Mental Health Report: Physical Health of SMIs in Acute Settings

This report examines the critical issue of mental health within acute inpatient settings, specifically addressing the deteriorating physical health of severely mentally ill (SMI) patients. It highlights the importance of mental health nurses (MHNs) developing the necessary knowledge and skills to assess and manage the physical health needs of these patients. The report includes a critical analysis using the CASP and Joanna Briggs Institute appraisal tools, evaluating the methodologies and findings of relevant research studies. The analysis focuses on the roles, attitudes, and training needs of MHNs in providing physical health care, as well as the ethical considerations and data analysis rigor of the studies. The report's key findings underscore the need for improved training and role clarification for MHNs to effectively address the physical health needs of SMI patients, ultimately contributing to their overall well-being in acute care settings.

Running head: MENTAL HEALTH
Mental health
Name of the Student
Name of the University
Author note

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Introduction, background and importance of issue
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.
Critical analysis and findings
CASP Appraisal Tool for Qualitative Research
1. Was there a clear statement of the aims?

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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.
2. 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.
3. Was the research design appropriate to address the aims of the research?
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

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attitude of the MHNs in addressing the physical health needs and compliance towards
required training.
4. 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.
5. 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.
6. Has the relationship between researcher and participants been 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

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patients were taken who were for at last 1 week in wards where LH (first author) was
employed as Physical Health Lead Nurse.
7. 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.
8. 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.
9. Is there a clear statement of findings?
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.
10. How valuable is the research?

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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).
Joanna Briggs Institute Critical Appraisal tool for the cross-sectional study (Quantitative
study)
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.
2. 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

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rather in community settings along with received training in physical health care for the
severe mentally ill patients.
3. 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.
4. Were confounding factors identified?
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.
5. 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.
6. Were the outcomes measured in a valid and reliable way?

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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.
7. 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.
CASP Appraisal Tool for Systematic review
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

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that 23 papers have been selected out of 425 in reliable databases CINAHL and
PsycINFO.
2. 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.
3. 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.
4. Did the review’s authors do enough to assess the quality of the included studies?
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.
5. If the results of the review have been combined, was it reasonable to do so?

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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.
6. 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.
7. How precise are the results?
As this is a systematic literature review, there is no use of confidence intervals.
8. 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.
9. 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).
10. Are the benefits worth the harms and costs?

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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.
Findings
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.

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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
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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
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