District nurses' perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity

AIMS AND OBJECTIVES: To describe district nurses' perspectives on detecting mental health problems and promoting mental health among homebound older people with multimorbidity. BACKGROUND: Mental health problems among older people with multiple chronic conditions, that is, multimorbidity, are challenging issues. These patients' homes often serve as arenas in which district nurses can promote health. Mental health promotion must be studied in greater depth within primary care because older people with multimorbidity are particularly prone to developing poor mental health, which can go undetected and untreated. DESIGN: A descriptive, qualitative study using semi-structured interviews and content analysis. METHODS: Twenty-five district nurses completed individual or focus group interviews. Data were analysed using qualitative content analysis. RESULTS: Most district nurses stated that detecting mental health problems and promoting mental health were important tasks but that they typically focused on more practical home health care tasks. The findings revealed that district nurses focused on assessment, collaboration and social support as means of detecting mental health problems and promoting mental health. CONCLUSIONS: The district nurses described various factors and actions that appeared to be important prerequisites for their involvement in primary mental health care. Nevertheless, there were no established goals for mental health promotion, and district nurses often seemed to depend on their collaboration with other actors. Our findings indicated that district nurses cannot bear the primary responsibility for the early detection of mental health problems and early interventions to promote mental health within this population. RELEVANCE TO CLINICAL PRACTICE: The findings of this study indicated that workforce training and collaboration between different care providers are important elements in the future development of this field. Early detection and early treatment of mental health-related issues should also be stated as explicit objectives in the provision of care to community-dwelling older people with multimorbidity