Background and Problem Statement

In acute mental health settings, there is prevalence of deteriorating physical health problems in severe mentally ill (SMIs) patients. Various contributing factors have an impact on their physical health like lifestyle choice, psychotropic medications, psychiatric symptoms and disparities in health care (Unsworth, McKeever and Kelleher 2012). SMI patients suffer from physical diseases like bacterial infection, neoplasm, respiratory tract diseases, cardiovascular and nutritional diseases. The recognition and addressing the deteriorating specific physical health needs of SMI patients is crucial and considered a significant problem (Cooper et al. 2011). MHNs need to develop knowledge and skills to assess and manage the physical health needs of the SMI patients.

This is an important nursing issue, as MHNs need proper training and skills to address the physical health needs of these patients in acute inpatient mental health settings. There is difference in the confidence and willingness to take up the role of physical health carer as the healthcare professionals neglect it (Liaw et al. 2014). Nurses are uncertain about their role in meeting the physical needs and require appropriate skilled training and role clarification. Individuals with SMI experience poor physiological health problems in acute inpatient setting as compared to the general population (Chua et al. 2013). Therefore, MHNs working in these acute settings should undertake training and skill development to address these needs and provide overall well-being to the SMI patients.

CASP Appraisal Tool for Qualitative Research

1. Was there a clear statement of the aims?

The research goal was to investigate the perceptions and views of mental health nurses (MHNs) in the mental health management and practices for acute inpatients in these settings. The research is also aimed at determining the role of MHNs in the assessment and management of physical health needs of the patients, ascertain the MHNs confidence for the physical health assessment, and care management. It is also aimed at identifying the education and training needs of MHNs required for SMIs. This thought was important, as there is physiological deterioration in the severally mental ill patients in acute mental health settings. It is important for the nurses to understand the physical health needs and provide appropriate interventions in addressing them for ensuring quality health and safety in health and social care (Mackintosh, Rainey and Sandall 2011). This study is relevant as the paper addresses the attitude and training skills of the MHNs in addressing physical needs of the patients.

1. Is a qualitative methodology appropriate?

The researcher interpreted the attitudes of the nurses in the research in acute mental health settings in the addressing of physical health needs of SMIs. It is the right methodology for addressing the research goal like self-reported questionnaire and audit of case studies. These methods identified the perceived of MHNs with respect to physical health and confidence in reviewing the physical needs of patients.

1. Was the research design appropriate to address the aims of the research?  

Research Methodology

The research design was appropriate as it illustrated the perceived of MHNs in reviewing the physical health needs of the severally mental illness in acute mental settings. Self-reported questionnaire and audit of case studies were used to examine the confidence and attitude of the MHNs in addressing the physical health needs and compliance towards required training.

1. Was the recruitment strategy appropriate to the aims of the research?  

The researcher has explained the sample size for the study from six acute wards in acute inpatient care settings. The wards were of mixed sex and nurses were recruited irrespective of their gender, experiences and age. The chosen sample was chosen based on the qualifications and unqualified staffs were excluded from the study.  

1. Was the data collected in a way that addressed the research issue?

The data collection was justified as it was made clear in the paper through a self-reported questionnaire and audit of case notes that the descriptive survey design is. Newly data collection tools were developed for the study, as there was no existing questionnaire found. This new tools were critically reviewed by the expert panel that consisted of Consultant Nurse, Trust physical health policy, doctorate student, mental health lecturer and senior statistician. The form of the data was clear and there was no saturation of data because the sample size was mixed irrespective of gender, age or experience.

1. Has the relationship between researcher and participantsbeen adequately considered

There was formulation of the research questions that addressed the research aims of investigating the views and practice of RN in mental health wards for physical health assessment and care management for the SMI adults in acute mental health inpatient settings. The data was collected through self-reported questionnaire and audit of case studies that showed the views of the nurses towards physical health needs and assessment of SMIs in acute settings. The choice of location was London, UK where records of the patients were taken who were for at last 1 week in wards where LH (first author) was employed as Physical Health Lead Nurse.

1. Have ethical issues been taken into consideration?

There were ethical considerations as the research study was registered with Trust’s Ethics Committee, Research, and Development Committee and approval granted. Prior permission was taken from the wards managers before accessing nurses on the wards. Department of Health Research Governance guidelines (2005b) and the Data Protection Act (1998) was considered throughout the study.

1. Was the data analysis sufficiently rigorous?

The data was analyzed that supported the research aims, as response rates were impressive of the nurses were high. It showed that nurses are willing to take the health care assessment role with proper training and supervision. There was no diversification in the study findings. The results illustrated that proper embracement of skills and training can help to overcome barriers and undertake the physical health management of the SMI patients.

1. Is there a clear statement of findings?

Data Collection and Analysis

The evidence findings were in favour of the researchers as they are adequately discussed. The findings showed that MHNs are willing to participate in the physical health assessment role and address the needs of the SMIs. There was also clear difference between the perceived responsibility and practice of MHNs for the role clarification and skill training to take up the physical health care role and address the physical needs of the SMIs.

1. How valuable is the research?

The research is valuable as physical health assessment and training of the mental health nurses is important to address the deteriorating physical health needs of the SMI patients. In acute inpatient mental health settings, severely mental illness patients are subjected to deterioration of physical health along with mental health status. This is a major nursing issue in mental health Therefore, this study added to the existing knowledge and helpful as it provides a framework for the need of physical health assessment and skill training of the nurses to address the physical needs of the mentally ill patients in acute settings (Scott and Happell 2011).

1. Were the criteria for inclusion in the sample clearly defined?

The criteria for inclusion is not clearly defined in the paper as it mentioned only the sample size that comprised of 585 qualified nurses in a large NHS workforce in a mental health setting. They hypothesized the nurses in the sample size have an additional qualification as RN/RGN nurses as they work in inpatient settings rather than community. They also assumed that the nurses in sample size have already received training in the physical health care of the mentally ill patients with great confidence and positive attitudes.

1. Were the study subjects and the setting described in detail?

Yes, the study subjects were defined along with the setting. The sample size comprised of qualified mental health nurses (MHNs) where 52% (n=585) responded variably towards physical health practice selected from National Health Service (NHS) Mental Health Trust in UK. The sample size was hypothesized where they are RN/RGN in inpatient rather in community settings along with received training in physical health care for the severe mentally ill patients.

1. Were objective, standard criteria used for measurement of the condition?

During the selection of the sample size, they hypothesized a standard criterion that the nurses’ sample are highly qualified and have an additional qualification as adult RGN/RN. They also assumed that they are well-acquainted in working in inpatient mental health setting rather than community setting and are trained in providing physical health care to the severe mentally ill patients and possess positive attitudes and confidence in this particular area of practice. This shows risk of bias and there is matching of the key characteristics that fulfil the objective criteria.  

1. Were confounding factors identified?

Results and Findings

Confounding factors are difficult to judge where the attitudinal, behavioural or lifestyle factors are being studied that have an impact on the outcome or results. This paper did not identify any confounder as there were no comparison groups involved and bias was not affected by any factor.

1. Were strategies to deal with confounding factors stated?

The strategies to deal with the confounding factors were dealt with the study design and data analysis. The confounding factor was adjusted by using cross-sectional study and was adjusted during the stratification and matching of the sample size. Multivariate regression analysis is used for the measurement of confounding factors in this study to examine the associations between attitudes and practice.

1. Were the outcomes measured in a valid and reliable way?

The measurement tool that was used for this study was validated and had a significant impact on the outcome assessment validity. The psychometric testing stage called Physical Health Attitude Scale for Mental Health Nurses (PHASe) was used that consisted of postal questionnaire of 585 nurses sample recruited from NHS workforce in UK.  PHASe is standardized questionnaire that elicited clinical practice, demographic and training characteristics. This shoes that there was validation in the outcomes measured in the study.

1. Was appropriate statistical analysis used?

Multivariate regression analysis was used as the statistical method for the study. The predictors that were analyzed go relate to the outcome were physical healthcare practice, positive attitudes amongst the sample. The confidence for practicing healthcare was found to be related to four variables; RGN qualification, inpatient sets, male sex and perceived before physical health training. The appropriateness of multivariate regression analysis is that it helps to predict the unknown value from known value of predictors or variables.

1. Did the review address a clearly focused question?

Yes, in the review the nursing issue has been discussed where the MHNs work in acute settings with deteriorating patients and unpredictable events. Nurse-patient interaction has been focused in the study that is important in this challenging setting for the interaction between the inpatients and MHNs. The outcome of the search is that 23 papers have been selected out of 425 in reliable databases CINAHL and PsycINFO.

1. Did the authors look for the right type of papers?

The review’s question is to summarize the literature in acute inpatient mental health settings focusing on the communication between inpatients and MHNs. There is an appropriate study design for the review through inclusion and exclusion criteria. For the inclusion, English papers that were peer-reviewed and studied the nurse-patient interaction in acute inpatient mental health settings since 1999 and follow qualitative methodology containing aims, methods, results and discussion.

1. Do you think all the important, relevant studies were included?

Reliable databases were used for the study through electronic searching through PsycINFO, CINAHL, Ovid Medline. All peer-reviewed papers published since 1999 in English language were added that discussed the nurse-patient interaction and contain followed qualitative methodology.

1. Did the review’s authors do enough to assess the quality of the included studies?

Discussion and Implications

There was no rigor of study in the review, authors adhered to the specific perspective of nurse-patient relationship, and there is thoroughness in collecting data as the authors have collected the relevant information by critical search through reliable databases. Through the inclusion and exclusion criteria, the authors selected 23 papers out of 425 and limited their search the fulfilled the research question criteria.

1. If the results of the review have been combined, was it reasonable to do so?

As the inclusion criterion was explicitly discussed, the results were similar in all the papers and there was no scope for variations. The review results showed that nurse-patient communication is important that involves interpersonal approaches exemplifying personal skills and developed communication for the acute and challenging mental health setting.

1. What are the overall results of the review?

Yes, through the review the author explained the research questions and thematic analysis was used to express the results. In this meta-synthesis of qualitative study, it revealed that there existed interpersonal challenges and risk taking among the nurses in mental health settings to achieve the patient outcomes. It is an important parameter to provide patient-centred care.

1. How precise are the results?

As this is a systematic literature review, there is no use of confidence intervals.

1. Can the results be applied to the local population?

The important limitation of this paper is that some of the themes studied have small sample size limiting the generalization to other population settings and general contexts due to lack of interpretations.

1. Were all important outcomes considered?

From the qualitative review, it is evident that nurse-patient interaction is important for the nurses to provide patient-centred care in acute mental health settings. It is the corner stone and crucial in addressing the physical needs of the severe mental illness patients (SMIs).

1. Are the benefits worth the harms and costs?

The benefits were worth the costs and harms. The study of nurse-patient interaction is important as it paves way in providing patient-centred care in acute inpatient mental health settings and in addressing the psychosocial needs of the SMIs.

The original research question was that to provide health care management to the physiologically deteriorating mental ill patients by mental health nurses. After conducting the qualitative, quantitative and systematic review, the information provided by the three articles are beneficial as it shows that MHNs are willing to address the physical health needs of the SMIs, although there was disparity in the perceived tole and confidence in addressing them. The results also suggested that proper training and skill enhancement is required for the MHNs for recognizing the physical health needs and their role clarification in addressing them.  

The nurses possess positive attitude and response in addressing the physical health needs of the SMIs; however, they lack proper training and skill development in addressing them. In the systematic review, it illustrated that nurse-patient interaction is important in these acute challenging settings to address the overall patient-centred care to the SMIs. This would also suggest that for the safe care delivery in these unpredictable and challenging settings, MHNs should hold an ideal position and promote their healthy living. MHNs have the responsibility to improve the physical health needs of the SMIs to provide overall well-being of SMIs. These findings are significant and provide scope for future studies to provide training to nurses to allow them take the role of physical health carer.

References

Chua, W.L., Mackey, S., Ng, E.K.C. and Liaw, S.Y., 2013. Front line nurses’ experiences with deteriorating ward patients: a qualitative study. International nursing review, 60(4), pp.501-509.

Cleary, M., Hunt, G.E., Horsfall, J. and Deacon, M., 2012. Nurse-patient interaction in acute adult inpatient mental health units: a review and synthesis of qualitative studies. Issues in Mental Health Nursing, 33(2), pp.66-79.

Cooper, S., McConnell-Henry, T., Cant, R., Porter, J., Missen, K., Kinsman, L., Endacott, R. and Scholes, J., 2011. Managing deteriorating patients: registered nurses’ performance in a simulated setting. The open nursing journal, 5, p.120.

Hert, M., Correll, C.U., Bobes, J., Cetkovich?Bakmas, M.A.R.C.E.L.O., Cohen, D.A.N., Asai, I., Detraux, J., Gautam, S., Möller, H.J., Ndetei, D.M. and Newcomer, J.W., 2011. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World psychiatry, 10(1), pp.52-77.

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.

Liaw, S.Y., Zhou, W.T., Lau, T.C., Siau, C. and Chan, S.W.C., 2014. An interprofessional communication training using simulation to enhance safe care for a deteriorating patient. Nurse education today, 34(2), pp.259-264.

Mackintosh, N., Rainey, H. and Sandall, J., 2011. Understanding how rapid response systems may improve safety for the acutely ill patient: learning from the frontline. BMJ Qual Saf, pp.bmjqs-2011.

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

Scott, D. and Happell, B., 2011. The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness. Issues in mental health nursing, 32(9), pp.589-597.

Unsworth, J., McKeever, M. and Kelleher, M., 2012. Recognition of physical deterioration in patients with mental health problems: the role of simulation in knowledge and skill development. Journal of psychiatric and mental health nursing, 19(6), pp.536-545.