Utilizing Evidence-Based Practice To Understand The Physical Health Needs Of Mentally Disabled Patients: A Literature Review

Evidence-Based Practice and Physical Health Needs of Mentally Disabled Patients

Evidence based practice is the conscientious, unequivocal and judicious utilization of recent and authentic best practice evidences in the process of making clinical decisions regarding the planning and implementation procedure of the care for individual patients. It is a technique of systematic research of external clinical evidence from reliable databases to inform best practice within the care scenario; and researchers are of the opinion that the use of evidence based practice has the potential to revolutionize the safety and effectiveness of care by enhancing the efficiency of the care strategies selected and reducing the possibility of errors completely (Melnyk et al. 2010).

In case of this assignment, the technique of evidence based research has been selected to address the issue of how nurses can explore, understand and address the physical health needs of the mentally disabled patient population. It has to be understood that understanding the physical health needs of the mentally disabled can be very difficult given their communication and behavioral limitations and cognitive impairment. Often addressing even the most basic physical health status can become very difficult. Hence, the nurses require a wealth of knowledge and skills to explore and attend to the physical health needs of a patient population that neither understands nor can express their personal needs (Stevens 2013). Hence, this assignment will be an attempt to explore this issue and implement evidence based practice taking the assistance of the database CINAHL.

A search strategy is the amalgamation of the systematic step by step action that has been taken for conducting the research and results attained by the research. For this literature search study, the chosen database had been CINAHL or Cumulative Index to Nursing and Allied Health Literature and the database has been accessed through the university website (my.lsbu.ac.uk).The rationale for choosing this database for the study includes the fact that CINAHL is the database that provides indexes for more than 3075 nursing and allied health journals providing a wide variety of authentic and reliable options to choose from while finding literature evidences. Researchers are of the opinion that CINAHL is the most widely used and respected researching tool for the nurses, students and allied health professionals across the world (Hill 2009). It covers nursing, biomedicine, health sciences librarianship, alternative or complementary medicine, consumer health and 17 other allied health disciplines and has more than 2.3 million records that goes back to 1981.

Chosen Search Strategy

The search began with a single phrase to optimize the number of results and the first search item utilized the search phrase “Mental illness” which had resulted in 28762 results and there had been no limiters used for the first search. To narrow down the results gradually, the next search item included two phrases with respect to the research question and use of one boolean operator ‘AND’ along with the truncation of “nurses” which got 1592 results. The next research  included three phrases “Mental illness”, “mental health service users” and  “Nurses” using two Boolean operators (AND and OR) and limiting the time frame from 2008 to 2018 which helped to narrow down the results to 272 results. Next the search was limited for finding papers relevant to the research question which further narrowed down the search to 33 results and the search used a different set of search phrases including “
mental illness”, “physical health needs”, and “Nurses” using two Boolean operators AND. Lastly, to further narrow down the focus to relevant papers same search phrases and two Boolean operators AND were used with limiter of 2008-2018, this yielded 11 results. Lastly, to further narrow down the focus on UK specific studies, the limiter or UK and Ireland was used with same search items which helped find 6 relevant and authentic papers which have been reviewed in the assignment below.

Article 1:

Healthcare professionals should examine patient’s physical health condition properly since they are suffering from mental illness. This article report that there is lack of efficiency of healthcare professionals and their education is insufficient to address the physical health of patient who is suffering from serious mental illness (SMI). Researchers pointed out that there is a necessity to develop education for registered nurse as well as other health care professionals. They should provide apposite interventions to patients with SMI and should maintain a regular physical checkup of their health. They mentioned that there is a lack of understanding between patient and professionals and hence any changes in the outcome of the patient is difficult to determine. They also pointed out some question that if the secondary care setting is effective enough to modify life style factors like poor diet, lack of physical activities and tobacco smoking. This article talked about Well-being Support programme where patient undergone six meetings with a nurse professional. The result of this programme is encouraging (Hardy el al. 2011)

Limitations of Healthcare Professionals in Addressing Physical Health Needs

Article 2:

It has been observed from many relevant research that the physical health requirements are neglected in case of patients suffering from serious mental illness. In this aspect Mental Health Nurses (MHN) have a crucial role in fulfilling their needs. During admission of these patients in hospital, nurses have a particular role but they are uncertain about this. They lack in their levels of confidence and have inappropriate skills and trainings. This article explains some role of MHN. The primary role of ward doctor and MHN is the assessment of patient’s medical history and health care activities. They should undertake regular physical health checkups like measuring patient’s weight, their blood pressure and pulse rate. They should also assess the adverse effects of medications that the patient is undertaking. Proper assessment of lifestyle factor is also required that includes smoking habits, diet and oral care. The ward doctor should take the responsibility of assessing the sexual health of the patient with SMI. Another aspect is the level of confidence of nurses. They should be confident while providing care management, undertaking physical examination like vital signs, during urinalysis and measuring the blood glucose levels. Their confidence level should be high while assessing side effects by using formal adverse effect assessing tools (Howard and Gamble 2011).       

Article 3:

Mental disabled people who are suffering from bipolar disorder and schizophrenia are more prone to get affected from a variety of physical health issues like diabetes and cardiovascular diseases. Their life span is less as compared to normal population due to these health issues. Services given by health care professionals is insufficient to address their problem because of less frequency in monitoring these people with SMI. This article developed a physical health improvement profile for patient with SMI that helped mental health nurses to measure the physical health issues properly and directed them towards interventions that are evidence based for addressing the identified health issues in detail. This health improvement profile pointed out some parameters like pulse rate, body mass index, teeth, blood pressure, temperature, liver function test, urine, lipid levels, sleep, diet, alcohol and fluid intake and many others. If the value of these parameters falls outside the normal or healthy range, then this should be enlisted in an isolated column with a mark that will give an indication to later discussion with patient. The proper assessment of these parameters helped nurses to determine the physical health issues properly. For example, rise in body temperature is a sign of a sporadic but potentially lethal neuroleptic malignant syndrome. Similarly, increase in lipid profile range may results into hyperlipidaemia that is a precise risk factor of cardiovascular disease for this population. Teeth parameter as mention in HIP denotes the frequency of dental checkups. If patient lacks in the frequency of checkup then nurse should support him to attend a dentist (White, Gray and Jones 2009.).

Development of the Physical Health Improvement Profile

Article 4:

This article examined physical health related issues on ageing persons with intellectual disabilities (ID). This specifically focus on the cardiovascular which is prevalent among ID patients. Beside this hypertension, gastro esophageal reflux disease (GERD), Musculoskeletal conditions like osteoporosis, some oral health conditions like caries, gingivitis, periodontal disease are also seen in ID patients with ageing. Some lifestyle health risks are tobacco use. This exposure is frequent among adults who are having severe ID. Overweight, and obesity increases cardiovascular risk, metabolic and pulmonary diseases. The risk of osteoporosis also increases with obesity and this is high in adult people with ID. Some interventions and recommendations based on lifestyle risk factors are also mentioned in this article. These include regular physical activity that may decrease osteoporosis, coronary heart disease, hypertension, diabetes, obesity, type 2 diabetes, constipation. ID patients lack motivation, self-efficiency and expect poor outcome and these serves as key barriers during participation in regular exercises. Health professionals should motivate and encourage them to participate in this activity for their betterment. Some assessment and interventions for oral conditions includes poor treatment and oral care as compared with general population. It is the responsibility of the caregivers and health care professionals to provide an annual dental checkup for the identification of the oral disease. They should also assist children, adult as well as aged people to take care for their teeth and gums properly (Haveman et al. 2010).       

Article 5:

As compared to general population, people having serious mental illness are more likely to cause physical health problems. Mental health nurses occupies the prime position in the reduction of unacceptable death amongst this population. This research article highlights the role of healthcare professionals in improving the condition of physical health of people in UK who are having serious mental illness by intervening and gaining proper knowledge. They founded that mental health care nurses are not regularly involved in gaining knowledge about the physical health problems. The setting of healthcare is poor, primary-secondary care is not sufficient to meet the needs of this vulnerable population. Researchers identified lack of communication between health care services and the knowledge and training in health care is not sufficient to educate them. They founded out some efforts to enable MHN to assess patient having serious mental health properly. Well-being support Programme (WSP) in UK was set up in secondary care group individually where a nurse advisor was appointed who was competent to screen the physical health requirement of the people. These nurses prepared a register for patients with serious mental illness that provides health promotion advices, management of weight and physical active groups. They identified the training needs of both primary and secondary health care needs.  MHN needed to have positive attitudes in changing their role and motivating patient to progress their outcomes of health. There is a need to change the philosophy of the effort of mental health service and further research will inspect the approaches of MHN with respect to their health care role to improve clinical practices (Blythe and White 2012).

Role of Mental Health Nurses in Addressing Physical Health Needs

Article 6:

Mental health problem is major cause of more physical health issues and premature death as compared to general populations. This article pointed out the fact that registered mental health nurses in UK should be well armed in therapeutic clinical services. They should able to deliver a wide range of psychological mediations, should have skills in building relationships with patient and should be efficient in interpersonal communication. This article also identified specific issues within inpatient setting like negative attitudes and lack of enthusiasm. These issues are required to address and proper education and training is required. Some other issues are short-staffing, turnover of many staff and low level of staff confidence. Unless and until these issues are addressed and taken seriously, no productive investment will be possible for training and educating staff. The service users should have meaningful interactions with mental health nurses and should desire a consistent relationship. There is a requirement for further research planning for identifying active mechanism to eliminate these issues (Bee et al. 2008).

It has to be understood that for any patient population with a mental disability, their physical health is not addressed to the optimal manner in the care planning and implementation procedure. As my practice scope is centered on providing care to the mentally disabled patients including black afro service users, the communication gap and other related cultural factors have a considerable impact on the care planning of their physical health needs which they almost can never express properly. It has to be mentioned that the impact of cognitive disability has a huge impact on the living condition and physical wellbeing of an individual; they often cannot communicate or understand their health needs, have self care deficit, and can participate in various feuds which can lead to various physical health concerns for the mental patients. The lack of effective and culturally competent communication strategies and resilient, compassionate approach is very important for exploring and addressing their various physical health needs. People with mental disability are more prone to experience deprived physical health condition as compared to normal people present in general population (Howard and Gamble 2011). The major life style factors that are responsible for the poor health condition of mentally disabled people are low levels of exercises, poor and unhealthy diet and nutrition, high levels of cholesterol, improper dental care, and tobacco smoking. Other factors are psychotropic medication, psychosocial issues, alcohol, and usage of illegal drugs. These all contribute to the occurrence of higher incidence of metabolic disturbances like type 2 diabetes and cardiovascular disease. Stanley and Laugharne (2014) suggested that mentally disabled people are more likely to perform sporadic physical activity as compared to constant physical activity. These people also have poor dietary habits like foods rich in saturated fats that again contribute to their obesity. This poor diet condition is also related to high levels of cholesterol which in turn results in Cardiovascular disease. Researchers suggested olanzapine and clozapine are responsible for dyslipidemia. Dental care is also very poor in case of disabled people. They often found to have bad odoured, ulcerated and bleeding mouth. The shortcoming of this article is that it gives a general overview of lifestyle factors that are responsible for physical illness of mental disabled people. Hence there is need for more research and training to help educate the nurses for better physical health assessment along with proving mental health care. Conradie et al. (2017) in support suggested that more research is required to understand these patients mental condition completely in order to provide them enough guidelines and recommendations .

Conclusion

This evidence based search discovered various qualitative, quantitative and systematic review articles in the research out of which only 6 relevant UK based articles were selected that focused on the physical health needs of the mentally disabled service users. The first article focused on the lack of education and knowledge in the mental health care providers in addressing the physical health needs of the mentally disabled. The next article focused on the uncertainty, confidence and expertise in addressing physical health needs rather than mental health needs. The third article provided understanding of how assessment protocol, tools and parameters can help nurses address physical health needs of mental patients more effectively, which undoubtedly is a very important insight. The fourth article focused on oral health as a part of physical health needs which is often compromised in mentally ill patients with encouraging and assisting strategies to help them. The last two articles helped highlight the role of healthcare professionals in improving the physical health condition of mental patients in UK by intervening and gaining proper knowledge and the need for registered mental health nurses in UK to be well armed in therapeutic clinical services as well. All of the selected studies have helped me understand the barriers to better understanding of the physical health needs and the training needs for addressing them better. It can be hoped that it will help me exponentially in my future practice to communicate compassionately and with cultural competence.

Conclusion:

Nursing is a professional that is associated with continuous development and change, there are various amendments and alteration in the practice standards and technologies that the nursing professionals will have to comply to in order to be able to provide safe and effective patient centred care for the patents that adheres to each and every practice guideline, policies, and protocol provided by the local and global health authorities. It has to be mentioned here that an excellent tool for the nurses to be able to do this is to adapt evidence based practice. This study has helped me discover the use of evidence based practice to explore a crucial public health issue of how to better address the physical health needs of mentally ill patients. The entire experience has enabled me to understand the need for skill enhancement, training and change in care approach and philosophy. 

References: 

Bee, P., Playle, J., Lovell, K., Barnes, P., Gray, R. and Keeley, P., 2008. Service user views and expectations of UK-registered mental health nurses: a systematic review of empirical research. International journal of nursing studies, 45(3), pp.442-457.

Blythe, J. and White, J., 2012. Role of the mental health nurse towards physical health care in serious mental illness: An integrative review of 10 years of UK literature. International Journal of Mental Health Nursing, 21(3), pp.193-201.

Conradie, M., Erwee, D., Serfontein, I., Visser, M., Calitz, F.J. and Joubert, G., 2017. A profile of perceived stress factors among nursing staff working with intellectually disabled in-patients at the Free State Psychiatric Complex, South Africa. Curationis, 40(1), pp.1-8.

Hardy, S., White, J., Deane, K. and Gray, R., 2011. Educating healthcare professionals to act on the physical health needs of people with serious mental illness: a systematic search for evidence. Journal of Psychiatric and Mental Health Nursing, 18(8), pp.721-727.

Haveman, M., Heller, T., Lee, L., Maaskant, M., Shooshtari, S. and Strydom, A., 2010. Major health risks in aging persons with intellectual disabilities: an overview of recent studies. Journal of Policy and Practice in Intellectual Disabilities, 7(1), pp.59-69.

Hill, B., 2009. Comparison of journal title coverage between CINAHL and Scopus. Journal of the Medical Library Association: JMLA, 97(4), p.313.

Howard, L. and Gamble, C., 2011. Supporting mental health nurses to address the physical health needs of people with serious mental illness in acute inpatient care settings. Journal of Psychiatric and Mental Health Nursing, 18(2), pp.105-112.

Melnyk, B.M. and Fineout-Overholt, E. eds., 2011. Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B. and Williamson, K.M., 2010. Evidence-based practice: step by step: the seven steps of evidence-based practice. AJN The American Journal of Nursing, 110(1), pp.51-53.

Reynolds, S., 2008. Evidence-based practice: A critical appraisal. John Wiley & Sons.

Stanley, S. and Laugharne, J., 2014. The impact of lifestyle factors on the physical health of people with a mental illness: a brief review. International journal of behavioral medicine, 21(2), pp.275-281.

Stevens, K., 2013. The impact of evidence-based practice in nursing and the next big ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), p.4.

White, J., Gray, R. and Jones, M., 2009. The development of the serious mental illness physical Health Improvement Profile. Journal of psychiatric and mental health nursing, 16(5), pp.493-498

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