The Revised Common Rule and Mental Illness: Enduring Gaps in Protections

Mental health bias in physical care: An integrative review of the literature

WHAT IS KNOWN ON THE SUBJECT?: Individuals experiencing mental illness make up a significant portion of the world's population. Individuals with mental illness experience higher rates of morbidity and die on average at least a decade earlier than individuals without mental health disorders. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Issues of stigma, diagnostic overshadowing, premature closure, inadequate workup, fear and lack of training negatively impact the care of individuals with mental illness. Issues impacting the care of individuals experiencing mental illness cross geographic and care setting boundaries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Partnerships between physical and mental health practitioners are needed to thoroughly assess and accurately diagnose symptoms experienced by individuals with mental illness. Educational interventions can help prepare practitioners to care for individuals with mental illness. Nurses can better advocate for effective patient care by learning about the phenomenon of diagnostic overshadowing and calling attention to its occurrence. ABSTRACT: Introduction Individuals with mental illness experience significantly higher overall rates of morbidity and mortality than counterparts without mental illness. Misdiagnosis of symptoms emanating from physical illnesses as psychiatric in nature presents one important cause. Aim This integrative review explores research on healthcare professionals' misattribution of physical health symptoms to patients' comorbid psychiatric issues and seeks to identify unifying themes, shared causes, and possible strategies for addressing the issue. Method This review uses Whittemore and Knafl's 2005 integrative review methodology coupled with vetted quality appraisal tools. Results Following a systematic search of allied health, medical, psychological, sociological and general literature, 24 publications employing qualitative, quantitative, mixed and synthesis research methodologies were selected. Each study was appraised according to design, and relevant data were extracted. Discussion Themes of stigmatization, diagnostic overshadowing, incomplete medical examination, insufficient training, and fears experienced by providers and patients emerged. Implications for Practice Increased partnering between physical and mental health practitioners, continuing education, and improving patient-provider communication are key to providing equitable care. Nurses play primary roles in empathizing with patients, advocating for appropriate care and educating others on the dangers of misattributing physical symptoms to psychiatric cause.

Broad Consent-Are We Asking Enough?

Biobanks and health data repositories provide rich reservoirs of information for use in biomedical research. These repositories depend on participants donating identifiable health data and biospecimens that may be used in perpetuity by unlimited numbers of researchers for unnamed research topics. Since 1991, U.S. federal regulatory provisions, collectively known as the Common Rule, have required informed consent of participants in federally funded human subjects research, but recent changes to the Common Rule now sanction "broad consent" in the repository research context. Broad consent is not defined in the revised Common Rule; thus, researchers and their institutions are left to determine ad hoc what broad consent means and requires. Without leadership and guidance from the U.S. Department of Health and Human Services, stakeholders with potential conflicts of interest will reach their own conclusions and craft new and varied standards for consent. The result will be uneven protections for participants.