Barriers and Needs of Mental Health Nursing Practitioners toward the Provision of Physical Health Care for Individuals with Severe Mental Illness: Findings from a Cross-Sectional Survey in India.

Despite the potential and opportunity for nurses in mental health settings to deliver comprehensive care to individuals with severe mental illnesses, existing evidence indicates inadequacy in providing physical health care. To understand this gap, we examined the mental health nurse's attitudes, practices, training needs, and barriers toward physical healthcare of individuals with severe mental illness and explored the associated socio-demographic differences. All mental health nurses working in an apex mental health care center in India were assessed using a self-administered questionnaire, which included a socio-demographic profile and the Physical Health Attitude Scale (PHASe). Overall, the nurses held positive attitudes, with items related to smoking and confidence toward physical health care delivery showing more positive ratings than those items related to attitude and perceived barriers. Lack of motivation from patients and nurse's workload in provision of psychiatric care were perceived as major barriers. Nurses with lesser years of experience had a slightly more positive attitude. The findings have important implications for mental health nursing practice and training toward strengthening holistic nursing care for individuals with severe mental illness, specifically in countries with limited resources.

Health-promoting behaviours, their relationships and correlates in nursing students: Implications for nursing education and practice.

BACKGROUND: Despite numerous studies across the globe, most studies on Health-Promoting Lifestyle behaviours among nursing students were restricted to descriptive analysis with limited implications for nursing education and practice. PURPOSE: The purpose of this study was to investigate the level of health-promoting lifestyle behaviours, analyze their relationships and correlates among nursing students. METHODS: Cross-sectional study was conducted among 270 nursing students in India. Socio-demographic profile and Health-Promoting Lifestyle Profile-II scale were administered. Subscales inter-correlation were computed. Hierarchical multivariate logistic regression was used to determine the predictors of Health Promoting Behaviours. RESULTS: Nursing students had modest level of health-promoting behaviours (131.57 ± 17.90). Physical activity had the lowest score (16.44 ± 4.31). Regression analyses showed health-related characteristics to have more influence on health-promoting behaviours than socio-demographic characteristics (p < 0.002). Nursing students with insufficient physical activity (AOR = 0.26; 95% CI: 0.13-0.52) had poor Health-promoting lifestyle profile than those with good physical activity. CONCLUSION: There is a need to strengthen the nursing curriculum and training environment to promote physical activity for nursing students to promote their health and empower them as future health promoters.

Grounded theory of 'lifestyle adaptation' - Perspectives from persons with schizophrenia and their caregivers.

INTRODUCTION: Available evidence highlights that persons diagnosed with schizophrenia are predisposed to develop physical co-morbidities. Lifestyle modification interventions are identified as appropriate strategies to maintain their physical health. A comprehensive understanding of the facilitators and barriers in adhering to healthy lifestyle interventions is critical to developing individualized interventions that are effective and accessible for these patients. AIM: To develop and formulate a theory of lifestyle adaptation for the prevention of physical co-morbidities for persons with schizophrenia and their caregivers who are availing mental health services in the psychiatry wards. MATERIALS AND METHODS: The qualitative data were collected by semi-structured interviews using topic guides from persons with schizophrenia and their family caregivers from the tertiary level psychiatry center, South India. The interviews explored their perceptions and experiences of the facilitators and barriers in adopting a healthy lifestyle. Final data was analyzed based on grounded theory, and the data was used to formulate the theory of lifestyle adaptation. CONCLUSION: The persons with schizophrenia and their family caregivers' perceptions helped in formulating this theory. The present study provides recommendations for physical health services for patients with mental illness. The findings of the study may guide health professionals and mental health advocacy groups, policymakers to plan for appropriate decisions related to incorporating mental health care with physical health care services.

Misconceptions about traumatic brain injury among nursing students in India: implications for nursing care and curriculum.

BACKGROUND: Despite the devastating consequences of Traumatic brain injuries (TBIs), TBI misconceptions are common among healthcare professionals. As an essential member of multi-professional team providing TBI care, it is important that nurses have correct information and adequate skills to achieve the best possible outcomes for TBI. For example, some common misconceptions about TBIs are that a second blow to the head can improve memory functioning and wearing seatbelts can cause as many brain injuries as it prevents. In India, perhaps such misconceptions towards TBI among nursing professionals were not yet documented. As nursing students form the future health workforce, understanding TBI misconceptions among nursing students in resource-limited settings like India will provide useful information for strengthening the nursing curricula for improved care and rehabilitation of TBIs. METHODS: We used a cross-sectional survey to study the TBI misconceptions among nursing students in India. A Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire was administered to 154 nursing students from a nursing college of a tertiary care neuro-centre in India. The mean percentage of misconceptions were calculated for 7-domains of CM-TBI. T-test for independent samples and ANOVA were used to study the association of misconception with socio-demographic variables using total score for each respondent. RESULTS: Of the 143 nursing students who completed the survey, majority of them were female (97%) and in the 19-20 year age-group (95.1%). Domain on brain damage (81.1%) had highest rate, while amnesia domain (42.0%) had lowest rate of misconception. The overall mean-score was 22.73 (Standard Deviation: 4.69) which was significantly higher than the median score of 19.5. The study did not show significant differences on overall misconceptions about TBI for any of the socio-demographic characteristics. CONCLUSIONS: Misconceptions about TBIs were common among nursing students and it was pervasive irrespective of age, gender, place of residence and year of education. A need to strengthen nursing curriculum in the area of TBIs has been emphasized for improved care and management of TBIs. The study findings also suggest the need for understanding such misconceptions among other healthcare professionals involved in TBI care.

Healthy lifestyle behavior and personal control in people with schizophrenia with healthy controls: A cross-sectional comparative study.

The aim of the article was to compare persons with schizophrenia and healthy controls about their life style on their physical health and personal control. Evidences highlights that it helps to change risk behaviours associated with co morbid physical health problems. Subjects were recruited from adult mental health services in tertiary level psychiatric center.Comparisons between the groups were done by using the lifestyle and personal control questionnaire. Subjects were 86 with schizophrenia, 72 were healthy controls. Results showed significant difference. However, physical health was considered to be a less important priority in their personal life by persons with schizophrenia.

Facilitators of healthy life style behaviors in persons with schizophrenia-A qualitative feasibility pilot study.

INTRODUCTION: Persons with schizophrenia experience high rates of cardio metabolic disorders and have a 20-25% shorter life expectancy than the general population. Health professionals led life style modification behavior programs have shown improvements, in managing aspects of metabolic problems. This study sought to identify the life style modification by exploring (1) facilitators that help persons with schizophrenia to adopt the lifestyle modification behaviors and (2) factors that help to adhere to life style modification behaviors. METHODS: A qualitative study utilizing face to face interviews was conducted for five persons (n = 5) diagnosed as schizophrenia (ICD 10) and their caregivers (n = 13) receiving inpatient mental health services in a tertiary level psychiatry centre, in South India. Qualitative data was collected, organized and analyzed with thematic analysis using ATLAS.ti software. RESULTS: The study results identified four major themes as facilitators. (1) Factors of increased self- confidence, and personal development. (2) The need for social support and conducive environment; (3) level of self motivation (4) encouragement from health professional and availability of health services. Participants believed that engaging with programs of physical activity, dietary modification, and illness support from family would motivate them to live more healthily. CONCLUSION: Individuals with serious mental illnesses such as schizophrenia encounter physical health related problems, facilitators of lifestyle change behavior help them to adhere to change in their routine life. Lifestyle change interventions also motivate individuals to eat healthy diet and exercise regularly to prevent premature mortality.

Exercise, diet and educational interventions for metabolic syndrome in persons with schizophrenia: A systematic review.

INTRODUCTION: Individuals with major psychotic disorders such as schizophrenia are at increased risk for developing metabolic syndrome due to lifestyle- and treatment-related factors. Numerous interventions have been tested in inpatient and outpatient mental health settings to decrease risk factors. Diet and exercise represent the mainstay of weight loss treatment. With this background the review aimed to evaluate the effects of psychoeducation, diet and physical activity interventions on reduction of metabolic syndrome risk factors such as BMI, Body weight, biochemical profiles in schizophrenia. METHODS: The authors conducted database searches of PsychINFO, MEDLINE, Pubmed, Proquest, EBSCO and the Cochrane Database of Systematic Reviews, and manual searches from 1968 to 2017. Search indentified 11 studies that met the inclusion criteria. Study quality was critically appraised by 2 reviewers using established criteria. The outcome measures were body mass index, body weight, waist circumference, lipid profile, fasting glucose. RESULTS: Interventions led to significant weight reduction (8 studies), reduced body mass index (5 studies), decreased waist circumference (4 studies) and lower blood glucose levels (5 studies). Dietician and nurse led interventions (6 studies). The studies showed non pharmacological interventions were effective in reducing risk factors. CONCLUSION: This review was able to demonstrate effectiveness of peychoeducation, diet and physical activity interventions were helpful to decrease and manage antipsychotic-induced weight gain. Results showed lifestyle interventions are safer and effective for promoting decrease or maintenance of weight and it can be delivered at low cost, safe and improves quality of life.