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Abdulhaq B, Dardas LA, Sami O. Monitoring for the metabolic side effects of second-generation antipsychotic medications: Psychiatrists' views and practices. Perspect Psychiatr Care 2021; 57:1237-1243. [PMID: 33156542 DOI: 10.1111/ppc.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/20/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The aims of this study were to explore (1) the knowledge, attitudes, practices, and adherence of psychiatrists in Jordan regarding published guidelines for metabolic monitoring of patients taking second-generation antipsychotics (SGAs), and (2) their perceived barriers to metabolic screening. METHODS The study utilized a cross-sectional survey. Data were collected from 91 psychiatrists using a self-administered questionnaire. FINDINGS Almost 74% of psychiatrists reported they were aware of metabolic screening guidelines for patients taking SGA. However, the results of their assessment practices revealed a lack of adherence to these guidelines. Reported barriers to metabolic screening were the financial burden on the family and lack of family and patient compliance with recommendations of monitoring. PRACTICE IMPLICATIONS Metabolic side effects of SGAs are important in Arab countries, where baseline levels of obesity and metabolic syndrome are already high in the general population. By virtue of their close proximity to patients, nurses are ideally placed to monitor how patients perceive SGAs and to provide information, advice, and counseling support.
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Affiliation(s)
| | - Latefa A Dardas
- The University of Jordan School of Nursing, Amman, Jordan.,Psychological Sciences Association, Amman, Jordan
| | - Omar Sami
- The University of Jordan School of Medicine, Amman, Jordan
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Grover S, Mallnaik S, Chakrabarti S, Mehra A. Factors associated with dropout from treatment: An exploratory study. Indian J Psychiatry 2021; 63:41-51. [PMID: 34083819 PMCID: PMC8106432 DOI: 10.4103/psychiatry.indianjpsychiatry_87_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/22/2019] [Accepted: 08/22/2020] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the factors associated with treatment dropout among patients attending the psychiatric outpatient services. MATERIALS AND METHODS Seventy-two patients who dropped out from treatment were contacted and they were compared with 200 regular attendees for sociodemographic and clinical variables, medication adherence, treatment satisfaction, attitude toward medication, insight, and therapeutic alliance. RESULTS Compared to "regular attendees," those who dropped out from treatment were significantly older, were more likely to be married, had higher age of onset, had longer duration of illness, received less supervision for medication at home, higher proportion of them continued to remain symptomatic, had more negative attitude toward medications, had poorer insight, were poorly complaint with medication, were less satisfied with the treatment provided, and had poor quality of therapeutic alliance. CONCLUSION This study suggests that dropout from treatment can be avoided by addressing issues of negative attitude toward medications, improving satisfaction with the treatment contact and enhancing therapeutic alliance.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sridhar Mallnaik
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Soerensen AL, Lisby M, Nielsen LP, Poulsen BK, Mainz J. Improving Medication Safety in Psychiatry - A Controlled Intervention Study of Nurse Involvement in Avoidance of Potentially Inappropriate Prescriptions. Basic Clin Pharmacol Toxicol 2018; 123:174-181. [DOI: 10.1111/bcpt.12989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/12/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Ann L. Soerensen
- Danish Center for Healthcare Improvements; Faculty of Social Science; Aalborg University; Aalborg Denmark
- University College of Northern Denmark; Aalborg Denmark
| | - Marianne Lisby
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus Denmark
| | - Lars P. Nielsen
- Department of Clinical Pharmacology; Aarhus University Hospital; Aarhus Denmark
| | - Birgitte K. Poulsen
- Department of Clinical Pharmacology; Aarhus University Hospital; Aarhus Denmark
| | - Jan Mainz
- Department of Psychiatry; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Faculty of Health; Aalborg University; Aalborg Denmark
- Department of Community Mental Health; The University of Haifa; Haifa Israel
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Mitchell AJ, Selmes T. Why don't patients attend their appointments? Maintaining engagement with psychiatric services. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.106.003202] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patients miss about 20% of scheduled appointments for mental health treatment, almost twice the rate in other medical specialties. Up to 50% of patients who miss appointments drop out of scheduled care. Many who miss appointments because of slips and lapses later rearrange their appointments without adverse consequences. Those that do not are at risk of further deterioration, relapse and hospital readmission. Predictors of non-attendance are complex and linked with the predictors of missed medication. Service barriers and administrative errors are common but are often overlooked in the absence of feedback from patients. Of prime importance are the therapeutic alliance and degree of ‘helpfulness’ of the clinician but again these are rarely measured routinely. Useful markers of engagement include patient-rated trust, satisfaction and degree of perceived participation in treatment decisions. Much can be done to improve attendance in most services. Simple measures such as offering prompt, convenient appointments, offering reminders and augmenting with telephone contact have a reasonable evidence base. Scales to assess therapeutic alliance are now available. Complex interventions need to be evaluated carefully in order that the overall benefits outweigh costs. We suggest that clinicians consider accessibility, discharge policies and patient feedback when examining local rates of non-attendance.
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Ellis H, Alexander V. Eradicating Barriers to Mental Health Care Through Integrated Service Models: Contemporary Perspectives for Psychiatric-Mental Health Nurses. Arch Psychiatr Nurs 2016; 30:432-8. [PMID: 27256953 DOI: 10.1016/j.apnu.2016.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/27/2015] [Accepted: 01/06/2016] [Indexed: 11/26/2022]
Abstract
There has been renewed, global interest in developing new and transformative models of facilitating access to high-quality, cost-effective, and individually-centered health care for severe mentally-ill (SMI) persons of diverse racial/ethnic, cultural and socioeconomic backgrounds. However, in our present-day health-service delivery systems, scholars have identified layers of barriers to widespread dispersal of well-needed mental health care both nationally and internationally. It is crucial that contemporary models directed at eradicating barriers to mental health services are interdisciplinary in context, design, scope, sequence, and best-practice standards. Contextually, nurses are well-positioned to influence the incorporation and integration of new concepts into operationally interdisciplinary, evidence-based care models with measurable outcomes. The aim of this concept paper is to use the available evidence to contextually explicate how the blended roles of psychiatric mental health (PMH) nursing can be influential in eradicating barriers to care and services for SMI persons through the integrated principles of collaboration, integration and service expansion across health, socioeconomic, and community systems. A large body of literature proposes that any best-practice standards aimed at eliminating barriers to the health care needs of SMI persons require systematic, well-coordinated interdisciplinary partnerships through evidence-based, high-quality, person-centered, and outcome-driven processes. Transforming the conceptual models of collaboration, integration and service expansion could be revolutionary in how care and services are coordinated and dispersed to populations across disadvantaged communities. Building on their longstanding commitment to individual and community care approaches, and their pivotal roles in research, education, leadership, practice, and legislative processes; PMH nurses are well-positioned to be both influential and instrumental in the development of innovative, revolutionary, and transformative paradigmatic models aimed at eradicating treatment barriers, promoting well-being, and reducing preventable mortalities and morbidities among SMI persons.
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Sino CGM, Munnik A, Schuurmans MJ. Knowledge and perspectives of Dutch home healthcare nurses regarding medication frequently used by older people. Int J Older People Nurs 2012; 8:131-8. [PMID: 22805649 DOI: 10.1111/j.1748-3743.2012.00336.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Home healthcare nurses in their roles as caregivers, educators and administrators of medications are particularly well positioned to act on a preventive way to be alert of adverse drug reactions. However, knowledge about medication and a professional attitude is required. AIM To describe medication-related knowledge and perspectives of Dutch home healthcare nurses regarding frequent used medication by older people. METHOD A cross-sectional study was conducted among home healthcare nurses (n=146) in the Netherlands based on the ten most frequently used drugs by older people. FINDING The mean score for total medication knowledge was 76.2% of the maximum score. Most home healthcare nurses (80.3%) felt responsible for improving older patients' medication use. Three-quarters of the home healthcare nurses agreed with the statement: "By taking appropriate action at the right time, I am able to prevent a medication-related hospital admission". CONCLUSION Although most home healthcare nurses felt responsible for their older patients' proper medication use and agreed with the statement that they played a role in preventing older patients' medication-related hospital admissions, their knowledge regarding medications could be improved. IMPLICATIONS FOR PRACTICE Home healthcare nurses should profit as a professional from gaining more knowledge of medication frequently used by older people.
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Affiliation(s)
- Carolien G M Sino
- Research Centre for Innovation in Health Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands.
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Liu W, Manias E, Gerdtz M. Understanding medication safety in healthcare settings: a critical review of conceptual models. Nurs Inq 2011; 18:290-302. [PMID: 22050615 DOI: 10.1111/j.1440-1800.2011.00541.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Understanding medication safety in healthcare settings: a critical review of conceptual models Communication can impact on the way in which medications are managed across healthcare settings. Organisational cultures and the environmental context provide an added complexity to how communication occurs in practice. The aims of this paper are: to examine six models relating to medication safety in various hospital and community settings, to consider the strengths and limitations of each model and to explore their applications to medication safety practices. The models examined for their ability to address the complexity of the medication communication process include causal models, such as the Human Error Model and the System Analysis to Clinical Incidents Model, and exploratory models, such as the Shared Decision-Making Model, the Medication Decision-Making and Management Model, the Partnership Model and the Medication Communication Model. The Medication Communication Model provides particular insights into possible interactions between aspects that influence medication safety practices. The implications of all six models for healthcare practice and future research are also discussed.
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Affiliation(s)
- Wei Liu
- The University of Melbourne, Carlton, Vic., Australia
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Gabe ME, Davies GA, Murphy F, Davies M, Johnstone L, Jordan S. Adverse drug reactions: treatment burdens and nurse-led medication monitoring. J Nurs Manag 2011; 19:377-92. [PMID: 21507109 DOI: 10.1111/j.1365-2834.2011.01204.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marie E Gabe
- Research Capacity Building Collaboration (RCBC) Wales, College of Human and Health Sciences, Swansea University, Swansea, UK.
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Montes JM, Maurino J, Diez T, Saiz-Ruiz J. Telephone-based nursing strategy to improve adherence to antipsychotic treatment in schizophrenia: A controlled trial. Int J Psychiatry Clin Pract 2010; 14:274-81. [PMID: 24917439 DOI: 10.3109/13651501.2010.505343] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Objective. Adherence to prescribed antipsychotic medication is a major factor in achieving optimal long-term clinical outcomes. The aim of this study was to evaluate the impact of a telephone-based strategy provided by a nurse on adherence to antipsychotic treatment among patients with schizophrenia. Methods. A total of 928 clinically stable outpatients with schizophrenia were randomized to receive a monthly telephone call by a nurse or routine clinical care. Telephone calls were performed at weeks 4, 8, and 12, consisting of a standardized interview to detect and assess therapeutic adherence and subjective attitude towards medication. Patients were followed for 4 months. A cut-point of ≥ 60% of prescribed dose was used to classify patients as being adherent. Results. At week 16, a significantly higher percentage of patients who received a telephone-based follow-up (96.7%, n = 410) were classified as adherent compared to the control group (91.2%, n = 402) (P = 0.0007). Patients in the intervention group were significantly more likely to be adherent than control group (adjusted OR = 3.3 95% CI 1.6-6.6, P = 0.0001). Conclusions. Telephone-based nursing strategy showed a significant improvement in adherence to antipsychotic drugs. Further studies are necessary to confirm if this kind of intervention could be a complementary strategy to optimize adherence in patients with schizophrenia.
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Affiliation(s)
- Jose Manuel Montes
- Department of Psychiatry, Hospital del Sureste, Arganda del Rey, Madrid, Spain
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Tschannen D, Kalisch BJ. The impact of nurse/physician collaboration on patient length of stay. J Nurs Manag 2010; 17:796-803. [PMID: 19793236 DOI: 10.1111/j.1365-2834.2008.00926.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM This study examines the relationship between nurse/physician collaboration and patient length of stay (LOS). BACKGROUND The quality of nurse/physician relationships has been shown to have an impact on patient outcomes. As the acuity level of patients admitted to hospitals continue to rise, the need for collaboratively determined care is essential for avoiding errors and promoting quality. METHODS Data were collected on four units located in two Midwest hospitals. Nurses (n = 135) were asked to complete a survey seeking perceptions of nurse/physician collaboration. The survey data were then linked with patient (n = 310) data, including LOS, diagnostic-related groups (DRG) category and other patient-specific characteristics. RESULTS Perceptions of nurse/physician collaboration were positively linked with actual LOS (P < 0.001) and inversely related to deviation from expected LOS (i.e. patient stay longer than expected) (P < 0.01). Patients receiving care from nurses who perceived greater collaboration were elderly and had higher levels of acuity. Longer LOS for these patients may be a result of their higher acuity level. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT This study found that collaboratively determined care may result in longer LOS, but could prevent complications that may otherwise go untreated. Nurse administrators must implement strategies that foster the development of nurse/physician collaboration.
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Affiliation(s)
- Dana Tschannen
- Nursing Business andHealth Systems, University of Michigan, Ann Arbor, MI, USA.
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Dilles T, Vander Stichele R, Van Rompaey B, Van Bortel L, Elseviers M. Nurses' practices in pharmacotherapy and their association with educational level. J Adv Nurs 2010; 66:1072-9. [PMID: 20337787 DOI: 10.1111/j.1365-2648.2010.05268.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study of the association between educational level and nurses' practices in pharmacotherapeutic activities in three clinical settings. BACKGROUND The preparation and administration of medication are at the core of nursing practice, and nurses' involvement in pharmacotherapy is essential to medication safety. Nursing strategies to improve patient adherence to treatment and to identify adverse drug reactions have been described, but nurses' practice patterns in monitoring adherence and adverse drug reactions remain undocumented. METHODS A cross-sectional correlational survey design was used. Data were collected between 2005 and 2007. Each year, the focus was on a different setting. Nurses were selected by convenience sampling: 260 worked in nursing homes, 82 in community care services and 1070 in hospitals. Questions focused on the provision of medication information, observation of patient medication adherence and identification of adverse drug reactions during the preceding month. RESULTS Involvement in providing drug information varied considerably, from 50% among hospital nurses to 82% among nurses in community care services. Statistically significantly fewer nurses observed non-adherence in hospitals (50%) than in the other settings (about 80%). Between 40% and 49% of the nurses had observed an adverse drug reaction. Nurses' information-seeking behaviour and problem responses also varied according to setting. Bachelor's degree holders were 35% more likely than diploma holders to have observed an adverse drug reaction. CONCLUSION Nurses assume considerable pharmacotherapeutic responsibilities. Practice patterns are codetermined by the healthcare setting and nurses' educational level.
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Affiliation(s)
- Tinne Dilles
- Department of Nursing Science, University of Antwerp, Belgium and Heymans Institute for Pharmacology, University of Ghent, Belgium.
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Abstract
OBJECTIVE To develop and examine the reliability and validity of a new instrument, the nurse-nurse collaboration (NNC) scale. BACKGROUND Nurse-nurse collaboration (NNC) is recommended to reduce medical errors and improve patient care and nurses' job satisfaction. While instruments are available to measure nurse-physician collaboration, an instrument to measure NNC was not available in the literature. Because collaboration is necessary for optimal patient care, a valid and reliable instrument would make it possible to measure the level of collaboration among nurses. METHODS A comprehensive literature review was conducted to develop a definition and define relevant domains of NNC and identify instruments with acceptable psychometrics that included items measuring NNC. Instrument items to develop the Nurse-Nurse Collaboration Scale (NNC Scale) were adapted from previously published tools or developed based on domains identified in the literature. Five domains were identified: problem solving, communication, coordination, shared process, and professionalism. Psychometric testing of the NNC Scale included pilot testing for content and construct validity and field testing among 76 staff nurses working in 4 ICUs in a large tertiary-care academic medical center in the northeast United States. Psychometric tests assessing reliability and convergent validity correlations were conducted. RESULTS The overall Cronbach alpha for the scale was .89. Convergent validity correlations, however, were low to moderate, indicating minimal shared variance among the subscales. Therefore, the instrument did not measure a global concept but rather 5 separate domains of collaboration. Internal consistency testing of the 5 subscales produced acceptable results ranging from .66 to .91. CONCLUSION The NNC Scale demonstrated acceptable reliability and validity for measuring the level of NNC in intensive care nurses. Further psychometric testing and a factor analysis with a larger-sample, more diverse groups of nurses are necessary to further characterize the generalizability of the NNC Scale.
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