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Are We Preparing Future Nurses to Provide Patient-Centered Care to People With Mental Illness?: Do We Need to Pivot to Self-Management? Nadia Ali Muhammad Ali Charania; Shattell, Mona. Journal of Psychosocial Nursing & Mental Health Services;;;;

ThorofareThorofareThorofareThorofare Vol. 61, Iss. 10, (Oct 2023): 2-4. DOI:10.3928/02793695-20230915-01

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Full text PDF Abstract/Details 10 References 154 With shared references

Abstract TranslateM

According to the Agency for Health Care Research and Quality (2020), future nurses must use SM to support and

help people manage their chronic health conditions daily. [...]we all know that one size does not fit all. [...]health care

providers must demonstrate cultural humility to learn from patients while expanding their ability to provide culturally

competent care. [...]in addition to recognizing their positionality in patient-centered care, using SM requires health

care providers to recognize and manage their personal biases about people with mental illness and the strategies

they identify and use to address them.

TranslateM

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Millions of people worldwide struggle with the burden of mental illness requiring urgent attention. Limited and

inequitable quality and access to mental health care, self- and social stigma, negative experiences in prior

encounters with mental health services, and little or no social support for seeking care further complicate the

struggle of people with mental illness.

The World Health Organization's ( ) latest World Mental Health Report states that transforming mental health

for all will require deliberate attention from all sectors and stake-holders. The report also points to the need to

strengthen the competencies of the health care workforce in transforming mental health. The report notes that

people with mental illnesses must feel socially included, protect their rights, and receive person-centered care. The

American Association of Colleges of Nursing ( ) has also indicated in the new Essentials that nurses must be

competent in person-centered care, among other competencies/domains. The Essentials define person-centered care as “holistic, individualized, just, respectful, compassionate, coordinated, evidence-based, and developmentally

appropriate” ( , p. 10). The Quality and Safety Education for Nurses ( ) project also calls for preparing

future nurses with knowledge, skills, and attitudes to address health system challenges by equipping them with a

range of competencies, including safe, high-quality, evidence-based, patient-centered care.

As a behavioral health nursing faculty, we prepare future nurses with knowledge and skills to work with people with

mental illness while also working to change the negative attitudes (if any) toward this population. We might ask

whether we prepare future nurses to do more than recognize signs and symptoms of various mental illnesses, place

them in diagnostic buckets, and ensure they know how to implement ordered medical management. Is there a need

to transform mental health nursing curricula to prepare future nurses for the focus and competencies envisioned by

the WHO and AACN? If so, how should we go about it?

We need to reflect on the behavioral health nursing courses offered at the undergraduate level and determine how we

prepare future nurses, particularly in developing competencies in caring for people with mental illness. In such a

reflective process, we must go beyond reviewing the course description and objectives to determine how the AACN

Essentials-specific competencies/domains are actualized. Time for collective reflection within and across nursing

education institutions and clinical settings could be of immense value. For example, determining what concepts and

frameworks need to be incorporated into the behavioral health curriculum while identifying and strategizing about

existing faculty challenges. Whether we use individual or collective reflection, one thing is clear: to achieve the

desired outcome of preparing future nurses capable of providing safe, respectful, caring, holistic, equitable, high-

quality, evidence-based, and patient-centered care while meeting the challenges of the current health care

environment, we must be more intentional.

To begin discussions about what concepts and frameworks to consider, we suggest that behavioral health nursing

faculty who envision preparing future nurses to provide patient-centered care consider the concept of self-

management (SM) as part of the behavioral health nursing curriculum. Scholars suggest that undergraduate nursing

curricula need more mental health education ( ) and concept-based education with clinical relevance for

student application ( ; ). According to the Agency for Health Care Research and Quality ( ),

future nurses must use SM to support and help people manage their chronic health conditions daily. According to

Van de Velde et al. ( ), health care providers need education to facilitate their patients' SM skills in the clinical

setting; therefore, “...self-management competencies must be part of healthcare curricula” (p. 13).

SM has been defined in several ways over decades, including as a strategy (Corbin & Strauss, 1989), self-regulatory

process ( ), and framework supporting patients' strategies for monitoring and managing illness over

time ( ). Van de Velde et al. ( ) performed a conceptual analysis of SM and proposed three main

groups of SM–related attributes: (a) person-oriented, (b) person-environment-oriented, and (c) summarizing

attributes. Their work led to the definition of SM as “the intrinsically controlled ability of an active, responsible,

informed and autonomous individual to live with the medical, role and emotional consequences of his chronic

condition(s) in partnership with his social network and the healthcare provider(s)” ( , p. 10).

We see value in integrating SM as a framework for reconceptualizing behavioral health content and practice

approaches for preparing future nurses for several reasons. First, SM would help providers recognize the centrality of

the patient's role in their care plan and the need to invite their participation as experts in their illness experiences and

unique contexts. Second, there must be a partnership between patient and provider based on trust and respect in

which the patient feels included. A patient–provider partnership facilitates learning from patients about their

experiences with their illness and strategies they have used or would like to try to manage their health condition.

Such discussions would help patients consider safety (recognizing that not all strategies are safe and have

therapeutic value), associated barriers (e.g., social factors), and facilitators (e.g., social support). Third, we all know

that one size does not fit all. We also have more empirical knowledge about SM strategies that diverse populations

use to manage their mental illness. Therefore, health care providers must demonstrate cultural humility to learn from

patients while expanding their ability to provide culturally competent care. This approach of learning from the patient

challenges the notion that the health care provider is the expert and final authority on the patient's care plan, and the

patient is simply a follower of the care plan. If the patient has difficulty following the prescribed care plan, the patient

is at fault. Finally, in addition to recognizing their positionality in patient-centered care, using SM requires health care

providers to recognize and manage their personal biases about people with mental illness and the strategies they

identify and use to address them.

Complementing the conversation about pivoting to using SM as a conceptual framework for patient-centered care,

we share the acronym “MY PT CARE STRATEGY” as an example to help nursing faculty consider using it in teaching

behavioral health nursing theory and clinical practice to our future nurses. In addition, the MY PT CARE STRATEGY

acronym should serve as a reminder tool for nursing students to ensure they prioritize the integration of the SM

concept into mental health clinical practice to offer patient-centered care:

MMMM—My personal biases against people with mental illness need to be acknowledged first.

YYYY—Yearn to find ways to address identified biases (if any) before becoming involved in caring for people with mental

illness.

PPPP—Portray cultural humility to learn from patients about their illness experiences and contexts, including family,

community, society, and culture.

TTTT—A trusting patient–provider partnership is essential to the patient's journey with recurrent chronic mental illness.

CCCC—Care is patient-centered while ensuring that it is safe, holistic, compassionate, and high quality.

AAAA—Actively seek the patient's participation in SM of their mental health condition. Recognize, however, that

depending on the patient's health status, the level and quality of participation may vary.

RRRR—Revitalize professional commitment to the delivery of patient-centered care.

EEEE—Ensure equitable, accessible, evidence-based mental health care.

SSSS—Identify social determinants of health factors that affect the mental well-being of patients and contribute to the

difficulty of managing their mental illness.

TTTT—Teach self-regulation and the value of actively managing mental illness daily.

RRRR—Rehearse SM strategies when seeking professional help and in their contexts.

AAAA—Ask patients about facilitators and barriers to implementing identified SM strategies in their daily management of

mental illness.

TTTT—Be there when patients face struggles in their mental illness journey.

EEEE—Evaluate the effectiveness of strategies tried during the patient–provider interaction to determine which were

helpful or not in managing their mental illness, sustaining daily functioning and promoting holistic well-being.

GGGG—Go beyond patient identification of SM strategies that focus only on illness management to prevent a relapse.

YYYY—Yield patient-centered care in which a patient with mental illness drives their care with available professional and

other contextual support.

Our acronym, MY PT CARE STRATEGY, where PT stands for the word patient, provides behavioral health faculty with

strategies for framing their classroom discussions and clinical practice. At the same time, it allows nursing students

and current practicing nurses to think critically about integrating each aspect of the acronym into their patient care

practices.

The value of integrating the SM concept seems promising for preparing future nurses to engage in patient-centered

care in the ever-evolving complexities of mental health. As part of its premise, SM recognizes the centrality of

engaging patients as experts on their illness experiences and contexts in developing a care plan. Such a care plan

includes patient-centered SM strategies that the patient can use or revise, with professional and contextual support,

to live with a recurrent, chronic mental illness. The empirical value of integrating SM as a framework in behavioral

health courses and preparing future nurses from the SM framework in caring for people with recurrent and chronic

mental illness remains to be established.

Nadia Ali Muhammad Ali Charania, PhD, RNNadia Ali Muhammad Ali Charania, PhD, RNNadia Ali Muhammad Ali Charania, PhD, RNNadia Ali Muhammad Ali Charania, PhD, RN

University of Michigan, School of Nursing

Ann Arbor, Michigan

Mona Shattell, PhD, RN, FAANMona Shattell, PhD, RN, FAANMona Shattell, PhD, RN, FAANMona Shattell, PhD, RN, FAAN

Editor

ReferencesReferencesReferencesReferences

Agency for Health Care Research and Quality. (2020). Self-management support.

https://www.ahrq.gov/ncepcr/tools/self-mgmt/index.html

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing

education. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

Baron, K. A. (2017). Changing to concept-based curricula: The process for nurse educators. The Open Nursing

Journal, 11, 277–287. 10.2174/1874434601711010277

Bennett, C. (2021). Improving mental health education in nursing school. Nursing, 51(9), 48–53.

10.1097/01.NURSE.0000769868.09336.15

Charania, N. A. M. A., & Hagerty, B. M. (2016). The pervasive role of religion/spirituality in Pakistani women's self-

management of recurrent depression. International Journal of Current Research, 8(04), 30107–30114.

Corbin, J., & Strauss, A. (1985). Managing chronic illness at home: Three lines of work. Qualitative Sociology, 8(3),

224–247.

Hagerty, B. M., Bathish, M. A., & Kuchman, E. (2020). Development and testing ofaself-regulation model for recurrent

depression. Journal of Health Psychology, 25(10–11), 1732–1742. 10.1177/1359105318772083

Quality and Safety Education for Nurses. (2020). QSEN Institute competencies. https://qsen.org/competencies/pre-

licensure-ksas/

Van de Velde, D., De Zutter, F., Satink, T., Costa, U., Janquart, S., Senn, D., & De Vriendt, P. (2019). Delineating the

concept of self-management in chronic conditions:Aconcept analysis. BMJ Open, 9, e027775. 10.1136/bmjopen-

2018-027775

World Health Organization. (2022). World mental health report: Transforming mental health for all.

https://www.who.int/publications/i/item/9789240049338

AuthorAffiliationAuthorAffiliationAuthorAffiliationAuthorAffiliation

Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

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WHO; 2022

AACN; 2021

AACN, 2021 2020

Bennett, 2021

Baron, 2017 Bennett, 2021 2020

2019

Hagerty et al., 2020

Charania & Hagerty, 2016 2019

Van de Velde et al., 2019

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Here is the key takeaway.

Future nurses must be prepared to provide patient-

centered care for individuals with mental illness by

integrating self-management strategies into their

education and practice.

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Subject

Nursing education

Clinical medicine

Core curriculum

Psychiatric-mental health nursing

Patient-centered care

Mental health care

Nurses

Nursing care

Mental disorders

Chronic illnesses

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