Journal Of Psychiatric And Mental Health Nursing – Annika Björkman Department of Public Health and Care Sciences, Uppsala University, Uppsala, Sweden; ; Faculty of Health and Professional Studies, University of Havel, Havel, Sweden. Correspondence to firstname.lastname@example.org http://orcid.org/0000-0001-9513-3102 , PhD, RN, Kaisa Andersson Faculty of Health and Occupational Research, Stu Gavle University, Gavle , Sweden , RN, MSc , Jenny Bergström Faculty of Health and Occupational Research, University of Gavle, Gavle, Sweden , RN, MSc and Martin Salzmann-Eriksson Faculty of Health and Occupational Research, University of Gavle, http Sc, Gavle //orcid.org/0000 -0002- 2610-8998, RN, Doctor of Philosophy
Patients with mental illness usually come to the health care facility through a registered nurse. Although research suggests that coping with and providing care to people seeking help with mental illness can be challenging, there is little research on how primary care nurses (PCNs) view the challenges they face. The purpose of this study was to qualitatively explore PCNs’ considerations regarding encounters with mental health care seekers in primary care settings. Findings included three themes: persistent experiences of patients failing, limitations due to lack of knowledge and resources, and establishing trusting relationships to overcome taboo, shame, and guilt.
Journal Of Psychiatric And Mental Health Nursing
Mental illness is prevalent in all countries and cultures, and approximately 20% of patients are associated with mental illness (Aczon-Armstrong, Inouye, & Reyes-Salvail, 2013; World Health Organization, 2016). The term “mental illness” is an umbrella term that includes a variety of conditions ranging from mild symptoms of anxiety to complex conditions such as psychosis, bipolar disorder, and major depression. The prevalence of mental illness is increasing in all age groups, both among men and women. Mental illness is more common among youth, women, and the unemployed (Alonso et al., 2004; Koochaksaraei, Mirghafourvand, Hasanpoor, & Bani, 2016). The prevalence of anxiety in Sweden has increased over the past 25 years, and approximately 25% of the population has experienced mental illness at some point (Calling, Midlöv, Johansson, Sundquist, & Sundquist, 2017). There is an enormous amount of unmet need related to mental health problems among people of all ages, placing great demands on the health care system and its organization (Abel, 2018). Patients suffering from mental illness are at risk of chronic disease and relapse and functional impairment if they do not receive appropriate treatment at an early stage (Hunter and Storet, 1994; Jansson and Fridlund, 2016). Early detection of mental illness is important because it allows for early treatment and a better prognosis (Alison, Nativio, Mitchell, Ren, & Yuhasz, 2014). Nurses play an important role in this as they are often a patient’s first point of contact with the healthcare system.
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In Sweden and many other Western countries, several professions provide care for patients with mental illness, such as physicians, social workers, psychologists, and registered nurses (RNs)/PCNs. Many patients with mental illness first seek help from their primary care physician (PHC). These contacts are usually made by telephone, with RNs answering the calls. Primary care providers are considered appropriate providers of psychiatric care (Cleary et al., 2014; Luoma, Martin, & Pearson, 2002). However, patients with depressive disorders express concerns about the ability of PMD providers to meet their mental health needs (Kravitz et al., 2011). Research has shown that patients with mental illness face many barriers when seeking medical care (Ali et al., 2017; Barney, Griffiths, Zorm, & Christensen, 2006; Gulliver, Griffiths, & Christensen, 2010; Kravitz et al. , 2011). . They perceive issues related to mental illness as stigmatized or taboo and fear the response of health care providers when seeking help for mental illness. Some patients report that they prefer to have a physical illness because it makes seeking medical care less embarrassing (Kravitz et al., 2011).
Several studies have shown that both health professionals and patients perceive mental illness as stigmatizing, taboo, and difficult to talk about (Björkman, Angelman, & Jönsson, 2008; Dardas, Bailey, & Simmons, 2016; Natan, Drori, & Hochman, 2015; Oates, Dray, & Jones, 2017; Tharaldsen, Stallard, Kuipers, Brew, & Bajastad, 2017). Both health professionals and patients with mental illness report negative attitudes toward mental illness (Hansen, Jormfeld, Swedberg, & Svensson, 2013; Mittal et al., 2014). This negative attitude is related to a lack of confidence in the opportunities that people with mental illness have in society, such as their chances of getting a job and social life. Health professionals working in physical care perceive patients with mental illness as unpredictable, intimidating and more demanding than other patients (Björkman et al., 2008). Lack of knowledge can make health care nurses fearful of patients with mental illness (Mabundla, 2000). Research has shown that nurses with a specialist degree in psychiatric care have more positive attitudes towards patients with mental illness than nurses without a specialist degree (Björkman et al., 2008; Natan et al., 2015) and understanding of mental illness. How less stigma. As the largest proportion of the healthcare workforce, nurses play an important role as they are uniquely positioned to care for individuals seeking help with depression and are able to restore, maintain and/or promote mental health and well-being (Dardas, Bailey ). , & Simmons, 2016). Most RNs working in primary care are primary care nurses (PCNs); i.e. health workers with advanced specialized university education in health care (Swedish District Nurses Association [DSF], 2008; Leppänen, 2010). In Sweden, the Primary Care Nursing program is an advanced academic Master of Science in Nursing degree and consists of 75 credits at an advanced level. To obtain PCN status, candidates must be RNs and have a bachelor’s degree in nursing before enrolling in a specialized educational program (Swedish District Nurses Association, 2008). The 75-credit course includes courses in public health epidemiology, pharmacology and pathophysiology, and nursing with an emphasis on prevention and health promotion of the elderly, children, and adolescents.
In Sweden, nursing education consists of approximately 2 weeks of theoretical training in mental illness and 5 weeks of clinical training in psychiatric wards. However, nursing students report a lack of theoretical knowledge during clinical practice, especially in psychiatric care (Löfmark & Wikblad, 2001), and there is a gap between theory and practice (Jonsen, Melender, & Hilli, 2013). The specialized education program for PCNs in Sweden does not include specific courses in mental disorders; The topic of mental illnesses is included in public health diseases. Haddad et al. (2005) reported that PCNs found their training limited in working with patients with psychiatric problems. Although participants expressed a desire to develop their skills, three-quarters had not received training in the past five years. Nurses’ lack of knowledge about how to communicate with, meet and care for patients with mental illness can mean that patients are at risk of receiving inappropriate or inadequate care (Kerrison & Chapman, 2007). After receiving specialized training, PCNs are responsible for the leadership and development of health care within their PHC. PCNs report that approximately 16% of their patients suffer from mental health problems (Haddad et al., 2005).
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Mental illness is a common problem in modern society and its prevalence is increasing, especially among adolescents and women (Calling et al., 2017). This results in longer hospital stays (World Health Organization, 2013). In Sweden, mental illness accounts for ~44% of all sick leave by gender, but women are overrepresented: 48% of all sick leave is due to mental illness compared to 36% for men (Health Technology Assessment, 2004 r. Swedish Council. ). Early treatment is essential for successful treatment and continuity is important for the relationship with the caregiver (Kane et al., 2015). Dealing with and providing care to people seeking help with mental illness is not easy, and PCN/RNs lack the experience and judgment to handle this complex job.
The purpose of this study was to explore PCNs’ considerations regarding the help-seeker encounter with mental illness in primary care settings.
Based on purposive sampling, five medical centers in close geographic proximity were selected (Creswell, 2002; Pollitt & Beck, 2008). A written request for permission to conduct research has been sent to the head of the branch for approval. Health service managers at each health center assisted with recruitment by identifying potential participants who met eligibility criteria. PCNs who wished to participate contacted the researchers by email or telephone to arrange a time and place for the interview. Inclusion criteria for participation were having a PCN, working in a medical center for at least 6 months, and having experience supervising patients with mental health problems while working in a medical center. Participant recruitment was based on purposive sampling, which aimed to obtain respondents’ long-term and in-depth knowledge from their experience in the research field (Creswell, 2002). Eight PCNs, all of whom were women, agreed to participate. They worked in five different health centers in the selected municipality, and their ages ranged from 27 to 62 years (mean = 46.6 years). Next, background variables are introduced
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Annica Bjorkman PhD, RN http://orcid.org/0000-0001-9513-3102 , Kajsa Andersson RN, MSc , Jenny Bergström RN, MSc and Martin Salzmann-Erikson RN, PhD http://orcid.org/0000- 0002-2610-8998
Data were collected from individual semi-structured interviews based on an appropriate interview guide