Knowledge of Metabolic Risk and Its Relationship to Psychiatric Practice in the United States

Purpose: Persons with serious mental illness (SMI) die on average, 25 years earlier than those in the general population. Co-morbidities are significant in this population and clearly contribute to poor health outcomes (NASMHPD, 2006). Metabolic syndrome is a constellation of health related factors which put people at increased risk for the development of diabetes and cardiovascular disease. Antipsychotic drugs which are often needed to treat symptoms of mental illness are associated with metabolic risk and MetS. Despite knowledge about the increased metabolic and cardiovascular risks faced by persons with SMI, there are few integrated programs to address both the psychiatric and medical needs of this population (Castillo, Rosati, Williams, Pessin & Lindy, 2015). Nurses are important care providers for individuals with SMI at all levels of the care spectrum from inpatient hospitalization to ongoing outpatient care and treatment. The purpose of this study was to identity the knowledge of psychiatric nurses related to MetS in persons with SMI and to identify whether or not psychiatric nurses were incorporating the recommendations for monitoring the risk factors into their practice. In addition, we sought to identify perceived knowledge gaps linked to the care of individuals with MetS.

Methods: This study used a survey design to elicit information from psychiatric mental health nurses about their basic knowledge related to the health factors associated with Metabolic Syndrome (MetS) in persons with SMI, to identify the practice activities associated with their role and to discover their perceived educational needs related to MetS. The authors developed a short knowledge test based on the criteria for MetS identified by the Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes (2004). Next, with permission, we adapted the Mental Health Nurse Physical Health Attitude Scale (PHASe) developed by Robson and Haddad (2012). The survey was posted to a psychiatric nursing web-based, social media site. This study was approved by the University of Massachusetts Lowell IRB.

Results: Data from 154 completed surveys were analyzed representing registered nurses from across the US. The mean age was 55.3 and the mean number of years practicing mental health nursing was 20.61 years. While the majority

Conclusion: Despite development of standards for monitoring patients for metabolic risk at the Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes (2004), nurses in our study were not routinely screening for all factors. Blood pressure monitoring, weight checks, waist circumference measurement and laboratory studies including fasting glucose, hemoglobin A1C measurement and lipid studies are all necessary to identify risk factors. While knowledge regarding MetS risk factors was high, integration of this knowledge into care was lagging. Developing interventions to improve outcomes for this population is critical.