The role nurses can play in bridging the gap between behavioral, physical healthcare

Nurses can bridge the gap between behavioral healthcare and physical healthcare for providers looking to better integrate the two.

A nurse is typically the first person a patient interacts with, and he or she can set the tone for the entire visit. This is especially crucial in treating patients with behavioral health conditions or addiction, as they may be afraid to open up about the situation, said Teresa Jacobson, project manager for the Holistic Health Integration Project in Clermont County, Ohio.

She was speaking at a web event this week on the role nurses can play in integrated behavioral and physical healthcare that was hosted by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. 

Because nurses are in such a front-line role, they can serve a critical role in getting reluctant patients into treatment, said Jacobson, whose project is part of Greater Cincinnati Behavioral Health Services. "Trust is formed, worth is felt and a therapeutic relationship can begin," Jacobson said. 

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Nurses who work with patients in both a primary care and behavioral healthcare capacity can act as a "one-stop shop" of information both for doctors and for the patients themselves, said Dean Visk, R.N., director of nursing services at Greater Cincinnati Behavioral Health Services.

Greater Cincinnati's path to a more integrated care model overcame several key challenges, he said, including a cultural shift for nurses and other clinicians, increased training and another look at hiring and recruitment strategies. 

The team forged partnerships with local nursing schools to help nurses keep their skills fresh; for example, Visk said one of the behavioral health nurses studied up on phlebotomy for the first time since her medical training. In addition to the outside training, in-house programs focused on engaging nurses around evidence-based care models, he said. 

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Jacobson said the training reflects the way Greater Cincinnati was deploying nurses in new areas to meet patients with behavioral health needs where they are. It has clinics which are staffed at all times by nurses, even if a doctor is not on site, and behavioral health nurses have also been embedded in its federally qualified health centers. Nurses are also trained to make community visits when patients miss appointments or are flagged as being at risk, Visk said. 

"Coordination of care and continuity of care is a vital thing that really helps these patients holistically get what they need from our treatment team," he said. 

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Jacobson said a key piece of the puzzle has been training these nurses on "motivational interviewing" skills, which they can use to have more effective conversations with patients. The goal, she said, is to have conversations in which patients feel empowered to take control of their lives and make choices for themselves. These conversations can also flag physical symptoms that could be linked to mental health or substance abuse disorders, she said. 

Nurses must avoid the temptation to use judgmental language, she said, which could shut down the discussions. Scare tactics may make patients defensive, angry or cautious. 

"The nurse or nurse practitioner can convey to the patient that change is difficult and ambivalence about change is normal," Jacobson said.