Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Andrea Bostrom

Second Advisor

Dianne Conrad

Third Advisor

Sandra Portko

Fourth Advisor

Patricia Hawkins


Adults with severe mental illness (SMI) experience higher morbidity and mortality rates than the general population due to poor physical health and because physical and psychiatric health are rarely addressed holistically. Two questions were posed for this project: (a) Will the use of a physical health screening tool and development of healthpromotion goals result in a change in healthy lifestyle behaviors for participants? (b) Will case managers see value in the use of the screening tool and health-promotion action plan development and incorporate the tool into their day-to-day work with clients? Fourteen adults with SMI, from a community case management clinic, participated. Ages ranged from 25-60 (mean = 42). Most were diagnosed with Bipolar Disorder; all experienced a physical health concern. These included overweight, hypertension, diabetes, and musculoskeletal problems with chronic pain.

Three appointments were held with each participant. A Physical Health Check (PHC) tool was used to obtain a physical health history and develop a health-promotion goal for the project. Appointments focused on progress towards stated goals and providing support and resources for goal accomplishment. Initial and final data included height, weight, Body Mass Index calculation, waist circumference, and self-efficacy (using the Self-Efficacy for Managing Chronic Disease 6-Item Scale). A focus group with case managers obtained their perceptions on the use of the PHC tool, intentional focus on clients’ physical health, and health-promotion goal development.

Descriptive and qualitative analyses were used for the biometric, goal progress, and focus group data. A paired t-Test was used to analyze the pre- and post-self-efficacy scores. All clients worked on their health-promotion goals, incorporating healthy lifestyle behaviors into their lives. Modest weight loss and a reduction in waist circumference were noted. A significant increase (p <0.05) was noted in self-efficacy related to clients’ perceived ability to accomplish health-promotion goals. Case managers valued the use of the PHC tool by a dedicated health professional focused on physical health. Addressing the physical and psychiatric health needs in an integrated manner for adults with SMI improves their health status. The DNP prepared nurse is a valuable resource to translate the research evidence for this holistic approach into practice.

Included in

Nursing Commons