A needs assessment of the delivery of nursing care for the mentally ill patients in the general medical wards : the nurses' perception.

Abstract

Mental health care is an essential but often forgotten component of health care. Nurses as health care providers, need to be able to contribute effectively to mental health care. The education and training of nurses in Malta does not equip them with the necessary knowledge and skills that would help them provide proper mental health care to patients in the medical wards. The result is an inferior, type of mental health care being offered to those who need it. If nurses on the medical wards are better trained, any signs of mental illness will be detected more quickly. This would lead to economic benefits by decreasing the length of the patient's stay in hospital and preventing unnecessary readmissions. It is common practice in the Maltese Health Care system to admit to Mater Dei Hospital patients who have no one to care for them or who are unable to care for themselves. Methodology: Due to the complexity of the issue under study, both qualitative and quantitative measures were used by collecting original information and adapting what was already available as suggested by Williams, R. & Wright, 1.(1994). A self-administered questionnaire was distributed to all nurses (N=54) working on the general medical wards at Mater Dei Hospital (MDH). Questionnaires were used to

identify the needs of a larger population. A structured interview was carried out with all Nursing Officers (NOs) and Deputy Nursing Officers (DNOs) (N=10). The aim was to identify the needs of nurses from different perspectives. A semi structured interview was also carried out with key persons of nursing management (N=2). These could play an important role in organising training sessions for nurses working on the medical wards. They could also help promote the introduction of the Mental Health Nurse (MHN). Findings & Discussion: All nurses, DNOs , NOs and key persons stressed the need for more training as well as support from a mental health nurse. They also identified the need to improve the service being offered to this client group. However, these key persons had some reservations as to how much nurses in medical wards would benefit from the presence of a MHN on the medical ward. Nurses admitted that, when dealing with mentally ill patients, they lacked proper knowledge as well as being unsure of the type of care expected from them. Stigma also played an important role in the nurses' perceptions of this client group. Participants labelled mentally ill patients as pessimistic and cold hearted. It was evident that participants found it difficult to identify patients with mental illness and also had difficulty in communicating with such patients. Participants acknowledged that they need training in certain areas. Communication skills topped the list. Five participants expressed a desire to learn more about the signs and

symptoms of treatment withdrawals and drug interaction. Another three participants expressed a need to learn how to identify mentally ill patients from behaviour or other symptoms. Knowing and learning how to deal with the relatives of a mentally ill patient on the medical wards was an issue brought up by one participants. Requirements identified in this study were similar to the findings in the literature. The key persons stressed the necessity of having a case summary about the patients' condition when these are transferred from an institution to the medical wards. Unfortunately there exists no mechanism in the health care system in Malta which provides information from one institution to another. This would ensure continuity of nursing care on the medical wards. Conclusion & Recommendations: The study shows how unprepared nurses on the medical wards are when they have to care for mentally ill patients. This explains the desire of participants to have further training and mental health nursing support. This research recommends that the Ministry of Health, Elderly and Community Care (MHECC) should implement a policy that promotes the allocation of at least one mental health trained professional nurse within the general hospital.