# Exploring Intensive Care Nurses' Experiences and Perceptions of Patients With a Co‐Morbid Mental Health Disorder

## TL;DR

This study explores how ICU nurses experience caring for patients with mental health disorders, revealing a need for better support and education.

## Contribution

The study provides new insights into ICU nurses' experiences and perceptions of caring for patients with co-morbid mental health disorders.

## Key findings

- ICU nurses feel frustrated and lack confidence in managing patients with mental health disorders.
- There is a need for additional education, clinical leadership, and integration of mental and physical healthcare.
- Stigma and lack of support from mental health services impact ICU nurses' ability to provide care.

## Abstract

Patients with a co‐morbid MH disorder are roughly twice as prevalent in intensive care units (ICU) than in other general secondary care areas. Such patients may be subject to social stigma and diagnostic overshadowing while being nursed in general healthcare settings. Studies in non‐ICU areas suggest that staff lack knowledge and work in a non‐collaborative manner, impacting negatively on the delivery of holistic humanised care. There is limited evidence on this topic from the perspective of ICU nurses.

This study aimed to add to the small body of evidence exploring how ICU nurses experience caring for patients with an MH disorder.

A pragmatic approach was taken. Twelve members of registered ICU nursing and advanced practice staff were recruited via social media and professional networks. Participants engaged in online individual semi‐structured interviews which were audio‐recorded. The transcripts were checked and then analysed using a six‐stage reflexive thematic analysis process.

Five themes were identified: (1) frustration and futility, (2) the impact of a lack of knowledge, (3) perceptions, (4) unpredictable and violent and (5) the ICU environment is unsuitable.

The findings of this study indicate that ICU nurses require additional support, education and clinical leadership to manage patients with an MH disorder. Participants expressed feelings of frustration regarding patients' limited access to on‐going MH support. Participants appeared especially uncomfortable when caring for patients who had self‐harmed or attempted suicide. A need for further research into the experience of MH patients in ICU is indicated.

Due to the high prevalence of patients with an MH disorder in ICU, it is important that ICU nurses understand their specific needs and how socially held stigmatised views can impact on care. Stigma and previous traumatic events can lead to staff avoiding engagement with MH patients. Strong clinical leadership, collaborative working and continued education are necessary to support both staff and patients.

The prevalence of mental health disorders in ICU patients is twice that of patients in other areas of secondary care.There is a paucity of high‐quality research in this area of practice. Previous reviews suggested that nurses may deliver care influenced by socially generated bias and stigma.Nurses working in ICU appear to lack confidence in their skills when managing patients with mental health disorders. A need for greater support and education was identified.

The prevalence of mental health disorders in ICU patients is twice that of patients in other areas of secondary care.

There is a paucity of high‐quality research in this area of practice. Previous reviews suggested that nurses may deliver care influenced by socially generated bias and stigma.

Nurses working in ICU appear to lack confidence in their skills when managing patients with mental health disorders. A need for greater support and education was identified.

ICU nurses feel unsupported by MH services and experience frustration at the assumption that ICU is a ‘safe place’ due to its capacity for 1:1 nursing. They feel the area is unsafe for this patient group, and there were concerns that they might harm other patients.ICU nurses are keen to deliver high‐quality patient care, but feel concerned about their ever‐widening nursing role and the ability to maintain skills.This is an important topic and participants were keen to share their experiences. More support for clinical staff is indicated.This study is part of a series of work undertaken to explore the experiences of ICU nursing staff when caring for a patient with a co‐morbid MH disorder. The study has demonstrated a need for further support and education and a lack of integration between mental and physical health care.

ICU nurses feel unsupported by MH services and experience frustration at the assumption that ICU is a ‘safe place’ due to its capacity for 1:1 nursing. They feel the area is unsafe for this patient group, and there were concerns that they might harm other patients.

ICU nurses are keen to deliver high‐quality patient care, but feel concerned about their ever‐widening nursing role and the ability to maintain skills.

This is an important topic and participants were keen to share their experiences. More support for clinical staff is indicated.

This study is part of a series of work undertaken to explore the experiences of ICU nursing staff when caring for a patient with a co‐morbid MH disorder. The study has demonstrated a need for further support and education and a lack of integration between mental and physical health care.