ICU nurses' perceptions of patients with co-morbid mental health disorders: An integrative review

Background The prevalence of patients with a mental health (MH) disorder in intensive care units (ICU) is roughly twice that of other secondary care areas. This patient group can struggle to access the health care system because of stigma. Nurses' perceptions of MH patients in the Emergency Department have been studied and were associated with avoidance, misconceptions and perceived lack of skills to manage this patient group; however, it was unclear if similar issues were present amongst ICU nurses.

Aim This review aimed to explore how nurses perceive ICU patients with a co-morbid MH disorder.

Study Design An integrative review was undertaken in March 2024 using CINAHL, Medline, Embase and PsychInfo to synthesize empirical and theoretical evidence from a range of different research approaches. A five-step approach (problem identification, literature search, data evaluation using the Mixed Methods Appraisal tool, data analysis and presentation) was followed. Papers were included if they focused on nurses' perceptions of adult ICU patients with a co-morbid MH disorder. Totally, 620 studies were identified following duplicate removal.

Results Eight studies were selected for inclusion. Four themes were identified: (1) ‘Those types of patient’, (2) Patients with MH disorders are all violent and aggressive, (3) ‘They’ don't belong in ICU and (4) ‘They’ need someone with special skills. The themes explored issues of preconceptions, stigma and ‘othering’.

Conclusions There was a paucity of research on this topic, and it was limited in geographical area. The findings suggest that stigma, misconceptions, a lack of support and a perceived lack of skills might lead nurses to deliver suboptimal care to this vulnerable patient group.

Relevance to Clinical Practice Stigma against patients with MH disorders could lead ICU nurses to reduce their engagement with them, impacting negatively on the provision of holistic care. Education and ongoing support are required to reduce misconceptions and bias and increase nurses' confidence when managing patients with co-morbid MH disorders.