175 The Development of an Oral Health Nursing Tool in Patients with a Psychotic Disorder Introduction Since the World Health Organization emphasised that oral health is integral and essential to general health and well-being [1,2], oral health has improved in the general population; however, vulnerable patients are an exception [3]. Epidemiological studies have shown that the lifespan of patients with psychotic disorders is shorter compared to that of the general population without mental illness. An unhealthy lifestyle is an important cause of the 15-to-25-year shortened life expectancy for patients diagnosed with (severe) mental illness. Several studies of patients with (severe) mental illness have shown that oral health and oral health-related quality of life are substandard among those with an unhealthy lifestyle [4–9]. Inadequate oral health self-management, lower tooth-brushing frequency, and a lack of motivation to perform proper oral hygiene are known barriers to adequate oral health for patients with psychotic disorders [10–13]. Roebroek et al. [14] demonstrated that psychiatric care needs were well discussed by psychiatrists, psychologists, and mental health nurses (MHNs), but treatment plans paid little attention to physical care needs and needs related to social well-being. This was supported by Happell et al. [15], who reported that when patients express concerns regarding their physical health, health care professionals tend to pay little attention to them [15]. The literature shows that a healthy lifestyle and behavioural changes are difficult to initiate and even more challenging to sustain over time [16]. This highlights the disconnection that can occur in mental health care settings between patients’ concerns and responses from MHNs, as well as the inherent difficulties in altering one’s lifestyle to become healthier, both in the initiation phase and in maintaining these lifestyle changes permanently. One explanation is that psychiatric treatment and care have historically been provided mainly based on the medical model, which focuses on alleviating the symptoms of illness (e.g., by giving medication), despite the fact that nursing should be provided from a holistic point of view. In the 19th century, when nursing was defined for the first time, Florence Nightingale articulated the concept of the science of holistic nursing [17,18]. This concept of a holistic vision of care underpins the profession of MHNs; it is important that the integration of physical issues, such as oral health, is further addressed. Unfortunately, we see this too little in clinical practice. 6
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