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Course: Medical Surgical Nursing

Topic: Significance and Impact of Mental Health on General Health and Wellness

The Nurses International Community

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Module Goals

Learners will be able to:

Discuss how mental health is related to physical health.
Outline the medical-surgical nurse’s role in the promotion of mental health.
Discuss the challenges in managing medical treatment in clients with mental health comorbidity.
Discuss the impact of depression on the mental and physical health of individuals.
Describe depression as it relates to various populations.

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Definition of Mental Health

A state of mental well-being that affects:

Decision-making abilities.
Social relationships.
Contributions to communities and the world.

It is not simply the absence of a mental illness.

It is experienced differently by individuals and may change over time.

It is influenced by several determinants of mental health.

World Health Organization, 2022a

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Definition of Health

State of complete physical, social, and mental well-being.

Not simply the absence of disease or illness.

Fundamental right to enjoy the highest attainable standard of health.

Social determinants of health are non-medical factors that influence health.

World Health Organization, 2022b

World Health Organization, 2022c

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Mental Health and Physical Health

Mental and physical health are important aspects of overall health.

Mental and physical health are interrelated.

Mental illness may increase the risk of certain physical illnesses.

Depression → heart disease, diabetes, and stroke

Chronic physical conditions may increase the risk of mental illness.

Prior mental and physical health have strong effects on an individual’s current state of mental and physical health.

CDC, 2021

Ohrnberger, Fichera, & Sutton, 2017

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Critical Thinking Question

Based on the definition of mental health, discuss why a lack of mental health could have an impact on physical health.

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Nurse’s Role in Mental Health Promotion

Nurses play many roles in promoting the mental health of clients:

Acting as facilitator
Providing educational support
Empowering the client
Providing practical support

Svedburg, 2011

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Facilitator - the nurse helps the client identify health goals and needs; does not act as the “expert”
Providing educational support - the nurse shares individualized information with the client and provides opportunities for the client to evaluate it in the context of their personal situations and circumstances
Empowering the client - the nurse encourages the client’s cooperation by taking an active role in their own healthcare
Providing practical support - the nurse assists the client in using and building their individual skills and capabilities for everyday life (social situations, communities)
Alliance should be centered around trust, mutuality, and a personal relationship in order to promote health. This is built through kind interactions and continuity with the client.
A client’s past experiences (success and failure) determine their self-efficacy. The nurse should acknowledge and affirm positive qualities and potential in the client to convey hope and show respect for the client throughout the relationship

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Nurse’s Role in Mental Health Promotion (Continued)

Establishing an alliance with the client

Therapeutic relationship built over time

Strengthening the client’s self-efficacy

Self-belief leading to change
Conveying hope

Svedburg, 2011

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Nurse’s Role in Mental Health Promotion (Continued)

Promoting mental health through physical assessments

Assessing the client’s mental state
Reviewing client medications
Use of screening tools
Ensuring safety

Ernstmeyer & Christman, 2022

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Mental Health Promotion of Nurses

Potential mental health effects of burnout on nurses

Depression
Anxiety
Substance use issues
Stress
Fatigue

Interventions to promote the mental health of nurses

Organizational support
Use of effective coping strategies
Safety precautions

Ernstmeyer & Christman, 2022

Melnyk et al., 2021

Contact info: info@nursesinternational.org

Depression has been shown to be a leading predictor of medication errors that are self-reported.
Depression in its severe form can lead to provider and nurse suicide.
The Covid-19 pandemic has worsened mental health issues among nurses.
Organizational support: cultivating a culture of wellness, identifying and fixing system issues, building resiliency among staff, and encouraging cognitive-behavioral skills (i.e., the use of positive thinking, awareness of how thoughts impact behavior and emotion) (Melnyk et al., 2021).
Examples of coping strategies - exercise (i.e., yoga), meditation, prayer, journaling, being in supportive relationships, enjoying time spent in nature, practicing mindfulness.
Safety precautions - when caring for clients with mental health needs, nurses should prioritize their own safety through:

- Dressing in a way that prevents clothing or hair from being caught, grabbed, or pulled

- Exercising environmental awareness- noting exits, sounds, and routines in the client’s room

- Awareness of client behaviors- verbal and nonverbal cues

- Knowledge of organizational safety protocols

(Ernstmeyer & Christman, 2022)

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What Would the Nurse Do?

The nurse is admitting a new client to the medical ward in the hospital. Upon arrival, the nurse begins the admission process and initial assessment of the client.

Discuss ways the nurse can assess and promote mental health during this interaction.

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Mental and Physical Health Comorbidities

Mental and physical health issues that exist concurrently result in more complex care needs.

Factors contributing to comorbidities

Social determinants of health
Lifestyle factors
Sleep disturbances
Medication side effects
Genetics

Ee et al., 2020

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Mental and Physical Health Comorbidities (Continued)

Examples of mental health comorbidities associated with physical conditions:

Cancer: major depressive disorder, anxiety, adjustment disorders, sleep disorders
Chronic obstructive pulmonary disease (COPD): depression, anxiety
Cardiovascular disease: depression, schizophrenia
Diabetes: depression, anxiety, schizophrenia
Arthritis: depression
Alzheimer’s disease: depression

Ee et al., 2020

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Mental and Physical Health Comorbidities (Continued)

Substance use disorders:

Often occur alongside the presence of a mental health disorder
Can contribute to the occurrence of mental health disorders (and vice versa)
When both are present, several risks increase for the client

Possible explanations of why these often occur together:

Substances can mask symptoms of mental health disorders
Substances can trigger certain mental health disorders
Both can be caused by similar factors

Substance Abuse and Mental Health Services Administration

& Office of the Surgeon General, 2016

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17 million (or 6.7%) of adults suffered from a substance use disorder and mental health disorder in 2020 (Substance Abuse and Mental Health Services Administration & Office of the Surgeon General, 2016).

When mental health disorders occur alongside substance use disorders, the following result:

- Further functional impairment

- Increased morbidity and mortality

- Increased healthcare costs (treatments)

- Increased risk for homelessness, incarceration, and suicide

Substances can mask symptoms such as depression or anxiety.
Substances triggering mental health disorders - for example, substances can impair the brain’s capacity to recover from a traumatic experience. This can increase the risk of developing post-traumatic stress disorder (PTSD).
Similar factors include neurobiology, genetics, and exposure to certain life events (stressful or traumatic).

(Substance Abuse and Mental Health Services Administration & Office of the Surgeon General, 2016)

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Nursing Care for Clients with Comorbidities

Mental health comorbidities produce challenges for nurses:

Stigmatization
Fear
Negative attitudes
Knowledge gaps

Clients may sense these challenges

Potentially lead to poor outcomes

Giandinoto & Edward, 2014

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Stigmatization - despite nursing knowledge of mental health, the stigma persists in patient care wards

Staff see the client as “difficult,” treat the client differently, or avoid the client
This affects the nurse/client therapeutic relationship

Fear - the threat of safety to the nurse or the client

The nurse may anticipate aggressive behaviors
Viewing the client as unpredictable or dangerous

Negative attitudes - allowing stereotypes of clients with mental illness to distort their expectations of care

Can result from a lack of organizational support and positive reinforcement for caring for these clients

Knowledge gaps - having poor literacy regarding mental health care

Feeling unprepared or uneducated despite undergraduate education
View therapeutic communication skills as incompetent

(Giandinoto & Edward, 2014)

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Nursing Care for Clients with Comorbidities (Continued)

Goal: Improve both physical and mental health

Providing safe, compassionate care through:

Medication administration
Education on lifestyle factors
Establishment of a therapeutic relationship
Non-pharmacologic interventions
Collaboration with other members of the healthcare team

Ee et al., 2020

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Critical Thinking Question

Nurses can experience stigmatization, fear, negative attitudes, and knowledge gaps when caring for clients with mental health comorbidities.

Which do you anticipate being the most difficult for you to overcome? How do you plan to address and overcome this challenge in your practice?

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Depression

Leading cause of disability worldwide

Affects approximately 5% of adults

5.7% of adults age 60 and older

Episodes differ from normal mood fluctuations

Symptoms persist for most of the day, nearly every day
At least two weeks

World Health Organization, 2021

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Depression (Continued)

Patterns of depressive episodes can vary:

Single-episode depressive disorder
Recurrent depressive disorder
Bipolar disorder

Episodes cause increased difficulty in several areas of functioning.

Episodes range from mild → moderate → severe.

World Health Organization, 2021

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Depression and Physical Health

Depression and physical health are strongly interrelated.

Clients with recurrent depression exhibit higher rates of:

Gastric ulcers
Rhinitis (Hay fever)
Osteoarthritis
Thyroid disease
Hypertension
Asthma

Farmer et al., 2018

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Depression and Mental Health

Depression affects mental health to varying degrees.

It depends on the client and the severity of the episodes.
Clients with a traumatic history have a higher risk of developing depression.

Poor mental health may result from incorrect diagnoses.

Effects of depression on mental health:

Stress
Impaired functioning

World Health Organization, 2021

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Critical Thinking Question

Discuss how the mental health effects of depression can worsen a client's mental health if they are not addressed.

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Depression Among Populations

Depression can affect all types of individuals.

It is a common illness worldwide (approx. 3.8% of all people affected).

Certain populations have increased risk:

Women
Elderly

WHO, 2021

National Institute on Aging, 2021

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Depression in the Elderly Client

Age-related factors related to the risk of developing depression:

Medical conditions (i.e., stroke, cancer)
Difficulty sleeping
Social isolation or loneliness
Functional limitations for activities of daily living
Lack of physical exercise/activity
Pain
Hearing disorders

National Institute on Aging, 2021

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Depression in the Elderly Client (Continued)

Depression may present differently in elderly populations.

Common depressive symptoms could include:

“Numbness”- lack of interest in conversation or activities
Restlessness
Fatigue or moving more slowly
Increased difficulty concentrating or making decisions
Changes in sleep and/or appetite

National Institute on Aging, 2021

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Critical Thinking Question

Discuss ways in which elderly clients exhibit depression symptoms differently than younger clients.

Why is this important for the nurse to understand?

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Red Flags

Expression of suicidal thoughts or actions in clients with depression

In elderly populations, this could include thoughts of death

Presentation of depressive symptoms for two weeks

Evaluation by a health care provider if undiagnosed

National Institute on Aging, 2021

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Cultural Considerations: Examples

In some cultures, individuals present with depression through physical symptoms:

Fatigue
Weakness
Pain
Headaches
Cramps
Digestive problems

National Institute on Aging, 2021

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures, talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures, family members play a large role in healthcare decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting and following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health-seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be acceptable in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References

Agency for Healthcare Research. (2020). Health Literacy Universal Precautions Toolkit, 2nd Edition. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

Centers for Disease Control and Prevention. (2021). About mental health. https://www.cdc.gov/mentalhealth/learn/index.htm

Ee, C., Lake, J., Firth, J., Hargraves, F., de Manincor, M., Meade, T., Marx, W., & Sarris, J. (2020). An integrative collaborative care model for people with mental illness and physical comorbidities. International Journal of Mental Health Systems, 14(83), 1-16. https://doi.org/10.1186/s13033-020-00410-6

Ernstmeyer, K. & Christman, E. (Eds.). (2022). Nursing: Mental health and community concepts.Pressbooks. https://wtcs.pressbooks.pub/nursingmhcc/

Farmer, A., Korszun, A., Owen, M., Craddock, N., Jones, L., Jones, I., Gray, J., Williamson, R., & McGuffin, P. (2018). Medical disorders in people with recurrent depression. British Journal of Psychiatry, 192(5), 351-355. doi:10.1192/bjp.bp.107.038380

Contact info: info@nursesinternational.org

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References

Giandinoto, J. & Edward, K. (2014). Challenges in acute care of people with co-morbid mental illness.British Journal of Nursing, 23(13), 729-732. doi: 10.12968/bjon.2014.23.13.728

Ohrnberger, J., Fischera, E., & Sutton, M. (2017). The relationship between physical and mental health: A mediation analysis. Social Science & Medicine, 195, 42-49. https://doi.org/10.1016/j.socscimed.2017.11.008

Melnyk, B., Hsieh, A., Davidson, J., Carpenter, H., Choflet, A., Heath, J., Hess, M., Lee, P., Link, T., Marcus, J., Pabico, C., Poindexter, K., & Stand, L. (2021). Promoting nurse mental health. American Nurse Journal, 16(1), 20-22, 59. Retrieved from https://www.myamericannurse.com/wp-content/uploads/2020/11/an1-Suicide-1216b.pdf

National Institute on Aging. (2021). Depression and Older Adults. https://www.nia.nih.gov/health/depression-and-older-adults

Contact info: info@nursesinternational.org

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References

Substance Abuse and Mental Health Services Administration, & Office of the Surgeon General. (2016). Facing addiction in America: The surgeon general's report on alcohol, drugs, and health. US Department of Health and Human Services. https://pubmed.ncbi.nlm.nih.gov/28252892/

World Health Organization. (2022a). Mental health: Strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

World Health Organization. (2022b). Constitution. https://www.who.int/about/governance/constitution

World Health Organization. (2022c). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_3

World Health Organization. (2021). Depression. https://www.who.int/news-room/fact-sheets/detail/depression

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