225 General discussion Discussion This dissertation aims to contribute to nursing knowledge regarding oral health problems in patients with psychotic disorders. In this general discussion, there will be a reflection on the most important findings for current nursing care, oral health, and lifestyle interventions, mental health nurses (MHNs) as lifestyle role models, as well as for national policy. In this dissertation, we used various research designs (qualitative, quantitative, design-based). In the methodological considerations, lessons learned will be explored. We reflect on design-oriented research, and we reflect on applying the Double Diamond framework within design-oriented research. We explain why this research design adds value, what this added value is. Furthermore, we give recommendations for further research on oral health care and MHN, recommendations for policy and practice, and a recommendation for education will be provided. At the end, implications of the case that prompted this dissertation, that of Joshua and MHN Maaike, will be outlined. Current nursing care From our research (chapter 2 and 5), we can conclude that oral health care activities do not currently seem to be an integral part of mental health nursing care [1]. Fragmentation in nursing care, as well as in the healthcare system, contributes to the suboptimal provision of oral health care within the mental health care sector. However, this is not surprising in an organization where care provision is predominantly centered on current pathology and not on risk factors. This complexity renders the identification of somatic issues and their risk in patients with psychotic disorders challenging for MHNs. However, this is in profound contrast to the foundational tenets of a holistic care philosophy of the nursing profession, as put forward by luminaries such as Florence Nightingale [2], Dorothea Orem [3], Virginia Henderson [4], and Mieke Grijpdonck [5]. Therefore, the question arises: “Has the role of MHNs significantly changed over the past 160 years?” A shift is occurring. Poor physical outcomes in patients have contributed to an increased emphasis on lifestyle and somatic care within mental health services. This shift has also fostered an emphasis on a holistic approach. Furthermore, the introduction of recovery-oriented care and a revised definition of health have promoted a new perspective on healthcare. This encourages working from a holistic viewpoint, aligning with the training that MHNs receive. Consequently, MHNs are better equipped to assume 7
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