Oral health knowledge, attitudes, and practices of people living with mental illness: a mixed-methods systematic review.

People living with mental illness experience poorer oral health outcomes compared to the general population, yet little is known about their oral health knowledge, attitudes, and practices. The aim of this mixed-methods systematic review was to synthesise evidence regarding oral health knowledge, attitudes, and practices of people living with mental illness to inform preventative strategies and interventions. Database searches were conducted in PubMed, MEDLINE, PsycINFO, CINAHL, ProQuest, and Scopus with no limitations placed on the year of study. All studies available in the English language, that explored the oral health knowledge, attitudes, and/or practices of people with a mental illness were included. Articles were excluded if they primarily pertained to intellectual disability, behavioural and psychological symptoms of dementia, drug and alcohol or substance use, or eating disorders. A thematic synthesis was undertaken of 36 studies (26 high-moderate quality), resulting in 3 themes and 9 sub-themes. Study participants ranged from n = 7 to n = 1095 and aged between 15-83 years with most having a diagnosis of schizophrenia, schizoaffective, or bipolar affective disorder. People diagnosed with a mental illness were found to have limited oral health knowledge, particularly regarding the effects of psychotropic medication. Various barriers to oral health care were identified, including high dental costs, the negative impact of mental illness, dental fears, lack of priority, and poor communication with dental and health care providers. Study participants often displayed a reduced frequency of tooth brushing and dental visits. The findings highlight the potential for mental health care providers, oral health and dental professionals, mental health consumers, and carers to work together more closely to improve oral health outcomes for people with mental illness. The systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO), (registration ID CRD42022352122).

Clarity, confidence and complexity: Learning from mental health nurses' experiences of events involving physiological deterioration of consumers in acute inpatient mental health settings.

AIMS AND OBJECTIVE: To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. BACKGROUND: Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. METHOD: An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward-based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. RESULTS: Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). CONCLUSION: The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. RELEVANCE TO CLINICAL PRACTICE: Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance.

A review of general pain measurement tools and instruments for consideration of use in COPD clinical practice.

BACKGROUND: The experience of pain can have a significant impact on the everyday life of individuals including those with COPD. Recently, pain has emerged as an area in COPD research. When considering pain measurement in COPD studies, it is important to consider the validity, reliability, responsiveness and interpretability of instruments and tools. This review sought to assess these domains of general pain instruments and tools using the consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS: Three separate analyses were used to assess general pain measurement tools and instruments. These comprise COSMIN's, 1) methodological quality assessment with dichotomous responses, 2) the 4-point rating scale, and 3) overall quality criteria using an assessment scale for clinimetric properties by Terwee. RESULTS: Overall Pain Sensitivity Questionnaire (PSQ) was found to have the highest rating in all domains of validity, reliability, responsiveness and interpretability. In the first analysis, PSQ and Geriatric Pain Measure (GPM) scored highest in four of the six domains. In the second analysis, using the 4-point rating, the PSQ scored highest in three of four domains. In the third analysis, the GPM scored the highest in all four domains. Overall the PSQ, GPM and Defense and Veterans Pain Rating Scale scores were consistently high in the three separate analyses in this review. CONCLUSION: This review found variability in the domains of validity, reliability, responsiveness and interpretability in general pain tools and instruments. The PSQ was found to be the most valid and reliable general pain measurement instrument for adult populations.