Medical-Surgical Patients With a Secondary Diagnosis of Mental Illness: How Are Nurses Prepared?

Sunday, 22 July 2018: 10:15 AM

Jeanette J. Avery, PhD
College of Nursing Department of Baccalaureate Education, East Carolina University, Greenville, NC, USA
Ann M. Schreier, PhD
Department of Nursing Sciences, East Carolina University, Greenville, NC, USA


Even with the development of mental health care in many countries world health remains affected by mental illness as the burden of mental disorders continues to grow. Thus, the global prevalence and impact of mental illness cannot be overlooked in acute medical settings where the complexity of care for medical-surgical patients increases with a secondary diagnosis of mental illness (MSMI). The preparedness of nurses to competently care for the complex needs of MSMI patients is paramount to positive outcomes for the patients’ physical and mental health. However, few nurses on medical-surgical units are fully prepared to care for the mental health needs of MSMI patients. The purpose of this study was to explore and measure the personal, educational and professional variables more frequently associated with and most predictive of nurses’ preparedness to care for MSMI patients.


In the fall of 2016, a descriptive correlational design was used with a convenience sample of registered nurses (N=260) from a large tertiary health system in the south-eastern United States. The registered nurses who currently or had ever provided care for MSMI patients completed an electronic survey that included a Level of Familiarity Questionnaire, Nursing Care Self-Efficacy Scale (NCSES), Behavioral Health Care Competency Survey (BHCC) and demographic items.


Using independent-group t-tests or one-way ANOVA to compare mean BHCC scores between the personal, educational and professional variables, the professional variable was indicated as the strongest predictor of NCSES and BHCC subscales. Simultaneous multiple regression analysis on each BHCC subscale for the best linear combination of variables from education, professional and NCSES complex subscale found the largest beta coefficients with NCSES (assessment, practice resource adequacy = <.001) and mentoring (assessment, drug recommendation, resource adequacy = <.05, and practice = <.001). Significance (<.05) for frequency of care and continuing education for MSMI patients was also indicated.


This research indicates significant findings with components of the professional variable. Nurses currently providing care for MSMI patients with high complex nursing care self-efficacy perceptions and mentoring related to care of MSMI patients are the most prepared to care for this complex population. It is imperative research of structure to develop stronger nursing care self-efficacy and to explore mentor development for the care of MSMI patients be continued. Continuing education development with accessible and affordable options for enhanced understanding regarding MSMI patients can strengthen nursing preparedness for this population. Globally, for nurses practicing today and for future nursing graduates, nurse leaders and educators must develop more effective policies to empower the current nursing workforce and work environment with a preparedness for positive MSMI patient outcomes.