137 A Human-Centered Design Approach to Develop Oral Health Nursing Interventions in Patients with a Psychotic Disorder Overall, some participants (MHNs and the expert by experience) seemed to be unconsciously incompetent. Participants acknowledged their lack of knowledge regarding oral health. Half of these participants finished the Bachelor of Nursing without any education on oral health care. Most frequently mentioned in terms of lack of knowledge were the importance of oral health, oral health in mental health, oral health diseases and symptoms, and medication and oral health. “I know that oral care is important, but I do not know why. Well, brushing twice a day, I think that when I have more background information and underpinning information, I will also do more with it in practice” (Participant 3). All participants stated that the need for skills stemmed from a knowledge deficit. Some participants indicated that observing oral health, being able to ask questions, explaining properly, and assuming a coaching role are important skills, but they are not always applied. In terms of skills, all participants agreed that effective communication skills are needed. Half of the participants confirmed that these skills were needed to talk to patients about oral health. Motivational interviewing is an important part of this, but according to one participant, MHNs have mastered the skill of motivational interviewing but do not know how to apply this to oral health. Some of the participants indicated that they felt the need to know how best to start a conversation about oral health. Other participants stated that they can start a conversation but are unsure of what actions to perform afterward. “Good communication skills are essential, because the shame and the fear of stigmatization play a crucial role, so you must be able to empathize with patients” (Participant 9). Interventions for MHNs for Providing Oral Health Care During the interview, the participants were asked what they needed in terms of interventions regarding oral health. Less than half of them said they needed training as an intervention. Training can occur in the form of a continuing education course, refresher course, or peer review to gain more knowledge and create more awareness about oral health. Participants indicated that a one-day training could contribute to more knowledge and create awareness. 5
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