Exploring the Preparedness of Nurses to Care for Medical-Surgical Patients with a Secondary Diagnosis of Mental Illness

Abstract

The prevalence and impact of mental illness in the United States cannot be overlooked in acute medical settings where the complexity of care for medical-surgical patients increases with a secondary diagnosis of mental illness (MSMI). However, many nurses in acute care are not fully prepared to care for these patients. Research exploring nurses' preparedness to care for MSMI patients is scarce. The purpose of this study was to measure the components of nursing preparedness regarding MSMI patients and to explore what variables are more frequently associated with and most predictive of preparedness. Understanding this preparedness is the beginning of determining necessary changes for improved MSMI patient outcomes. The proposed preparedness model was guided by Bandura's social cognitive theory. It proposed nursing preparedness (nursing care self-efficacy and mental health care competence) to care for MSMI patients was influenced by personal, educational and professional variables. To determine the effect of the independent variables on preparedness, a descriptive correlational design was used with a convenience sample of registered nurses (N=260) in a large tertiary health care system who currently provided or had ever provided care for MSMI patients. Participants completed an on-line survey. The survey assessed participants for their level familiarity with mental illness (LOF), education, professional experiences with MSMI patients, self-reported nursing care self-efficacy (NCSES) and self-reported behavioral health care competence (BHCC). Statistically significant higher mean competency scores related to BHCC subscales of assessment, practice and drug recommendation were observed in nurses who provided more frequent care for MSMI patients, received mentoring related to mental illness, and who participated in continuing education related to mental illness. Using simultaneous multiple regression the strongest predictors of preparedness were complex nursing care self-efficacy and mentoring. Essential for the workforce of today and the future, this research lends direction to further research and filling the gap towards nursing preparedness for care of MSMI patients. The effect nurses have on MSMI patient outcomes can be altered with these findings as nursing leaders are informed of needed policy changes for empowerment of the nursing workforce and work environment with a preparedness for MSMI patients.