007 415 mental health nursing literature review final3 · the majority of articles are literature...

CLINICAL PROFESSIONAL RESOURCE

Literature review Scoping Selected Literature on the Role of the Mental Health Nurse in Improving the Physical Health Care of Clients Diagnosed with Severe Mental Illness

SCOPING SELECTED LITERATURE ON THE ROLE OF THE MENTAL HEALTH NURSE

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ROYAL COLLEGE OF NURSING

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1. Introduction 4

2. Key Findings 5

3. Proposed Solutions 10

4. Summary 13

Appendix 14

Contents


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1. IntroductionAim

To undertake a scoping of readily available literature on the role of the mental health nurse (MHN) in improving the physical health care of people diagnosed with severe mental illness as part of the Parity of Esteem Work Programme.

Scoping Question

No scoping question was identified, but the work relates to the role of the MHN in the physical health of people diagnosed with severe mental illness in the context of the RCN’s Parity of Esteem Work Programme. The scope covers the role specifics, what may work in reducing the mortality gap, the skills and resources MHNs need and the systems that are in place to enable them to work effectively.

Search Strategy

An opportunistic search was undertaken by the author using Google and Google Scholar, and only articles that were immediately available, or readily available through the RCN Library Service were reviewed. Additional searches were undertaken through the RCN Library’s A-Z journals pages. Additional articles were identified through scanning the reference lists of articles obtained. All reviewed articles are listed in the evidence table, which can be found in the Appendix.

Limitations

The scoping review does not follow the usual trajectory of an evidence review due to database and time limitations which will affect the number of returns. As such, the findings should be treated with caution. Articles reporting quantitative findings (10/38) report the key limitations as limited generalisability of findings largely due to small sample sizes, inherent bias, or only being carried out in one location. Articles reporting qualitative findings (12/38) also report limited generalisability for similar reasons. However, another way of describing the limits of the qualitative studies is transferability, which is synonymous with generalisability. Transferability and generalisability are established by providing the readers of research with some evidence that the findings may be applicable to other contexts, situations, times and populations. The majority of articles are literature reviews, (14/38), two of which are systematic reviews. Of these only the systematic reviews and one literature review reported limitations. Overall, out of the 38 articles scoped, 18 failed to report any limitations, however 2/38 were abstracts only, and 1/38 was an expert opinion paper (see Appendix).


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2. Key FindingsThe key findings centre on the scale of the problem, the role of the mental health nurse and other health care professionals in improving the physical health of clients diagnosed with severe mental illness, the incentives and barriers to reducing the rate of premature mortality, and the potential solutions that have been identified in the literature reviewed.

The Scale of the Problem

People diagnosed with severe mental illness have been identified as experiencing inequalities and disparities in meeting their physical health care needs. This ultimately results in them being at high risk of morbidity and experiencing much earlier death than the general population1 2 3 4 5 6 7 8

9 10 11 12 13. An international paper describing a multi-level model aimed at reducing high levels of premature death states “Persons with severe mental health disorders…die 20 to 30 years earlier than the general population…this mortality has been well documented in a number of meta-analyses and systematic reviews”36. The causes of death among this client population are due to “preventable physical diseases”36 and have been identified as the natural causes that lead to death in the wider population. The most notable causes of early death include cardiovascular disease2 6 7 9 13 14, respiratory diseases 1 3 13, diabetes 3 4 13, infectious diseases3, cancers 2 3 24 27 and HIV3

13. Researchers have estimated the number of years of life lost ranges from 10 to 30 years1 7 30, and the reasons for this have been identified as the risky health behaviours and lifestyles of this client population3 10 13, the effects of psychotropic medications3 8 11

24 28, and limited monitoring and assessment of the physical health needs of clients diagnosed with severe mental illness3 4 22

24 20 21 34 35. What the research findings also reveal is that people diagnosed with severe

mental illness do not die prematurely only as a result of suicide27. According to Liu et al36 the patterns of premature mortality appear similar across countries.

While the dangers of poor physical health have been known for a number of years, there remains a significant level of concern over the health inequalities that continue to be experienced by those diagnosed with severe mental illness8 10 20 21. This has led some commentators to argue that while the life expectancy of the general population has increased significantly since 1960, the life expectancy of those diagnosed with severe mental illness has reduced23. This is reinforced more recently by Liu et al36 who argue that little progress has been made and “evidence suggests the gap may be increasing over time…recently published studies show standardised mortality ratios are higher than those previously reported”.

The Role of the MHN

Commentators have identified the main role of the MHN as one of assessment and monitoring the physical health care of clients diagnosed with severe mental illness3 13 19 24. However, a number of issues are raised in relation to how well-equipped and supported MHNs are in being able to fulfil this role. Research indicates that MHNs have reported confidence in providing advice on diet, smoking cessation24, weight management35, and monitoring blood pressure35. However, nurses who themselves were smokers were found to display a more permissive attitude to clients who smoked, perceiving smoking to be a coping mechanism, rather than a key contributory factor in cardiovascular disease24. Nurses reported feeling much less confident in relation to discussing medication side effects or sexual behaviours11 24. Some nurses felt these last two activities were the role of the doctor11.


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While confidence was identified by nurses as a factor in how they felt they were able to fulfil a monitoring and assessment role, they also cited a lack of knowledge and skills1 4 14 19

29 35, systemic issues linked to fragmentation of services8 15, lack of training and education3

9 10 11 19 22 24 34, and the lack of policies and guidance for practice11 30 34.

A study exploring MHNs’ view of their role reported that nurses shared a clear commitment to physical health monitoring and screening in mental health settings34. However, nurses also acknowledged that a lack of knowledge and skills was a hindrance, and many nurses reported having no access to physical health training34. The author concludes that there is a need to focus training on individual and social determinants of health that contribute to the poor physical health of people with severe mental illness. What is required is an inclusive, robust system in practice, in which there is clear guidance and information around referral pathways, and support for nurses working with clients who have complex, diverse health needs. Physical care monitoring policies should be easily accessible and clear. Furthermore, mandatory training as well as continuing professional development courses should reflect physical health skills in addition to mental health skills34.

The literature also flags an element of ambivalence from nurses on whether it is their role to assess and monitor clients’ physical health14. However, there was a recognition that this ambivalence was complex and multi-layered, reflecting perceptions of the relationship between physical and mental health14 23. Some commentators suggest that despite an acknowledgement of the importance of the risks to physical health, nurses still displayed a tendency to mainly focus on mental health issues33.

A number of authors highlight challenges resulting from the continuing lack of clarity about who should provide health promotion together with the realisation that responsibility lies with health care professionals working across primary and secondary care1. While MHNs have been identified as being well positioned to have a positive impact on the mental and physical health of those diagnosed with severe mental illness, the sole responsibility for health promotion cannot just rest on their shoulders1.

Some commentators argue that defining the role of the MHN remains problematic and is tempered not only by a lack of clarity, but also by a lack of knowledge and confidence. Furthermore, poor communication between health care services, in which primary care professionals lack knowledge about severe mental illness3 and secondary care professionals lack knowledge about primary care screening leads to a failure of both sectors to take responsibility for the physical health needs of clients with severe mental illness. A key consequence has been described as diagnostic overshadowing, whereby physical health concerns will often be attributed to a person’s mental illness28

31 32. A further challenge identified, as a result of the lack of clarity around roles and responsibilities aligned to screening, assessment and monitoring of physical health needs, is a lack of follow-up19 21. One researcher reports nurse concerns that screening was seen as a legal requirement, and any failure to follow up and complete the process could create legal liability21.

While MHNs were cognisant of their role in health promotion5 8 12 18 22 30, the literature identifies the importance of ensuring a multi-disciplinary approach which would include secondary, primary and community care workers2 3 6 9 10 19 15 and the role of specialist nurses20.


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Incentives to Reduce the Rate of Premature Mortality in Those Diagnosed with Severe Mental Illness

Research exploring the perspectives of service users1 revealed that professionals often fail to view clients holistically despite the link between mental and physical health. Users also felt that a continued focus on ill-health rather than health promotion often took place in a paternalistic environment with rigid adherence to the medical model and a continued failure to take users’ physical health concerns seriously1. A systematic review16 identified evidence to suggest the integration of mental and physical health care services may significantly reduce disparity. The authors argued the need to adapt the role of the MHN to include regular assessment of physical health needs and appropriate interventions, and suggested that MHNs already have many of the skills required to provide such interventions.

A study investigating user perspectives found that one of the greatest incentives was a desire to lose weight, which was the single most important motivator for attending lifestyle interventions identified by users. The social benefits associated

with attendance at lifestyle interventions were peer and staff support, and building relationships. Users valued the environment, context and the role and characteristics of the health care professional delivering the lifestyle interventions29. These staff characteristics were identified as being helpful, knowledgeable, informative and approachable. The benefits associated with reducing early mortality rates for people diagnosed with severe mental illness includes symptom reductions, and targeted support that helps users make the necessary lifestyle and behaviour changes in order to live a longer, healthier life29.

From a provider perspective incentives have been identified as increased knowledge and skills, facilitated through the provision of post-registration training10 12 19 24 32, improvements in the quality of patient care, and increased morale and job satisfaction for nurses37.

In terms of the incentives for the wider society, any decrease in the mortality of those diagnosed with severe mental illness lies in the reduction of inequalities and disparities in service provision, and the enhancement of the human rights of this section of the population8.


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Barriers to the Reduction in the Rate of Premature Mortality in Those Diagnosed with Severe Mental Illness

A number of barriers have been identified that can be located at different levels of the service. System-related barriers include the separation of physical and mental health services leading to fragmentation of services. Organisation level barriers include a continued emphasis on the biomedical model which focuses on ill-health rather than health promotion, diagnostic overshadowing, and continued stigma associated with mental illness. Individual level barriers include professional attitudes, client behaviour and lifestyle choices, and user non-compliance with advice on medication3 18 19 22 29 30 34 35.

The issue of diagnostic overshadowing has been reported as a significant phenomenon in the literature28, where it has been identified as a cause of misdiagnosis of people with mental illness who present with physical symptoms31. Diagnostic overshadowing is the misattribution of physical symptoms to mental illness31. Factors contributing to diagnostic overshadowing are “…complex presentations or aspects related to poor communication or the challenging behaviour of the patient”31. Other contributory factors include overcrowding and noise in the emergency department, time pressures, targets, and the stigmatising attitudes of staff31. To counteract the impact of diagnostic overshadowing, greater joint working between psychiatric and emergency department staff is needed31

28, and further operationalisation of the procedures used to reduce disagreements about where responsibility lies31.

Since early 2002 the UK government has focused on improving the physical health of people diagnosed with severe mental illness but international research reveals a number of barriers to accessing appropriate services,

and these emanate from users, professionals and organisation bureaucracy22. This research has focused mainly on the professional, rather than the user view, and reveals how the quality of care is compromised by a number of practical problems and interpersonal difficulties between users, health care professionals and between mental and physical health care providers22.

Service-related barriers are identified in the way clients’ physical health needs are often overlooked, the failure to screen, assess and monitor, and the continued lack of clarity about who is responsible for providing health promotion3. Illness-related barriers have been identified as the consequence of those with serious mental illness failing to report physical health problems that may have arisen as a result of risky behaviours, including smoking, substance and alcohol abuse, poor diet and unsafe sexual practices3

26. Treatment-related barriers are identified as medication side effects which can lead to weight gain, diabetes, cardiovascular disease, metabolic syndrome, eye and dental health, and sexual effects26. These barriers may be exacerbated by MHNs’ lack of confidence in discussing and giving advice on sexual health and medication side effects as reported above.

An additional barrier has been identified as a lack of consensus regarding the frequency and type of monitoring required, and although guidelines and policies exist, these are not always implemented30. One study exploring the boundaries of care provision applied implementation theory to examine the capability of the health care system to integrate physical health promotion into mental health delivery and identified several boundaries existing around illness, provision of services, sectors, the health care system, and society30. The authors argue these multi-level boundaries, combined with whether or how people feel enabled to integrate physical health promotion into existing practice, act


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as significant barriers to the adoption of evidence-based guidance in practice30.

Other barriers include the beliefs and attitudes of users toward the promotion of a healthy lifestyle, which may vary depending on the mental illness they have been diagnosed with18, and the attitudes of health care professionals29 31 34. One commentator has suggested that it is important to consider users’ readiness to engage in screening and monitoring, and has described this as “therapeutic nihilism” which is identified as a “term often used to denote ambivalence by service users to engage in care interventions”34.

Roberts & Bailey argue that an invisible barrier is the negative or defeatist attitudes of staff, and they go on to suggest the evidence strongly supports this view29. This finding is also supported by research exploring the views of emergency department

staff which reports how clinicians’ attitudes towards those with mental health issues have a tendency to stigmatise these clients and this also results in avoiding such clients due to the fear of violence28. This is echoed by others who suggest that the stereotypical views held by professionals and the public alike about people with mental illness often prevent those people from accessing help about their physical health concerns34. Furthermore, Mwebe argues that “mental health nurses are strategically placed to address the stigma of mental illness by challenging stereotypical attitudes…towards people with severe mental illness”34.

Other barriers have been identified as resource allocation and local culture34, nurse workload and lack of client compliance with advice given35.


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The literature reviewed proposes a range of solutions that may help reduce early mortality in those diagnosed with severe mental illness. These solutions can be placed on a continuum of system, organisation and individual levels. At the system level these include the re-integration of physical and mental health services. Organisation level solutions include the provision of post-registration training and education and the introduction of specialist nurses into mental health settings. At the organisation and individual level, proposed solutions include the use of checklists and tools, the implementation of guidelines and policies, and a greater emphasis on health promotion interventions.

Limited detail is provided on what will be required to initiate the re-integration of physical and mental health services. However, a systematic review notes “There is evidence to suggest that the integration of mental and physical health care services might significantly reduce the disparity observed between populations with and without mental illness…”16. The authors suggest that the mental health nursing profession have a key role to play in assessing physical health needs and delivering the necessary interventions. The authors also state that while MHNs have many of the skills needed to provide successful behaviour interventions, they will require “…ongoing education and training [which] will require systemic support….”16.

Others have suggested that integration of physical and mental health services could be facilitated through better co-ordination and active engagement with the physical health of patients with mental illness through the development of GP-led clinics with health community teams attached to them. This would facilitate greater involvement of psychiatrists and the development of shared care to establish full integration between physical and mental health services22.

Regardless of the changes that have been made to nurse education, the literature reveals that MHNs report feeling less confident and unprepared to address the physical health care needs of their clients. This is a problem that has been reported by nurses in other Western countries who have undergone different education and training programmes32. This has led some commentators to argue that the evidence suggests the provision of physical health care by MHNs is not simply a question of education and training, but is due to the lack of opportunities MHNs have to practise skills that may impact on their level of competence and confidence in engaging with physical health activities32. Furthermore, the same authors argue that the political shift from hospital to community may also have complicated the situation. The solution is more than changing pre-registration nursing curricula, there is also a need for greater interprofessional collaboration, and more opportunities to practise new knowledge and skills, as well as a requirement for a change in attitudes and a need for service flexibility32. For this to happen, robust post-qualification training and education programmes need to be provided together with opportunities to practise skills and build confidence32. This is echoed by others who suggest that continuing professional development programmes aimed at MHNs should reflect physical health skills and not just training in mental health practice34.

Happell et al argue for the provision of specialist nurses in mental health settings to support MHNs to assess and monitor the physical health care needs of their client population20 21. They suggest that MHNs should work more closely with their colleagues in general health and there is a growing interest in the benefits that could accrue from co-locating physical health care in community mental health settings25.

3. Proposed Solutions


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While assessing and monitoring physical health does lie within the scope of mental health nursing practice, Happell et al argue that expecting MHNs to attend to both the physical and mental health needs of their clients may be unrealistic given their other priorities and demands on their time. Furthermore, they argue that MHNs have divergent attitudes towards the provision of physical health care as well as differing levels of skills and knowledge to do this.

The solution offered is the provision of a physical health nurse consultant into the mental health setting to bridge the gap, with the specific role of monitoring the physical health of those with serious mental illness. They also refer to this role as a cardio-metabolic nurse21. An additional benefit for this dedicated role would be to reduce the burden on users to attend different locations for physical health care. The authors cite supporting evidence which shows that dedicated nurse-led roles aimed at improving access to quality primary care result in significant improvements in physical health behaviours and outcomes. They conclude that introducing such a role would be an immediate and decisive response to reduce the inequalities and disparities experienced by people diagnosed with severe mental illness25.

Mwebe34 reports how nurses wanted a more robust inclusive system in practice, one with clear guidance and information around referral pathways and policies that should be easily accessible and clearly state the functions and roles of all the mental health professionals responsible for addressing physical health needs and health promotion. Nurses also supported the need for a physical health lead nurse who could act as a go-to resource for staff who needed clear guidance around physical health issues34.

Health promotion guidelines have been recommended as a means of improving the

physical health care of people with severe mental illness, but there is little agreement about the nature of the work associated with improving physical health, whose responsibility it is, and how work would be enacted30. The successful implementation of evidence-based guidelines is necessary to determine how sectors and disciplines should work collaboratively in overcoming boundaries to care and to integrate physical health promotion. However, it is also acknowledged that the successful implementation of evidence-based guidelines are heavily reliant on the capability of the workforce to develop and adopt boundary-mediating strategies30.

Another solution has been identified as checklists and tools as a way of supporting MHNs to improve the physical health needs of their clients. One such tool has been identified as the Health Improvement Profile (HIP) which was introduced into the NHS in 20094. The HIP has been implemented in Australia14, Hong Kong33 and Thailand38, been developed for use in primary care9 and evaluated7.

The HIP addresses the major health priorities in the general population, health problems where there is evidence of increased morbidity and mortality in people diagnosed with severe mental illness, and health behaviours. It flags each health parameter, assigning green if healthy, and red if evidence-based action is required. The developers have created a training manual10 and their aim is to implement high population change4.

A pragmatic case evaluation of users’ and clinicians’ perspectives of the HIP in the community report 189 health issues were identified using the HIP. The items most frequently flagged red and in need of intervention were BMI, breast self-examination, waist circumference and diet. The authors found considerable physical morbidity in all patients. In addition, they report a concern that the HIP, while


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facilitating a recognition of potential physical health issues, may also underestimate actual morbidity, suggesting a need for additional training to support MHNs in using the HIP, especially in relation to asking about sensitive subjects7.

Other commentators suggest that through using the HIP, MHNs can be sensitised, prepared and empowered to turn this serious health issue around. The HIP was adapted for use in Australia and supported MHNs to identify, record, work with consumers, and work collaboratively with psychiatrists and other stakeholders. The authors conclude that the mental health benefits are likely to result from physical intervention given the intrinsic connection between the primary and mental health care identified in multi-disciplinary team-working14.

Adapting the HIP for use in Hong Kong, researchers identified four key themes:

1. The influence on nursing practice including an increased focus on physical health, working comprehensively and systematically, and providing opportunities for health education.

2. Service-related implementation challenges including referral frustrations, the need for targeted multi-disciplinary team services, and the need to introduce lifestyle intervention groups.

3. Raising clients’ awareness of the state of their physical health, leading to increased motivation for lifestyle changes, and the opportunity to observe behavioural changes in clients.

4. An understanding of the adaptations needed for using the HIP, including understandable units of measurement, the need to adjust parameters for local population, and the requirement for a Chinese language version and the incorporation of traditional Chinese medicine33.

The authors suggest that refocusing nurses’ attention on physical needs appears to have improved nurses’ physical health literacy, and reinforced the importance of holistic care. However, despite acknowledging the importance of the risks to physical health, nurses maintained some ambivalence about whose role it should be, and also displayed a tendency to focus on mental health issues. Furthermore, the authors report that using the HIP revealed gaps in nurse knowledge and skills beyond physical health, which they argue were beyond the content provided in the intervention training33.

A quasi-experimental study carried out in Thailand used a before and after model to investigate the impact of the Thai HIP on the physical health and health behaviours of people diagnosed with schizophrenia over a 12-month period. The authors report a significant reduction in BMI and bodyweight, and a significant decrease in the number of red-flagged parameters, suggesting lowered potential health risks. The findings suggest the HIP intervention has the potential for improving the physical health of those diagnosed with severe mental illness when incorporated into routine community mental health care38.


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This scoping report has described the scale of the problem facing mental health professionals in improving the physical health care of people diagnosed with severe mental illness. Research over the last 18 years has revealed the increasing rates of premature mortality which far exceed premature mortality rates in the general population. The main reason for this inequality has been identified as a failure to screen, assess and monitor the physical health of people with severe mental illness and an associated failure to focus energy and resources on health promotion rather than ill-health.

A number of incentives and barriers have been identified as well as a range of potential solutions to improve the quality of care delivered to people with severe mental illness. A key focus has been to explore the role of the MHN in reducing the inequalities and disparities experienced by this section of the population. However, some caution is needed in thinking that the sole responsibility for improvement should rest on the shoulders of individual MHNs, or on the wider mental health nursing profession. It has been shown that such responsibility must be shared across secondary, primary and community health care professionals, managers and leaders.

Furthermore, the literature reviewed raises a number of challenges associated with improving the care experiences of those who are diagnosed with severe mental illness. It reveals how these challenges are apparent at system, organisation and individual level, and will only be improved through multi-disciplinary collaboration and partnership working. The Health Improvement Profile has been identified as a potential evidence-based intervention that could support improvements in the physical health of people diagnosed with severe mental illness.

Implications for Mental Health Nursing

Implications for practice reflect the common themes within this review and the key messages emerging from a recent survey of RCN membersa. Together these suggest that the future role and focus for mental health nursing should aim to:

• shift the role from managing mental health to managing health promotion

• promote service models that integrate mental and physical health

• create improved accountability within the system to ensure there is an effective primary care response to reduce the risk of diagnostic overshadowing and undertake effective monitoring

• stress the importance of having systemic support to maintain skills and competence with new roles in mental health settings (for example, physical health care nurses in mental health settings)

• promote creative commissioning that enables MHNs to work in and across communities in order to tackle the social determinants of care.

a RCN (2018) Parity of Esteem Report, 007 109

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a m

uch

youn

ger

ag

e th

an t

hose

wit

h no

n-m

ajo

r m

enta

l illn

ess.

Mo

st d

ied

fro

m n

atur

al c

ause

s si

mila

r to

the

lead

ing

cau

ses

of d

eath

fo

und

nat

ionw

ide.

MH

and

PH

are

inte

rtw

ined

, an

d s

houl

d b

e in

teg

rate

d in

he

alth

car

e d

eliv

ery

syst

ems.

Furt

her

rese

arch

tra

ckin

g

mo

rtal

ity

and

pri

mar

y ca

re is

nee

ded

to

pro

vid

e in

form

atio

n fo

r ad

dit

iona

l ac

tio

n, t

reat

men

t m

od

ifica

tio

n, d

iag

nosi

s-sp

ecifi

c ri

sk, a

nd e

vid

ence

-b

ased

pra

ctic

e.

Not

rep

ort

ed.

3R

obso

n &

Gra

y (2

00

6)

SM

I and

PH

pro

ble

ms.

A

dis

cuss

ion

pap

er. I

ntl

Jour

nal N

ursi

ng S

tud

ies

44

:457

-46

6.

UK

Lit

revi

ewT

hose

wit

h S

MI h

ave

hig

her

mo

rbid

ity

and

mo

rtal

ity

rate

s th

an t

he

gen

eral

po

pul

atio

n, s

uffe

ring

hig

her

rate

s of

infe

ctio

us d

isea

ses,

d

iab

etes

, res

pir

ato

ry d

isea

ses,

can

cers

and

HIV

.Li

fe e

xpec

tanc

y of

peo

ple

wit

h sc

hizo

phr

enia

is r

educ

ed b

y 10

yea

rs.

MH

Ns

are

in a

str

ateg

ic p

osi

tio

n to

hav

e a

po

siti

ve im

pac

t o

n th

e m

enta

l and

phy

sica

l wel

lbei

ng o

f clie

nts

wit

h S

MI.

The

re a

re a

num

ber

of r

easo

ns w

hy t

hose

wit

h S

MI h

ave

po

or

phy

sica

l hea

lth,

incl

udin

g s

ervi

ce-r

elat

ed f

acto

rs (

thei

r P

H n

eed

s ar

e ov

erlo

oke

d,

a la

ck o

f ass

essm

ent,

lack

of c

lari

ty a

bo

ut w

ho s

houl

d

pro

vid

e he

alth

pro

mot

ion,

and

a r

ealis

atio

n th

at r

esp

ons

ibili

ty li

es

wit

h he

alth

care

pro

fess

iona

ls in

bot

h p

rim

ary

and

sec

ond

ary

care

)-i

llnes

s-re

late

d f

acto

rs (

peo

ple

wit

h S

MI a

re le

ss li

kely

to

rep

ort

p

hysi

cal s

ymp

tom

s)-h

ealt

h b

ehav

iour

s of

peo

ple

wit

h S

MI (

smo

kers

, sub

stan

ce a

bus

e,

po

or

die

ts, u

nsaf

e se

xual

pra

ctic

es)

-tre

atm

ent-

rela

ted

fac

tors

(m

edic

atio

n si

de

effe

cts,

dia

bet

es, C

VD

, m

etab

olic

syn

dro

me,

eye

hea

lth,

den

tal h

ealt

h, s

exua

l eff

ects

)Li

ttle

co

nsen

sus

reg

ard

ing

the

mo

nito

ring

(fr

eque

ncy

and

typ

e) o

f th

e P

H n

eed

s of

peo

ple

wit

h S

MI a

ltho

ugh

gui

del

ines

do

exis

t.

Bas

is o

f po

or

PH

of p

eop

le

wit

h S

MI a

re c

om

ple

x an

d

inte

ract

ive.

Whi

lst

adve

rse

effe

cts

of m

edic

atio

n ha

ve a

si

gni

fica

nt im

pac

t, t

he h

ealt

h b

ehav

iour

s of

thi

s cl

ient

p

op

ulat

ion,

and

the

att

itud

es

and

the

lack

of t

rain

ing

fo

r he

alth

car

e p

rofe

ssio

nals

als

o p

lay

a ro

le.

MH

Ns

have

an

op

po

rtun

ity

to im

pro

ve t

he M

H a

nd P

H

of p

eop

le w

ith

SM

I thr

oug

h sy

stem

atic

mo

nito

ring

an

d c

olla

bo

rati

ve h

ealt

h p

rom

otio

n in

terv

enti

ons

.

Not

rep

ort

ed.

Appendix


15

4W

hite

et

al (

200

9) T

he

dev

elo

pm

ent

of t

he s

erio

us

men

tal i

llnes

s p

hysi

cal

Hea

lth

Imp

rove

men

t P

rofi

le.

Jour

nal P

sych

iatr

ic M

enta

l H

ealt

h N

ursi

ng. 1

6: 4

93-4

98

.

UK

Lit

revi

ewP

eop

le w

ith

schi

zop

hren

ia a

nd b

ipo

lar

dis

ord

er a

re m

ore

like

ly

to s

uffe

r fr

om

a r

ang

e of

long

-ter

m p

hysi

cal c

ond

itio

ns in

clud

ing

d

iab

etes

and

CV

D, a

nd a

s a

resu

lt d

ie u

p t

o 10

-15

year

s ea

rlie

r th

an

peo

ple

in t

he g

ener

al p

op

ulat

ion.

Hea

lth

serv

ices

hav

e fa

iled

to

add

ress

thi

s m

ajo

r he

alth

ineq

ualit

y d

ue

to a

lack

of c

ons

ensu

s ab

out

the

typ

e an

d f

req

uenc

y of

mo

nito

ring

th

ose

wit

h S

MI,

and

a la

ck o

f kno

wle

dg

e an

d la

ck o

f ski

lls in

the

MH

w

ork

forc

e.H

IP w

as d

evel

op

ed t

o he

lp M

HN

s p

rofi

le t

he P

H o

f the

SM

I pat

ient

s th

ey w

ork

wit

h, a

nd d

irec

t th

em t

o ev

iden

ce-b

ased

inte

rven

tio

ns in

o

rder

to

imp

rove

hea

lth

out

com

es.

The

aut

hors

dev

elo

ped

a

dra

ft S

MI H

IP, r

evie

wed

and

cr

itiq

ued

the

fac

e va

lidit

y an

d u

tilit

y of

the

HIP

, p

rod

uced

a f

inal

ver

sio

n of

th

e H

IP, d

evel

op

ed a

tra

inin

g

pac

kag

e, t

rain

ed a

gro

up o

f M

HN

s to

act

as

trai

ners

and

tr

aine

d M

HN

s to

use

the

HIP

The

aut

hors

rep

ort

a n

eed

fo

r fu

rthe

r ev

alua

tio

n an

d t

he

pub

licat

ion

of a

cas

e se

ries

an

d a

pla

nned

eff

ecti

vene

ss

tria

l.

Not

rep

ort

ed.

5B

row

n &

Smit

h (2

00

9) C

an

a b

rief

hea

lth

pro

mot

ion

inte

rven

tio

n d

eliv

ered

by

MH

key

wo

rker

s im

pro

ve

clie

nts’

PH

: A R

CT.

Jou

rnal

M

enta

l Hea

lth

18(5

):37

2-37

8.

UK

Qua

ntTo

mea

sure

whe

ther

a b

rief

hea

lth

pro

mot

ion

inte

rven

tio

n d

eliv

ered

by

MH

key

wo

rker

s ca

n p

rod

uce

heal

th g

ains

in p

eop

le w

ith

SM

I.St

udy

po

pul

atio

n ha

d a

rel

ativ

ely

unhe

alth

y lif

esty

le a

t th

e st

art

of

the

tria

l.T

hose

in t

he c

ont

rol g

roup

wer

e m

ore

dep

ress

ed t

han

tho

se in

the

in

terv

enti

on

gro

up.

Inte

rven

tio

n su

bje

cts

lost

a li

ttle

am

oun

t of

wei

ght

; co

ntro

l sub

ject

s g

aine

d w

eig

ht -

the

dif

fere

nce

was

not

sig

nifi

cant

.B

oth

gro

ups

rep

ort

ed d

ieta

ry im

pro

vem

ents

, and

the

inte

rven

tio

n g

roup

rep

ort

ed a

sm

all b

ut s

igni

fica

nt in

crea

se in

exe

rcis

e.N

o si

gni

fica

nt d

iffe

renc

es w

ere

foun

d in

sub

stan

ce a

bus

e o

r an

y of

th

e m

easu

res

of w

ellb

eing

.

Ove

rall

the

hig

h g

ains

wer

e sm

all,

and

dro

po

ut r

ate

was

hi

gh.

Whi

le k

ey w

ork

ers

may

o

bta

in g

oo

d o

utco

mes

usi

ng

the

inte

rven

tio

n p

acka

ge

wit

h se

lect

ed a

nd m

otiv

ated

in

div

idua

ls, i

t is

unl

ikel

y to

p

rod

uce

mea

ning

ful h

ealt

h g

ains

fo

r th

e p

op

ulat

ion.

Aut

hors

sug

ges

t ke

y w

ork

ers

coul

d a

chie

ve g

reat

er h

ealt

h g

ains

wit

h b

ette

r tr

aini

ng o

r a

mo

re in

tens

ive

pro

gra

mm

e.

Rec

ruit

men

t w

as d

iffi

cult

le

adin

g t

o sm

all

sam

ple

siz

e.

6O

sbor

n et

al (

2010

) Im

pac

t of

a n

urse

-led

inte

rven

tio

n to

imp

rove

scr

eeni

ng

for

card

iova

scul

ar r

isk

fact

ors

in p

eop

le w

ith

SM

I. P

hase

2 c

lust

er

rand

om

ized

fea

sib

ility

tri

al

of c

om

mun

ity

men

tal h

ealt

h te

ams.

BM

C H

ealt

h S

ervi

ces

Res

earc

h 10

:61.

UK

Qua

ntit

ativ

eP

eop

le w

ith

SM

I are

at

incr

ease

d r

isk

of C

VD

and

gui

del

ines

re

com

men

d r

egul

ar s

cree

ning

fo

r C

VD

ris

k fa

cto

rs.

Fin

din

gs

show

the

nur

se-l

ed in

terv

enti

on

was

sup

erio

r an

d r

esul

ted

in

an

abso

lute

incr

ease

of 3

0%

mo

re p

eop

le w

ith

SM

I rec

eivi

ng

scre

enin

g f

or

each

CV

D r

isk

fact

or.

No

evid

ence

tha

t co

mm

unit

y m

enta

l hea

lth

team

s p

rovi

ded

CV

D s

cree

ning

in

eith

er a

rm o

f the

tri

al.

In t

he n

urse

-led

arm

it is

p

oss

ible

tha

t st

aff t

houg

ht

this

wo

uld

be

pro

vid

ed

by t

he n

urse

, so

felt

less

co

mp

elle

d t

o o

rgan

ise

scre

enin

g t

hem

selv

es.

Giv

en t

he la

ck o

f scr

eeni

ng

it m

ay b

e d

iffi

cult

to

achi

eve

com

plia

nce

wit

h N

ICE

g

uid

ance

aro

und

scr

eeni

ng

for

pat

ient

s w

ho h

ave

not

rece

ived

it f

or

GP.

Res

po

nse

rate

w

as m

ajo

r lim

itat

ion.

Rec

ruit

men

t w

as t

ime-

limit

ed a

nd

fell

sho

rt o

f nu

mb

ers

req

uire

d.

Lim

ited

g

ener

alis

abili

ty

of f

ind

ing

s.


16

7Sh

uel e

t al

(20

10)

Usi

ng t

he

SM

I hea

lth

imp

rove

men

t p

rofi

le (

HIP

) to

iden

tify

p

hysi

cal p

rob

lem

s in

a

coho

rt o

f co

mm

unit

y p

atie

nts:

A p

rag

mat

ic

case

ser

ies

eval

uati

on.

Intl

Jo

urna

l Nur

sing

Stu

die

s 47

:136

-14

5.

UK

Qua

ntit

ativ

eP

H o

f tho

se w

ith

SM

I is

of g

row

ing

co

ncer

n si

nce

life

exp

ecta

ncy

may

b

e re

duc

ed b

y up

to

25 y

ears

, and

pat

ient

s m

ay li

ve w

ith

cons

ider

able

p

hysi

cal m

orb

idit

y w

hich

aff

ects

the

ir q

ualit

y of

life

, and

co

ntri

but

es

to t

heir

so

cial

exc

lusi

on.

189

heal

th is

sues

wer

e id

enti

fied

usi

ng t

he H

IP, a

nd t

he it

ems

mo

st

freq

uent

ly f

lag

ged

red

and

in n

eed

of i

nter

vent

ion

wer

e B

MI,

bre

ast

self-

exam

inat

ion,

wai

st c

ircu

mfe

renc

e an

d d

iet.

Ind

ivid

ualis

ed c

are

was

pla

nned

and

del

iver

ed f

or

each

pat

ient

on

the

HIP

.28

dis

cret

e in

terv

enti

ons

wer

e id

enti

fied

incl

udin

g g

ivin

g a

dvi

ce,

pro

mot

ing

hea

lth

beh

avio

ural

cha

nge,

per

form

ing

EC

Gs,

and

mak

ing

re

ferr

als.

Pur

po

se o

f the

HIP

was

to

sup

po

rt M

HN

s to

pro

file

the

H

P o

f pat

ient

s w

ith

SM

I in

ord

er t

o d

eliv

er e

vid

ence

-b

ased

inte

rven

tio

ns.

The

aut

hors

fin

d

cons

ider

able

phy

sica

l m

orb

idit

y in

all

pat

ient

s, a

nd

the

qua

litat

ive

feed

bac

k w

as

po

siti

ve t

hat

this

res

ulte

d in

im

pro

ved

hea

lth.

Aut

hors

rep

ort

so

me

conc

ern

that

the

HIP

, whi

lst

enha

ncin

g r

eco

gni

tio

n,

may

und

eres

tim

ate

actu

al

mo

rbid

ity,

and

arg

ue t

his

may

sug

ges

t th

e ni

hilis

m.

Pro

vid

es a

sn

apsh

ot

onl

y. L

imit

ed

gen

eral

isab

ility

of

fin

din

gs.

8La

wre

nce

& K

isle

y (2

010

)In

equa

litie

s in

hea

lthc

are

pro

visi

on

for

peo

ple

w

ith

SM

I. Jo

urna

l of

Pys

chop

harm

acol

ogy

24(1

1)

Sup

pl 4

, 61-

68

.

Aus

tral

iaLi

t re

view

Man

y fa

cto

rs c

ont

rib

ute

to t

he p

oo

r P

H o

f tho

se w

ith

SM

I, in

clud

ing

lif

esty

le f

acto

rs, a

nd m

edic

atio

n si

de

effe

cts.

The

re is

incr

easi

ng e

vid

ence

tha

t d

isp

arit

ies

in h

ealt

h ca

re p

rovi

sio

n co

ntri

but

e to

po

or

PH

out

com

es.

The

se d

isp

arit

ies

have

bee

n at

trib

uted

to

a co

mb

inat

ion

of s

yste

mic

fa

cto

rs s

uch

as t

he s

epar

atio

n of

men

tal h

ealt

h se

rvic

es f

rom

oth

er

heal

th s

ervi

ces,

the

per

vasi

ve s

tig

ma

still

ass

oci

ated

wit

h m

enta

l ill

ness

, the

co

nseq

uenc

es o

f med

ical

illn

ess,

and

med

icat

ion

sid

e ef

fect

s.To

tac

kle

the

syst

emic

fac

tors

inte

gra

ted

car

e m

od

els

coul

d b

e em

plo

yed

incl

udin

g c

o-l

oca

tio

n of

phy

sica

l and

men

tal h

ealt

h se

rvic

es, o

r th

e us

e of

cas

e m

anag

ers

or

othe

r st

aff t

o un

der

take

a

co-o

rdin

atin

g o

r lia

iso

n ro

le b

etw

een

serv

ices

.T

he h

ealt

h ca

re s

ecto

r co

uld

be

targ

eted

fo

r p

rog

ram

mes

aim

ed a

t re

duc

ing

the

sti

gm

a of

men

tal i

llnes

s.T

he c

og

niti

ve d

efic

its

and

oth

er c

ons

eque

nces

of S

MI c

oul

d b

e m

itig

ated

thr

oug

h th

e p

rovi

sio

n of

hea

lthc

are

skill

s tr

aini

ng t

o th

ose

w

ith

SM

I, o

r th

e us

e of

pee

r su

pp

ort

ers.

In a

dd

itio

n, p

op

ulat

ion

heal

th a

nd h

ealt

h p

rom

otio

n ap

pro

ache

s co

uld

be

dev

elo

ped

and

tar

get

ed a

t th

is p

op

ulat

ion

thro

ugh

inte

gra

ting

hea

lth

pro

mot

ion

acti

viti

es a

cro

ss t

he d

om

ains

of i

nter

est.

Par

ity

in h

ealt

h ca

re f

or

peo

ple

wit

h S

MI s

houl

d b

e re

gar

ded

as

a b

asic

hum

an

rig

ht.

Thi

s ra

ises

que

stio

ns o

f w

heth

er w

e sh

oul

d r

egar

d

equa

lity

in h

ealt

h ca

re a

s m

eani

ng e

qua

lity

in a

cces

s to

hea

lth

care

, eq

ualit

y in

the

us

e of

hea

lth

care

, and

use

of

hea

lth

care

in p

rop

ort

ion

to n

eed

or

equa

lity

in h

ealt

h o

utco

mes

.A

hum

an r

ight

s ar

gum

ent

coul

d b

e m

ade

that

peo

ple

w

ith

a hi

ghe

r b

urd

en o

f p

hysi

cal i

llnes

s, s

uch

as t

hose

w

ith

SM

I, sh

oul

d b

e en

titl

ed

to h

ighe

r us

e of

hea

lth

care

g

iven

the

ir le

vel o

f nee

d.

The

co

mp

lex

and

mul

ti-

face

ted

nat

ure

of t

he

pro

ble

ms

und

erly

ing

in

equa

litie

s of

hea

lth

care

fo

r th

ose

wit

h S

MI r

equi

re m

ulti

-fa

cete

d s

olu

tio

ns.

Not

rep

ort

ed.


17

9H

ardy

& G

ray

(20

10)

Ad

apti

ng t

he s

ever

e m

enta

l ill

ness

phy

sica

l Hea

lth

Imp

rove

men

t P

rofi

le f

or

use

in p

rim

ary

care

. Int

l Jou

rnal

M

enta

l Hea

lth

Nur

sing

19

: 35

0-3

55.

UK

Qua

lP

eop

le w

ith

SM

I hav

e a

dra

mat

ical

ly r

educ

ed li

fe e

xpec

tanc

y w

hen

com

par

ed t

o th

e g

ener

al p

op

ulat

ion,

dyi

ng o

n av

erag

e 10

-15

year

s ea

rlie

r. P

rim

ary

caus

es o

f dea

th d

ue t

o C

VD

, dia

bet

es a

nd o

bes

ity.

In t

he U

K it

is t

he d

uty

of h

ealt

h p

rofe

ssio

nals

to

mo

nito

r th

e p

hysi

cal

heal

th o

f tho

se w

ith

SM

I, b

ut t

hey

have

bee

n g

iven

litt

le t

rain

ing

to

do

this

eff

ecti

vely

.St

udy

eval

uate

s a

pro

ject

whi

ch a

dap

ted

the

HIP

fo

r us

e in

pri

mar

y ca

re.

HIP

is a

PH

ris

k as

sess

men

t to

ol,

has

27 it

ems,

is u

sed

ann

ually

, and

ta

kes

aro

und

30

min

utes

to

com

ple

te.

The

HIP

is a

co

mp

rehe

nsiv

e ev

iden

ce-b

ased

to

ol t

hat

iden

tifi

es a

nd a

dd

ress

es t

he

PH

nee

ds

of p

atie

nts

wit

h S

MI.

Ad

apti

ng t

he H

IP f

or

use

in

pri

mar

y ca

re a

nd p

rovi

din

g

trai

ning

will

ens

ure

that

p

rim

ary

care

hea

lth

care

p

rofe

ssio

nals

are

usi

ng b

est

pra

ctic

e g

uid

ance

.Fa

cilit

atin

g p

artn

ersh

ip

wo

rkin

g b

etw

een

pri

mar

y an

d s

eco

ndar

y ca

re n

urse

s w

ill p

rovi

de

a m

ore

ski

lled

w

ork

forc

e.

Not

rep

ort

ed.

10H

ardy

et

al (

2011

) E

duc

atin

g h

ealt

hcar

e p

rofe

ssio

nals

to

act

on

the

PH

nee

ds

of

peo

ple

wit

h S

MI:

a sy

stem

atic

sea

rch

for

evid

ence

. Jou

rnal

P

sych

iatr

ic M

enta

l Hea

lth

Nur

sing

. 18

: 721

-727

UK

Syst

emat

ic

Rev

iew

Aim

was

to

per

form

a s

yste

m s

earc

h w

ith

the

aim

of e

valu

atin

g

the

evid

ence

of t

he e

ffic

acy

of e

duc

atio

n in

terv

enti

ons

. 147

pap

ers

wer

e id

enti

fied

and

no

ne w

ere

elig

ible

fo

r in

clus

ion.

No

pap

ers

wer

e re

view

ed.

No

info

rmat

ion

was

rep

ort

ed o

n th

e o

utco

mes

of t

he e

duc

atio

n w

ith

reg

ard

to

pro

fess

iona

ls’ k

now

led

ge,

att

itud

es a

nd b

ehav

iour

s.K

now

led

ge

of in

crea

sed

mo

rtal

ity

rate

s fo

r p

eop

le w

ith

SM

I as

a re

sult

of p

hysi

cal h

ealt

h co

ndit

ions

has

long

bee

n kn

own

but

litt

le h

as

chan

ged

in r

out

ine

pra

ctic

e to

ref

lect

thi

s kn

owle

dg

e.T

he e

duc

atio

n ne

eds

of s

taff

are

not

bei

ng m

et.

The

re is

po

or

pre

par

atio

n fo

r th

e P

H r

ole

of M

HN

s, a

nd o

nly

2% o

f p

ract

ice

nurs

es h

ave

trai

ning

in m

enta

l hea

lth.

Pri

mar

y ca

re n

urse

s al

so n

eed

sui

tab

le s

upp

ort

and

tra

inin

g t

o in

crea

se t

heir

kno

wle

dg

e an

d s

kills

and

to

chan

ge

atti

tud

es t

o M

H.

Aut

hors

arg

ue t

here

is a

ne

ed t

o d

evel

op

ed

ucat

ion

for

qua

lifie

d n

urse

s an

d o

ther

he

alth

car

e p

rofe

ssio

nals

to

pro

vid

e p

hysi

cal h

ealt

h ch

ecks

and

ap

pro

pri

ate

inte

rven

tio

ns f

or

tho

se w

ith

SM

I.It

is a

lso

nece

ssar

y to

d

emo

nstr

ate

that

thi

s ed

ucat

ion

will

imp

rove

p

atie

nt o

utco

mes

.

May

hav

e fa

iled

to

iden

tify

sm

all

stud

ies

and

ev

alua

tio

ns o

r ev

alua

tio

ns in

p

rog

ress

.


18

11H

owar

d &

Gam

ble

(20

11)

Sup

po

rtin

g M

H n

urse

s to

ad

dre

ss t

he P

H n

eed

s o

f p

eop

le w

ith

SM

I in

acut

e in

pat

ient

car

e se

ttin

gs.

J

Psy

chia

tric

& M

H N

ursi

ng

18:10

5-1

12

UK

Mix

ed

met

hod

sA

dd

ress

ing

phy

sica

l nee

ds

of p

atie

nts

wit

h S

MI v

iew

ed a

s im

po

rtan

t by

MH

Ns.

Phy

sica

l ass

essm

ent/

case

man

agem

ent

seen

as

role

of M

HN

.C

are

pla

nnin

g/h

ealt

h p

rom

otio

n se

en a

s ro

le o

f MH

N.

Less

sup

po

rt f

or

MH

N r

ole

in P

H s

cree

ning

.A

sses

smen

t of

med

ical

his

tory

/hea

lth

care

act

ivit

ies

seen

as

do

cto

r’s

role

.A

sses

sing

sex

ual h

ealt

h se

en a

s ro

le o

f the

do

cto

r.R

efer

ring

fo

r m

edic

al r

evie

w s

een

as r

ole

of t

he d

oct

or.

MH

N n

urse

s fe

lt v

ery

conf

iden

t in

ass

essi

ng p

hysi

cal n

eed

s an

d

asce

rtai

ning

tre

atm

ents

, but

fel

t le

ss c

onf

iden

t in

ass

essi

ng

med

icat

ion

sid

e ef

fect

s, u

nder

taki

ng h

ealt

h sc

reen

ing

, or

asse

ssin

g

sexu

al h

ealt

h.M

HN

do

cum

enta

tio

n p

ract

ices

wer

e p

oo

r, p

hysi

cal c

heck

s w

ere

not

rout

inel

y un

der

take

n o

r re

cord

ed.

Litt

le e

vid

ence

tha

t M

HN

wer

e un

der

taki

ng P

H s

cree

ning

act

ivit

ies,

an

d li

ttle

evi

den

ce t

hey

wer

e un

der

taki

ng c

are

pla

nnin

g o

r he

alth

p

rom

otio

n ac

tivi

ties

.M

HN

s fe

lt t

hey

had

not

rec

eive

d e

noug

h ed

ucat

ion

and

tra

inin

g

on

PH

car

e, a

nd t

he m

ajo

rity

of M

HN

s w

ere

unfa

mili

ar w

ith

any

gui

del

ines

/po

licie

s re

lati

ng t

o th

e P

H o

f pat

ient

s w

ith

SM

I.

MH

Ns

and

the

ir le

ader

s sh

oul

d:

- g

ain

acce

ss t

o su

per

visi

on

- ro

utin

ely

aud

it P

H c

are

and

sta

ff c

om

pet

ence

in

do

cum

enti

ng c

are

del

iver

ed-

esta

blis

h th

roug

h p

olic

y g

uid

ance

how

eac

h p

rofe

ssio

n co

ntri

but

es t

o P

H

care

del

iver

y-

ackn

owle

dg

e th

e d

istr

ess

user

s ar

e lik

ely

to f

ace

rela

ting

to

sexu

al f

unct

ioni

ng

and

off

er a

pp

rop

riat

e su

pp

ort

- ap

pra

ise

phy

sica

l hea

lth

pro

ble

ms

face

d b

y us

ers

and

the

ir t

end

ency

to

avo

id

cop

ing

str

ateg

ies

thro

ugh

syst

emat

ic a

sses

smen

t -

com

mis

sio

n P

H t

rain

ing

fr

om

HE

inst

itut

ions

- tr

ain

the

who

le t

eam

to

be

PH

aw

are.

Sm

all s

amp

le

size

lim

its

the

gen

eral

isab

ility

o

f th

e fi

ndin

gs.

12W

and

(20

11)

Rea

l MH

p

rom

oti

on

req

uire

s a

reo

rien

tati

on

pf

nurs

ing

ed

ucat

ion

, pra

ctic

e an

d r

esea

rch

. Jou

rnal

P

sych

iatr

ic a

nd M

enta

l H

ealt

h N

ursi

ng 1

9: 1

31-

138

Aus

tral

iaLi

t re

view

The

evi

den

ce f

or

the

ind

ivid

ual,

soci

al a

nd e

cono

mic

ben

efit

s of

MH

p

rom

otio

n is

now

wel

l est

ablis

hed

.T

here

is a

n in

dic

atio

n th

at a

bro

ader

PH

ap

pro

ach

is n

eed

ed t

hat

add

ress

es s

oci

al a

nd e

nvir

onm

enta

l fac

tors

rel

ated

to

MH

and

wel

l-b

eing

.M

ains

trea

m M

H s

ervi

ces

cont

inue

to

op

erat

e in

rel

ativ

e is

ola

tio

n,

whe

reby

the

gre

ates

t p

rop

ort

ion

of f

und

ing

and

res

our

ces

go

es t

o th

e tr

eatm

ent

of m

enta

l illn

ess

and

dis

ord

ers.

Thi

s p

aper

exp

lore

s th

e b

idir

ecti

ona

l lin

k b

etw

een

PH

and

MH

and

the

so

cial

det

erm

inan

ts o

f MH

and

the

imp

ort

ance

of h

ealt

h p

rom

otio

n.T

here

is a

gro

win

g in

tere

st in

the

po

siti

ve a

spec

ts o

f hea

lth

and

w

ellb

eing

whi

ch f

ocu

ses

on

wel

lnes

s ra

ther

tha

n ill

ness

.

MH

pro

mot

ion

conc

entr

ates

o

n th

e m

od

ifiab

le s

oci

al

det

erm

inan

ts o

f MH

and

su

pp

ort

s th

e p

rinc

iple

s of

co

llab

ora

tio

n, p

arti

cip

atio

n an

d e

mp

ower

men

t in

the

p

ursu

it o

f wel

lbei

ng.

It a

lso

reco

gni

ses

the

inse

par

abili

ty o

f PH

and

M

H a

nd t

he in

div

idua

l, so

cial

and

eco

nom

ic

ben

efit

s as

soci

ated

wit

h M

H

pro

mot

ion.

MH

nur

sing

ed

ucat

ion

and

p

ract

ice

larg

ely

neg

lect

ed

MH

pro

mot

ion.

The

ed

ucat

iona

l pre

par

atio

n of

MH

Ns

mus

t in

clud

e P

H

and

the

bro

ader

pri

ncip

les

of

heal

th p

rom

otio

n at

und

er-

and

po

st-g

rad

uate

leve

l.A

ret

hink

of n

urse

ed

ucat

ion,

re

sear

ch a

nd p

ract

ice

is

need

ed in

ord

er t

o ra

ise

men

tal h

ealt

h aw

aren

ess,

re

duc

e st

igm

a an

d

emp

hasi

se M

H is

rel

evan

t to

al

l as

an e

ssen

tial

co

mp

one

nt

of o

vera

ll he

alth

.

No

t re

po

rted

.


19

13Sc

ott

& H

app

ell (

2011

) T

he

hig

h p

reva

lenc

e o

f p

oo

r P

H a

nd u

nhea

lthy

life

styl

e b

ehav

iour

s in

ind

ivid

uals

w

ith

SM

I. Is

sues

in M

enta

l H

ealt

h N

ursi

ng 3

2: 5

89

-597

Aus

tral

iaN

arra

tive

re

view

The

evi

den

ce r

evea

ls t

hat

for

ind

ivid

uals

wit

h S

MI t

here

is a

n in

tern

atio

nal p

reva

lenc

e of

ob

esit

y, m

etab

olic

syn

dro

me,

dia

bet

es

mel

litus

, sym

pto

ms

of C

VD

and

res

pir

ato

ry d

isea

se w

hich

exc

eed

s th

at o

f the

gen

eral

po

pul

atio

n by

at

leas

t tw

o ti

mes

. HIV

pre

vale

nce

may

be

incr

ease

d a

s m

uch

as e

ight

tim

es. T

his

incr

ease

d p

reva

lenc

e of

chr

oni

c d

isea

se is

larg

ely

resp

ons

ible

fo

r th

e in

crea

sed

ris

k of

d

eath

and

up

to

30 y

ears

of l

ife lo

st.

Whi

le t

his

revi

ew f

ocu

ses

on

seve

re il

lnes

s, t

hose

wit

h se

vere

men

tal

illne

ss m

ay a

lso

be

at g

reat

er r

isk

of t

uber

culo

sis,

hep

atit

is B

and

C,

ost

eop

oro

sis,

po

or

eye

and

den

tal h

ealt

h, a

nd s

exua

l and

thy

roid

d

ysfu

ncti

on.

The

se m

ay b

e ex

acer

bat

ed b

y p

oo

r d

iet,

sm

oki

ng, d

rug

-tak

ing

, low

p

hysi

cal a

ctiv

ity,

alc

oho

l ab

use

and

ris

ky s

exua

l beh

avio

urs.

The

inte

gra

tio

n of

phy

sica

l an

d p

sych

oso

cial

hea

lth

is

need

ed t

o im

pro

ve s

ervi

ce

del

iver

y.M

HN

s ar

e w

ell p

lace

d t

o p

lay

a le

ader

ship

ro

le in

d

evel

op

ing

a m

ore

ho

listi

c ap

pro

ach

to c

are.

MH

Ns

mus

t co

nsid

er t

he

inve

stig

atio

n an

d t

reat

men

t of

phy

sica

l dis

ord

ers

as a

n im

po

rtan

t p

art

of t

heir

ro

le.

MH

Ns

sho

uld

reg

ular

ly

mo

nito

r p

hysi

cal h

ealt

h an

d

pro

vid

e lif

esty

le a

dvi

ce f

or

clie

nts

wit

h S

MI.

No

t re

po

rted

.

14H

app

ell e

t al

(20

12a)

S

houl

d w

e o

r sh

oul

dn’

t w

e?

MH

Ns’

vie

ws

on

PH

car

e o

f M

H c

ons

umer

s. In

tl J

MH

N

ursi

ng 2

1:20

2-21

0.

Intl

Lit

Rev

iew

It is

wel

l kno

wn

that

po

ore

r he

alth

out

com

es a

nd e

arly

dea

th in

p

eop

le w

ith

SM

I in

a m

ajo

r fo

rm o

f ine

qua

lity.

Res

earc

h ev

iden

ce s

ugg

ests

tha

t lo

wer

leve

ls o

f PH

ass

oci

ated

wit

h m

enta

l illn

ess

are

due

to

inad

equa

te q

ualit

y of

car

e.N

urse

s w

ho w

ork

at

the

cro

ssro

ads

of P

H a

nd M

H h

ave

a ke

y ro

le t

o p

lay

in im

pro

ving

the

sta

ndar

ds

of p

hysi

cal c

are.

Nur

ses

can

imp

rove

the

qua

lity

of p

hysi

cal c

are

for

peo

ple

wit

h S

MI b

y ha

ving

a m

ore

dir

ect

role

whi

ch in

clud

es c

heck

ing

phy

sica

l sy

mp

tom

s, li

aisi

ng w

ith

do

cto

rs, a

nd p

rovi

din

g a

dvi

ce o

n ex

erci

se,

die

t, a

nd s

leep

.T

his

pap

er o

utlin

es s

pec

ifics

on

how

MH

Ns

can

be

sens

itis

ed,

pre

par

ed a

nd e

mp

ower

ed t

o tu

rn t

his

seri

ous

hea

lth

issu

e ar

oun

d.

In p

arti

cula

r M

HN

s co

uld

be

trai

ned

to

use

the

new

phy

sica

l hea

lth

chec

k an

d r

esp

ons

e sy

stem

in t

he U

K, k

now

n as

the

HIP

, whi

ch h

as

bee

n ad

apte

d f

or

use

in A

ustr

alia

.

Lead

ersh

ip f

ocu

sed

on

imp

rovi

ng t

he P

H o

f peo

ple

w

ith

SM

I is

long

ove

rdue

.C

ont

inue

d n

egle

ct o

f thi

s p

op

ulat

ion

rem

ains

a m

ajo

r sh

ort

com

ing

of h

ealt

hcar

e p

ract

ice

and

a m

ajo

r fo

rm o

f so

cial

inju

stic

e.W

hile

the

mo

re f

und

amen

tal

need

is f

or

mo

re p

olit

ical

b

acki

ng a

nd f

und

ing

fo

r he

alth

care

ref

orm

and

ad

dre

ssin

g t

he s

tig

ma

asso

ciat

ed w

ith

men

tal

illne

ss, t

here

are

pat

hway

s fo

r im

pro

ving

phy

sica

l car

e th

roug

h in

nova

tio

n fo

cusi

ng

on

MH

Ns

and

men

tal h

ealt

h te

am d

esig

n.O

ne s

uch

inno

vati

on

is t

he

HIP

whi

ch c

an u

tiliz

e th

e un

ique

cap

acit

y of

MH

Ns

to

iden

tify

, rec

ord

, and

wo

rk

wit

h co

nsum

ers,

and

thr

oug

h w

ork

ing

in c

olla

bo

rati

on

wit

h p

sych

iatr

ists

and

oth

er

stak

eho

lder

s.M

H b

enef

its

are

likel

y to

re

sult

fro

m p

hysi

cal

inte

rven

tion

giv

en t

he in

trin

sic

conn

ectio

n b

etw

een

the

PH

an

d M

H id

entif

ied

in M

DT.

No

t re

po

rted


20

15H

app

ell e

t al

(20

12a)

S

houl

d w

e o

r sh

oul

dn’

t w

e?

MH

Ns’

vie

ws

on

PH

car

e o

f M

H c

ons

umer

s. In

tl J

MH

N

ursi

ng 2

1:20

2-21

0.

Aus

tral

iaQ

ual -

Fo

cus

gro

ups

Nur

ses’

res

po

nses

to

phy

sica

l car

e as

par

t of

the

ir r

ole

was

mix

ed,

sug

ges

ting

a le

vel o

f am

biv

alen

ce.

Suc

h am

biv

alen

ce w

as c

om

ple

x an

d m

ulti

-lay

ered

, and

ref

lect

s p

erce

pti

ons

of r

elat

ions

hip

s an

d t

he f

acto

rs a

ffec

ting

tho

se

rela

tio

nshi

ps.

The

maj

or

them

es id

enti

fied

are

the

rel

atio

nshi

ps

bet

wee

n P

H a

nd

MH

, and

the

rel

atio

nshi

ps

bet

wee

n nu

rses

, clie

nts,

co

lleag

ues

and

th

e o

rgan

isat

ion.

Ove

rall,

nur

ses

wer

e g

ener

ally

in f

avo

ur o

f PH

ca

re a

s p

art

of t

heir

ro

le,

but

ack

now

led

ged

the

ne

ed f

or

sup

po

rt a

nd

reso

urce

s.N

urse

s re

po

rted

tha

t nu

rses

alo

ne c

anno

t ad

dre

ss t

he P

H n

eed

s of

M

H c

lient

s.N

urse

s st

ress

ed t

hat

any

enha

nced

PH

car

e co

mm

itm

ent

by M

HN

s w

oul

d n

eed

to

be

adap

tab

le t

o th

e g

reat

d

iver

sity

of c

ons

umer

s,

serv

ice

arra

ngem

ents

, an

d g

eog

rap

hica

l o

pp

ort

unit

ies

and

re

stra

ints

.

Lim

ited

16H

app

ell e

t al

(20

12b)

Hea

lth

beh

avio

ur in

terv

enti

ons

to

imp

rove

PH

in in

div

idua

ls

wit

h a

men

tal i

llnes

s: a

sy

stem

atic

rev

iew

. Int

l Jo

urna

l of

Men

tal H

ealt

h N

ursi

ng. 2

1: 23

6-2

47.

Aus

tral

iaSy

stem

atic

R

evie

wM

etho

do

log

ical

qua

lity

of t

he s

tud

ies

revi

ewed

wer

e av

erag

e (n

=42)

, and

cov

ered

a r

ang

e of

beh

avio

ural

and

inte

rven

tio

n d

esig

ns.

So

me

caut

ion

is n

eces

sary

in in

terp

reti

ng t

he f

ind

ing

s.F

ind

ing

s of

fer

gre

at p

rom

ise

in r

elat

ion

to c

hang

es in

hea

lth

beh

avio

urs

of t

hose

dia

gno

sed

wit

h S

MI.

Mo

st c

om

mo

n b

ehav

iour

s ta

rget

ed w

ere

nutr

itio

n an

d e

xerc

ise.

Mo

st p

op

ular

fo

rm o

f int

erve

ntio

n ap

pea

red

to

be

gro

up-b

ased

p

rog

ram

mes

whi

ch d

emo

nstr

ated

a h

igh

succ

ess

rate

.

The

re is

evi

den

ce

to s

ugg

est

that

the

in

teg

rati

on

of M

H a

nd

PH

car

e se

rvic

es m

ight

si

gni

fica

ntly

red

uce

dis

par

ity

in t

he P

H

ob

serv

ed b

etw

een

tho

se

wit

h an

d w

itho

ut m

enta

l ill

ness

.A

utho

rs a

rgue

MH

N

pro

fess

ion

has

the

op

po

rtun

ity

to a

dap

t th

e ro

le o

f the

MH

N t

o in

clud

e re

gul

ar a

sses

smen

t an

d

inte

rven

tio

ns.

The

fin

din

gs

sug

ges

t th

at

succ

essf

ul t

echn

ique

s of

hea

lth

beh

avio

ur

inte

rven

tio

n d

eliv

ery

may

b

e su

itab

le f

or

the

MH

N

role

, and

als

o su

gg

est

that

MH

Ns

have

man

y of

the

ski

lls r

equi

red

to

pro

vid

e su

cces

sful

hea

lth

beh

avio

ur in

terv

enti

ons

.A

dd

ress

ing

hea

lth

beh

avio

urs

in M

H u

sers

m

ay r

esul

t in

sig

nifi

cant

im

pro

vem

ent

in b

ehav

iour

an

d h

ealt

h o

utco

mes

, b

ut t

o in

crea

se t

heir

kn

owle

dg

e of

hea

lth

beh

avio

ur a

dvi

ce

pro

visi

on,

MH

Ns

need

o

ngo

ing

ed

ucat

ion

and

tr

aini

ng.

Qua

litat

ive

revi

ew o

nly.

Onl

y E

nglis

h la

ngua

ge

stud

ies

revi

ewed

.


21

17H

app

ell e

t al

(20

12c)

M

HN

ince

ntiv

e p

rog

ram

: Fa

cilit

atin

g P

H c

are

for

peo

ple

wit

h m

enta

l illn

ess.

In

tl Jo

urna

l of

Men

tal H

ealt

h N

ursi

ng 2

2:5

AB

ST

RA

CT

ON

LY

Aus

tral

iaQ

uant

-S

urve

yP

H c

are

pro

visi

on

in c

olla

bo

rati

on

wit

h G

Ps

and

oth

er h

ealt

h ca

re

pro

fess

iona

ls w

as r

epo

rted

as

com

mo

n.F

ind

ing

s su

gg

est

the

MH

NIP

pro

vid

es in

teg

rate

d c

are,

whe

re

nurs

es a

nd G

Ps

wo

rk in

co

llab

ora

tio

n, a

llow

ing

eno

ugh

tim

e to

d

iscu

ss P

H c

are

or

shar

e P

H a

ctiv

itie

s.C

ons

umer

s of

thi

s se

rvic

e ap

pea

red

to

have

go

od

acc

ess

to

pri

mar

y ca

re p

rofe

ssio

nals

to

dis

cuss

the

ir p

hysi

cal h

ealt

h ne

eds

and

nur

ses

had

acc

ess

to p

rim

ary

care

pro

fess

iona

ls t

o d

iscu

ss

thei

r co

nsum

ers’

phy

sica

l hea

lth

and

dev

elo

pm

ent

thei

r cl

inic

al

skill

s in

the

phy

sica

l do

mai

n.

Ab

stra

ct o

nly.

Ab

stra

ct

onl

y.

18V

erha

eghe

et

al (

2011

) P

erce

pti

ons

of

MH

Ns

and

p

atie

nts

abo

ut h

ealt

h p

rom

oti

on

in M

H c

are:

a

liter

atur

e re

view

. Jou

rnal

P

sych

iatr

ic M

enta

l Hea

lth

Nur

sing

18

: 487

-49

2.

Bel

giu

mLi

tre

view

Po

siti

ve p

erce

pti

ons

of b

oth

MH

Ns

and

pat

ient

s to

war

ds

heal

th

pro

mot

ion

targ

etin

g p

hysi

cal a

ctiv

ity,

eat

ing

hab

its

in M

H c

are

wer

e id

enti

fied

,S

ever

al b

arri

ers

wer

e al

so id

enti

fied

, inc

lud

ing

the

bel

iefs

and

at

titu

des

tow

ard

s th

e p

rom

otio

n of

a h

ealt

hy li

fest

yle,

whi

ch m

ay

vary

dep

end

ing

up

on

the

men

tal d

iso

rder

.T

he li

tera

ture

als

o hi

ghl

ight

s ho

w s

om

e M

HN

s fe

el m

ore

sec

ure

abo

ut f

ocu

sing

on

MH

pro

ble

ms

and

less

co

nfid

ent

abo

ut

add

ress

ing

issu

es o

f hea

lth

pro

mot

ion.

Nur

se e

duc

atio

n ne

eds

to t

each

MH

Ns

how

to

reco

gni

se t

he

pot

enti

al f

or

heal

th p

rom

otio

n o

pp

ort

unit

ies

and

how

to

dev

elo

p

and

pla

n he

alth

pro

mot

ion

to e

nsur

e it

bec

om

es a

ro

utin

e p

art

of

thei

r p

ract

ice.

Sup

po

rt f

rom

MH

Ns

also

ap

pea

rs t

o b

e an

ele

men

t of

co

ncer

n fo

r so

me

peo

ple

wit

h m

enta

l dis

ord

ers,

and

suc

h su

pp

ort

incl

udes

d

irec

tio

n, s

truc

ture

and

mot

ivat

ion.

The

lite

ratu

re h

ighl

ight

s th

e ne

ed f

or

an a

ctiv

e co

llab

ora

tio

n b

etw

een

MH

Ns

and

oth

er h

ealt

h ca

re p

rofe

ssio

nals

in o

rder

to

des

ign

heal

th p

rom

otio

n p

rog

ram

mes

.

The

res

ults

fro

m t

his

revi

ew p

rovi

de

cont

extu

al

evid

ence

of t

he d

iffe

rent

p

erce

pti

ons

of M

HN

s an

d p

atie

nts

of h

ealt

h p

rom

otio

n in

MH

car

e.P

osi

tive

per

cep

tio

ns o

f b

oth

gro

ups

was

ap

par

ent

in r

elat

ion

to h

ealt

h p

rom

otio

n ta

rget

ing

p

hysi

cal a

ctiv

ity

and

ea

ting

hab

its

in in

pat

ient

an

d o

utp

atie

nt s

etti

ngs.

Des

pit

e th

e aw

aren

ess

of

the

imp

ort

ance

of h

ealt

h p

rom

otio

n, a

ttit

udes

to

war

ds

this

, and

wha

t it

m

ight

loo

k lik

e, n

eed

to

chan

ge.

Mos

tly q

ual-

itativ

e lit

erat

ure

limite

d

gen

eral

-is

abili

ty

of fi

ndin

gs.


22

19B

lyth

e &

Whi

te (

2012

) R

ole

o

f th

e M

HN

tow

ard

s P

H

care

in S

MI:

an in

teg

rati

ve

revi

ew o

f 10

yea

rs o

f U

K

liter

atur

e. In

tl J.

Men

tal

Hea

lth

Nur

sing

21:

193-

201

UK

Lit

revi

ewF

our

the

mes

/pat

tern

s id

enti

fied

:-

lack

of k

now

led

ge/

trai

ning

in P

H c

are

– no

fo

rmal

tra

inin

g o

n P

H c

are;

MH

Ns

are

will

ing

to

und

erg

o tr

aini

ng, b

ut d

o no

t ha

ve

the

sup

po

rt o

f man

ager

s; n

urse

ed

ucat

ion

curr

icul

um n

eed

s to

be

add

ress

ed, a

nd it

nee

ds

to b

e ac

know

led

ged

tha

t o

rgan

isat

ions

p

erce

ive

trai

ning

nee

ds

dif

fere

ntly

to

MH

Ns;

bar

rier

s to

tra

inin

g

incl

ude

staf

f sho

rtag

es, l

ack

of r

eso

urce

s, s

oci

alis

atio

n, a

nd

org

anis

atio

n cu

ltur

e-

role

am

big

uity

– d

efin

ing

the

ro

le o

f the

MH

N is

pro

ble

mat

ic,

tem

per

ed w

ith

a la

ck o

f cla

rity

and

lack

of k

now

led

ge

and

a la

ck o

f co

nfid

ence

, MH

Ns

will

oft

en p

ut p

hysi

cal c

om

pla

ints

dow

n to

MH

p

rese

ntat

ion

– kn

own

as d

iag

nost

ic o

vers

had

owin

g.

- p

oo

r co

mm

unic

atio

n b

etw

een

heal

th c

are

serv

ices

(p

rim

ary

care

p

rofe

ssio

nals

lack

kno

wle

dg

e ab

out

sev

ere

men

tal i

llnes

s an

d

seco

ndar

y ca

re p

rofe

ssio

nal l

ack

know

led

ge

of p

rim

ary

heal

th

scre

enin

g, r

esul

ts in

a f

ailu

re o

f bot

h se

cto

rs t

o ta

ke r

esp

ons

ibili

ty,

whi

ch h

as le

d t

o th

e id

enti

fica

tio

n of

a n

eed

fo

r a

spec

ialis

t nu

rse-

led

mo

del

to

imp

rove

phy

sica

l hea

lth

of p

atie

nts

wit

h S

MI,

and

im

pro

ve c

om

mun

icat

ion

bet

wee

n p

rim

ary

and

sec

ond

ary

care

se

rvic

es-

effo

rts

mad

e to

ena

ble

MH

Ns

to a

sses

s an

d a

ct o

n p

hysi

cal n

eed

s of

peo

ple

wit

h se

rio

us m

enta

l illn

ess

– id

enti

fied

so

luti

ons

incl

ude

Wel

lbei

ng S

upp

ort

Pro

gra

mm

es (

WS

P)

and

gre

ater

use

of t

he

Hea

lth

Imp

rove

men

t P

rofi

le (

HIP

).

Bot

h p

rim

ary

and

se

cond

ary

care

ser

vice

s ha

ve id

enti

fiab

le t

rain

ing

ne

eds.

MH

Ns

are

in a

pri

me

po

siti

on

to h

elp

imp

rove

th

e P

H o

f tho

se w

ith

SM

I w

ith

rig

ht s

upp

ort

and

tr

aini

ng.

MH

Ns

also

nee

d t

o ha

ve

a p

osi

tive

att

itud

e to

hel

p

mak

e ch

ang

es t

o th

eir

role

.A

cha

nge

in c

ultu

re o

f th

e fo

cus

of M

H s

ervi

ce

pro

visi

on

is n

eed

ed f

rom

o

rgan

isat

ions

to

sup

po

rt

and

res

our

ce s

uch

a sh

ift

in t

he r

ole

of t

he M

HN

.

No

t re

po

rted

.

20H

app

ell e

t al

(20

13a)

P

rop

ose

d n

urse

-led

in

itia

tive

s in

imp

rovi

ng

PH

of

peo

ple

wit

h S

MI:

a su

rvey

of

nurs

es in

men

tal

heal

th. J

ourn

al C

linic

al

Nur

sing

23:

10

18-1

029

Aus

tral

iaQ

uant

- s

urve

yT

here

was

a h

igh

end

ors

emen

t of

all

nine

nur

se-b

ased

str

ateg

ies

for

PH

, esp

ecia

lly li

fest

yle

pro

gra

mm

es, s

cree

ning

and

link

ing

se

rvic

es.

The

re w

as le

ss s

upp

ort

fo

r re

duc

ing

ant

i-p

sych

otic

s o

r ad

voca

ting

fo

r fe

wer

sid

e ef

fect

s.N

urse

s as

sig

ned

the

hig

h va

lues

to

the

colo

cati

on

of p

rim

ary

and

m

enta

l car

e se

rvic

es, l

ifest

yle

pro

gra

mm

es, a

nd im

pro

ving

pri

mar

y ca

re s

ervi

ces,

thr

oug

h re

duc

ing

sti

gm

a an

d t

rain

ing

mo

re G

Ps.

Stra

teg

ies

to im

pro

ve t

he

PH

of p

eop

le w

ill S

MI a

re

need

ed a

s a

mat

ter

of

som

e ur

gen

cy.

Nur

ses

have

bee

n id

enti

fied

as

a p

rofe

ssio

nal

gro

up w

ith

the

pot

enti

al

to c

ont

rib

ute

to t

his

imp

rove

men

t.H

owev

er, d

esp

ite

nurs

es

iden

tify

ing

wit

h st

rate

gie

s to

pro

mot

e im

pro

vem

ent,

th

ese

imp

rove

men

ts a

re

not

emer

gin

g.

Furt

her

rese

arch

, ed

ucat

ion

and

tra

inin

g

are

need

ed t

o m

ove

fro

m

pot

enti

al t

o ac

tio

n.

Sm

all s

amp

lesi

ze m

eans

lim

ited

g

ener

al-

isab

ility

of

find

ing

s.


23

21H

app

ell e

t al

(20

13b)

S

cree

ning

PH

? Y

es! B

ut…

: nu

rses

’ vie

ws

on

phy

sica

l he

alth

scr

eeni

ng in

men

tal

heal

th c

are.

Jou

rnal

Clin

ical

N

ursi

ng 2

2: 2

286

-229

7.

Aus

tral

iaQ

ual

Fo

cus

gro

up

& inte

rvie

ws

Maj

ori

ty o

f nur

ses

felt

scr

eeni

ng a

nd m

oni

tori

ng w

as im

po

rtan

t to

ass

ist

wit

h cl

arif

ying

a d

iag

nosi

s of

men

tal i

llnes

s, id

enti

fy P

H

issu

es, a

nd e

stab

lishi

ng a

bas

elin

e fo

r m

oni

tori

ng c

hang

es.

Nur

ses

in g

ener

al f

elt

mo

nito

ring

sho

uld

be

rout

ine.

Nur

ses

also

sug

ges

ted

the

nee

d f

or

follo

w-u

p s

cree

ning

at

reg

ular

in

terv

als.

Nur

ses

iden

tifi

ed g

aps

bet

wee

n sc

reen

ing

po

licy

and

pra

ctic

e,

alth

oug

h th

e ex

tent

and

nat

ure

of t

he g

ap v

arie

d.

In a

cute

car

e th

ere

was

a s

tro

ng e

mp

hasi

s o

n M

H c

are

and

m

anag

emen

t, a

nd t

his

tend

ed t

o w

ork

ag

ains

t sc

reen

ing

fo

r P

H

pro

ble

ms.

Alt

houg

h p

olic

ies

wer

e in

pla

ce, b

asic

che

cks

did

not

hap

pen

.T

here

wer

e cl

ear

view

s th

at n

urse

s d

id n

ot h

ave

the

reso

urce

s to

co

nduc

t sc

reen

ing

, wit

h ti

me

bei

ng id

enti

fied

as

a m

ajo

r fa

cto

r.N

urse

s id

enti

fied

var

ious

scr

eeni

ng a

nd m

oni

tori

ng s

yste

ms

but

q

uest

ione

d h

ow t

hese

co

ntri

but

ed t

o b

ette

r P

H o

utco

mes

.N

urse

s fe

lt s

cree

ning

was

onl

y of

val

ue if

ap

pro

pri

ate

acti

on

was

ta

ken,

but

giv

en t

he li

mit

ed a

vaila

bili

ty o

f ser

vice

s, la

ck o

f cla

rity

re

gar

din

g w

hose

ro

le it

was

to

follo

w u

p, a

pp

rop

riat

e ac

tio

n w

as

not

take

n.S

cree

ning

was

see

n as

a le

gal

req

uire

men

t, a

nd s

om

e nu

rses

fel

t it

w

as n

eces

sary

to

avo

id li

abili

ty.

Ano

ther

vie

w w

as t

hat

scre

enin

g w

oul

d le

ad t

o le

gal

liab

ility

– if

th

ere

was

a r

esp

ons

ibili

ty t

o sc

reen

and

the

n fo

llow

up

, the

n a

failu

re t

o co

mp

lete

the

pro

cess

co

uld

cre

ate

leg

al li

abili

ty.

Whe

n in

tro

duc

ed t

o th

e H

IP n

urse

s of

ten

reac

ted

str

ong

ly, a

nd

view

ed it

as

mo

re p

aper

wo

rk, m

ore

dup

licat

ion,

and

mo

re a

dm

in

bur

den

.T

he H

IP w

as n

ot v

iew

ed a

s an

ans

wer

to

the

sho

rtfa

lls in

PH

car

e.

Scr

eeni

ng f

or

PH

is

imp

ort

ant,

but

cur

rent

b

arri

ers

(ed

ucat

ion,

tr

aini

ng, o

rgan

isat

iona

l cu

ltur

e) m

ean

that

nur

ses

are

unlik

ely

to a

ctiv

ely

emb

race

thi

s ro

le.

In r

eco

gni

tio

n of

the

ran

ge

of d

iffi

cult

ies

iden

tifi

ed

in t

his

stud

y, t

he r

ole

of a

ca

rdio

met

abo

lic n

urse

has

b

een

pro

po

sed

to

pro

vid

e cl

arit

y an

d c

entr

edne

ss in

sc

reen

ing

and

mo

nito

ring

.T

he p

rop

ose

d r

ole

is

iden

tifi

ed a

s a

nurs

e w

ith

exp

erti

se in

car

dio

vasc

ular

an

d m

etab

olic

sys

tem

s,

lead

ing

and

co

-ord

inat

ing

p

hysi

cal r

isk

asse

ssm

ent

and

fo

llow

up

wit

hin

and

ac

ross

acu

te in

pat

ient

, co

mm

unit

y m

enta

l hea

lth

care

and

link

ing

ser

vice

s w

ith

pri

mar

y ca

re.

Nur

ses

wo

rkin

g in

M

H s

etti

ngs

are

wel

l p

osi

tio

ned

to

cont

rib

ute

to im

pro

vem

ents

in P

H,

but

PH

scr

eeni

ng c

anno

t si

mp

ly b

eco

me

anot

her

role

fo

r nu

rses

to

take

on

wit

hout

a c

ons

ider

atio

n of

wo

rklo

ads,

ro

le

resp

ons

ibili

ties

and

the

w

ider

sys

tem

ic is

sues

.If

the

pot

enti

al o

f nur

ses

to p

arti

cip

ate

in s

cree

ning

is

to

be

real

ised

, eff

ecti

ve

follo

w u

p is

ess

enti

al.

Sm

all s

amp

le

fro

m o

ne

area

onl

y lim

its

gen

eral

-is

abili

ty o

f fi

ndin

gs.


24

22C

hadw

ick

et a

l (20

12)

Min

din

g o

ur o

wn

bo

die

s:

revi

ewin

g t

he li

tera

ture

re

gar

din

g t

he p

erce

pti

ons

o

f se

rvic

e us

ers

dia

gno

sed

w

ith

SM

I on

bar

rier

s to

ac

cess

ing

PH

car

e. In

tl

jour

nal o

f M

enta

l Hea

lth

Nur

sing

21:

211-

219

UK

Lit

revi

ewIn

tern

atio

nal s

tud

ies

cons

iste

ntly

dem

ons

trat

e th

at in

div

idua

ls

dia

gno

sed

wit

h S

MI h

ave

incr

ease

d r

isk

of c

o-m

orb

id P

H c

are

pro

ble

ms

and

ear

ly d

eath

.D

urin

g t

he la

st 1

0 y

ears

the

UK

gov

ernm

ent

has

focu

sed

on

imp

rovi

ng t

he P

H o

f peo

ple

wit

h S

MI,

but

inte

rnat

iona

l res

earc

h co

ntin

ues

to r

epo

rt b

arri

ers

to a

cces

sing

ap

pro

pri

ate

serv

ices

.T

hese

bar

rier

s em

anat

e fr

om

ser

vice

use

rs, p

rofe

ssio

nals

, and

o

rgan

isat

iona

l bur

eauc

racy

.M

ost

of t

he r

esea

rch

has

focu

sed

on

the

view

of t

he p

rofe

ssio

nals

w

ith

littl

e at

tent

ion

bei

ng p

aid

to

the

view

of t

he u

ser.

Thi

s re

view

fo

und

nin

e p

aper

s fr

om

the

last

10

yea

rs, s

ix

qua

litat

ive,

thr

ee q

uant

itat

ive,

whi

ch s

ugg

est

that

po

or

phy

sica

l he

alth

car

e re

mai

ns a

pro

ble

m a

cro

ss t

he d

evel

op

ed w

orl

d.

The

qua

lity

of c

are

is c

om

pro

mis

ed b

y a

num

ber

of p

ract

ical

p

rob

lem

s an

d in

terp

erso

nal d

iffi

cult

ies

bet

wee

n us

ers

and

hea

lth

care

pro

vid

ers,

and

bet

wee

n M

H a

nd P

H p

rovi

der

s.P

oten

tial

so

luti

ons

rep

ort

ed in

clud

e: u

se o

f sp

ecifi

c p

hysi

cal h

ealt

h m

oni

tori

ng t

oo

ls, e

duc

atio

n of

ser

vice

use

rs, f

urth

er t

rain

ing

fo

r he

alth

car

e p

rofe

ssio

nals

, im

pro

ved

co

llab

ora

tio

n b

etw

een

serv

ice

pro

vid

ers,

dev

elo

pm

ent

of s

pec

ific

heal

th p

rom

otio

n ac

tivi

ties

, b

ette

r co

-ord

inat

ion

and

act

ive

eng

agem

ent

wit

h th

e P

H o

f MH

p

atie

nts

(eg

. GP

-led

clin

ics

wit

h m

enta

l hea

lth

com

mun

ity

team

s;

gre

ater

invo

lvem

ent

of p

sych

iatr

ists

and

the

dev

elo

pm

ent

of

shar

ed c

are

to e

stab

lish

full

inte

gra

tio

n b

etw

een

MH

and

PH

se

rvic

es)

and

aw

aren

ess

of t

he p

oten

tial

cha

nges

re

wo

rklo

ad a

nd

the

resp

ons

ibili

ties

of p

ract

itio

ners

.

Acc

essi

ng t

he p

hysi

cal

need

s of

tho

se w

ith

SM

I req

uire

s sk

illed

and

kn

owle

dg

eab

le in

nova

tive

fr

ont

line

pra

ctit

ione

rs

and

ser

vice

use

rs t

o b

e in

volv

ed in

the

des

ign

and

co

mm

issi

oni

ng o

f ser

vice

s.In

ad

dit

ion

the

pro

mot

ion

and

ad

op

tio

n of

p

erso

nalis

ed c

are

will

ne

cess

itat

e co

ord

inat

ed

and

co

llab

ora

tive

ap

pro

ache

s w

ith

serv

ice

user

s, w

ho w

ill b

e ce

ntra

l to

thi

s p

roce

ss.

No

t re

po

rted

.

23B

rad

shaw

& P

edle

y (2

012

) E

volv

ing

ro

le o

f M

HN

s in

th

e P

H c

are

of

peo

ple

wit

h S

MI.

Intl

Jour

nal o

f M

enta

l H

ealt

h N

ursi

ng 2

1: 26

6-2

73.

UK

Lit

revi

ewLi

fe e

xpec

tanc

y in

the

gen

eral

po

pul

atio

n ha

s st

ead

ily im

pro

ved

in

mo

st c

oun

trie

s si

nce

196

0, b

ut in

the

sam

e p

erio

d t

he li

fe

exp

ecta

ncy

of p

eop

le d

iag

nose

d w

ith

SM

I has

red

uced

. T

he m

ajo

rity

of p

rem

atur

e d

eath

s o

ccur

as

a re

sult

of n

atur

al

caus

es, m

ost

co

mm

onl

y C

VD

. Ob

esit

y ha

s b

een

iden

tifi

ed a

s a

key

risk

fo

r C

VD

and

is c

ause

d b

oth

by a

n un

heal

thy

lifes

tyle

and

the

si

de

effe

cts

of a

ntip

sych

otic

dru

gs.

MH

Ns

have

an

imp

ort

ant

role

to

pla

y in

imp

rovi

ng t

he P

H o

f p

eop

le w

ith

SM

I. T

he e

vid

ence

how

ever

sug

ges

ts t

hat

MH

Ns

are

amb

ival

ent

abo

ut t

his

role

and

may

see

the

mse

lves

as

bei

ng

inad

equa

tely

tra

ined

and

lack

ing

in c

onf

iden

ce.

Aut

hors

sug

ges

t th

at

MH

Ns

may

nee

d t

o re

-eva

luat

e th

eir

pra

ctic

e an

d r

eco

gni

se t

hat

the

pro

visi

on

of P

H is

eq

ually

as

imp

ort

ant

as M

H.

MH

Ns

can

coo

rdin

ate

annu

al p

hysi

cal h

ealt

h ch

ecks

, get

invo

lved

in

hea

lth

educ

atio

n in

terv

enti

ons

, and

mak

e m

ore

use

of a

sses

smen

t to

ols

and

che

cklis

ts.

No

t re

po

rted

.


25

24R

obso

n et

al (

2013

) M

HN

an

d P

H c

are:

a c

ross

–se

ctio

nal s

tud

y o

f nu

rses

’ at

titu

des

, pra

ctic

e, a

nd

per

ceiv

ed t

rain

ing

nee

ds

for

the

phy

sica

l hea

lth

care

o

f p

eop

le w

ith

SM

I. Jo

urna

l M

enta

l Hea

lth

Nur

sing

22

:40

9-4

17

UK

Qua

nt -

surv

eyM

HN

s re

po

rted

car

ryin

g v

aryi

ng le

vels

of P

H p

ract

ice,

mo

st

freq

uent

ly in

pro

vid

ing

ad

vice

on

die

t an

d e

xerc

ise.

MN

Hs

rep

ort

ed le

ss f

req

uenc

y in

pro

vid

ing

ad

vice

on

canc

er

scre

enin

g, s

mo

king

ces

sati

on,

and

sex

ual h

ealt

h.M

HN

s w

ho w

ere

smo

kers

the

mse

lves

hel

d m

ore

per

mis

sive

at

titu

des

ab

out

sm

oki

ng a

nd w

ere

less

like

ly t

o se

e sm

oki

ng

cess

atio

n ad

vice

as

par

t of

the

ir r

ole

.H

avin

g r

ecei

ved

po

st-r

egis

trat

ion

PH

car

e tr

aini

ng a

nd w

ork

ing

in

inp

atie

nt s

etti

ngs

was

ass

oci

ated

wit

h g

reat

er r

epo

rted

in

volv

emen

t, b

ut s

om

e ca

utio

n re

qui

red

in in

terp

reti

ng t

hese

fi

ndin

gs.

Mo

re p

osi

tive

att

itud

es w

ere

evid

ent

for

nurs

es w

ho h

ad a

tten

ded

p

ost

-reg

istr

atio

n p

hysi

cal h

ealt

h tr

aini

ng, o

r w

ho h

ad a

n ad

dit

iona

l o

r d

ual n

ursi

ng q

ualif

icat

ion

(fo

r ex

amp

le, m

enta

l hea

lth

and

ad

ult

nurs

ing)

.

The

att

itud

es o

f MH

Ns

tow

ard

s P

H c

are

are

gen

eral

ly p

osi

tive

and

th

ere

app

ears

to

be

a w

illin

gne

ss t

o ta

ke o

n th

e ro

le o

f mo

nito

ring

the

P

H n

eed

s of

MH

pat

ient

s,

esp

ecia

lly in

rel

atio

n to

d

iet

and

exe

rcis

e.H

owev

er, M

HN

s ap

pea

r am

biv

alen

t to

war

ds

such

is

sues

as

canc

er s

cree

ning

, sm

oki

ng c

essa

tio

n an

d

they

als

o ap

pea

r le

ss

conf

iden

t in

the

ir a

bili

ty

to p

rovi

de

sup

po

rt a

nd

advi

ce a

bo

ut t

he a

dve

rse

effe

cts

of m

edic

atio

n,

den

tal,

ora

l, ey

e,

rep

rod

ucti

ve o

r se

xual

he

alth

.A

utho

rs s

ugg

est

ther

e is

a r

equi

rem

ent

that

sp

ecifi

c tr

aini

ng is

link

ed

to p

osi

tive

att

itud

es a

nd

eng

agem

ent

in p

ract

ice.

Cro

ss-

sect

iona

l d

esig

n lim

its

refe

renc

e to

ca

usal

ity.

Lim

ited

g

ener

al-

isab

ility

of

find

ing

s.

25H

app

ell e

t al

(20

15)

Ad

dre

ssin

g t

he P

H o

f p

eop

le w

ith

seri

ous

m

enta

l illn

ess:

a p

ote

ntia

l so

luti

on

for

an e

ndur

ing

p

rob

lem

. Int

l Jou

rnal

So

cial

P

sych

iatr

y 1-

2

Aus

tral

iaE

xper

t o

pin

ion

Peo

ple

wit

h S

MI f

ace

sig

nifi

cant

ineq

ualit

ies

in h

ealt

h ca

re

pro

visi

on

and

thi

s in

crea

ses

the

risk

of c

ard

iom

etab

olic

dis

ord

ers,

w

ith

pre

mat

ure

mo

rtal

ity

bei

ng f

ar g

reat

er t

han

that

ob

serv

ed in

th

e g

ener

al p

op

ulat

ion.

Whi

le p

hysi

cal m

oni

tori

ng is

cle

arly

wit

hin

the

sco

pe

of p

ract

ice

for

nurs

es, e

xpec

ting

MH

Ns

to a

tten

d t

o P

H n

eed

s of

tho

se w

ith

SM

I may

be

unre

alis

tic

giv

en o

ther

pri

ori

ties

and

dem

and

s fo

r th

eir

tim

e.E

vid

ence

sug

ges

ts t

hat

MH

Ns

have

div

erg

ent

atti

tud

es t

owar

ds,

an

d d

iffe

rent

cap

acit

ies

for

cari

ng f

or

the

PH

of t

hose

wit

h S

MI.

A s

olu

tio

n w

ith

the

pot

enti

al t

o im

pro

ve t

he P

H o

f tho

se w

ith

SM

I is

the

pro

visi

on

of a

phy

sica

l hea

lth

nurs

e co

nsul

tant

who

can

bri

dg

e th

e g

ap b

etw

een

PH

and

MH

car

e.T

he s

pec

ific

role

of t

he P

H n

urse

co

nsul

tant

wo

uld

be

to m

oni

tor

the

PH

of t

hose

wit

h S

MI,

and

the

ir lo

cati

on

wit

h M

H s

ervi

ces

wo

uld

red

uce

the

bur

den

on

cons

umer

s to

att

end

ad

dit

iona

l lo

cati

ons

.R

ecen

t st

udie

s ha

ve d

emo

nstr

ated

tha

t d

edic

ated

nur

se-l

ed r

ole

s re

sult

in s

igni

fica

nt im

pro

vem

ents

in P

H b

ehav

iour

s an

d o

utco

mes

.

Intr

od

ucin

g a

PH

nur

se

cons

ulta

nt in

to M

H

sett

ing

s w

oul

d b

e an

im

med

iate

and

dec

isiv

e re

spo

nse

to r

educ

e th

e he

alth

car

e in

equa

litie

s ex

per

ienc

ed b

y in

div

idua

ls

wit

h se

vere

men

tal i

llnes

s.

n/a


26

26R

ober

ts &

Bai

ley

(20

11)

Ince

ntiv

es a

nd b

arri

ers

to

lifes

tyle

inte

rven

tio

ns w

ith

peo

ple

wit

h S

MI:

a na

rrat

ive

synt

hesi

s o

f q

uant

itat

ive,

q

ualit

ativ

e an

d m

ixed

m

etho

ds

stud

ies.

Jou

rnal

A

dva

nced

Nur

sing

. 67(

4):

6

9-7

08

UK

Lit

revi

ewN

o st

udie

s w

ere

foun

d t

hat

spec

ifica

lly e

xplo

red

ince

ntiv

es a

nd

bar

rier

s to

par

tici

pat

ion

in li

fest

yle

pro

gra

mm

es f

or

peo

ple

wit

h S

MI.

Exi

stin

g li

tera

ture

rep

ort

so

me

po

ssib

le in

cent

ives

and

bar

rier

s.

Ince

ntiv

es in

clud

e; -

sym

pto

m r

educ

tio

n, p

eer

and

sta

ff s

upp

ort

, kn

owle

dg

e, p

erso

nal a

ttri

but

es a

nd p

arti

cip

atio

n of

sta

ff. T

he

bar

rier

s id

enti

fied

incl

uded

: - il

lnes

s sy

mp

tom

s, t

reat

men

t ef

fect

s,

lack

of s

upp

ort

, and

neg

ativ

e st

aff a

ttit

udes

.

Hea

lth

care

pro

fess

iona

ls,

in p

arti

cula

r nu

rses

, w

ho d

eliv

er li

fest

yle

inte

rven

tio

ns t

o p

eop

le

wit

h S

MI s

houl

d t

ake

into

acc

oun

t id

enti

fied

in

cent

ives

and

bar

rier

s to

eng

agem

ent

in o

rder

to

ach

ieve

max

imum

b

enef

its.

No

t re

po

rted

.

27La

wre

nce

et a

l (20

13)

The

g

ap in

life

exp

ecta

ncy

fro

m

pre

vent

able

phy

sica

l illn

ess

in p

sych

iatr

ic p

atie

nts

in W

este

rn A

ustr

alia

: a

retr

osp

ecti

ve a

naly

sis

of

po

pul

atio

n b

ased

reg

iste

rs.

Bri

tish

Med

ical

Jo

urna

l. 34

6:f

2539

do

i: 10

.1136

bm

j.f2

539

(p

ublis

hed

23r

d M

ay

2013

).

Aus

tral

iaQ

uant

Mai

n o

utco

me

mea

sure

s w

ere

tren

ds

in t

he li

fe e

xpec

tanc

y fo

r p

sych

iatr

ic p

atie

nts

com

par

ed w

ith

Wes

tern

Aus

tral

ian

po

pul

atio

n an

d c

ause

s of

exc

ess

mo

rtal

ity,

incl

udin

g p

hysi

cal h

ealt

h co

ndit

ions

and

unn

atur

al c

ause

s of

dea

th (

suic

ide)

.F

ind

ing

s re

veal

tha

t w

hen

usin

g a

ctiv

e p

reva

lenc

e of

dis

ord

er

(co

ntac

t w

ith

serv

ices

in p

revi

ous

fiv

e ye

ars)

the

life

exp

ecta

ncy

gap

incr

ease

d f

rom

13.

5 to

15.

9 ye

ars

for

mal

es a

nd f

rom

10

.4 t

o 12

.0 y

ears

fo

r fe

mal

es b

etw

een

198

5 an

d 2

00

5.77

.7%

of e

xces

s d

eath

s w

ere

attr

ibut

ed t

o P

H c

ond

itio

ns, i

nclu

din

g

CV

D (

29.9

%)

and

can

cer

(13.

5%).

Sui

cid

e w

as t

he c

ause

of 1

3.9

%

of d

eath

s.

Des

pit

e kn

owle

dg

e ab

out

ex

cess

ear

ly m

ort

alit

y in

peo

ple

wit

h m

enta

l ill

ness

, the

gap

in t

heir

life

ex

pec

tanc

y co

mp

ared

w

ith

the

gen

eral

p

op

ulat

ion

has

wid

ened

si

nce

198

5.W

ith

mo

re e

xces

s d

eath

s b

eing

due

to

PH

co

ndit

ions

, pub

lic

effo

rts

sho

uld

be

dir

ecte

d

tow

ard

s im

pro

ving

PH

to

red

uce

mo

rtal

ity

in

peo

ple

wit

h m

enta

l illn

ess,

in

ad

dit

ion

to o

ngo

ing

ef

fort

s to

pre

vent

sui

cid

es.

Rel

ianc

e on

ad

min

istra

tive

data

of

cont

acts

with

se

rvic

es a

s so

me

peop

le

with

men

tal

illne

ss m

ay

not m

ake

cont

act w

ith

serv

ices

.

28V

an N

ieuw

enhu

izen

et

al (

2013

) E

mer

gen

cy

dep

artm

ent

staf

f vi

ews

and

ex

per

ienc

es o

n d

iag

nost

ic

over

shad

owin

g r

elat

ed

to p

eop

le w

ith

men

tal

illne

ss. E

pid

emio

log

y an

d

Psy

chia

tric

Sci

ence

s 22

:255

-26

2

UK

Qua

l -re

view

sD

iag

nost

ic o

vers

had

owin

g w

as r

eco

gni

sed

as

a si

gni

fica

nt

phe

nom

eno

n.R

eco

gni

tio

n/fa

mili

arit

y of

dia

gno

stic

ove

rsha

dow

ing

was

mo

re

evid

ent

amo

ng s

enio

r p

rofe

ssio

nals

, and

thi

s w

as t

he o

nly

dif

fere

nce

ob

serv

ed.

Co

ntri

but

ing

fac

tors

incl

uded

:-

pro

ble

ms

of k

now

led

ge

and

info

rmat

ion

gat

heri

ng (

pro

ble

ms

ob

tain

ing

his

tory

, pro

ble

ms

wit

h ex

amin

atio

n, c

linic

ians

’ lac

k of

kn

owle

dg

e ab

out

MH

)-

clin

icia

ns’ a

ttit

udes

tow

ard

s p

eop

le w

ith

MH

issu

es, s

ubst

ance

m

isus

e an

d f

req

uent

att

end

ers

(lab

ellin

g a

nd s

tig

ma,

avo

idan

ce

due

to

fear

of v

iole

nce)

- d

iffi

cult

ies

in w

ork

ing

wit

h M

H p

atie

nts

in t

he c

ont

ext

of 4

ho

ur

dis

char

ge

targ

et f

or

ED

s (t

ime

pre

ssur

es, e

nvir

onm

ent)

.

The

phy

sica

l car

e of

p

eop

le w

ith

men

tal i

llnes

s in

ED

s m

ay b

e ad

vers

ely

effe

cted

by

dia

gno

stic

ov

ersh

adow

ing

and

av

oid

ance

by

clin

ical

sta

ff,

alo

ng w

ith

dif

ficu

ltie

s cr

eate

d b

y th

e ill

ness

, m

edic

atio

n an

d E

D

envi

ronm

ent.

Imp

rove

d jo

int

wo

rkin

g

bet

wee

n p

sych

iatr

y an

d

ED

sta

ff is

sug

ges

ted

as

one

way

to

red

uce

dia

gno

stic

ove

rsha

dow

ing

.

Find

ings

no

t ge

nera

lisab

le.


27

29R

ober

ts &

Bai

ley

(20

13)

An

ethn

og

rap

hic

stud

y o

f th

e in

cent

ives

and

bar

rier

s to

lif

esty

le in

terv

enti

ons

fo

r p

eop

le w

ith

SM

I. Jo

urna

l A

dva

nced

Nur

sing

. 69

(11)

: 25

14-2

524

.

UK

Qua

l –

inte

rvie

ws

&

ob

serv

atio

ns

Aim

was

to

exp

lore

ince

ntiv

es a

nd b

arri

ers

to e

ngag

ing

peo

ple

w

ith

SM

I in

an e

duc

atio

nal l

ifest

yle

pro

gra

mm

e to

gai

n an

un

der

stan

din

g o

f the

way

s se

rvic

e us

ers

exp

erie

nce

inte

rven

tio

ns.

The

des

ire

to lo

se w

eig

ht w

as t

he s

ing

le m

ost

imp

ort

ant

mot

ivat

or

for

atte

ndin

g a

life

styl

e in

terv

enti

on.

Whi

le s

oci

al a

nxie

ty w

as id

enti

fied

as

a m

ajo

r b

arri

er, f

ind

ing

s re

veal

the

so

cial

ben

efit

s of

att

end

ing

a li

fest

yle

inte

rven

tio

n w

ere

pee

r su

pp

ort

and

bui

ldin

g r

elat

ions

hip

s.T

he e

nvir

onm

ent,

co

ntex

t, r

ole

and

cha

ract

eris

tics

of h

ealt

h ca

re

pro

fess

iona

ls d

eliv

erin

g in

terv

enti

ons

nee

d c

aref

ul c

ons

ider

atio

n.U

sers

val

ued

hel

pfu

l, kn

owle

dg

eab

le, i

nfo

rmat

ive

and

ap

pro

acha

ble

sta

ff.

An

invi

sib

le b

arri

er id

enti

fied

was

the

neg

ativ

e o

r d

efea

tist

at

titu

des

of s

taff

, and

the

evi

den

ce s

tro

ngly

sup

po

rts

this

vie

w.

Use

rs a

lso

iden

tifi

ed t

he im

po

rtan

ce o

f ed

ucat

ion,

and

the

y w

ante

d in

form

atio

n ab

out

life

styl

e, w

hich

rei

nfo

rces

the

im

po

rtan

ce o

f hea

lth

pro

mot

ion.

Nur

ses

and

oth

er h

ealt

h ca

re p

rofe

ssio

nals

of

feri

ng h

ealt

h p

rom

otio

n st

rate

gie

s sh

oul

d d

evel

op

st

rate

gie

s to

del

iver

in

terv

enti

ons

mo

re

effe

ctiv

ely.

Suc

h in

terv

enti

ons

sh

oul

d in

clud

e w

eig

ht

man

agem

ent

in t

he

cont

ext

of b

road

er

lifes

tyle

fac

tors

, pro

vid

ing

us

eful

and

info

rmat

ive

lear

ning

mat

eria

ls,

and

ens

urin

g le

arni

ng

op

po

rtun

itie

s p

rovi

de

a so

cial

co

ntex

t in

whi

ch

ind

ivid

uals

can

lear

n, f

ind

p

eer

sup

po

rt, a

nd d

evel

op

so

cial

net

wo

rks.

O

nly

by d

eliv

erin

g

app

rop

riat

e an

d t

arg

eted

in

terv

enti

ons

can

the

p

hysi

cal h

ealt

h ri

sks

to p

eop

le w

ith

SM

I be

imp

rove

d.

Smal

l sam

ple

size

, lim

ited

g

ener

al-

isab

ility

of

find

ing

s.


28

30E

hrlic

h et

al (

2014

) Im

pro

ving

the

PH

of

peo

ple

w

ith

SM

I: b

oun

dar

ies

of

care

pro

visi

on

. Int

l Jou

rnal

M

enta

l Hea

lth

Nur

sing

23:

24

3-25

1

Aus

tral

iaQ

ual -

in

terv

iew

sT

here

is c

om

pel

ling

evi

den

ce t

hat

the

PH

of t

hose

wit

h S

MI i

s p

oo

r (r

evea

ling

up

to

30 y

ears

of l

ost

life

).H

ealt

h p

rom

otio

n g

uid

elin

es h

ave

bee

n re

com

men

ded

as

a w

ay t

o im

pro

ve t

he P

H o

f thi

s p

op

ulat

ion.

How

ever

, sig

nifi

cant

bar

rier

s re

mai

n to

the

ad

op

tio

n of

evi

den

ce-

bas

ed g

uid

ance

in p

ract

ice.

Thi

s st

udy

app

lied

exi

stin

g im

ple

men

tati

on

theo

ries

to

exam

ine

the

cap

abili

ty o

f the

hea

lthc

are

syst

em t

o in

teg

rate

PH

pro

mot

ion

into

MH

ser

vice

del

iver

y.T

he c

ore

the

me

emer

gin

g w

as t

hat

of ‘c

are

bo

und

arie

s’ w

hich

in

flue

nced

the

like

liho

od

of g

uid

ance

bei

ng im

ple

men

ted

.B

oun

dar

ies

exis

ted

aro

und

the

illn

ess,

car

e p

rovi

sio

n se

rvic

es,

sect

ors

, the

hea

lthc

are

syst

em, a

nd s

oci

ety.

The

se m

ulti

-lev

el b

oun

dar

ies

com

bin

ed w

ith

par

tici

pan

t’s

way

s of

res

po

ndin

g t

o th

em, i

mp

acte

d o

n ca

pab

ility

(ie

the

ab

ility

to

inte

gra

te P

H p

rom

otio

n in

to e

xist

ing

pra

ctic

es).

Ove

rwhe

lmin

gly

p

arti

cip

ants

wer

e aw

are

of t

he p

oo

r P

H o

f tho

se

wit

h S

MI,

but

the

re w

as

littl

e ag

reem

ent

abo

ut

the

natu

re o

f the

wo

rk

asso

ciat

ed w

ith

imp

rovi

ng

PH

, who

was

res

po

nsib

le

for

do

ing

thi

s, a

nd h

ow

wo

rk w

oul

d b

e en

acte

d.

The

re w

as li

ttle

ag

reem

ent

abo

ut t

he w

ork

of

pro

vid

ing

PH

pro

mot

ion.

Ind

ivid

ual p

ract

itio

ner

dis

cip

linar

y an

d t

eam

p

hilo

sop

hies

and

bel

iefs

ab

out

car

e d

irec

tly

imp

acte

d o

n ca

re

pro

visi

on.

Det

erm

inin

g w

ho w

as

resp

ons

ible

fo

r w

hich

el

emen

ts o

f hea

lth

pro

mot

ion

was

nee

ded

.D

eter

min

ing

how

sec

tors

an

d d

isci

plin

es w

oul

d w

ork

co

llab

ora

tive

ly t

o p

rovi

de

phy

sica

l hea

lth

pro

mot

ion

was

ess

enti

al.

Mul

ti-l

evel

rel

atio

nshi

ps

wer

e ne

cess

ary

to

over

com

e b

oun

dar

ies

to

care

and

to

inte

gra

te a

nd

coo

rdin

ate

PH

pro

mot

ion

amo

ng in

div

idua

ls a

nd

sect

ors

.T

he im

ple

men

tati

on

of

evid

ence

-bas

ed g

uid

elin

es

dep

end

ed h

eavi

ly o

n th

e ca

pab

ility

of t

he w

ork

forc

e to

dev

elo

p a

nd a

do

pt

bo

und

ary-

med

iati

ng

stra

teg

ies.

One

g

eog

rap

hic

area

cov

ered

, th

us li

miti

ng

gen

eral

-is

abili

ty o

f fin

din

gs.

No

user

in

volv

emen

t.

31Sh

efer

et

al (

(20

14)

Dia

gno

stic

ove

rsha

dow

ing

an

d o

ther

cha

lleng

es

invo

lved

in t

he d

iag

nost

ic

pro

cess

of

pat

ient

s w

ith

men

tal i

llnes

s w

ho p

rese

nt

in e

mer

gen

cy d

epar

tmen

ts

wit

h p

hysi

cal s

ymp

tom

s –

a q

ualit

ativ

e st

udy.

PLo

S O

NE

9

(11)

: E11

168

2. D

OI:1

0.13

71/

jour

alp

one

.011

168

2

UK

Qua

l -

Inte

rvie

ws

Dia

gno

stic

ove

rsha

dow

ing

can

lead

to

mis

dia

gno

sis

of p

eop

le w

ith

men

tal i

llnes

s w

ho p

rese

nt in

ED

wit

h p

hysi

cal s

ymp

tom

s.D

irec

t fa

cto

rs w

hich

may

lead

to

mis

dia

gno

sis

are

com

ple

x p

rese

ntat

ions

or

asp

ects

rel

ated

to

po

or

com

mun

icat

ion

or

chal

leng

ing

beh

avio

ur o

f the

pat

ient

.B

ackg

roun

d f

acto

rs in

clud

e th

e cr

owd

ed n

atur

e of

the

ED

en

viro

nmen

t, t

ime

pre

ssur

es, t

arg

ets

and

sti

gm

atis

ing

att

itud

es

held

by

a m

ino

rity

of s

taff

.

The

exi

sten

ce o

f p

sych

iatr

ic li

aiso

n te

ams

in t

he E

D 2

4/7

can

he

lp r

educ

e th

e ri

sk o

f m

isd

iag

nosi

s.H

owev

er, p

roce

dur

es

used

by

emer

gen

cy

and

psy

chia

tric

liai

son

staf

f req

uire

ful

ler

op

erat

iona

lisat

ion

to

red

uce

dis

agre

emen

t ov

er

whe

re r

esp

ons

ibili

ties

lie.

Fin

din

gs

cann

ot b

e g

ener

alis

ed.


29

32W

alke

r &

McA

ndre

w (

2015

) T

he s

ame

but

dif

fere

nt:

dis

cuss

ing

the

lite

ratu

re

reg

ard

ing

MH

Ns

dif

ficu

lty

in m

eeti

ng t

he P

H n

eed

s o

f se

rvic

e us

ers,

reg

ard

less

o

f d

iffe

ring

ed

ucat

ion

pro

gra

mm

es. J

ourn

al

Psy

chia

tric

and

Men

tal

Hea

lth

Nur

sing

22:

64

0-6

46

UK

Lit

revi

ewD

esp

ite

chan

ges

to

nurs

e ed

ucat

ion

MH

Ns

rem

ain

less

co

nfid

ent

and

pre

par

ed t

o ad

dre

ss t

he P

H c

are

need

s of

the

ir c

lient

gro

up.

Thi

s p

rob

lem

is r

epo

rted

by

nurs

es in

oth

er W

este

rn c

oun

trie

s w

ho

have

und

erg

one

dif

fere

nt e

duc

atio

n an

d t

rain

ing

pro

gra

mm

es.

Aut

hors

sug

ges

t th

at t

he e

vid

ence

sug

ges

ts t

hat

the

pro

visi

on

of

PH

car

e by

MH

Ns

is n

ot ju

st a

que

stio

n of

ed

ucat

ion

and

tra

inin

g,

rath

er it

is a

nee

d t

o ad

dre

ss f

ar m

ore

co

mp

lex

issu

es.

Fo

r M

HN

s th

e la

ck o

f op

po

rtun

itie

s to

pra

ctis

e sk

ills

may

imp

act

on

thei

r le

vel o

f co

mp

eten

ce a

nd c

onf

iden

ce in

eng

agin

g w

ith

PH

ac

tivi

ties

.In

ad

dit

ion

the

po

litic

al s

hift

to

fro

m h

osp

ital

to

com

mun

ity

may

fu

rthe

r co

mp

licat

e th

e si

tuat

ion.

Peo

ple

wit

h M

H is

sues

who

do

acce

ss P

H a

re o

ften

co

nfro

nted

w

ith

an o

vers

had

owin

g p

rob

lem

, whi

ch is

an

atti

tud

inal

pro

ble

m

ind

icat

ive

of a

lack

of r

esp

ect

on

the

par

t of

the

hea

lth

care

p

rofe

ssio

nal w

ho v

iew

s th

e us

er a

s an

exp

ert

in t

heir

ow

n ri

ght

.W

hils

t ac

know

led

gin

g t

hat

the

MH

N is

bes

t p

lace

d t

o ad

dre

ss t

he

co-e

xist

ing

MH

and

PH

nee

ds,

the

re n

eed

s to

be

mo

re t

han

just

ch

ang

ing

pre

-reg

istr

atio

n nu

rsin

g c

urri

cula

, the

re is

als

o a

need

fo

r g

reat

er in

terp

rofe

ssio

nal c

olla

bo

rati

on,

an

op

po

rtun

ity

to p

ract

ise

new

kno

wle

dg

e an

d s

kills

, as

wel

l as

a ch

ang

e in

att

itud

es a

nd

serv

ice

flex

ibili

ty.

Inte

rnat

iona

l and

nat

iona

l ac

cep

tanc

e th

at t

here

is

an

incr

ease

d le

vel o

f co

exis

tenc

e b

etw

een

PH

an

d M

H p

rob

lem

s.M

HN

s g

ener

ally

acc

ept

they

hav

e a

role

to

pla

y in

imp

rovi

ng h

ealt

h o

utco

mes

fo

r th

ose

wit

h P

H p

rob

lem

s.U

sers

hav

e ex

pre

ssed

co

ncer

ns a

bo

ut e

nsur

ing

th

eir

PH

nee

ds

are

met

w

hils

t in

rec

eip

t of

MH

se

rvic

es.

Des

pit

e th

eir

leve

l of

educ

atio

n M

HN

s fe

el

ill-e

qui

pp

ed, a

nd la

ck

conf

iden

ce t

o en

gag

e in

thi

s im

po

rtan

t ar

ea o

f ca

re.

The

aut

hors

arg

ue t

hat

it is

not

just

a m

atte

r of

ch

ang

ing

the

em

pha

sis

wit

h p

rog

ram

mes

of

nurs

e ed

ucat

ion,

but

th

ere

is a

nee

d t

o ad

dre

ss

def

icit

s in

kno

wle

dg

e an

d

und

erst

and

ing

of t

he P

H

care

fo

r th

ose

wit

h m

enta

l ill

ness

.A

utho

rs f

urth

er s

ugg

est

that

MH

Ns

mus

t ha

ve a

p

osi

tive

att

itud

e in

rel

atio

n to

the

ir r

ole

bei

ng k

ey t

o im

pro

ving

the

PH

of t

hose

w

ith

men

tal i

llnes

s.F

or

this

to

hap

pen

ro

bus

t p

ost

-qua

lific

atio

n tr

aini

ng a

nd e

duc

atio

n p

rog

ram

mes

nee

d t

o b

e p

rovi

ded

to

get

her

wit

h o

pp

ort

unit

ies

to p

ract

ise

and

bui

ld c

onf

iden

ce.

No

t re

po

rted

.


30

33B

ress

ing

ton

et a

l (20

16)

Ref

ocu

sing

on

PH

: C

om

mun

ity

psy

chia

tric

nu

rses

per

cep

tio

ns o

f us

ing

en

hanc

ed h

ealt

h ch

ecks

fo

r p

eop

le w

ith

seve

re m

enta

l ill

ness

. Int

l Jou

rnal

Men

tal

Hea

lth

Nur

sing

.

Inte

rnat

iona

lQ

ual –

In

terv

iew

sF

our

the

mes

iden

tifi

ed:

- in

flue

nces

on

nurs

ing

pra

ctic

e (i

ncre

ased

fo

cus

on

PH

; wo

rkin

g

com

pre

hens

ivel

y an

d s

yste

mat

ical

ly; o

pp

ort

unit

y fo

r he

alth

ed

ucat

ion)

- se

rvic

e-re

late

d im

ple

men

tati

on

chal

leng

es (

refe

rral

fru

stra

tio

n;

need

fo

r in

teg

rate

d m

ulti

dis

cip

linar

y te

am s

ervi

ces;

intr

od

ucin

g

lifes

tyle

inte

rven

tio

n g

roup

s)-

rais

ing

clie

nts’

aw

aren

ess

of t

heir

PH

sta

te (

incr

ease

d m

otiv

atio

n fo

r lif

esty

le c

hang

es, o

bse

rvab

le b

ehav

iour

al c

hang

es in

clie

nts)

- ad

apta

tio

ns r

equi

red

fo

r us

ing

HIP

s (u

nder

stan

dab

le u

nits

of

mea

sure

men

ts; a

dju

stin

g p

aram

eter

s fo

r lo

cal p

op

ulat

ions

; C

hine

se la

ngua

ge

and

tra

dit

iona

l Chi

nese

med

icin

e).

HIP

see

n as

fea

sib

le t

o im

ple

men

t an

d v

iew

ed a

s b

enef

icia

l.R

efo

cusi

ng n

urse

s’

atte

ntio

n o

n p

hysi

cal

need

s ap

pea

rs t

o ha

ve

imp

rove

d n

urse

s’ p

hysi

cal

heal

th li

tera

cy, a

nd

rein

forc

ed t

he im

po

rtan

ce

of h

olis

tic

care

.D

esp

ite

ac

know

led

gem

ent

of t

he

imp

ort

ance

of t

he r

isks

to

PH

, nur

ses

dis

pla

yed

a

deg

ree

of a

mb

ival

ence

ab

out

who

se r

ole

it w

as,

and

had

a t

end

ency

to

fo

cus

on

MH

issu

es.

Usi

ng t

he H

IP r

evea

led

g

aps

in n

urse

kno

wle

dg

e an

d s

kills

re

PH

bey

ond

th

e co

nten

t p

rovi

ded

in

the

inte

rven

tio

n tr

aini

ng.

Smal

l sam

ple

mea

ns li

mite

d

gene

ral-

isab

ility

of

findi

ngs.

34M

web

e (2

016

) P

H

mo

nito

ring

in m

enta

l hea

lth

sett

ing

s: a

stu

dy

exp

lori

ng

men

tal h

ealt

h nu

rses

’ vie

ws

of

thei

r ro

le. J

ourn

al C

linic

al

Nur

sing

26

: 30

67-

3078

.

UK

Qua

l -

Inte

rvie

ws

Fo

ur t

hem

es id

enti

fied

:-

feat

ures

of c

urre

nt p

ract

ice

and

phy

sica

l hea

lth

mo

nito

ring

- p

erce

ived

bar

rier

s to

PH

mo

nito

ring

- p

erce

ived

ed

ucat

ion

and

tra

inin

g n

eed

s-

stra

teg

ies

to im

pro

ve P

H m

oni

tori

ngN

urse

s re

po

rted

tha

t ta

king

up

the

ir r

ole

in a

sses

sing

and

m

oni

tori

ng P

H r

equi

res

inve

stm

ent

and

tim

e, a

s w

ell a

s ad

dre

ssin

g

the

lack

of t

rain

ing

and

ed

ucat

ion

for

skill

s d

evel

op

men

t.K

ey b

arri

ers

wer

e id

enti

fied

as

reso

urce

allo

cati

on,

loca

l cul

ture

an

d s

taff

att

itud

es.

The

so

luti

ons

off

ered

incl

uded

imp

rovi

ng s

taff

ing

leve

ls,

avai

lab

ility

of m

edic

al e

qui

pm

ent

and

sp

ecia

list

role

s in

pra

ctic

e.

Nur

ses

felt

the

re s

houl

d

be

a m

ore

ro

bus

t, in

clus

ive

syst

em in

pra

ctic

e, c

lear

g

uid

ance

and

info

rmat

ion

aro

und

ref

erra

l pat

hway

s,

and

sup

po

rt f

or

nurs

es

wo

rkin

g w

ith

a g

roup

of

pat

ient

s w

ith

com

ple

x d

iver

se n

eed

s.P

H c

are

mo

nito

ring

p

olic

ies

sho

uld

be

easi

ly a

cces

sib

le

and

cle

arly

sta

te t

he

func

tio

n an

d r

ole

s of

th

e M

H p

rofe

ssio

nals

in

add

ress

ing

PH

nee

ds

and

he

alth

pro

mot

ion

need

s.S

om

e id

enti

fied

the

nee

d

for

a P

H le

ad p

ract

itio

ner

to a

ct a

s a

go

-to

reso

urce

fo

r st

aff w

ho r

equi

red

g

uid

ance

.M

and

ato

ry t

rain

ing

and

C

PD

co

urse

s sh

oul

d

refl

ect

PH

ski

lls a

nd

not

just

tra

inin

g in

MH

p

ract

ice.

No

t re

po

rted

.


31

35W

ynad

en e

t al

(20

16)

The

ch

asm

of

care

: Whe

re d

oes

th

e M

N r

esp

ons

ibili

ty li

e fo

r th

e P

H o

f p

eop

le w

ith

SM

I. In

tl Jo

urna

l Men

tal H

ealt

h N

ursi

ng 1

5: 5

16-5

25

Aus

tral

iaQ

uant

-

Sur

vey

MH

Ns

view

giv

ing

ad

vice

on

wei

ght

man

agem

ent,

nut

riti

on

and

p

reve

ntio

n of

car

dia

c d

isea

se a

s b

eing

wit

hin

thei

r re

mit

, but

the

y ar

e le

ss s

ure

it is

the

ir r

esp

ons

ibili

ty t

o p

rovi

de

advi

ce o

n ex

erci

se.

MH

Ns

are

conf

iden

t in

mo

nito

ring

blo

od

pre

ssur

e an

d

hyp

og

lyca

emia

, but

less

co

nfid

ent

abo

ut t

heir

kno

wle

dg

e of

th

e ri

sks

and

sid

e ef

fect

s as

soci

ated

wit

h p

sych

otro

pic

dru

gs,

es

pec

ially

in r

elat

ion

to h

ow t

hese

dru

gs

can

dam

age

the

eyes

.M

HN

s id

enti

fied

bar

rier

s as

clie

nts’

lack

of a

dhe

renc

e/co

mp

lianc

e w

ith

advi

ce g

iven

, and

MH

Ns

wer

e d

ivid

ed a

s to

whe

ther

the

ir

wo

rklo

ad w

as a

bar

rier

to

the

del

iver

y of

PH

.T

he c

hasm

of c

are

in r

elat

ion

to t

he P

H o

f clie

nts

wit

h S

MI r

emai

ns

flui

d, l

imit

ed a

nd p

erm

eab

le, a

nd t

his

gro

up r

emai

n hi

ghl

y vu

lner

able

to

the

mis

man

agem

ent

of t

heir

PH

pro

ble

ms.

Aut

hors

sug

ges

t M

HN

s ha

ve a

pro

fess

iona

l and

an

ethi

cal

ob

ligat

ion

to a

dd

ress

thi

s d

ivid

e an

d t

o p

rovi

de

lead

ersh

ip f

or

red

ucin

g t

he d

isp

arit

y in

life

exp

ecta

ncy

for

thei

r cl

ient

s.F

ind

ing

s re

veal

MH

Ns

are

amb

ival

ent

abo

ut t

he p

rovi

sio

n of

PH

ca

re t

o M

H c

lient

s, w

hich

in p

art

is d

ue t

o co

mp

lexi

ty o

f illn

ess,

co

mp

etin

g p

rio

riti

es, o

r th

eir

bel

ief t

hat

add

ress

ing

PH

nee

ds

is

som

eone

els

e’s

resp

ons

ibili

ty.

Aut

hors

iden

tify

co

ncep

t of

“th

erap

euti

c fa

talis

m”

whi

ch is

def

ined

as

“w

here

hea

lthc

are

pro

fess

iona

ls a

re n

ot w

illin

g t

o in

vest

tim

e tr

ying

to

inst

igat

e ch

ang

e as

the

y fe

el s

uch

tim

e is

was

ted

” an

d is

man

ifest

ed in

man

y cl

inic

al s

itua

tio

ns w

here

so

me

of t

he

sym

pto

ms

of P

H n

eed

s ar

e d

irec

tly

rela

ted

to

trea

tmen

t fo

r m

enta

l ill

ness

, and

thu

s, a

re in

evit

able

.A

utho

rs p

oin

t o

ut t

he la

ck o

f im

po

rtan

ce a

ttac

hed

to

heal

th

pro

mot

ion,

and

the

y ar

gue

tha

t st

igm

atis

ing

att

itud

es r

emai

n p

reva

lent

, and

tha

t st

igm

atis

ing

att

itud

es e

xist

at

the

sam

e le

vels

b

etw

een

pro

fess

iona

ls a

nd t

he g

ener

al p

op

ulat

ion.

MH

Ns

rem

ain

uncl

ear

re

thei

r le

vel o

r re

spo

nsib

ility

an

d a

cco

unta

bili

ty f

or

PH

out

com

es, e

ven

tho

ugh

they

hav

e b

een

iden

tifi

ed a

s ho

ldin

g k

ey

resp

ons

ibili

ties

in t

his

area

.N

o M

H w

itho

ut P

H

cont

inue

s un

add

ress

ed

by k

ey s

take

hold

er

gro

ups

dec

ades

aft

er it

w

as f

irst

intr

od

uced

in

the

liter

atur

e. M

HN

s ca

n p

rovi

de

lead

ersh

ip in

th

is a

rea,

but

in o

rder

to

act,

the

y ne

ed im

pro

ved

ed

ucat

ion

and

tra

inin

g a

nd

gre

ater

aw

aren

ess

of t

he

crit

ical

link

s b

etw

een

MH

an

d P

H o

utco

mes

fo

r th

eir

clie

nts.

No

t re

po

rted

.

36Li

u et

al (

2017

) E

xces

s m

ort

alit

y in

per

sons

wit

h se

vere

men

tal d

iso

rder

s;

a m

ulti

leve

l int

erve

ntio

n fr

amew

ork

and

pri

ori

ties

fo

r cl

inic

al p

ract

ice,

po

licy

and

res

earc

h ag

end

as.

Wor

ld P

ysch

iatr

y 16

:30

-40

.

Int

Lit

revi

ewE

xces

s m

ort

alit

y in

tho

se d

iag

nose

d w

ith

seve

re m

enta

l illn

ess

is a

g

lob

al p

ublic

hea

lth

chal

leng

e w

arra

ntin

g a

ctio

n.T

he n

umb

er a

nd s

cop

e of

tes

ted

inte

rven

tio

ns r

emai

ns li

mit

ed, a

nd

stra

teg

ies

for

imp

lem

enta

tio

n an

d s

calin

g u

p p

rog

ram

mes

wit

h a

stro

ng e

vid

ence

bas

e ar

e sc

arce

.T

he a

utho

rs p

rese

nt a

mul

ti-l

evel

mo

del

hig

hlig

htin

g r

isk

fact

ors

fo

r ex

cess

mo

rtal

ity

in t

hose

wit

h S

MI a

t in

div

idua

l, he

alth

sys

tem

, an

d s

oci

o-e

nvir

onm

enta

l lev

els,

and

des

crib

e a

com

pre

hens

ive

fram

ewo

rk f

or

des

igni

ng, i

mp

lem

enti

ng a

nd e

valu

atin

g

inte

rven

tio

ns a

nd p

rog

ram

mes

aim

ed a

t re

duc

ing

exc

ess

mo

rtal

ity.

Inte

rven

tio

ns a

t in

div

idua

l le

vel:

- m

enta

l hea

lth

dis

ord

er

man

agem

ent

- p

hysi

cal h

ealt

h tr

eatm

ent

- lif

esty

le a

nd b

ehav

iour

in

terv

enti

ons

.In

terv

enti

ons

at

heal

th

syst

em le

vel:

- sc

reen

ing

fo

r m

edic

al

cond

itio

ns-

care

co

ord

inat

ion

and

co

llab

ora

tive

car

e st

rate

gie

s (f

or

exam

ple

, nu

rse

care

man

ager

)-

gui

del

ines

fo

r in

teg

rate

d

del

iver

y of

phy

sica

l and

m

enta

l hea

lth.

Inte

rven

tio

ns a

t so

cio

-en

viro

nmen

tal l

evel

:-

soci

al s

upp

ort

- st

igm

a re

duc

tio

n in

terv

enti

ons

- p

olic

y le

vel i

nter

vent

ions

.

No

t re

po

rted

.


32

37In

ce e

t al

(20

18)

The

o

pin

ions

of

Turk

ish

men

tal

heal

th n

urse

s o

n P

H

care

fo

r in

div

idua

ls w

ith

men

tal i

llnes

s. In

tl Jo

urna

l P

sych

iatr

ic &

Men

tal H

ealt

h N

ursi

ng 2

4:4

AB

ST

RA

CT

ON

LY

Turk

eyQ

ual -

In

terv

iew

sF

our

the

mes

iden

tifi

ed:

- b

arri

ers

to P

H c

are

- P

H c

are

pra

ctic

es-

mot

ivat

ors

- ne

ed f

or

bet

ter

PH

.

MH

Ns

mo

stly

fo

cus

on

the

exis

ting

PH

nee

ds

of

ind

ivid

uals

wit

h m

enta

l ill

ness

, how

ever

, the

y d

o no

t in

clud

e p

ract

ices

of

dis

ease

pre

vent

ion,

and

he

alth

pro

mot

ion

for

thes

e cl

ient

s.A

des

ire

to s

ee p

osi

tive

ch

ang

es in

ind

ivid

uals

w

ith

MH

illn

ess,

rec

eivi

ng

po

siti

ve f

eed

bac

k,

feel

ing

use

ful a

nd

hap

py, f

eelin

g s

atis

fied

w

ith

thei

r p

rofe

ssio

n al

l m

otiv

ate

MH

Ns

in t

erm

s of

p

rovi

din

g P

H c

are.

The

kno

wle

dg

e an

d s

kills

re

qui

red

to

pro

vid

e P

H

care

nee

d t

o b

e in

crea

sed

.In

stit

utio

ns s

houl

d e

mp

loy

exp

ert

nurs

es w

ho a

re

able

to

gui

de

MH

Ns

to

pro

vid

e b

ette

r P

H c

are.

It is

imp

ort

ant

to p

rovi

de

adeq

uate

infr

astr

uctu

re

and

hum

an r

eso

urce

s to

p

rovi

de

bet

ter

PH

car

e in

M

H s

ervi

ces.

No

t re

po

rted

.

38H

app

ell e

t al

(20

15)

Ad

dre

ssin

g t

he P

H o

f p

eop

le w

ith

seri

ous

m

enta

l illn

ess:

a p

ote

ntia

l so

luti

on

for

an e

ndur

ing

p

rob

lem

. Int

l Jo

urna

l So

cial

P

sych

iatr

y 1-

2M

eep

ring

et

al (

2018

) T

he

effe

cts

of

the

Tha

i Hea

lth

Imp

rove

men

t P

rofi

le o

n th

e p

hysi

cal h

ealt

h an

d h

ealt

h b

ehav

iour

s o

f p

eop

le w

ith

schi

zop

hren

ia: A

qua

si

exp

erim

enta

l stu

dy.

Intl

Jo

urna

l of

Men

tal H

ealt

h N

ursi

ng. 2

7:26

-37

Tha

iland

Qua

nt –

surv

eyTo

exa

min

e th

e th

erap

euti

c ef

fect

s of

the

Hea

lth

Imp

rove

men

t P

rofi

le o

n th

e p

hysi

cal h

ealt

h of

peo

ple

dia

gno

sed

wit

h sc

hizo

phr

enia

at

12-m

ont

h fo

llow

up

.

The

Hea

lth

Imp

rove

men

t P

rofi

le in

terv

enti

on

has

the

pot

enti

al t

o im

pro

ve t

he

phy

sica

l hea

lth

of t

hose

d

iag

nose

d w

ith

SM

I whe

n in

corp

ora

ted

into

ro

utin

e co

mm

unit

y m

enta

l hea

lth

care

.

Sel

f-re

po

rted

b

ias.

Li

mit

ed

gen

eral

-is

abili

ty.


33

37In

ce e

t al

(20

18)

The

o

pin

ions

of

Turk

ish

men

tal

heal

th n

urse

s o

n P

H

care

fo

r in

div

idua

ls w

ith

men

tal i

llnes

s. In

tl Jo

urna

l P

sych

iatr

ic &

Men

tal H

ealt

h N

ursi

ng 2

4:4

AB

ST

RA

CT

ON

LY

Turk

eyQ

ual -

In

terv

iew

sF

our

the

mes

iden

tifi

ed:

- b

arri

ers

to P

H c

are

- P

H c

are

pra

ctic

es-

mot

ivat

ors

- ne

ed f

or

bet

ter

PH

.

MH

Ns

mo

stly

fo

cus

on

the

exis

ting

PH

nee

ds

of

ind

ivid

uals

wit

h m

enta

l ill

ness

, how

ever

, the

y d

o no

t in

clud

e p

ract

ices

of

dis

ease

pre

vent

ion,

and

he

alth

pro

mot

ion

for

thes

e cl

ient

s.A

des

ire

to s

ee p

osi

tive

ch

ang

es in

ind

ivid

uals

w

ith

MH

illn

ess,

rec

eivi

ng

po

siti

ve f

eed

bac

k,

feel

ing

use

ful a

nd

hap

py, f

eelin

g s

atis

fied

w

ith

thei

r p

rofe

ssio

n al

l m

otiv

ate

MH

Ns

in t

erm

s of

p

rovi

din

g P

H c

are.

The

kno

wle

dg

e an

d s

kills

re

qui

red

to

pro

vid

e P

H

care

nee

d t

o b

e in

crea

sed

.In

stit

utio

ns s

houl

d e

mp

loy

exp

ert

nurs

es w

ho a

re

able

to

gui

de

MH

Ns

to

pro

vid

e b

ette

r P

H c

are.

It is

imp

ort

ant

to p

rovi

de

adeq

uate

infr

astr

uctu

re

and

hum

an r

eso

urce

s to

p

rovi

de

bet

ter

PH

car

e in

M

H s

ervi

ces.

No

t re

po

rted

.

38H

app

ell e

t al

(20

15)

Ad

dre

ssin

g t

he P

H o

f p

eop

le w

ith

seri

ous

m

enta

l illn

ess:

a p

ote

ntia

l so

luti

on

for

an e

ndur

ing

p

rob

lem

. Int

l Jo

urna

l So

cial

P

sych

iatr

y 1-

2M

eep

ring

et

al (

2018

) T

he

effe

cts

of

the

Tha

i Hea

lth

Imp

rove

men

t P

rofi

le o

n th

e p

hysi

cal h

ealt

h an

d h

ealt

h b

ehav

iour

s o

f p

eop

le w

ith

schi

zop

hren

ia: A

qua

si

exp

erim

enta

l stu

dy.

Intl

Jo

urna

l of

Men

tal H

ealt

h N

ursi

ng. 2

7:26

-37

Tha

iland

Qua

nt –

surv

eyTo

exa

min

e th

e th

erap

euti

c ef

fect

s of

the

Hea

lth

Imp

rove

men

t P

rofi

le o

n th

e p

hysi

cal h

ealt

h of

peo

ple

dia

gno

sed

wit

h sc

hizo

phr

enia

at

12-m

ont

h fo

llow

up

.

The

Hea

lth

Imp

rove

men

t P

rofi

le in

terv

enti

on

has

the

pot

enti

al t

o im

pro

ve t

he

phy

sica

l hea

lth

of t

hose

d

iag

nose

d w

ith

SM

I whe

n in

corp

ora

ted

into

ro

utin

e co

mm

unit

y m

enta

l hea

lth

care

.

Sel

f-re

po

rted

b

ias.

Li

mit

ed

gen

eral

-is

abili

ty.


34


35

36

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January 2019Publication code 007 415

007 415 mental health nursing literature review final3 · the majority of articles are literature...

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