135 A Human-Centered Design Approach to Develop Oral Health Nursing Interventions in Patients with a Psychotic Disorder include oral health in their repertoire of actions. Out of the ten participants, two participants discussed oral health care in their team and stated that their colleagues did not consider oral health care to be part of their job and that the role of the family should be more prominent. The expert by experience supported this finding: “Because in my own experience with my bad teeth in health care, it was sometimes signalled by MHNs, but then nothing was done about it. And that is because, well, people (MHNs), do not think that is their job. And that is a wrong way of thinking” (Participant 9). The other participants did not feel responsible for maintaining and increasing oral health as part of their daily work. Barriers to Providing Oral Health Care The barriers participants experienced were quite diverse. The MHNs stated that when patients were admitted with a psychotic disorder, they acknowledged that there was a lack of materials (no toothbrush or toothpaste) or the MHNs did not know what was available. Sometimes, this was noticed after six days of care and patients were not asked. When patients are admitted with a psychotic disorder, care is focused on clinical recovery (e.g., reduction or cessation of symptoms). Oral health care is not considered part of recovery, and there is no focus on physical issues (e.g., oral health). In mental healthcare, it is felt that every patient should perform their activities of daily living, and little attention is paid to personal care at all. Participants often did not know whether there was an assurance for oral health care. Additionally, participants reported not having the time to provide oral health care. “We have about 30 min with a patient. In that time, we also must check on medication, and symptoms. After 30 min, we should go to the next patient. There is no time for MHNs to do something with oral health” (Participant 2). Most participants stated that the attitude of “a lack of attention for oral health” is not good. Participants stated that there was a lack of knowledge on what to do and why. Participants also indicated a lack of knowledge regarding what kind of 5
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