147 A Human-Centered Design Approach to Develop Oral Health Nursing Interventions in Patients with a Psychotic Disorder in a persona that encouraged a holistic perspective that included oral health; and (4) in line with the MHNs’ holistic professional profiles, most MHNs indicated that they considered the issue of oral health in patients with a psychotic disorder important, but in practice, they took limited responsibility for that role. To elaborate on the first finding, we found that the attitudes and perspectives of the MHNs regarding oral health in patients with a psychotic disorder varied enormously. Although some MHNs suggested that oral health in mental health is important, the findings suggested a difference between these expressed beliefs and the actual behavioral follow-up in daily practice. There is still a struggle for MHNs to take responsibility for oral health as part of general health in patients with a psychotic disorder. The literature shows that MHNs’ attitudes toward addressing physical issues are positive in general, but MHNs need more education to effectively include physical health promotion in their activities [45]. A recent study [46] showed that existing psychiatric care needs were well discussed by psychiatrists, psychologists, and MHNs, but physical care needs and social-wellbeing-related care needs remained untreated in psychosis care. Happell et al. [18] showed the need for education and training for MHNs to improve physical health care, but oral health as part of physical health was not included. The results of this study showed that some MHNs felt responsible to act on oral health issues, and several MHNs in certain situations felt responsible but were still uncomfortable acting on oral health. Oral health issues are important, as related risk factors are known to contribute to a lower quality of life and reduced life expectancy [8–13]. Since the MHN profession is underpinned by the concept of a holistic vision of care [18,47,48], it is important that the integration of physical issues, such as oral health, is addressed as a matter of priority. To elaborate on the second finding, there were differences in the barriers, needs, and suggestions for interventions among MHNs. The most important barriers acting against the MHNs to play an active role in oral care for their patients were a lack of information (e.g., what is proper oral health care? What is the benefit of proper oral health care for patients? What are the risk factors? What do MHNs have to look out for?), a lack of practical skills (e.g., how to carry out oral health care in patients), and a lack of practical facilities (e.g., an oral health screening form). However, the most important barrier was reported to be the patients, since they 5
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