176 Chapter 6 Since 2011, health has been defined as “the ability to adapt and self-manage, in light of the physical, emotional and social challenges of life” [19]. In this definition, which is widely accepted, health is no longer seen as the absence or presence of disease but as the ability to deal with (changing) physical, emotional, and social life challenges and manage oneself as much as possible. This implies a vision that fits with holistic nursing. From a holistic perspective [20], supporting the general health of patients with psychotic disorders, including their oral health, is one of the tasks of MHNs. MHNs are at the forefront of everyday care services [9,15]. However, MNHs indicate that they would like to be more aware of the oral health of their patients [9,21], but they hesitate to take action in this regard due to a lack of both relevant expertise and the practical tools necessary for supporting patient oral health [9]. Relevant expertise is lacking, and there is also a lack of practical tools for MHNs to use when supporting patients with their oral health. Oral health issues are important for everyone; however, patients with psychotic disorders are known to have related risk factors (e.g., smoking) that contribute to a lower oral health-related quality of life and are possibly associated with a shorter life expectancy [4–8]. Recent studies [7,21] show that a wide range of interventions must be developed for MHNs to support patients with psychotic disorders in maintaining and improving their oral health. Initially, MHNs must increase their sensitivity and alter their behaviour concerning oral health. To our knowledge, no studies have yet been conducted on the sensitisation of MNHs regarding maintaining and improving the oral health of patients with psychotic disorders. There are many models in the field of behavioural change, and Prochaska and DiClemente’s transtheoretical model of change is particularly suitable here because it shows the different phases of behavioural change [22]. The transtheoretical model’s broad applicability and focus on individual readiness make it a valuable model for understanding and facilitating change in MHNs, with a supportive tool to increase their sensitisation and provide them with the knowledge to recognise potential oral health problems in patients with psychotic disorders. Prochaska and DiClemente developed this model as a way to integrate the stages and processes of behavioural change by dividing it into six stages. Our previous study showed that MHNs act mainly in the first two stages of the model [21,23]: (1) pre-contemplation stage: MHNs do not intend to make behavioural changes in the foreseeable future; (2) contemplation stage: MHNs consider a behavioural change but do not yet make a firm commitment to change. To promote behavioural changes among MHNs, it is important to
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