The World Health Organization defines health as the “state of mental, physical, emotional, social wellbeing” and hence not just the absence of a disease (World Health Organization, 2011). Mental illnesses are conditions that affect the behaviors, actions, feelings and thoughts of an individual. Being mentally healthy means that an individual has the ability to capably manage life and deal with the various life challenges. While feelings such as sadness, disappointment, confusion and loneliness are normal, a mentally disabled person normal has the inability to feel or control such feelings. There is a wide range of mental conditions some of which are common among individuals and others that are rare. Two of the most common mental illnesses are depression and anxiety. Schizophrenia is a much rare form of mental illness. Some people suffer from a single episode of a certain mental condition while others are affected for the most part of their lives. Persistent mental illnesses require a long-term care support. In addition, some individuals are severely affected such that they are unable to perform activities independently. Fortunately, there is a wide range of treatments that are available for mentally ill patients which have been designed to improve their quality of life. Mental illnesses such as schizophrenia and depression can be managed effectively using antidepressant medications. Mentally ill patients require specialized care from family members and healthcare professional. Below is a systematic review of various research articles that include studies based on mental illnesses and mental health. The paper will evaluate the articles and establish the impact that the information presented has on nursing practice and care.
Marx, Duffort, Scerpella, Samus & Gitlin (2017), conducted a research study which focused on evaluating the various non-pharmacologic interventions that were previously utilized in studies that were conducted between 1990 and 2017 in managing neuropsychiatric symptoms (NPS), as well as mental health issues among residents living in assisted living facilities (ALFs) and nursing homes with s similar setting. According to this study, there are two major mental health disorders whose prevalence is considerably high: depression and NPS. Neuropsychiatric symptoms include wandering, rejection of care as well as aggression. The study further states that most facilities treat these symptoms with antipsychotic medications, which may cause detrimental adverse effects especially on patients suffering from dementia. The main objective of the paper is therefore to establish the role that non-pharmacologic interventions play in care of residents living in ALFs. Articles included in this study were searched from various databases and the inclusion criteria was based on three elements; studies conducted on an ALF or a similar setting, studies based on description of non-pharmacologic interventions and studies that reported outcomes for depression and NPS. The search results produced 174 research articles, 64 of which were duplicates leaving 111 articles. After application of the inclusion criteria, the study was conducted using 13 studies which had met the criteria. The study examined a number of non-pharmacologic interventions that were carried out in the 13 studies; music therapy, life review, activity engagement, animal-assisted therapy, aroma therapy, staff training, snoezelene and multi-component. The finding of the study established that the evidence that non-pharmacologic interventions have a significant benefit in managing mental health issues in patients living in ALFs is limited. However, results indicated that some interventions such as activity engagement and music therapy have more positive effects than other interventions such as staff training. One major limitation that this study had was the fact that there are multiple terms that are used to refer to ALFs. Some of the terms include: “care and support homes” and “sheltered housing”. From the study, it was concluded that incorporating some evidence-based interventions in management of mental issues affecting residents living in ALFs, can actually improve the health outcome of these individuals. Development of new interventions can also be crucial.
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Noghani (2016) conducted a study that was aimed at exploring the effects that living with people suffering from mental disorders had on the quality of life (QoL) of family caregivers. The study claims that recent advances in the medical field have resulted to improved treatment measures which consequently lead to early discharge of patients from hospitals. When mentally ill patients are discharged early, it’s the responsibility of family members and caregivers to care for them. According to this study, the health of caregivers is as important and should be considered as well. The main research question raised by the researchers of this study is whether caring for mentally ill patients compromises the health of their caregivers. This descriptive-analytical study was conducted in Iran where caregivers and their mentally ill family member from six psychiatric centers were selected randomly. Inclusion criteria was based on selection of patient whose diagnosis had taken place more than six months earlier, patients not younger than 18 years and those not older than 65 years, individuals not suffering from any type of a chronic disease; mental or physical. Those excluded from the study were assistant caregivers and those that were unable to respond to certain question asked such as questions involving quality of life. The sample size used was 199 and the designed questionnaires were responded to by caregivers. Questions from the questionnaire were based on demographics as well as eight subscale indicators for QoL. These subscale indicators were; bodily pain, general health, vitality, role limitation physical problems, role limitation emotional problems, mental health, sexual functioning and physical functioning. The collected data was analyzed using t-test and ANOVA and results from the study were published. Research findings established that the QoL of family caregivers of mentally ill patients was considerably lower in accordance with Iranian Community Standards. The diminishing individual health ultimately leads to poor family health. The study failed to consider certain aspects such as the severity of the illness, differences among caregivers and their emotional state.
Dam and Hall (2016) conducted a metasyntesis research study which explored the life that children who live with their mentally ill parents experience. This was done by examining certain previously conducted studies conducted to establish this phenomenon. The study however indicates that there is no study in existence which explores children’s own experiences. It has been established in the study that recent medical advancements have resulted to more open psychiatric care where patients are allowed to spend considerable amounts of time with their children. This has consequently lead to increased interest of establishing whether children of such parents are positively or negatively affected by living with their parents. With the design being a qualitative research synthesis, the steps for conducting the study were; synthesis conception, literatures search and retrieval, classification and appraisal of findings, synthesis of findings into metasummaries and metasynthesis. Literature search was conducted from databases such as PubMed, CINHAL, Google Scholar and Scopus and studies included were those conducted between 2000 and 2013. A total of 22 reports were used in the study. Appraisal and classification of findings was done using the Critical Appraisal Checklist for Interpretive and Critical Research. Data was analyzed and synthesized, and the findings were recorded. The results from this metaanalysis indicate that most children living with their mentally ill patients live in a world where thy have to conceal their lives while coping with it and caring for their parents as well. The study found out that to an extent. These children live in a paradoxical life where thy have to keep a considerable amount of distance from their parents while remaining close to them at the same time. The life of these children therefore revolved around being a responsible as well as a worrying carer, being a concealer, being responsible for roles, blaming oneself, feeling shame and sorrow, suffering social stigma and bullying as well as having wishes and wants. This therefore suggests that these children live in an unpredictable life, one which they have no idea what could happen next. Lack of a trained librarian to assist in searching of literature was a main limitation. Implications of this study are that children living with mentally ill parents require additional healthcare services from social workers as well as healthcare workers.
Silva Kurimoto, Mattos Penna, & Nitkin (2016), conducted a research study on mental health nursing care, whose main objective was to use Lacan’s concept of the subject of the unconscious, and thereby create an understanding of mental health nursing care. Two research questions emerged from the study; “What knowledge on nursing care could or can be constructed? What principles and care devices could or can be constructed?” This study was therefore focused on trying to provide answers to these questions. A snowbell sampling technique was used and 19 participants (nurse) were selected. The nurses were interviewed, where they provided detailed narratives with regards to their experiences while working with psychotic patients. Data was collected in form of audios and videos, which were then transcribed. The narrations were later analyzed, interpreted and presented. The results of the study establish that professionals should care for the mentally ill by not instilling their knowledge on them. The Freudian and Lacanian psychoanalysis theories were used to describe nursing care acts while distinguishing it from spirit of fineness. The nurses basically described various care activities that produce care effects. While the study was successful in establishing how language affects care, use of narratives is limitation itself, because, care is beyond language.
Magnee, Beurs, Schellevis, & Verhaak (2018), carried out a research study whose main purpose was to investigate how the national introduction of mental health nurses affected the prescription of antidepressant medications by Dutch general practitioners (GPs). For patients presenting with anxiety and depression, the first choice of treatment is not prescription of antidepressant medication, but rather, activities such as psychoeducation and counselling. If these should be ineffective, then its only rational to prescribe antidepressants. However, most (GPs) do not follow these guidelines and as a result there have been an increase in antidepressant prescriptions. To improve sustainability of mental health care, the Dutch introduced a reform in 2014, where mental health nurses were introduced in the system. This study therefore examined a two-year trend of antidepressant prescriptions by Dutch GPs. In addition, trend of prescription for patients with mild symptoms and those with disorders. Finally, the study evaluated whether mental health nurses were responsible for a decrease in antidepressant prescription by GPs. An observational method of study was used where an analysis of electronic general practice medical records between 2011 and 2015 were made. The sample size was 74 and involved patients aged between 10 and 65. Data was recorded based on the number of depression and anxiety episodes that an individual had over time as well as the type of antidepressant medication prescribed. Regression analysis was used to analyze and interpret data and findings showed that in 2015 there were fewer antidepressant prescriptions as compared to 2011. However, employment of mental health nurse had no association with decreased prescription of antidepressants. A major limitation of the study was the fact that it was an observation study and hence making conclusions on causal effects would not have been possible.
Mey, Çömlekçi, Reuver, Waard, Gool, Scheerman, & Meijel (2015), conducted a research study which was aimed at establishing the effects of education intervention on oral health on both mental health nurses and patients suffering from mental disorders. The hygiene practices of people suffering from mental health illnesses has been a topic of discussion for a number of years. The study was carried out in Netherlands in a mental organization, amongst nursing staff and patients, and participants included 68 nurses and 27 patients. A 20-minutes PowerPoint presentation was used to educate the nurses where a number of topic were covered including oral health, dental diseases, oral care as well as factors related to oral health such as smoking and alcohol. Education for the patients involved a hand-on experience where an oral examination was done on the patients who were later given a toothbrush and toothpaste which they used to brush their teeth. Instructions were given on a tell-show-do method, s the hygienist observed how the patients were responding. Data on the nursing staff intervention was collected before and after five weeks, where a 20-multiple choice questionnaire was used. This was designed to access self-developed knowledge. Data collection among the patients involved filling a questionnaire and evaluation of individual oral health through oral examination. Serious conditions were referred to a dentist. Pretest measurements were conducted on dental plaque and gingival bleeding and for weeks later posttest measurements were performed on the same. The finding of the study indicated that intervention among the nurses produced positive results and improved self-knowledge about dental health. There were also positive patient clinical outcomes after the intervention.
It is without doubt that mental health issues are serious illnesses that require accurate diagnosis, accurate treatment and specialized comprehensive care. Some patients have a difficulty in observing their own hygiene and for this reason, mental health nurses are very important. Incorrect diagnosis of a mental illness can put an individual on long-term medications which produce adverse effects in the long run. The conditions ranges from mild symptoms that are adequately treated and eliminated to more serious conditions that require an individual to live in an ALF. These facilities are specialized so that patients suffering from mental health conditions are taken care of comprehensively. However, the recent medical advancements have resulted to more open psychiatric care where patients are allowed to live at their homes with family members who are the immediate caregivers. In some instances, the patients are allowed to live with their children, which eventually affects the life of the child negatively. point worth noting is that mental health illnesses should not only be treated with pharmacologic agents, but should also be addressed using more safe methods such as psychoeducation and counselling.
The reviewed research studies have a great impact on nursing practice. Moreover, these studies have implications for nursing practice which range from more education for nurses with regards to oral hygiene and communication to the patients about their hygiene. More specialized communication skills and more specifically motivational skills are necessary when engaging with patients. In addition to this, the review has demonstrated that inadequate and improper diagnosis lead to irrational prescription of antidepressants which is harmful for the patients. Moreover, specific names should be given to ALFs, to ensure that they are not confused with other care facilities. At the same time, the review has provided an insight to the need of social worker and health care professions to determine the needs of caregivers who take care of the mentally ill, since their quality of life is normally too low. Finally, the review has established that patients with mental disorders have the capability of following simple instruction, and therefore engaging them in dialogues is an important aspect of care.
References
Dam, K., & Hall, E. O. (2016). Navigating in an unpredictable daily life: a metasynthesis on children's experiences living with a parent with severe mental illness. Scandinavian Journal of Caring Sciences, 30(3), 442-457. doi:10.1111/scs.12285
De Mey, L., Çömlekçi, C., De Reuver, F., Van Waard, I., Van Gool, R., Scheerman, J. F., & Van Meijel, B. (2015). Oral Hygiene in Patients with Severe Mental Illness: A Pilot Study on the Collaboration Between Oral Hygienists and Mental Health Nurses. Perspectives in Psychiatric Care, 52(3), 194-200. doi:10.1111/ppc.12117
Kurimoto, C. T., Penna, M. M., & Nitkin, R. K. (2017). Knowledge and practice in mental health nursing care. Good Practices and Fundamentals of Nursing Work in The Construction of a Democratic Society, 973-980.
Magnée, T., De Beurs, D. P., Schellevis, F. G., & Verhaak, P. F. (2018). Antidepressant prescriptions and mental health nurses: an observational study in Dutch general practice from 2011 to 2015. Scandinavian Journal of Primary Health Care, 36(1), 47-55. doi:10.1080/02813432.2018.1426145
Marx, A. K., Duffort N., Scerpella, N. L., Samus, Q. M., & Gitlin, L. N. (2017). Evidence-based Non-Pharmacologic Interventions for Managing Neuropsychiatric Symptoms and Mental Health Issues in Residents in Assisted Living. Seniors Housing & Care Journal, 71-83.
Noghani, F. (2016). Health Related Quality of Life in Family Caregivers of Patients Suffering from Mental Disorders. Journal of Clinical and Diagnostic Research. doi:10.7860/jcdr/2016/19671.8792
World Health Organization. (2011). Mental health beyond the crises. Bulletin of the World Health Organization, 89(5), 326-327. doi:10.2471/blt.11.040511
