The role of the inpatient mental health nurse in facilitating patient adherence to medication regimes

Causes of nonadherence to treatment in people with myocardial infarction: Content analysis

BACKGROUND

Nonadherence with the medication regimen in patients with heart disease can lead to treatment failure. The purpose of this study was to identify the causes of nonadherence in people with myocardial infarction.

MATERIALS AND METHODS

This study is a qualitative conventional content analysis. Data were collected through semistructured interviews. Thirteen individual interviews and a focus group were conducted with nurses, patients, and doctors. Data were analyzed using conventional content analysis.

RESULTS

Four main themes were identified, which are organizational-managerial causes and factors (drug-related problems, educational system-related problems, weak performance of hospitals, and problems related to insurance companies); sociocultural causes and factors (factors related to cultural problems and factors related to social problems); causes and factors related to care providers (skill problems of care providers and functional problems of care providers); and causes and factors associated with caregivers (factors related to social characteristics of the patient, factors related to patient characteristics, and factors related to the patient's belief).

CONCLUSIONS

Many individual and organizational factors affect nonadherence, which can be reduced by fundamental changes.

Analysis of non-pharmacological interventions attempted prior to pro re nata medication use

The aim of the present study was to elucidate what non-pharmacological interventions are applied by nursing staff prior to the administration of psychotropic pro re nata (PRN) medication. Best practices would instruct clinical staff to provide non-pharmacological strategies, such as de-escalation and skills coaching, as the first response to patient distress, anxiety, or agitation. Non-pharmacological strategies might be safer for patients, promote more collaborative relationships, and facilitate greater skills development for managing symptoms. The literature has highlighted that poor documentation of pre-PRN administration interventions has limited our understanding of this practice, but evidence suggests that when this information is available, non-pharmaceutical approaches are not being attempted in the majority of cases. This is troubling given that, while clinically appropriate in some instances, PRN have been subject to criticism and lack critical evidence to support their use. The current study is a continuation of our previous work, which examined the reason, frequency, documentation, and outcome (e.g. effectiveness, side-effects) of PRN medication use at our facility. A chart review was conducted to understand what happens prior to the administration of PRN medication at our facility across all inpatient units over the course of 3 months. Results support previous findings that non-pharmacological interventions are poorly documented by front-line staff and are seemingly used infrequently. The use of these interventions differs by patient presentation (e.g. agitation, insomnia), and most often include supportive measures. The findings suggest that both documentation and intervention practices of nursing staff require further investigation and adjustment to align with best practices.

Utilizing Peplau's Interpersonal Approach to Facilitate Medication Self-Management for Psychiatric Patients

This article focuses on the nurse's role in applying Peplau's interpersonal theory of nursing to medication self-management and self-administration through teaching, supporting and partnering with patients.

Nurses' perceptions of medication adherence in schizophrenia: results of the ADHES cross-sectional questionnaire survey

OBJECTIVES

Poor adherence to antipsychotic treatment is a widespread problem within schizophrenia therapy with serious consequences including increased risks of relapse and rehospitalization. Mounting evidence supports the key roles that nurses play in monitoring patient progress and facilitating long-term treatment adherence. The Adherencia Terapéutica en la Esquizofrenia (ADHES) nurses' survey was designed to assess the opinions of nurses on the causes and management of partial/nonadherence to antipsychotic medication.

METHODS

A questionnaire-based cross-sectional survey of 4120 nurses from Europe, the Middle East and Africa. Interpretation of results was based on a descriptive comparison of responses.

RESULTS

Nurses perceived 54% of patients seen in the preceding month to be partially/nonadherent to treatment. Most nurses (90%) reported some level of experience with administration of long-acting injectable (LAI) antipsychotics, with 24% of nurses administering >10 injections per month. The majority (85%) of nurses surveyed believed that improving adherence would improve patient outcomes. Nearly half (49%) reported that most of their patients depend on a family member or other nonprofessional carer to remind them to take their medication as prescribed. A similar proportion of nurses (43%) reported that most of their patients relied on a professional to remind them to take medication. Most nurses (92%) felt that ensuring continuous medication with LAI antipsychotics would yield long-term benefits for patients, but their opinion was that over a third of patients were unaware of LAI antipsychotic treatments. In a series of forced options, the strategy used most often by respondents (89%) to promote medication adherence was to build trusting relationships with patients while listening to and interpreting their needs and concerns. Respondents also rated this as the most effective strategy that they used (48%).

CONCLUSION

Nurses are highly aware of adherence issues faced by their patients; further patient education on treatment options is needed.

Association between physician beliefs regarding assigned treatment and clinical response: re-analysis of data from the Hypericum Depression Trial Study Group

BACKGROUND

We have previously shown an association between patient belief and treatment response in the Hypericum Depression Trial Study Group's 2002 study. We re-examined these data to determine whether clinical improvement was associated with physician belief about assigned therapy.

METHODS

Three hundred and forty adults with major depression and baseline scores ≥20 on the 17-item Hamilton Depression Scale (HDRS-17) were randomized to Hypericum 900-1500mg/day, sertraline 50-100mg/day, or placebo for 8 weeks. At week 8, physicians guessed their patients' treatment. We analyzed 277 subjects with at least one post-baseline visit and physician guess data. We examined association between guess and improvement in HDRS-17 and whether treatment assignment moderated the effect of belief on remission (final HDRS-17 score <8).

RESULTS

Patient and doctor guesses agreed at 53% for sertraline, 68% for Hypericum, and 52% for placebo (kappa=0.37). Doctors guessed placebo correctly (38%) more than sertraline (18%) or Hypericum (19%) (p=0.001). Adverse event scores were significantly greater among subjects for which the clinicians guessed Hypericum (p<0.001) or sertraline (p=0.005) compared to placebo. Significant improvements in HDRS-17 score were found when comparing the Hypericum-guess (p<0.001) or the sertraline-guess group (p<0.001) against the placebo-guess group. Remission rates were significantly greater for subjects whose clinicians guessed sertraline (p<0.001) or Hypericum (p<0.001) versus placebo.

CONCLUSION

Doctors tended to guess placebo more easily than Hypericum or sertraline, and their guesses tended to favor active therapies when improvement was more robust. Results show association but not causation, and merit more careful investigation.

Conflict of roles: a conflict of ideas? The unsettled relations between care team staff and independent mental health advocates

Drawing on a national study of independent mental health advocacy, we explored the social relations of independent advocacy. The study was commissioned by the Department of Health (England), and involved a case study design covering eight different geographies and service configurations, and interviews or focus groups with a total of 289 stakeholders across two phases of inquiry. This paper focused on the analysis of qualitative data relevant to the relationship between mental health-care services and independent advocacy services, drawn from interviews with 214 participants in phase two of the study. Discussion of these particular findings affords insights into the working relations of independent advocacy within mental health services beset by reorganizational change and funding cuts, and increasing levels of legally-sanctioned compulsion and coercion. We offer a matrix, which accounts for the different types of working relationships that can arise, and how these are associated with various levels of understanding of independent advocacy and appreciation for the value of advocacy. The discussion is framed by the wider literature on advocacy and the claims by practitioners, such as nurses, for an advocacy role as part of their professional repertoire.

Proposed nurse-led initiatives in improving physical health of people with serious mental illness: a survey of nurses in mental health

AIMS AND OBJECTIVES

To identify nurse perceptions on the potential value of general and specific nursing approaches to improving physical health outcomes of people with serious mental illness.

BACKGROUND

People diagnosed with serious mental illnesses experience heightened rates of physical illnesses and can be supported better via healthcare system prevention and management. Nurses working in mental health are a critical part of a system-wide approach to improving physical health care, but there is little known on their views on specific approaches within Australia (e.g. screening for risks, stigma reduction).

DESIGN

A national, cross-sectional and nonrandom survey study delivered online.

METHODS

Members of the Australian College of Mental Health Nurses (n = 643), representing nurses employed in mental healthcare services across Australia (71·6% from public mental health services). Participants were asked to rate the potential of nine nurse-based strategies for improving physical health (options: 'yes', 'no', 'not sure') and the potential value of 10 nursing and general strategies for improving physical health (rating from 'negative value' to 'significant value').

RESULTS

There was a high endorsement of all nine nurse-based strategies for physical health (e.g. lifestyle programmes, screening, linking services), although there was less support for reducing antipsychotics or advocating for fewer side effects. Participants mainly viewed all strategies as of moderate to significant value, with the most promising value attached to colocation of primary and mental care services, lifestyle programmes and improving primary care services (reduce stigma, train GPs).

CONCLUSIONS

Australian nurses working in mental health services view a range of nurse-based strategies for improving physical healthcare services and standards as important.

RELEVANCE TO CLINICAL PRACTICE

Nurses collectively need to work with consumers, health agencies and the general public to further define how to organise and implement physical health integration strategies, towards more comprehensive health care of people with serious mental illness.

Qualitative inquiry into motivators for maintaining medication adherence among Taiwanese with schizophrenia

Medication non-adherence is associated with higher rates of relapse in persons with schizophrenia. Psychiatric nurses play a significant role in facilitating their medication adherence. The motivators which strengthen patients with schizophrenia to maintain their adherence to medication have seldom been explored. This study aims to explore what motivates persons with schizophrenia to consistently maintain their medication adherence. A qualitative approach was used to collect data from a psychiatric day-care centre at an armed forces hospital in Taiwan. Ten clients agreed to undergo an in-depth interview. The data was analyzed by a content analysis method. Four themes were identified: (i) the benefits of antipsychotic medication treatment; (ii) firm and ongoing family support; and the Chinese values of (iii) filial piety and (iv) hope for the future. These findings may provide psychiatric nurses with a better understanding of the motivators for medication adherence in persons with schizophrenia from the Chinese perspective. Nurses will then be able to adjust their practice to facilitate patients' medication adherence.

Implementing a competence framework for administering medication: reporting the experiences of mental health nurses and students in the UK

Medicine administration is a high risk activity that most nurses undertake frequently. In this paper, the views of registered mental health nurses and final year student nurses are evaluated about the usefulness of the Medicines with Respect Assessment of the Administration of Medicines Competency Framework. A questionnaire using 22 items with closed and open response questions was distributed to 827 practising mental health nurses and 44 final year mental health nursing students. This article presents a content analysis of written replies to the open response questions. Four overlapping themes were identified in response to the open questions posed in the survey: (1) reasons for undertaking the Medicines with Respect Framework; (2) positive aspects; (3) negative aspects; and (4) service user benefits.

Problems with non-adherence to antipsychotic medication in Samoan New Zealanders: a literature review

This paper explores what is known about adherence to antipsychotic medications in general and the possible reasons for non-adherence in Samoan New Zealanders. Samoan New Zealanders are either Samoan-born immigrants or their descendents born in New Zealand. Clinicians recognize a high prevalence of non-adherence among Samoan New Zealanders. The authors hypothesize that traditional Samoan beliefs play a prominent role in problems with adherence. To investigate this hypothesis, a review of the literature on adherence in Samoan New Zealanders was undertaken. Documents from the Ministry of Health support the hypothesis. To investigate this issue, the Ministry of Health initiated a qualitative research project to examine the nature of Samoan traditional beliefs. The results of this study are summarized. No research had previously been undertaken on adherence in Samoan New Zealanders. In general, there is a lack of research on all aspects of the mental health of Pacific peoples in New Zealand. Literature reviews of adherence research consistently show that interventions that improve adherence address the beliefs, behaviours, and relationships surrounding adherence. This finding supports the author's hypothesis that traditional beliefs play an important role in the problem of adherence. Further definitive study with Samoan New Zealanders is required.

Care coordinators: a controlled evaluation of an inpatient mental health service innovation

The study aimed to evaluate the impact of introducing designated care coordinators into an acute mental health inpatient unit in terms of service delivery, clinical outcomes, and service user and significant other perceptions. A pre-post-controlled design was implemented with a consecutive sample of 292 service users admitted and staying more than 5 days in two wards, with care coordinators introduced in one ward. Data were obtained from clinical records, standard measures, and service user and significant other surveys. Care coordinator input was associated with significant improvements in service delivery and stronger involvement of significant others and community resources. Care-coordinated clients showed significantly better clinical outcomes, including the Health of Nations Outcome Scales behaviour subscale, less time in the intensive care subunit, less community crisis team input in the week following discharge, and lower rates of readmission in the month following discharge. Care-coordinated service users and their significant others gave higher ratings of service delivery, outcome, and satisfaction. The results indicate that designated care coordinators significantly improve care processes, outcomes, and service user experience in acute inpatient mental health settings.

Opportunity lost? Psychiatric medications and problems with sexual function: a role for nurses in mental health

AIM

To explore patients' non-adherence to psychiatric medication with mental health nurses.

BACKGROUND

The ability of consumers to maintain normal sexual behaviours is complicated by abnormally high incidence of sexual problems arising from the medications they are prescribed. Sexual side effects of psychiatric medications are identified as a major reason for non-adherence to psychiatric medication regimes yet it remains an issue mental health nurses tend to avoid in their practice with consumers.

DESIGN

An exploratory, descriptive qualitative approach.

METHOD

Individual interviews were conducted with 14 nurses currently working with adult consumers of mental health services. Data analysis followed the framework approach developed by Ritchie and Spencer as the process for identification of the main themes.

RESULTS

Problems with sexual function in relation to psychiatric medication issues was one major theme to emerge from this research. More specifically the participants referred to: assessment of sexual function, the side effects of psychiatric medication, consumer embarrassment, and, the pros and cons of information. Participants recognised that sexual side effects were likely to have an impact on adherence to medication and that this was an important consideration but most did not discuss this issue with consumers. Consumer embarrassment and the belief that knowledge itself might cause non-adherence were the two main reasons for not discussing this topic.

CONCLUSIONS

Problems with sexual function of consumers presents an important practice consideration for nurses working in mental health settings. There is an urgent need for strategies to enhance awareness and confidence among nurses in exploring this topic with consumers.

RELEVANCE TO CLINICAL PRACTICE

Mental health nurses can adopt a leadership role in recognising the relevance of sexuality in care and treatment for consumers of mental health services. Strategies to assist in developing skill and confidence in this domain are required as a matter of priority.

Registered nurses' medication management of the elderly in aged care facilities

BACKGROUND

Data on adverse drug reactions (ADRs) showed a rising trend in the elderly over 65 years using multiple medications.

AIM

To identify registered nurses' (RNs) knowledge of medication management and ADRs in the elderly in aged care facilities; evaluate an education programme to increase pharmacology knowledge and prevent ADRs in the elderly; and develop a learning programme with a view to extending provision, if successful.

METHOD

This exploratory study used a non-randomized pre- and post-test one group quasi-experimental design without comparators. It comprised a 23-item knowledge-based test questionnaire, one-hour teaching session and a self-directed learning package. The volunteer sample was RNs from residential aged care facilities, involved in medication management. Participants sat a pre-test immediately before the education, and post-test 4 weeks later (same questionnaire). Participants' perceptions obtained.

FINDINGS

Pre-test sample n = 58, post-test n = 40, attrition rate of 31%. Using Microsoft Excel 2000, descriptive statistical data analysis of overall pre- and post-test incorrect responses showed: pre-test proportion of incorrect responses = 0.40; post-test proportion of incorrect responses = 0.27; Z-test comparing pre- and post-tests scores of incorrect responses = 6.55 and one-sided P-value = 2.8E-11 (P < 0.001).

CONCLUSION AND IMPLICATIONS

Pre-test showed knowledge deficits in medication management and ADRs in the elderly; post-test showed statistically significant improvement in RNs' knowledge. It highlighted a need for continuing professional education. Further studies are required on a larger sample of RNs in other aged care facilities, and on the clinical impact of education by investigating nursing practice and elderly residents' outcomes.

Training inpatient mental health staff how to enhance patient engagement with medications: Medication Alliance training and dissemination outcomes in a large US mental health hospital

RATIONALE, AIMS AND OBJECTIVES

The Medication Alliance training programme has previously been shown to be effective in enhancing clinician knowledge, attitudes and skills in regard to non-adherent individuals in a community-based psychiatric setting. The current study attempts to replicate these findings in an inpatient setting and assess the feasibility of dissemination using a train-the-trainer model.

METHOD

One hundred and thirteen staff from four wards at an inpatient psychiatric facility attended Medication Alliance training workshops over 3 days. Two wards comprised an expert trained group (n = 67); and the remaining two wards made up a novice trained group (n = 46). The novice trained group attended training 6 months after the expert group, and were trained by selected trainees from the expert group. Participants completed a package of questionnaires both before and after their training to determine if Medication Alliance resulted in any changes in knowledge, attitudes and skills.

RESULTS

Paired t-tests showed significant improvements across both groups for knowledge, attitudes and one skill domain following training in Medication Alliance. There were no differences at baseline between groups and analysis of post-test scores yielded no significant difference between the groups in terms of training effect for knowledge, attitudes or skills.

CONCLUSIONS

Medication Alliance can be successfully implemented in an inpatient setting, enhancing knowledge, attitudes and at least some skill domains of staff in dealing with non-adherent patients. The equivalence of results between the expert and novice trained training groups suggests that Medication Alliance may be more broadly disseminated using a cost-effective train-the-trainer model.

Administration of medication in the acute mental health ward: perspective of nurses and patients

The administration of medication is an important therapeutic intervention. However, concerns have been raised about the management of this procedure in the acute area. Therefore, a survey was conducted with registered nurses (n = 24) and patients (n = 57) from three acute admission wards in an inner city hospital in the north west of England. Semistructured interviews were conducted immediately following medication administration and then analyzed using thematic analysis. Nurses' views were categorized into three themes: ward environment, communication, and sharing of information. Nurses reported that policies and procedures provided clear guidance, but that the task remained stressful and the role of other professionals affected the integrity of the procedure. Patients' views were categorized into four themes: effects and side-effects of medication, the process of administration, therapeutic relationships, and the sharing of information. Most patients were accepting of the administration of their medication, but called for improvements in information sharing and side-effect management. Information sharing is pivotal in establishing therapeutic relationships, but the time of administration might not be the most appropriate occasion for this.

Oral medication management in inpatient psychiatric care in Turkey

The aim of this study was to describe current status of oral medication management and related situations by nurses who work on psychiatric wards in Turkey. The study was performed in 34 psychiatric wards in Turkey, and 471 nurses agreed to participate in the study. Data were collected by a questionnaire. In our study, it was determined that one quarter of the nurses do not collect data about past medication history of the patient before giving medications, and 59.7% of the nurses checked all the patients' mouths after each pill was given. The orders are checked by 80.5% of the nurses every day. The leading patient reaction nurses face during medication administration was refusal to take the medication. The nurses stated that they first informed the physician without making any intervention on patients who did not take their pills. The nurses primarily observed the patient to evaluate the effect of a medication (84.3%) and, with a similar percent (82.8%), the side effects of a medication. In conclusion, continuing education, certification and post-graduated courses is provided for nurses about their other roles and responsibilities as well as increasing the quality of oral medication administration which is a difficult area.

Mental health nurses establishing psychosocial interventions within acute inpatient settings

Acute inpatient units provide care for the most acutely unwell people experiencing a mental illness. As a result, the focus for care is on the containment of difficult behaviour and the management of those considered to be 'at high risk' of harm. Subsequently, recovery-based philosophies are being eroded, and psychosocial interventions are not being provided. Despite the pivotal role that mental health nurses play in the treatment process in the acute inpatient setting, a review of the literature indicates that mental health nursing practice is too custodial, and essentially operates within an observational framework without actively providing psychosocial interventions. This paper will discuss the problems with mental health nursing practice in acute inpatient units highlighted in the current literature. It will then put forward the argument for routine use of psychosocial interventions as a means of addressing some of these problems.

Strategies nurses use to overcome medication refusal by involuntary psychiatric patients

Nurses seem to play an important role in assisting involuntarily hospitalized psychiatric patients to accept medication. The initial aim of this study was to develop a theoretical understanding of strategies nurses use to overcome medication non-acceptance in involuntary psychiatric patients using a grounded theory approach. Interviews (n = 17) were conducted with psychiatric nurses in inpatient settings. Data analysis using the constant comparative method and validation by nursing literature identified four key themes: Engagement, formulating a therapeutic relationship, finding out why, and persistently trying everything. These themes were frequently encountered in descriptions of getting patients to take medications. The findings indicate that psychiatric nurses use varied and individualized techniques to convince involuntary patients to take their medications.

A comparative study of antipsychotic medication taking in people with schizophrenia

Medication adherence is problematic in all chronic illnesses, none more so than in individuals with schizophrenia. The purpose of this exploratory study was to examine the factors that impacted upon antipsychotic medication taking in people with schizophrenia living in regional-rural and metropolitan Victoria, Australia, and to assess if differences existed between these two groups of participants in the factors that affected medication taking. The Factors Influencing Neuroleptic Medication Taking Scale was used with a non-probability survey sample of 81 people with schizophrenia. Ethics approval was given by university and hospital ethics committees. The results showed, overall, that there were no significant differences between the sets of participants in several demographic characteristics, insight, stigma, substance abuse, types of antipsychotic medications, significant others' support, and access to case managers and general practitioners. There were statistically significant differences between the two groups concerning living circumstances, involvement in religious/spiritual activities, perceived impact of medication side-effects, and access to psychiatrists. However, there were no statistically significant relationships between these factors and medication omission. The implications of the findings for consumers, mental health nurse case managers, families, mental health service provision, and further research, are considered.

Mental health clinicians' beliefs about medicines, attitudes, and expectations of improved medication adherence in patients

Nonadherence to antipsychotic medications remains a major factor in poor clinical outcomes. This study sought to identify clinician beliefs about patients who do not adhere to treatment, the clinicians' own beliefs about medicines, and the impact of beliefs on efforts to enhance patient adherence. In total, 292 clinicians responded to an anonymous questionnaire that included questions about their beliefs and their efforts to enhance adherence. Results indicated that clinicians' beliefs about their own adequacy to enhance adherence significantly predicted actual efforts to enhance adherence. Both pessimism about outcomes and empathy for the patient predicted outcome expectancy. It was concluded that enhancing clinicians' beliefs about working with nonadherent patients is a potentially important ingredient in efforts to improve patient adherence.

An exploration of mental health nursing models of care in a Queensland psychiatric hospital

This qualitative study that took place in 2006 in a publicly funded Queensland psychiatric hospital explored nursing models of care from multiple points of view. Eleven participants were interviewed. Two were post-acute consumers, three were nurse unit managers, one was an enrolled nurse, and the remaining five were registered nurses. Even though participants valued an approach that was different to a medical model, in the absence of an explicit nursing approach, the predominantly illness-care culture led nurses to resort to problem-focused care. Relying on implicit models of care created inconsistencies and precluded the nursing strategies from being systematically evaluated, revised, or extended. Various changes were identified and included the desire for further consultation and staff development so that an explicit model of care could be introduced and evaluated.

Iatrogenic sexual dysfunction and the protective withholding of information: in whose best interest?

In recent years a growing body of evidence has highlighted the impact of neuroleptics and antidepressants on sexual function. Research from a service user's perspective suggested that service users are dissatisfied with the information that they received on drugs, and would like more education, in particular, on the side effects of medication that impact on sexual function. This paper reports some of the findings of a grounded theory study that explored how psychiatric nurses responded to issues of sexuality in practice. Emphasis within the paper is given to how nursing staff addressed the side effects of drugs that impact on sexual function. Findings suggested that nurse addressed the issue of prescribed medication and sexual function in practice, using a 'Veiling Sexualities Cycle', which had three subcategories: 'Hanging the Veil', 'Lifting the Veil' and 'Re-veiling'. In the light of contemporary mental health policy, findings from the study are discussed and recommendations for practice and education made.

Nurses' collaboration with physicians in managing medication improves patient outcome in acute psychiatric care

The aim of the present paper was to examine the impact of nurses' collaboration with physicians in medication management on patient outcome in acute psychiatric care. Data for 143 patients with schizophrenia were assessed based on information given by nurses and physicians in charge. Twenty-two patients were defined as a collaborative group when physicians changed medication after receiving reports that nurses perceived the necessity to change. A control group was formed from the 50 patients when nurses perceived the necessity to change medication but did not tell physicians, or nurses advised of the necessity to physicians but medication was not changed. Physicians retrospectively evaluated patients' social functioning and acceptance of medication at admission and discharge. Social functioning was measured by Global Assessment of Functioning (GAF), and acceptance of medication by a single item using Japanese version of Schedule for Assessment of Insight (SAI-J). Changes in the scores from admission to discharge on GAF and acceptance of medication were defined as outcome measures. Nurses recognized the necessity to change medication for patients with frequent aggressive behavior and younger age. Compared with the control group, the collaborative group had less instruction for use of drugs, and more perceived necessity to decrease the current dose or the number of drugs because of stable symptoms. The collaborative group demonstrated significantly greater improvement in social functioning. The collaborative group improved acceptance of medication, although there were no significant differences between the two groups. Nurses' collaboration with physicians in medication management improved patient outcome in acute psychiatric care.

Educational interventions for mental health consumers receiving psychotropic medication: a review of the evidence

The objective of this systematic review is to investigate the efficacy of educational interventions, relating to psychotropic medications, for consumers with a mental health disorder. This review included only randomized controlled trials that compared the effects of various educational interventions on knowledge retention, compliance to medication and treatment, incidence of relapse, and insight into illness in patients aged 18 years and over with a mental disorder. Twenty-one trials met the quality criteria and were included in the final analysis. Patients who were provided with education demonstrated a significant increase in the level of knowledge and compliance compared with those who were not. However, there was no difference in the incidence of relapse and insight in those who were provided education. A structured education session using both written and verbal methods followed by discussion of the contents is demonstrated to be effective. The evidence suggests that consumers who were provided multiple education sessions had greater knowledge gains in the short term (up to 1 month); however, the effectiveness of multiple sessions in the long term (2 years) is inconclusive. The review provides evidence that multiple education sessions are better than single education sessions in improving knowledge relating to medications and insight into illness. Evidence from the trials demonstrates that structured educational interventions delivered at frequent intervals are useful as part of the treatment programme for people with a mental illness. More well designed and reported randomized studies investigating the efficacy of education are urgently needed.

Neuroleptic medication and sexuality: the forgotten aspect of education and care

Discussing issues of sexuality is a challenging and difficult issue for many health care workers. When it comes to sexuality and people with mental health problems there seems to be a dual taboo. Mental health nurses are ideal members of the health care team to talk to service users about issues as sensitive as sexuality and the side effects of medication that impact on sexual health. However, in both clinical practice and the nursing literature, the side effects of medications that impact on sexual function are often ignored and unspoken about. This paper examines the impact of both conventional and atypical neuroleptic medication on sexual function and discusses the probable causes of such effects. The possible reasons why health care professionals are reluctant to discuss side effects impacting on sexual health with service users are explored and emphasis is placed on the need for mental health nurses to respond to requests from service users for more education and discussion in the area of sexuality and sexual health.

Wanting to be heard: mental health consumers' experiences of information about medication

The complexities accompanying the prescription of antipsychotic medication for people experiencing a mental illness have been extensively documented in the literature. The views and experiences of consumers of mental health services, however, are almost entirely absent. This paper describes the findings of a qualitative study undertaken to examine the experiences of consumers, specifically in relation to education and decision making with regards to medication. The findings from a focus group conducted with consumers (n = 9) revealed an overall dissatisfaction with information provided and the opportunity to participate in decision making. Data analysis revealed four major themes: information to consumers; acknowledgement and recognition of consumers; roles of health professionals; and the experience of wellness and adherence. The findings suggest the need for significant change if the goals of the Third National Mental Health Plan are to be realized.

Enhancing medication adherence: clinician outcomes from the Medication Alliance training program

OBJECTIVE

Patient nonadherence to psychiatric medication is a key cause of relapse but clinicians do not appear to possess specific adherence skills. We sought to demonstrate that a brief training program on medication adherence strategies could improve the adherence skills, attitudes and knowledge of mental health clinicians.

METHODS

Twenty-three Tasmanian mental health workers were provided a 3 day training workshop on strategies to enhance patient adherence to medications (Medication Alliance). Pre- and post-training measures were taken of clinician knowledge about adherence strategies, ability to identify predictors of nonadherence, attitudes toward working with nonadherent patients, and optimism about treatment outcomes for patients. Videotapes of clinicians demonstrating key adherence therapy skills were also collected before and after training and blind-rated by two experienced therapists.

RESULTS

A series of paired samples t-tests indicated significant improvements in skills, knowledge and attitudes.

CONCLUSIONS

Compared with similar studies in the UK, Medication Alliance was found to be an effective and efficient training program. However, there is a need for further research to assess maintenance of training effects over time and patient outcomes.