“There is no true separation between mental and physical health,” said Patricia Cunningham, DNSc, APRN-BC, president of the American Psychiatric Nurses Association (APNA) and associate professor at the University of Memphis Loewenberg School of Nursing in Memphis, Tenn. “It’s no longer one or the other. The notion that there is a duality of body and mind is outdated.”
According to recommendations issued in a report by the Institute of Medicine of the National Academies, patient care should be delivered with “an understanding of the inherent interactions between the mind/brain and the rest of the body.” The reciprocal relationship between physical health and mental health is particularly important when caring for patients with chronic or acute illnesses. Often these patients are not aware that in addition to the symptoms of their diseases, they may also experience the unexpected symptoms of depression or anxiety. Based on the nursing profession’s commitment to providing comprehensive patient care, nurses are well-positioned to help patients address many mental health issues.
“Mental health issues like depression and anxiety are called the ‘unwelcome companion’ in healthcare, as they can negatively affect all aspects of patient care,” said Cunningham. “But no matter what area of nursing you specialize in, whether it is cardiology, oncology or rheumatology, we all know that when mental health concerns are present, quality care outcomes for patients may not be achieved as successfully. It’s important to treat these mental health issues as well.”
Rebecca Lehto, Ph.D., RN, OCN, assistant professor in the College of Nursing at Michigan State University in East Lansing, Mich., studies the impact that a cancer diagnosis can have on a patient’s mental health. According to Lehto, a cancer patient’s emotional state can have an impact on their physical health. For example, cancer patients who are depressed or anxious may have loss of appetite, experience disrupted sleep schedules, self isolate from their support network or be less likely to engage in health promotion activities like exercise. Conversely, if a patient has a positive mindset, they are more likely to stay actively engaged in behaviors that promote physical health and quality of life.
“When patients are feeling more hopeful about their life, and actually believe that there are things they can do that will help manage their cancer and improve their functioning, they are likely to be more motivated to participate in treatment decisions and commit to the care they are receiving,” said Lehto.
According to Lehto, although patients are sometimes reluctant to discuss mental health, it is important that the healthcare team, especially nurses, builds a foundation of trust with their patients to partner with them in addressing their mental health. This is especially critical for chronic conditions, such as rheumatoid arthritis, or in life-limiting illnesses like congestive health failure and cancer.
“Sometimes it is as simple as just asking,” said Lehto. “If the healthcare team does not ask any questions about the patient’s psychological functioning, the patient may not attribute as much importance to that compared to other pressing issues related to their treatment and medical management. I’ve noticed that cancer patients often think admitting mental health vulnerability makes them appear less strong and capable. They don’t want to further upset their family or be stigmatized.”
However, the social stigma associated with mental health has decreased in recent years.
“We have finally started to see a shift in thinking, and there is a neurobiological respect for mental health problems and disorders,” said Cunningham. “We’re moving from an era of blaming the individual to understanding that these are complex brain illnesses that deserve full research, examination and treatment. It’s coming out of the shadows.”
According to Cunningham, nurses are positioned to address a patient’s mental health, regardless of specialty. They can assess the psychological effects of a patient’s chronic or critical illness and help improve patient outcomes, both mentally and physically.
“All nurses know the fundamentals of mental health screening, just like all nurses know how to check vital signs. It is part of the foundation of nursing,” said Cunningham. “Nurses need to remain invested in mental health care. They can include an initial mental health assessment when screening patients and help them get the treatment they may need.”
“Nursing by its very nature carries a commitment to providing a holistic assessment of the patient as a human being,” said Lehto. “Nursing is patient-focused, not disease-focused. As humans, we are complicated, biological, psychological and social creatures. It’s all integrated. Addressing a patient’s mental health is part of providing that comprehensive care to a patient – and it’s an integral part of ensuring that we are providing the best care possible.”
To learn more about the American Psychiatric Nurses Association, visit www.apna.org.