A narrative review of medical and surgical nurses' attitudes and perceptions when caring for patients with a secondary diagnosis of mental illness

Abstract

Background

Medical and surgical nurses are responsible for prioritising patient-centred and holistic care. It is necessary for nurses to possess the relevant knowledge and interpersonal skills to deliver culturally responsive, compassionate, safe, and effective care to patients who have comorbidities inclusive of mental health conditions. It is important to acknowledge reported experiences of mistreatment, and discrimination from patients with a secondary diagnosis of mental illness (SDMI). To counter poor nursing practice and disrupt discriminatory attitudes and perceptions of medical and surgical nurses it is necessary for nurse educators to embed anti-discriminatory and social justice pedagogy into pre-registration nurse education.

Aim

This review seeks to explore and identify the attitudes and perceptions of medical and surgical nurses when caring for patients with a secondary diagnosis of mental illness.

Method

This literature review used a systematised approach to retrieve evidence that assessed the attitudes and perceptions of nurses when caring for patients with a SDMI in medical and surgical ward environments. Five databases were searched (PubMed, Embase, Clinical Knowledge Network, Cochrane and PsycInfo) between 2011 and 2023. Thematic synthesis was conducted on studies that met the following inclusion criteria: a) nurses as research participants who have cared or currently care for patients with a SDMI, b) nurse's attitudes, perceptions, feelings, and experiences, and c) surgical and medical inpatient units. Studies were excluded if they were: a) systematic reviews; b) reviews; c) literature not in English and d) grey literature.

Results

8 peer reviewed articles were included. Nurses' attitudes and perceptions were found to be stigmatising and discriminatory towards patients with a SDMI and negatively impacted their care. The themes from the retrieved evidence suggests that nurses commonly viewed patients with a SDMI as risky, unpredictable, fear inducing, and created feelings of futility and reduced professional satisfaction. Nurses felt unprepared when caring for this patient group. Several factors that negatively impacted nurses' preparedness included their previous education in mental health, personal experience with mental health issues, and social demographic variables.

Conclusion

Education reform in nursing is necessary to improve healthcare advocacy and safety for patients with a SDMI, cared for in medical and surgical nursing environments. This can only be achieved through a nursing workforce cognisant with human rights and social justice principles. Fair, just, and compassionate nursing responses to patient with a SDMI recognizes critical concepts of mental health recovery, hope and anti-discriminatory pedagogy in nurse education. Critical social justice approaches in curriculum provides nursing students with lessons to understand complex health issues, and national and global disparities in health that exist according to social, cultural, racial and political determinants of health and wellbeing. Recommendations to address these concepts include in-service mental health training focusing on clinical knowledge, clinical mentorship, anti-stigmatising training and simulation-based exercises based upon social justice principles in pre-registration nurse education curriculum.