new brain: concepts, challenges, and opportunities for mental health nursing

The new paradigm that the brain is able change itself (neuroplasticity) is acknowledged and teased out in terms of the ramifications for mental illnesses. Parallel studies in pain (central sensitization) and mirror neurones are examined to conceptually clarify these ramifications in relation to mental health, and to expand our understanding of empathy and social inclusion beyond good ideas to being a part of our nature. The paper then focuses on making clear what the concepts, challenges, and opportunities for mental health nursing might be; even advancing possibilities for recovery through better understanding the third space or intersubjective. What ramifications this has for mental health nursing is reviewed in terms of a paradigm change and the necessity for conceptual clarity, as it relates to the uniqueness of the person right before our very eyes. The author contends that to embrace this new paradigm is not only necessary but ethically obligatory, as it opens up new possibilities for understanding ourselves and this changeable person.