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Nurse Education in Practice 17 (2016) 91e96

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Nurse Education in Practice


journal homepage: www.elsevier.com/nepr

The value of physical examination in mental health nursing


Carolyn T. Martin*
School of Nursing, California State University, Stanislaus, One University Circle, Turlock, CA 95382, USA

a r t i c l e i n f o a b s t r a c t

Article history: This article explores the use of a physical examination assignment in a mental health general nursing
Accepted 3 November 2015 clinical placement course that addresses the poor physical health of people with mental illness and the
barriers traditionally impeding health care provision for this population. A descriptive qualitative
Keywords: approach utilizes inductive content analysis to investigate 145 student survey responses. The assignment
Mental health clinical assists student nurses in understanding that physical and mental well-being are intrinsically linked.
Physical examination
Students report increased comfort performing a physical examination on patients with mental illness
Mind-body connection
post assignment. Students' initial bias towards this population was minimized post the clinical assign-
Stigma
ment. Poor physical health is common among people with mental health problems. Many view the
provision of care as a major public health issue. Nurses are the front line caregivers of mental health
service consumers and are well positioned to assess their physical needs. Their assessment may be the
rst step in recognizing health care issues in this population.
2015 Elsevier Ltd. All rights reserved.

Background et al., 2013). It is important to point out that many countries train
RNs as generalist nurses. Even with a broader versus a specializa-
One quarter of adults living in the United States are diagnosed tion training, a holistic-based approach when caring for mental
with one or more mental disorders each year (National Institute of health consumers is needed. Assessment is widely regarded as the
Mental Health, n. d.). Although health care providers are highly rst step in addressing physical health in vulnerable populations
cognizant of the poor physical health of inpatients and community- (Tranter et al., 2012). Nurses working in acute psychiatric care
based mental health consumers they neglect the physical health of settings play an important role in assessing patients' physical need
people with mental illness (Muir-Cochrane, 2006; Lawrence and (Blythe and White, 2012; Howard and Gamble, 2011; Sutherland
Stephen, 2010). Few mental health workers in outpatient settings and Davis, 2010).
perform physical examinations (an evaluation of the body using It is well documented that physical illnesses are more common
inspection, palpation, percussion, and auscultation) on their pa- in people with mental disorders. Research demonstrates that the
tients as part of their routine assessment (Puskar, 1996). Sometimes physical health of those with mental illness is generally considered
the psychiatric symptoms are so overwhelming that medical staff poor compared to the general population (Chadwick et al., 2012;
overlook the physical problems. Impacting this issue is that many Colton and Mandersheild, 2006; De Hert et al., 2011; Scott and
people with severe mental illness only access the healthcare system Happell, 2011). Mental, physical, and social health is interdepen-
in the form of an inpatient psychiatric unit and this may be their dent and poor physical health affects mental well-being while
only chance to receive care for physical conditions (Frost, 2006). mental illness increases mortality and morbidity (World Health
Many have recommended improved monitoring of physical health Organization, 2010; World Federation for Mental Health, 2004).
in the inpatient unit (Frost, 2006; Happell et al., 2010). As a result of mental illness, the U.S. spends billions of dollars in
Mental health nurses, especially in countries where they have direct and indirect costs due to decreased productivity, absen-
post graduate psychiatric training, play a key role in meeting these teeism, lost jobs and wages, untold pain and suffering, and suicide
unmet needs particularly during hospital admissions (Happell (Borckardt et al., 2011). There is an urgent need for integration of
physical and psychosocial health care to improve service delivery
(Clark, 2009).
Resources or organizational issues often limit the implementa-
* One University Circle, Science 1 209E, Turlock, CA 95832, USA. Tel.: 1 209 664
6592; fax: 1 209 667 3690. tion of physical health care programs. Barriers to effective health-
E-mail address: cmartin2@csustan.edu. care for people with mental illness can be divided into general areas

http://dx.doi.org/10.1016/j.nepr.2015.11.001
1471-5953/ 2015 Elsevier Ltd. All rights reserved.
92 C.T. Martin / Nurse Education in Practice 17 (2016) 91e96

of focus: systemic (state and health care institutions/funding), disconnection between their mental health clinical practice and
provider (physicians, nurses), and/or patient-related issues (pa- other clinical practice experiences. Many do not see the importance
tient, family, caregiver) (Druss, 2007). Systemic issues include the of a mental health rotation and frequently miss important physical
separation of physical and mental healthcare agencies, and lack of details in the assessment of their patients. Not unlike society in
clarity as to who is responsible for the physical health of patients general, students report biases towards those with mental illness.
(Druss, 2007). At the provider level there are limitations of time and Clinical practice experiences help students make the connection
resources, unclear role delineations, the possibility of considering between mental and physical health that contributes to the de-
physical complaints as psychosomatic symptoms, and stigma con- livery of holistic care and a more favorable view of those with
siderations (Happell et al., 2010; Leucht et al., 2007). Patient-related mental health problems (Faught et al., 2013). Having a physical
issues include risk factors such as obesity, substance abuse, socio- examination assignment in the mental health clinical placement
economic factors, and side effects of psychiatric medications course may assist students with making the mind-body connection
(Compton et al., 2006; Sokal et al., 2004). People with mental illness and increase the students' awareness of the poor physical health of
may not maintain optimal physical health due to cognitive people with mental illness and the challenges faced in delivering
impairment, social isolation, and lack of social support (Lawrence both mental and physical health care in the mental health setting. It
and Stephen, 2010). These barriers, while not comprehensive, may also assist the student with developing a positive view of
demonstrate the depth of the problem that contributes to lack of people with mental illness.
maintaining optimal physical and mental health for those with
mental illness.
The purpose
Lack of holistic care leads to poor quality of life for those with
serious mental illness (World Federation of Mental Health, 2004).
The purpose of this study is to investigate the use of a physical
To improve the physical health of this vulnerable population
examination assignment in a mental health nurse clinical place-
mental health nurses must become aware of the problem and be
ment course. The objective of the proposal is to: a) to describe the
willing to nd solutions. Studies suggest that conducting a physical
student's perceptions of mental illness at the start and end of the
examination has the potential to enable nurses to identify threats
course; b) to better understand the student's comfort level with
to the physical well-being in this population (Tranter et al., 2012). A
mental health patients pre and post a physical examination
physical examination, for the purpose of this article, is dened as an
assignment; and c) to determine if the assignment assists the stu-
evaluation of the body using inspection, palpation, percussion, and
dents in understanding the connection between physical and
auscultation. A complete physical examination includes gathering
mental health.
information related to a person's medical history, which includes
lifestyle data and laboratory/screening test.
Physical examination must become part of usual care; while The assignment
organizational, personal, and other barriers need to be overcome.
Mental health nurses are positioned to support and monitor the The students, while in their mental health clinical placement,
physical health of people with mental illness (Gray et al., 2009; conduct a comprehensive, focused, bedside physical assessment of
Happell et al., 2010). Nurses need to combat the problem of the following components: skin, neurological, respiratory, abdom-
limited access to service for those with mental illness by utilizing inal, genitourinary, cardiac, and pain. Students are prepared for the
their under-used nursing skills on psychiatric inpatient units. There assignment by completing a health assessment theory and labo-
is scant research that investigates the level of physical examination ratory course prior to taking a mental health nursing theory and
that is being performed in acute mental health inpatient care set- clinical placement course.
tings and even less research evaluating what occurs once the The student, under the direct supervision of a mental health
physical examination is performed. clinical nursing instructor, with the consent of the patient, com-
pletes a physical examination on a patient in an acute mental health
Mental health nursing curriculum setting. The student conducts the physical examination in a private
examining room or in the patient's room, depending on availability.
Nurse educators are challenged to prepare new graduates Patients are dressed in street clothes, standard in mental health
entering practice who work in a variety of clinical placement facilities, which are loosened to assist with the examination. The
agencies. To become a registered nurse, a person must be able to procedure is explained in detail to the patient and they are
assess and plan the holistic care of patients (American Colleges of informed that they can decline to participate at any point in the
Nursing, 2008). Generalist graduates must have the knowledge examination. See Table 1 for details of the assignment.
and skill to integrate their patients' physical and mental health If a patient refused any part of the physical examination, it was
care needs and be prepared to conduct a comprehensive and not held against the student's grade. Students were encouraged to
focused physical assessment (American Colleges of Nursing, do a physical examination with a different patient, if the patient
2008). changed their mind and refused to participate in most of the
Nursing programs teach physical examination in much greater examination.
depth than what is used in clinical practice (Giddens, 2007). It is Performing a physical examination in this population requires
necessary to vary the assessments used given the population increased sensitivity to patient response and customization based
served and it is important to be aware that most skills can be on patient behavior (Davis, 2004). It is common for patients to
applied to all populations in all settings (Giddens, 2007). Although refuse a physical examination in a mental health environment
physical examination is a basic skill necessary for nursing practice, where patients may have a history of sexual assault or abuse, are
it is left to the faculty teaching the course to determine specic experiencing thought disorders, or have impaired information
content. Many nursing programs have a stand-alone course on processing or concentration. Faculty assist students with patient
physical examination, but it is not clear if the skill is integrated selection, deferring a physical examination for patients with
throughout all clinical placement settings. symptoms of paranoia and delusions or potentially unpredictable
Nursing educators must graduate students who understand the patients. Paramount is the comfort and safety of the patient and
value of a holistic approach to patient care. Often students report a the student.
C.T. Martin / Nurse Education in Practice 17 (2016) 91e96 93

Table 1
Mental health physical examination assignment.

Area of assessment Items included in each area of assessment

Skin Color, Turgor, Moisture, Temperature, Scars/Area of breakdown


Neurological Level of consciousness, PERRLA, Extremities (movement, strength, symmetry), Ortho (capillary rell, color, movement, sensation, pulses),
Positive/Negative symptoms (EPS, TD), AIMS, Gait and balance
Respiratory Respirations (depth, rate, rhythm, symmetry), Cough, Sputum, Lung sounds (anterior and posterior)
Cardiac Auscultation (aortic, pulmonic, Erbs point, tricuspid, mitral), Rate (rhythm, strength, equity), Color, Edema, Pulses (capillary rell)
Abdominal Auscultation, Palpation, Last bowel movement (LBM)
Pain Assessment Pain scale, Identies location, Description of pain, Assessment of pre and post administration of pain meds

Method decided not to participate. The hard-copy version of the survey was
administered and collected either by nursing faculty for the pro-
A descriptive study was conducted between January 2012 and gram or the researcher, depending on availability.
December 2013. Approval of the study was obtained from the
university institutional review board. Students complete the Data analysis
physical examination assignment in their mental health clinical
placement course with the supervision of a mental health clinical Content analysis was used to evaluate qualitative data
faculty. A standardized grading rubric used in all clinical placement and to identify the key concepts from open-ended questions
rotations in the nursing program is utilized to assign a grade for the (Krippendorff, 2004). Survey data were analyzed until data satu-
student. At the end of the course students complete a survey ration was reached with no new issues emerging.
related to the assignment.
Quantitative results
Participants and sampling
Perceptions of people with mental illness
Students (n 145) attending an undergraduate baccalaureate- When students (n 145) were asked about their perceptions of
nursing program in the western United States completed surveys. mental illness prior to taking a mental health clinical placement
All students completing a mental health clinical placement course course, 41 percent of the students (n 60) stated that they were
(n 190) were given the opportunity to participate in the study. All afraid of people with mental illness, mostly due to safety issues.
students are over the age of 18. Eight clinical mental health faculty They used terms such as crazy (n 12), dangerous (n 9), impaired
are assigned a maximum of 10 students per rotation. Four mental (n 6), unpredictable (n 7), unstable (n 3), and intimidating
health inpatient units located in three cities representing three (n 3). They described that they thought the inpatient unit would
counties are utilized as clinical placement sites. be chaotic and noisy with patients yelling and throwing things
while in straitjackets. Ten described themselves as having nega-
Survey instrument tively stereotyped people with mental illness and feeling bias and
stigma towards them. Twelve had previous knowledge about
The survey is a three-page form that poses nine questions that mental illness due to a personal or working connection or through
take approximately 15e20 min to answer. The survey tool was taking a psychology course. Several reported that they did not think
developed by mental health faculty and reviewed by non-mental that a mental health curriculum was needed in nursing and that
health faculty to ascertain content validity. they did not think of mental illness as a real illness or as impor-
Forty-nine students (n 49) were given access to an anony- tant as a medical illness.
mous on-line survey format and 141 were administered hard copy
surveys. Students are asked about their perception of mental illness Physical examination completion
pre and post taking the course. Participants are asked to indicate if Eighty one percent of the students (n 117) performed all or
they performed a physical examination during their mental health most of the physical examination assignment and 14 percent
clinical placement rotation and to identify the components of the (n 22) stated that they performed a limited physical examination
assessment that were included. If any part of the physical exami- or did not perform a physical examination during their clinical
nation was not performed, students are directed to give a rationale placement experience; six students did not respond to this ques-
for lack of completion. tion. Reasons for lack of completion included 10 students who re-
Using a ve-point Likert-type scale, students are asked to indi- ported that their instructor did not require the assignment and
cate their comfort level while assessing a patient with mental asked that the students not touch the patients or bring a
illness pre and post assignment with the average frequency of one stethoscope to clinical for safety reasons. Three students reported
being very uncomfortable and ve being very comfortable. Stu- that their patient refused and the other nine explained that they
dents, who did not complete the physical examination, were only took vital signs, completed mental status examinations, pain
directed to not respond to post assignment questions. Other open- assessments, and made observations.
ended questions relate to making the connection between mental
and physical health. There is an area on the survey for comments. Comfort
Students (n 117) who completed all or most of the physical
Procedure examination were asked to describe their comfort level while
performing a physical examination on a person with mental illness
Voluntary written informed consent was obtained from the before and after completing the assignment. Prior to completing
student participants and students' perceived coercion to take part the assignment, 41 percent (n 58) rated their comfort level as a
was addressed. The survey contained no personal identiers and three out of ve. After completing the assignment almost half, 46
students are assured that their grades would not be affected if they percent (n 54) rated their comfort level at a four out of ve. The
94 C.T. Martin / Nurse Education in Practice 17 (2016) 91e96

mean score before completing the assignments was 3.124 and it policy, and limited managerial support may be barriers to deliv-
was 4.49 after completing the assignment. ering physical care needs (Happell et al., 2010; Happell et al., 2012).
Although the demands on the mental health nurses are great, we
Making the connection are in a strategic position to have a positive impact on the mental
Students were asked, Did the physical examination assignment and physical well-being of people with mental illness (Robson and
assist you with making a connection between mental health and Gray, 2006). The ultimate goal is to change practice and the current
physical health? Most of the students (n 104) stated that it did. mindset in order to improve the health outcomes of those with
Students reported that they were surprised to see how many pa- physical and mental illness. Starting at the student nurse level, a
tients had mental illness along with physiological issues. Students step towards making this change may be to incorporate a physical
stated that mental and physical illness can exacerbate each other examination assignment in the mental health clinical placement
and that the two go hand in hand. course.

Care of people with mental illness Limitations


Students were asked if they thought a physical examination was
important to the overall care of a patient with mental illness. A survey method allows the collection of a diverse range of in-
Overwhelmingly the students reported that they thought it was formation. The study sample was from two public universities with
important; only four students responded that they thought it was identical mental health theory and clinical placement curricula,
not important and two did not respond to the question. One stu- thus these data might not accurately represent other nursing pro-
dent said, we should provide holistic care because people are not grams. The instrument relied on participants' self-report. Some
walking around as three separate entities, where the physical entity ndings may be explained by time spent in a clinical placement
can go to the medical surgical unit, the mental entity can go to the setting and completion of a mental health course versus perform-
mental health facility, and the spiritual entity can go to the religious ing the assignment. Students were not surveyed regarding the
elder. Several reported that it was important because the physical replacement of the assignment or how it affected their grade, if
concerns of these patients were not being met. they were not required to complete a physical examination during
their clinical experience. These students may have had an altered or
Most important thing learned negative view of the assignment. This study needs replication using
Finally, students were asked, What is the most important thing a larger sample of students from different geographic regions and
you learned from this assignment? Slightly more than one-third of programs.
the students, 39% (n 46), responded that they learned the
importance of the relationship between physical and mental Curriculum
health. Many (n 23) talked about understanding holistic care,
with one stating, I learned the importance of looking at patients as Nurse educators need to prepare graduates that provide holistic
a whole and not to focus on just one aspect of their lives. One quality care by integrating physical and mental health for patients
student stated that she learned, to be more aware of how impor- with mental illness. Lack of emphasis on the importance of per-
tant it is as a nurse to provide holistic care and recognize each forming a physical examination in mental health settings in the
patient as an individual with a unique set of experiences, per- nursing curriculum may contribute to a lack of physical care for this
spectives, and needs. One said that she learned that, mental complex group of patients. Lack of faculty buy in may be another
illness is just as crucial as the physical illness. contributing factor. One out of the eight clinical mental health
Seventeen said that the assignment helped them to not to be faculty advised students to not touch patients with mental illness
afraid to approach a patent with mental illness; with one stating, It and did not have the students complete the assignment. Research
helped to break the fear barrier. Several students (n 8) com- investigating how conscious and unconscious bias may impact
mented that the physical examination assisted with patient-nurse mental health curriculum development may be of benet.
rapport and allowed them to connect with your patient. It is important to include all nursing faculty in curriculum dis-
Twenty-ve talked about learning to treat mental health patients cussion in order to assure that the importance of the assignment is
equally and with respect and that they are normal people who understood. This is especially important for part-time faculty who
look and sound like me. Finally, another student said that he do not regularly participate in curriculum decisions. In addition, it
learned that, mental health patients are just that, patients. is important to add discussion about the importance of integrating
physical examinations throughout all of the clinical placement
Discussion settings and curriculum in the nursing program.

Nursing students, who perform a physical examination assign- Mental health textbooks
ment in a mental health clinical placement course, report that they
are more comfortable performing a physical examination on a pa- In order to understand what is available to assist faculty in
tient with mental illness. In addition, students report that the teaching physical examination in undergraduate mental health
assignment was important in the overall care of people with mental nursing courses, fteen mental health nursing textbooks published
illness and assisted with making the connection between mental internationally between 2003 and 2014 were reviewed. Keywords
and physical health. Lastly, students' perceptions of mental illness were searched using the index of the text and included physical
transitioned from one of fearful and negative stereotypical examination, physical assessment, assessment, and examination.
thoughts pre-assignment to less fearful and more accepting views Ten texts did not discuss nurses performing a physical examination
post assignment. on mental health patients or only recommended that a physician or
Nurses use their knowledge in all settings to improve the care of advanced practice nurse perform the examination (Antai-Otong,
those with mental health problems. In order to address the excess 2003; Damon et al., 2012; Fontaine, 2009; Frisch and Frisch,
burden of physical illness in patients with mental illness, nurses 2011; Goldbloom, 2006; Halter, 2014; Jones et al., 2012; Kneisl
must perform physical examinations in inpatient settings. Lack of and Trigoboff, 2013; Obrien et al., 2013; Videback, 2014). Most
condence in physical examination skills, staff shortages, lack of texts discussed doing a limited examination (mostly neurological
C.T. Martin / Nurse Education in Practice 17 (2016) 91e96 95

or observational for physical changes) for a specic diagnosis, such opportunity to update mental health nurses with physical exami-
as delirium, and eating or substance abuse disorders. They advised nation baseline knowledge and skills (Nash, 2005). In addition,
nurses to complete vital signs, to check laboratory and other tests, training in mental health issues should be offered to all healthcare
i.e., tuberculosis. providers.
One author stated a psychiatric mental health nurse is in an Physical health care is not yet part of usual care of people with
excellent position to assess not only mental health but also physical mental illness and systematic changes including policy reform will
health, but did not discuss it in any detail (Varcarolis and Halter, be required before this occurs. Physical illness that is not treated
2010, p. 82). One author included a comprehensive form that when patients are admitted to a psychiatric unit potentially lead to
listed comprehensive components of a physical assessment serious overall health issues, may delay recovery, and increases
(Townsend, 2011, 2012). One stated, mental health nurses should length to discharge (Felker et al., 1996). Frost (2006) recommends
examine physiological systems (Boyd, 2012, p.127). Mohr dedi- developing treatment protocols to assure care standards, utilizing a
cated ve paragraphs to detailing the physical examination and team approach to allow input from various disciplines involved in
states that mental health nurses should assume a critical role in patient care, and updating policies and training of interdisciplinary
basic physical examination (Mohr, 2013, p. 168). This author went hospital staff. It is also important to link patients to other health
on to say that a physical examination promotes accurate assess- professionals and to provide health care services in a variety of
ment that protects clients by combating the stigmatizing notion settings. Nurses must partner with psychiatrist, other health care
that all symptoms for clients with mental illness are psychiatric providers, and patients to improve the overall health for people
in nature (Mohr, 2013, p. 170). Mental health textbooks were with mental illness. Nurses must take an active role in the formal
approximately 830 pages in length and only devote a few sentences assessment process in collaboration with other health care pro-
or paragraphs, if any, to the performance of physical examination fessionals particularly in the inpatient setting with the goal to
by mental health nurses. It is apparent that there is little assistance improve health care and outcomes for patients with mental illness.
in current mental health textbooks to support the concept of per-
forming physical examination in mental health. Future textbooks Stigma
should add this as an important component to the overall health
care of people with mental illness. There is stigma related to mental health in all aspects of society,
which includes healthcare. It has been suggested that strategies to
Mentoring reduce stigma should be a high priority for those who work in
mental and community health areas (Sartorius, 2007). Lack of
Having a physical examination assignment in all clinical place- attention to a person's physical health resulting from stigma may
ment nursing courses may improve the likelihood that students cause people to delay or avoid seeking medical care (Corrigan et al.,
continue to perform the activity in the work world. It is important 2009). Educating health care providers can be an important step
that experienced nurses are role models of good practice for new towards reducing public stigma (Thornicroft et al., 2010). Students
nurses. Unfortunately novice nurses tend to conform to the group in this study reported bias and fear with the concept of caring for
norm when they arrive on a unit and do not use new skills (White their patients with mental illness. Early strategies aimed at
et al., 2009). If we encourage students and new nurses to feel resolving stigma, such as a student nurse physical examination
condent performing a physical examination in their clinical assignment, has potential to positively impact future experiences
placement rotation and to understand the need to continue the with patients with mental illness once in the practice setting.
practice, it is more likely that they will move into the work arena
with condence to avoid conforming to the group norm. Future research

Benets There is a need to identify effective solutions. Future research is


needed to explore the attitudes of mental health nurses in relation
Patients report that lack of knowledge is a deterrent to to their role in physical health care (Blythe and White, 2012).
improving the overall health (Buhagiar et al., 2011). Performing a Randomized clinical trials (RCTs) are needed to assess the effec-
physical examination in the inpatient environment may help pa- tiveness of physical health monitoring in people with mental illness
tients detect a physical problem before it gets worse and may lead and to evaluate how this facilitates the identication of unmet
to enhanced conversations related to preventative practices and health needs (Tranter et al., 2012; Tosh et al., 2010). Randomized
on-the-spot health promotion. A physical examination gives a clear clinical trials have highlighted the challenges of implementing
baseline for comparison, should the patient's physical status change in mental health settings. More work is required to over-
change. It is well known that an important rst step to improve come barriers, which limit physical health care in mental health
patient's health in a mental health crisis is to develop rapport and settings, particularly for those with a poor physical behavior pro-
trust, which results from quality time spent with the patient. The les. Research that highlights successful policy and program
process of completing a physical examination facilitates meaning- change is needed to determine effective strategies. Also research is
ful engagement, which can encourage therapeutic relationships. needed to test the efcacy and effectiveness of pedagogical ap-
proaches, such as physical examination, in mental health nursing
Strategies for improved care education.

Nurses performing physical examinations on patients with Implications for nursing


mental illness may not be easy to implement in practice. Many
nurses practicing today, despite training to do so, have not con- One of the largest challenges for nurses today is to provide
ducted a recent full physical examination on their patient. Barriers optimal healthcare to this vulnerable patient population. Mental
to doing a physical examination include lack of time and condence health nurses are in a unique position to improve the physical
in their ability to do so, or the belief that a physician should only do health of people who have mental illness. Nurse educators should
it (Rylance et al., 2012). One strategy to overcome these barriers consider the use of a physical examination assignment in the
is to develop ongoing physical care courses that provide the mental health clinical placement course. The physical examination
96 C.T. Martin / Nurse Education in Practice 17 (2016) 91e96

assignment supplies students with a hands-on approach that as- Happell, B., Platania-Phung, C., Hardy, S., Lambert, T., McAllister, M., 2010. A role of
mental health nursing in the physical health care of consumers with severe
sists with making a connection between physical and mental
mental illness. J. Psychiat. Ment. Health Nurs. 18 (8), 706e711. http://dx.doi.org/
health. Nurses can use this holistic approach with the ultimate goal 10.1111/j.1365-2850.2010.01666.x.
of improving overall health for these patients. Nurses must take an Happell, B., Platania-Phung, C., Scott, D., 2013. A systematic review of nurse physical
active role in formal assessment in the practice setting. Even small healthcare for consumers utilizing mental health services. J. Psychiat. Ment.
Health Nurs. 21 (1), 11e22.
changes in monitoring physical conditions may make a positive Happell, B., Scott, D., Nankivell, J., Platania-Phung, C., 2012. Screening physical
change for this underserved and disadvantaged population. health? Yes! But: nurses' views on physical screening in mental health care.
J. Clin. Nurs. 22 (15e16), 2286e2297.
Howard, L., Gamble, C., 2011. Supporting mental health nurses to address the
Conict of interest statement physical health needs of people with serious mental illness in acute inpatient
care settings. J. Psychiat. Ment. Health Nurs. 18 (2), 105e112. http://dx.doi.org/
The author reports no actual or potential conicts of interest. 10.1111/j.1365-2850.2010.01642.x.
Jones, J.S., Fitzpatrick, J.J., Rogers, U.L., 2012. Psychiatric-mental Health Nursing: an
Interpersonal Approach. Springer, New York, NY.
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