A mixed methods approach to exploring mental health nurses diabetes education and skills needs

Diabetes is emerging as a clinical practice and educational concern in mental healthcare. However, there is little research into the diabetes education and skills needs of practitioners such as Mental Health Nurses. Furthermore, there is very little research into Mental Health Service Users experiences of diabetes or diabetes care and how these could be used to enhance the education and training of Mental Health Nurses in this area. This research project used a mixed methods research approach to explore Mental Health Nurses diabetes education and skills needs from the view of both Mental Health Nurses and Mental Health Service Users. A quantitative Training Needs Analysis survey was undertaken in 2008 with a sample of 220 Mental Health Nurses regarding their diabetes care education and skills needs. 146 responded giving a response rate of 66%. The results of this survey where used to develop a qualitative interview schedule to explore the experiences of diabetes care of a purposive sample of seven Mental Health Service Users in 2011 and how these experiences could be used to inform Mental Health Nurses diabetes education and training. This study found that diabetes care is becoming a frequent care activity for Mental Health Nurses. While the sample reported prior training in diabetes care, this was predominantly in the period of student nurse training. This has an implication for the currency of clinical skills and knowledge. Mental Health Nurses reported varying levels of general and specific knowledge of diabetes. They also reported varying levels of confidence in aspects of diabetes care such as recognising symptoms of diabetes, knowledge of local diabetes services and liaison with local diabetes services. There was a recognition that further training was required and the sample reported high levels of motivation to attend training and retain diabetes care as an area of Mental Health Nursing practice. Mental Health Service Users reported negative experiences of diabetes care. This consisted of stigma, diagnostic overshadowing, a splitting of mental and physical health and low levels of confidence in Mental Health Nurses ability to provide diabetes care. Service Users broadly agreed with Mental Health Nurses expressed training needs but felt that education and training on stigma and how this can be a barrier to diabetes care is a priority area for education. This study recommends that Mental Health Service Users experiences of physical illness, in this instance diabetes, should be a foundation part of any training and education of Mental Health Nurses in this area. This is because these experiences can promote critical reflection on practice and encourage professionals to reflect on negative attitudes that may be an unwitting barrier to care. It also recommends that service users are more involved in identifying education and training needs so that education is responsive not only to the needs of nurses and Higher Education Institutions, but service users also.