Physical Healthcare and Promotion in Mental Health Nursing


Stan Mutsatsa

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  • Front Matter
  • Back Matter
  • Subject Index
  • Copyright


    The interplay between physical and mental health cannot be understated. This book provides us with a great opportunity to see both sides in action, to see how many physical ailments are influenced by, or even apparent symptoms of, mental health issues and vice versa. Traditionally, in healthcare, we have become blinkered in our thinking; body and mind somehow became separated and seen as disparate entities that had little influence over each other. This truly holistic book shows us ample examples of research and practice that prove this perspective to be flawed and helps the reader to consider aspects of both physical and mental health as one and same.

    This book offers many practical suggestions as to how to ensure we successfully manage the physical healthcare needs of those in our care, underpinned by a broad base of theory and evidence. The principles of person centred recovery, validation, respect and dignity are themes that are interwoven throughout the chapters. The book provides practical exercises that will help the reader to develop a stronger understanding of the red flags we must notice in terms of physical health and helps us to think beyond the symptoms to the person experiencing them.

    There is one outstanding theme, however, that bears further consideration as you embark on reading this text. The importance of a healthy lifestyle is a recurring theme throughout the chapters. It is essential that we are aware of our own lifestyle and remember that we are often seen as role models in caring for others, so caring for our own physical health is essential. The importance of good diet, exercise and sleep are repeatedly highlighted as essential for optimal health. There are some simple measures that a person can take to have substantial impact on their physical health that have been shown, in research, to have significant gains in terms of mental health too. The importance of this theme cannot be underestimated. The useful inclusion of models for change within the book helps to provide ideas about how we might go about educating and empowering others.

    If you are a student nurse, a newly qualified nurse or even a nurse of some years’ standing looking for tips to update your portfolio of skills, this book will stand you in good stead for practice. It can be read as a whole but can also be dipped into section by section as you come across situations in practice, perhaps, that warrant further exploration of that particular subject. Engaging with this book will help you to become a more effective practitioner of the art of mental health nursing, enhancing your ability to care for people of diverse backgrounds and needs.

    Sandra WalkerSenior Teaching Fellow in Mental HealthUniversity of Southampton


    The author and publishers thank the following for permission to reproduce copyright material:

    Häggström, M, Medical gallery of Mikael Häggström 2014. Wikiversity Journal of Medicine, for material reproduced as Figures 2.9, 7.3, 7.4 and 7.6.

    Julius R, Novitsky M, Dubin W, Medication adherence: a review of the literature and implications for cllinical practice. Journal of Psychiatric Practice, 1 Jan 2009, Wolters Kluwer Health, for material reproduced as Table 3.1, Stages of change and associated patient characteristics and possible interventions.

    Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I et al. (1981) A method for estimating the probability of adverse drug reactions. Clin. Pharmacol. Ther., 1 August, 30 (2), Nature Publishing Group, for material reproduced as Table 8.1, The adverse drug reaction scale.

    Prochaska JO, DiClemente CC (1984) Self change processes, self efficacy and decisional balance across five stages of smoking cessation. Prog. Clin. Biol. Res.156, 131–140, for The process of change, reproduced as Figure 3.1.

    The Rehabilitation for Addicted Prisoners Trust (RAPt) and Peter Gould ©, for material on disorders caused by alcohol, reproduced as Figure 7.2.

    Smolensky M, Lamberg L (2000) The Body Clock Guide to Better Health, Henry Holt, for the human circadian (24-hour) biological clock, reproduced as Figure 2.4.

    Finally, thank you to Simon Thistle for his artistic contribution.

    About the author

    Stan Mutsatsa PhD, RMN has extensive experience of working in both clinical and research settings in the nursing field of mental health. He has worked as a Research Associate at Imperial College for many years before taking up a post as Course Leader in Medication Management and later as a Physical Health Advisor on a large research project in physical health promotion, at Kings Institute of Psychiatry in London. Currently he is a Senior Lecturer in mental health nursing at City University London.

  • Glossary


    medium-sized, non-enveloped viruses that cause a wide range of illnesses, from mild respiratory infections in young children to life-threatening multi-organ disease in people with a weakened immune system

    Adrenal suppression or adrenal insufficiency

    a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol; may also include impaired production of aldosterone, which regulates sodium conservation, potassium secretion and water retention


    having no fever


    a chemical substance capable of activating a receptor to induce a pharmacological response


    a group of naturally occurring chemical compounds (natural products) that contain mostly basic nitrogen atoms


    the state of having mixed feelings or contradictory ideas about something or someone

    Antecubital fossa

    a triangular cavity of the elbow that contains a tendon of the biceps, the median nerve and the brachial artery


    a substance found in some foods and other products; it prevents harmful chemical reactions in which oxygen is combined with other substances


    temporary cessation of breathing, especially during sleep

    Atrial fibrillation

    individual or uncoordinated twitching of heart muscle fibres, usually associated with heart dysfunction

    Auscultatory gap

    a period of diminished or absent Korotkoff sounds during the manual measurement of blood pressure. The improper interpretation of this gap may lead to blood pressure-monitoring errors, namely an underestimation of systolic blood pressure and/or an overestimation of diastolic blood pressure


    measurable substance in an organism whose presence is indicative of some phenomena such as disease, infection or environmental exposure

    Brain-derived neurotrophic factor (BDNF)

    acts as a fertiliser of the brain’s neurons, making them grow more quickly and develop stronger connections


    the tightening and narrowing of airway muscles resulting in airflow blockage. Along with inflammation of the airways, it leads to symptoms such as coughing, wheezing and shortness of breath

    Cardiac arrhythmias

    abnormal heart beats, usually caused by an electrical ‘short circuit’ in the heart

    Cardiac myopathy

    a weakening of or other problem with the heart muscle. It often occurs when the heart cannot pump as well as it should, or with other heart function problems. Most patients with cardiomyopathy have heart failure

    Change talk

    the client’s mention and discussion of his or her desire, ability, reason and need to change behaviour and commitment to changing. The point here is that, when people themselves talk about change, they are more likely to change than if someone else, such as a nurse or relative, talks about it

    CK or CK-MB tests

    a cardiac marker used to assist the diagnosis of an acute myocardial infarction. It measures the blood level of the enzyme phosphocreatine kinase


    the ability to coagulate, that is, to change from liquid into a solid or semi-solid mass, as in the case of blood

    Coin lesions

    a round, well-circumscribed nodule in a lung that is seen on X-ray as a shadow the size and shape of a coin


    species in the genera of virus belonging to one of two subfamilies, Coronavirinae and Torovirinae. They are found in the nasal cavities, infect the upper respiratory tract and can also cause gastroenteritis


    small proteins released by cells that have a specific effect on communication between cells or on the behaviour of cells

    Diagnostic overshadowing

    the process of over-attributing a patient’s symptoms to a particular condition, resulting in key comorbid conditions being undiagnosed and untreated. For example, symptoms of physical illness may be attributed to the service user’s mental illness


    artificially induced profuse perspiration

    Diastolic blood pressure

    the pressure in the arteries when the heart muscle is resting between beats and refilling with blood. It is the bottom number in blood pressure measurement, and is also the lower of the two numbers

    Dynamic equilibrium

    exists when the rate of the forward reaction is equal to the reverse reaction


    a metabolic disorder of fat-like substance (lipoprotein) that may result in overproduction or deficiency of these lipoproteins. It is typically shown by an increase in the total cholesterol, the ‘bad’ low-density lipoprotein (LDL) cholesterol and the triglyceride concentrations, and a decrease in the ‘good’ high-density lipoprotein (HDL) cholesterol concentration in the blood

    Executive function

    a set of mental processes that help connect past experience with present action. People use executive function to perform activities such as planning, organising, strategising, paying attention to and remembering details and managing time and space


    involuntary contractions or twitching of groups of muscle fibres. It can occur in normal individuals without an associated disease or condition, or it can occur as a result of illness, such as muscle cramps, nerve disease or metabolic imbalance


    substances which prevent blood clots from growing and becoming problematic


    organic compound or biological pigment containing no nitrogen, found in many plants

    Gastro-oesophageal reflux disease

    a condition in which the stomach contents leak backwards from the stomach into the oesophagus. This action can irritate the oesophagus, causing heartburn and other symptoms

    Genome-wide association studies

    an examination of the many common genetic variants in individuals to associate any variants with a trait


    an inflammation of the tongue causing swelling, change in colour and a smooth appearance on the surface


    an enzyme that facilitates phosphorylation of glucose to glucose-6-phosphate. It occurs in cells in the liver, pancreas, gut and brain of humans and most other vertebrates. In each of these organs it plays an important role in the regulation of carbohydrate metabolism by acting as a glucose sensor, triggering shifts in metabolism or cell function in response to rising or falling levels of glucose, such as occur after a meal or when fasting


    excess glucose in the blood stream, often associated with diabetes mellitus


    excess insulin circulating in the blood relative to the level of glucose


    an abnormally elevated level of lipids (fats) in the blood plasma. It is a significant risk factor for coronary artery disease


    an exaggerated response of the deep tendon reflexes, usually resulting from injury to the central nervous system or metabolic disease


    abnormally high blood pressure

    Hyperviscosity syndrome

    a group of symptoms triggered by increased thickening of the blood


    deficiency of glucose in the blood stream


    deficiency of potassium in the blood stream

    Insulin-like growth factor

    proteins similar to insulin that are secreted either during fetal development or during childhood and that mediate growth hormone activity

    Ischaemic heart disease

    a disease of the blood vessels supplying the heart muscles with oxygen that causes temporary strain on the heart or even permanent damage to the muscle

    Killer cell (T cell, natural killer cell)

    a white blood cell (lymphocyte) with cytotoxic activity

    Korotkoff sound

    the sounds we listen for when we take blood pressure using a non-invasive procedure. They are named after Nikolai Korotkoff, a Russian doctor who discovered them in 1905

    Lactated Ringer’s solution

    a sterile, non-pyrogenic solution for fluid and electrolyte replenishment in single-dose containers for intravenous administration

    Mallory–Weiss tears

    severe and prolonged vomiting can result in lacerations (tears) in the lining of the oesophagus. Most tears heal within a few days without treatment, but Mallory–Weiss tears can cause significant bleeding. Depending on the severity of the laceration, surgery may be required to repair the damage

    Maturity-onset diabetes of the young (MODY)

    a rare form of diabetes which is different from both type 1 and type 2 diabetes, and runs strongly in families. MODY is caused by a mutation (or change) in a single gene. If a parent has this gene mutation, any child has a 50% chance of inheriting it from the parent

    Maximal pulsation

    the place where the apical pulse is palpated as strongest

    Metabolic acidosis

    an abnormally high acidity in the body during the metabolism of sugar

    Metabolic syndrome

    cluster of biochemical and physiological abnormalities associated with the development of cardiovascular disease and type 2 diabetes


    a virus family that is the second most common cause, after respiratory syncytial virus, of lower respiratory infection in young children


    the use of a single drug to treat a specific disorder or symptoms

    Mucociliary clearance

    the self-clearing mechanism of the bronchi using the cilia

    Oxidative stress

    essentially an imbalance between the production of molecules that cause damage to cells in our bodies and the ability of the body to counteract or detoxify their harmful effects through neutralisation by antioxidants

    Pericellular fibrosis

    the formation of excess fibrous connective tissue around cells in a reparative or reactive process. This can be a reactive, benign or pathological state


    a class of fats (lipids) that are a major component of all cell membranes as they can form lipid bilayers

    Phytonutrients (phytochemicals)

    chemical compounds that occur naturally in plants. Some are responsible for colour and other sense-stimulating properties, such as the deep purple of blueberries and the smell of garlic. There may be as many as 4,000 different phytochemicals having the potential to affect positively recovery from diseases such as cancer, stroke or metabolic syndrome


    air in the mediastinum. The mediastinum is the space in the middle of the chest, between the lungs


    the presence of air or gas in the cavity between the lungs and the chest wall, causing lung collapse


    the simultaneous use of multiple drugs to treat a single ailment or condition

    Proinflammatory markers

    proteins that promote inflammation

    Pulmonary oedema

    an excess collection of watery fluid in the air sacs of the lungs, making it difficult for the individual to breathe

    Pulse pressure

    difference between systolic and diastolic blood pressure

    Regenerative nodules

    a form of non-neoplastic nodule that arises in a cirrhotic liver

    Respiratory syncytial virus (RSV)

    a virus that causes infections of the lungs and respiratory tract. It is common in children and can also infect adults


    the breakdown of muscle fibres that leads to the release of muscle fibre contents (myoglobin) into the blood stream. Myoglobin is harmful to the kidney and often causes kidney damage


    the most common viral infective agents in humans and the predominant cause of the common cold. They flourish in temperatures between 33 and 35°C, the temperatures found in the nose

    Secondary delusions

    false beliefs held in spite of invalidating evidence but that are, at least in principle, understandable in the context of a person’s life history, personality, mood state or presence of other psychopathology. For example, a person becomes depressed, suffers very low mood and self-esteem, and subsequently believes that s/he is responsible for some terrible crime which s/he did not commit

    Serum myoglobin test

    blood test used to measure the levels of myoglobin in the blood stream

    Socratic questioning

    disciplined questioning that can be used to pursue thought in many directions and for many purposes, including to explore complex ideas, to get to the truth of things, to open up issues and problems, to uncover assumptions, to analyse concepts, and to distinguish what we know from what we do not know


    soreness or inflammation in the mouth. This can be in the cheeks, gums, inside of the lips, or on the tongue. There are two main forms of stomatitis: herpes stomatitis and aphthous stomatitis. Both forms usually occur more often in children and teens

    Systolic pressure

    the pressure in the arteries when the heart muscle contracts. It is indicated by the top number in blood pressure measurement and is usually the higher of the two numbers


    a naturally occurring ester consisting of glycerol and three fatty acids

    Trophic factors

    chemicals that are essential for the growth and survival of the neuron, synapsing with it with other neurons

    Troponin test

    measures the levels of troponin in the blood. Troponins are proteins released when the heart muscle has been damaged, such as occurs with a heart attack. The more damage there is to the heart, the greater the amount of troponin in the blood


    the fact or quality of being different, divergent or inconsistent

    Vascular endothelial growth factor

    a signal protein produced by cells that stimulates the formation of new blood vessels. It is part of the system that restores the oxygen supply to tissues when blood circulation is inadequate

    Ventricular fibrillation

    a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly

    Wernicke’s encephalopathy

    a neurological disorder caused by thiamine deficiency, typically from chronic alcoholism or persistent vomiting, and marked by mental confusion, abnormal eye movements and unsteady gait


    a brain disorder due to thiamine (vitamin B1) deficiency


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