How do mental health nurses work with people with mental illness who are overweight or obese to achieve a healthier weight?

Jo-Anne Richards

doi:10.25907/01051

Background: The topic of investigation was exploring the experience of mental health nurses (MHNs) working with people with mental illness who are overweight or obese, to achieve a healthier weight. This is an important topic in mental health nursing, as both mental illness and overweight and obesity are chronic health issues within the community. More research is needed in addressing how to provide more customised care for the individuals experiencing overweight. This includes needing more research on how to support those people with low motivation, along with consistent guidelines for MHNs on how to intervene in this area of care. It is crucial that MHNs use the experience that they have in this area, to further develop the care that they provide, so that people with mental illness, and co-occurring overweight or obesity, can be supported effectively to live longer lives, with enhanced quality of life. Aim: This study aimed to provide an in-depth examination of the lived experience of MHNs in Australia who are working with people with mental illness who are overweight or obese, to achieve healthier weights. This might lead to future improvements in care. Methods: The project explored what MHNs are already doing in this field, so that it could be better understood, which may lead to future developments for better care. Through interviews, understanding the lived experience of MHNs working with people with mental illness who are overweight or obese to achieve a healthier weight, this research attempted to identify the issues and present outcomes. A qualitative methodological approach using an interpretative phenomenological analysis framework for qualitative descriptive phenomenology was used. Participants comprised five MHNs working in Australia, with a post graduate qualification in mental health nursing, and they had recent experience within the last 12 months. Data were collected online through semi-structured interviews on Microsoft teams. Findings: Three themes were developed: navigating complex care, facing limitations and barriers, and being an advocate for positive change. Within these themes, subthemes were developed. Within navigating complex care, the subthemes that emerged were the role of the MHN, and medication is a double-edged sword. It was found that the MHNs’ role is multifaceted and challenging. Despite this, they are trying to intervene, however, psychotropic medications are compounding the difficulties in their role. From the facing limitations and barriers theme, subthemes found included inadequate resources, difficulties relating to the person with mental illness, and scope of practice and workload. MHNs felt that they have limited specialist allied health staff to refer to, which made weight management care difficult, and the clients they cared for experienced socioeconomic factors such as isolation and not being able to afford healthy food. MHNs felt somewhat powerless in their scope and felt because of their large workload, it was difficult for them to intervene and make a difference. Finally, within the theme of being an advocate for positive change, connecting with the person and changes for the future were the main subthemes. MHNs emphasised the importance of building trusting relationships with clients through rapport and offering groups to support the therapeutic relationship, where they needed to offer patience, compassion and encouragement. They expressed that they need to be listened to more so they could work towards offering welcoming groups to reduce workload pressures and support their clients whose difficulties also impacted on the success of weight management care. Discussion: This project reported that the role of the MHN in this area is broad and it would help to address large workloads nurses are experiencing. It was suggested that more allied health professionals are needed to refer to, and it may be of benefit for MHNs to learn skills such as coaching and group facilitation. It was recommended that the issue of weight gain due to medication be addressed by having interventions in place at the beginning, when medications are initially prescribed. It was expressed that socioeconomic factors of clients’ lives need to be considered and supported, such as not having enough money to buy healthy food. Ultimately, MHNs can make a difference through their connection and through the rapport they build in helping people with this health concern. Conclusion: The findings indicated that MHNs have challenging experiences in working with people with mental illness who are overweight or obese. Despite this, they are identifying positive factors that can help with client rapport. They have suggested some changes for future practice, and there could be the opportunity to learn new skills and expand the scope of MHN practice in this field. Overall, exploring these experiences suggested that there is a need to continue to improve the support and care for clients experiencing mental illness, and overweight or obesity.

How do mental health nurses work with people with mental illness who are overweight or obese to achieve a healthier weight?

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