Understanding Helpful Nursing Care From the Perspective of Mental Health Inpatients With a Dual Diagnosis: A Qualitative Descriptive Study

Abstract

BACKGROUND: An estimated 30% to 50% of people with a mental illness also have a substance use problem. Referred to as having a dual diagnosis, these patients experience high levels of unmet needs, poor health outcomes, and require specialized care during psychiatric hospitalization. Research on nursing inpatients with a dual diagnosis is limited and patient perceptions of helpful care during hospitalization are unknown. AIMS: What nursing interventions, attitudes, actions, and/or behaviors are perceived as helpful by patients with a dual diagnosis during psychiatric hospitalization? METHODS: A qualitative-descriptive design was used. Twelve adult inpatients with a dual diagnosis were recruited using purposive sampling. Individual, semistructured interviews were conducted, and interview data were analyzed using content analysis. RESULTS: Helpful nursing occurred across three themes: (1) promoting health in everyday living, (2) managing substance use in tandem with mental illness, and (3) building therapeutic relationships. CONCLUSIONS: Specific examples of helpful interventions and their reported outcomes reinforce the critical role that nurses play in the health and recovery of inpatients with a dual diagnosis. The importance of collaborative, strengths-based approaches is highlighted, and expanding the nurse’s role to include evidence-based responses to substance use is recommended.

Integrated nursing care for people with combined mental health and substance use disorders

“…2015; Ould et al . 2020; Pinderup 2018). In contrast, 11 studies show that despite the high prevalence of combined mental health and substance use disorders and its complexity, nurses are inadequately trained and unprepared to address substance disorders and deliver quality nursing care to people with combined mental health and substance use disorders (de Crespigny et al .…”

“…This review shows that in the absence of knowledge of substance use disorders, the main intervention selected by nurses was the use of pro re nata (PRN) medication as needed, rather than other interventions (Ould et al . 2020). Because of their frontline presence, nurses are well‐positioned to champion the integration of models of care.…”

“…It is important to note that a lack of nurses' understanding will delay diagnosis and treatment, potentially worsening symptoms and outcomes (Cleary et al 2009). This review shows that in the absence of knowledge of substance use disorders, the main intervention selected by nurses was the use of pro re nata (PRN) medication as needed, rather than other interventions (Ould et al 2020). Because of their frontline presence, nurses are well-positioned to champion the integration of models of care.…”

“…Studies from four articles in this review show that training equips nurses with the skill set to manage the levels of complexity of people that present with combined mental health and substance use disorders (de Crespigny et al 2015;Ould et al 2020;Pinderup 2018). In contrast, 11 studies show that despite the high prevalence of combined mental health and substance use disorders and its complexity, nurses are inadequately trained and unprepared to address substance disorders and deliver quality nursing care to people with combined mental health and substance use disorders (de Crespigny et al 2015;Groenkjaer et al 2017;Howard & Holmshaw 2010;Iqbal et al 2015;Moore 2013;Pinderup 2018;Searby et al 2017;Sorsa 2019;Sorsa et al 2017;Stewart & Bowers 2015;Wheeler et al 2014).…”

“…Sub-theme 2.1 gaps in education and professional development Studies identified a lack of training and education about combined mental health and substance use as a challenge hindering nurses in the delivery of quality care to this cohort (Groenkjaer et al 2017;Howard & Holmshaw 2010;Klingemann et al 2019;Ould et al 2020;Searby et al 2017Searby et al , 2018Sorsa et al 2017;Wheeler et al 2014).…”