Nurses need more education on co-morbidity

There are new programs in the works to ensure nurses have the right skills to manage patients presenting with both mental and physical health conditions. 

With yet more research suggesting that physical health conditions amplify the risk of mental illness, nurses and nursing students are being called on to increase their knowledge in order to successfully manage cases where physical and mental health issues coexist.

Around one in nine Australians aged 16-85 have a mental health disorder and a physical condition at the same time, according to the federal government’s latest figures on co-morbidity of mental disorders and physical conditions.

A report from the World Federation for Mental Health agrees there needs to be greater focus, saying that “even though mental health services are increasingly being recognised as critical, they still get short shrift”.

Associate Professor Kim Ryan, CEO of the Australian College of Mental Health Nurses (ACMHN) believes that with the relatively even spread throughout regional and rural Australia, the nursing profession is positively placed to address this growing concern.

“To ensure good health outcomes, it is critical to educate nurses about the co-morbidity of mental illness and chronic disease, and to equip them with the knowledge and skills to identify and manage the health of clients,” she said.

“Every nurse at some stage will work with a client who is at risk of developing, has developed or has shown early signs and symptoms of mental disturbance.”

Ryan believes that with suitable education and training, nurses can play a vital role in the prevention of mental health problems and identifying early symptoms, and that they are also critical to the provision of timely, effective and appropriate treatment services to patients.

Given the statistics and an overwhelming response from a survey sent out to more than 2500 general nurses, the ACMHN applied for and received funding to develop a new free e-learning program to assist nurses in identifying and managing mental health issues in patients that also have chronic physical disease.

Funded by the Department of Health and Ageing’s Chronic Disease Prevention and Service Improvement Fund, the course uses video vignettes and activities to highlight key issues related to mental health.

Broken down into five easy-to-complete 20-minute modules, the courses give nurses access to information across four chronic disease categories: respiratory disease, cardiovascular disease, cancer and diabetes.

A variety of interactive applications, including video stories, photos and quizzes are used to demonstrate skills related to communication, identification of mental health issues, managing difficult situations and understanding grief and loss.

The program is put together and backed by an expert reference group that includes Commonwealth Chief Nurse Rosemary Bryant, as well as groups such as the Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN), APNA (the peak professional body for nurses working in primary healthcare including general practice), CRANAplus, and the National Mental Health Consumer and Carer Forum, among others.

“The course is aimed at getting nurses to recognise that there are things that they can do in their daily practice that will improve the physical outcome of their patients by touching on their mental health and their emotional wellbeing,” said Peta Marks, senior project officer at ACMHN, “and to help nurses realise that those things aren’t necessarily scary – they can do small things that will make a big difference.

“We [ACMHN] are really trying to change the way that we nurses have been conditioned, and are doing so along with other mental health organisations and universities.”

A multidisciplinary approach to practice has also been highlighted to students through a recent initiative from the University of Wollongong’s (UOW) school of nursing, midwifery and Indigenous health.

Fifteen Bachelor of Nursing students, psychology students, an exercise physiologist, four nursing academics, a credentialed mental health nurse working in private practice and 28 people with lived experience of mental illness attended a Recovery Camp for five days, where students were able to learn about approaches to mental health through the lens of another health-related discipline.

“Of all the illnesses or issues nurses are going to encounter, mental health issues are going to be encountered everywhere,” said Dr Lorna Moxham, professor of mental health nursing at UOW.

“Healthcare can be very compartmentalised, so what happens often is you may well have a mental health issue and have quite a severe or chronic physical illness, but it doesn’t get the attention it should because the primary focus is the mental illness … when what we need is a holistic approach.

“We talk about it, but I don’t think healthcare does it very well.”

Students had to meet specific nursing objectives under the Australian Nursing and Midwifery Accreditation Council competency standards, but the main aim was to see the clients through more of a holistic lens – away from the small acute care medical model they would experience in a hospital.

Moxham confirmed that students got to see clients from a psychosocial perspective – one that acknowledged that, yes, the patient had mental illness, but they also had physical illnesses, children, work and families, and their mental illness was just a small part of the overall picture.

Sonia White, a third-year student who attended the camp, said it was a wonderful opportunity to focus on the mental health aspect – and is definitely something that should be done on a more regular basis.

“Mental health issues are so prevalent in society – it doesn’t matter what realm of nursing you go into, you will come across people who have mental issues, so it’s very important everyone understands people’s feelings and thoughts,” she said.

“The camp was a great learning experience because you could spend time with people, instead of a hospital environment where it is just generally in and out.

“It has definitely helped me see that everyone has a story, everyone has a background; so you really have to treat everyone individually and work step-by-step with each person.”

UOW lecturer Chris Patterson said that while student nurses are generally receiving great training in mental health nursing, with co-morbidity becoming an increasing concern, nurses in practice require more and ongoing training in being able to recognise mental health issues.

“Once nurses practice in an area that focuses more on physical diseases, there is a tendency to forget or be unsure of mental health issues,” he said.

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