AIM: To synthesise the available evidence related to nurses' pain assessment and management practices for patients with diagnosed mental health conditions. DESIGN: Mixed-methods systematic review. DATA SOURCES: Medline, CINAHL, PsycINFO, SPORTDiscus and Psychology and Behavioural Sciences Collection. METHODS: Databases search was conducted in March 2024 and updated in June 2025. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis followed the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. RESULTS: Of the 1318 eligible studies identified, 12 met the inclusion criteria. The included studies were methodologically robust overall but frequently neglected nonresponse bias and were predominantly conducted in high-income countries, potentially limiting generalisability. The synthesis revealed diverse experiences among nurses in assessing and managing pain in patients with diagnosed mental health conditions. Six key themes emerged: Inadequate and Inconsistent Pain Assessments, Seeing is Believing, To Trust or Not to Trust the Patient, A Balancing Act, Diagnostic Overshadowing and Organisational Restraint and Support. CONCLUSIONS: This review highlights the ongoing challenges nurses encounter in assessing and managing pain and the need for enhanced education and institutional support to strengthen nurses' capacity for effective pain assessment and management in patients with diagnosed mental health conditions. Stigma, both structural and interpersonal, continues to shape clinical decision-making, often leading to under-assessment and inadequate treatment of pain. Integrating clinical judgement with validated pain assessment tools will help ensure nurses provide evidence-based pain management for this often-marginalised group. IMPLICATIONS FOR PATIENT CARE: Enhancing nursing competence in pain assessment and management for patients with diagnosed mental health conditions leads to more accurate and timely pain relief, significantly improving physical and psychological wellbeing. Effective pain control for this vulnerable group can reduce hospital length of stay and minimise complications, ultimately contributing to better health outcomes and quality of life. PATIENT CONTRIBUTION: No patient contribution. IMPACT: What problem did the study address?: Pain is a complex sensation affecting people with diagnosed mental health conditions. They are likely to receive inadequate pain assessment and management due to mental health conditions preventing them from accurately self-reporting their pain and advocating for timely treatment. This review explored the pain assessment and management practices among nurses for patients with diagnosed mental health conditions. What were the main findings?: Significant barriers were identified, including inconsistent use of pain assessment tools, limited knowledge and confidence among nurses, power imbalances in the nurse-patient relationship, diagnostic overshadowing where physical symptoms are presumed to be related to mental illness, and organisational constraints such as staffing shortages, lack of education and restrictive hospital policies. Strategies to mitigate these barriers are essential to improving pain outcomes and promoting person-centred care for this vulnerable population. Where and on whom will the research have an impact?: This review highlights the need for more robust approaches to the assessment and management of pain experienced by patients with diagnosed mental health conditions. It underscores the importance of integrating pain assessment, mental health and substance use education into nursing curricula and post-registration nursing practice. The findings highlight the need to update clinical guidelines and organisational policies, ensuring that nurses receive the necessary training, resources and support to provide effective pain management for patients with mental health conditions to enhance the quality of care and promote more equitable health outcomes for individuals with mental health conditions. REPORTING METHOD: Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and Preferred Reporting Items for Systematic and Meta-analysis (PRISMA) reporting guideline for systematic reviews. PATIENT OR PUBLIC CONTRIBUTION: None.
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