149 A Human-Centered Design Approach to Develop Oral Health Nursing Interventions in Patients with a Psychotic Disorder The presence of MHNs like Anna suggested the need for oral health psychoeducation for patients with a psychotic disorder because this would allow MHNs to educate their patients on the importance of oral health and to engage patients in how to integrate oral health care into daily routines. A Cochrane systematic review showed that psychoeducation is effective for knowledge provision in patients with SMI [52]. In mental health, psychoeducation is widely deployed. To date, however, there has been no psychoeducation available on oral health in patients with a psychotic disorder. MHNs like Monica, Julia, and Paul probably need an oral health screening form to screen a patient’s oral health status because they need a tool to integrate oral health outcomes into daily care to support patients with a psychotic disorder. A recent systematic review of oral health assessments for non-dental healthcare professionals discussed 18 different screening forms [53]. This review found that the Oral Health Assessment Tool (OHAT) is the best validated and most complete tool for use by non-dental professionals (such as MHNs) assessing oral health [53–55]. The OHAT was validated for use among senior care dependents in community dwellings [53]. This means that the OHAT is potentially appropriate, and it might be preferable to specifically validate an OHAT for patients with a psychotic disorder. The development of a digital oral health screening tool can fit in the needs of MHNs. A recent review shows that the use of mobile health (MHealth) is promising for patients with a psychotic disorder [56]. However, considering this, it is important to discuss the impact of mobile technologies on the professional relationship between MHNs and patients with a psychotic disorder. Here, the findings of Schneider-Kamp and Fersch [51] demonstrate that technological solutions such as mHealth can improve some care processes for mentally vulnerable groups, such as patients with a psychotic disorder, and show how MHNs can get and stay involved in patients’ lives and everyday practices. Thus, the use of MHealth can support the reinvestment of time savings into the improvement of the MHN-patient relation. Additionally, it is important to point out that, for the positive effects of detached co-involvement to emerge and to avoid repercussions, a fine balance must be struck between face-to-face and MHealth [51]. MHNs like Anna need more information on motivation and engaging patients in oral health because her patients have told her that they are not motivated to engage in oral care, and Anna did not how to act. MHNs with these needs should use interventions that combine behavioral sessions (brief motivational interviewing sessions) and education sessions. 5
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