Supporting and maintain medication adherence is an essential role of mental health professionals. The main purpose of this paper is to review three journal articles related to adherence and non-adherence to antipsychotic medication on mental health nursing. The two journal articles researches were performed to investigate the issue of education of mental health nursing which is also emphasized from the first article. Generally the mental health professionals have a tendency to pay less attention to importance of education and training program for consumers compared to that education provided to the mental health professionals. This paper will detail the necessity of more structured and specific education and training program not only for the medical staff but also for the consumers using comparisons and analysis of three chosen journal articles.
The role of mental health professionals cannot be stressed enough in maintaining adherence to medication in mental health setting. Monitoring adverse effect of antipsychotic medications and establishing strategies are also very important role in mental health nursing. A failure of irregular intake of antipsychotic medication gives rise to deterioration of consumers’ symptoms and re-hospitalization. In order to enhance medication adherence, proper education and training programs including psycho educations should be established in the mental health settings. However, such educations and trainings in relation to adherence to medications have been much more focused on mental health professionals even though consumers also need to be educated and trained for that issue. Nevertheless, it has been regarded that education and training programs for mental health professionals as trivial matters. Furthermore, the hospital environment also has negative effects on educating and training for them.
The main point of this paper is to emphasis on the importance of maintaining and enhancing the balance of education and training for both mental health professionals and consumers to avoid the failure arising from lack of medications throughout review of the three journal articles.
The first journal article, by Happell…(2002), discusses responsibilities of mental health nurses to enhance medication adherence to patients. The author believes that lack of effective system on antipsychotic medications causes a patient to have fluctuating medical condition which affects their well-being. The author discusses a series of issues specifically for the mental health nurses based on a variety of published articles, books related to adherence to antipsychotic medication and nurses’ role of managing medications. The main issue of this article focuses on how to improve adherence to antipsychotic medications to the patients in relation to the role of mental health nurse. One specific point that the article explains is why non-adherence to the medication regimes frequently happens. Taking the medications frequently is important as failure to do so leads to readmission and relapse of their conditions. (Mulaik 1992; Usher & Happell citeel in Happell).
The article conducted studies on four subject matters regards on the important issues it considers. It has been found that the most nurses acknowledged their responsibilities in managing medication are vital for clients’ maintaining adherence to the medication. Those responsibilities include providing educations to the patients as well as the nursing staff members themselves. The nursing staffs learn about medication by self-educating themselves from the written resources, speeches from representatives from drug department and their personal experiences. However there are number of barriers to effective management of antipsychotic medication such as environmental factors, different views on roles of a nurse, patients’ social stigma and interference by patients’ social members. Most of the mental health nurses claim that they do not have enough education provided to them to learn enough about antipsychotic medications as well as not enough time to get to know the patients to earn their trusts which lead them to take medications. Given the importance of the patient/nurse relationship for psychiatric patients’ adherence medication it is believed that there is lack of opportunities to share the patients’ information on the formal meeting. As a result of that nurses often experience conflicts carrying out their role among educator custodians and promoters which does not help patients to take medications. The second barrier raised is that the patients often try to stop taking their medications to avoid having social stigmas attached to them. The authors propose a number of things that can be done to improve the adherence. These include having regular formal and proper nursing education for nursing staff especially the patients’ education should be supplied when their first psychotic event happens.
To prevent non-adherence to medication to happen the article especially stresses the importance of educations and trainings for nursing staffs related to side-effect of antipsychotic medications, monitoring side-effects and relationship between the nurses and the patients. It is essential that the role of mental health nurses include enhancing and facilitating adherence to medication. There are a number of obstacles to achieve this medical goal, therefore, it is important to bring in suitable and structured education programs.
The importance of the educations and trainings for the mental health professionals further continually emphasized in the second article, ,which also tries to supplement the limitations which are mentioned in the first article. This article mostly has a view from a medical professional’s stand point. Based on a research the authors stress the lack of education and training program for mental health nurses in managing medication adherence. The research also shows that there are many improvements yet to be made from the medical staffs.
The research obtained reasons for medication adherence and non-adherence by performing a test with 76 mental health professionals using Rating of Medication influences Scale (ROMI)(Walden et al,1994). 84% (n=64) of total participants are composed of nurses which 48 are mental health nurses. The results of the research show that the main reason for non-adherence medication is the lack of patient’s awareness followed by distress of adverse-effect. Furthermore this research shows that 58% of participants identified that nurses have the vital responsibility for observing the adverse-effect of antipsychotic medication. The most remarkable result from the research is that over 80% nurses insisted that they had not received any specific training and education program about medication adherence. Only 7 nurses had received medication adherence education and training. In relation to training hours only median of 6 hours training is supplied. Overall there are a number of reasons for non-adherence antipsychotic medication such as patient’s denial or refusal of mental illness. Actually mental patients seem to believe that they do not have any mental illness and adverse-effect of medication as well as poor relationship between patients and mental health professionals have a negative effect on keeping medication regularly (Corriar et al cited in…).
Even in this article most respondents said that to improve adherence to medication necessity of proper education and training program are crucial. The authors suggests that there should be an essential requirement of in-depth mental health nurse education and training program at the university level which takes a large portion of continuing training on the job. The main difference between the first journal article and the second one is that the second journal article holds more reliability compared to the first one as the first article only surveyed 22 participants whereas the second article surveyed 76 participants.
Unlike the first and the second article the third article, , focuses more on the consumers’ sides rather than from the medical staffs. That is the authors focused on education and training more for consumers than mental health professionals. The third article shows that insufficiency of consumers’ education and training regarding antipsychotic medication regimens from the medical staff brings about negative result and frustration or resentment of the treatment. Generally mental health nursing staffs had not obtained proper educations and trainings related to strategies for medication adherence. This paper rather stresses the consumers’ participation in making decision about their medication regimens to help their medical conditions.
The research from this article is conducted by “Victorian Mental Illness Awareness Council (VMIAC)” located in Victoria. Participants are composed of nine clients from the mental health services. They had casual and informal structured interviews in relation to experience of antipsychotic medication use, degree of received medical information including side-effects and the level of involvement in making own decision. The results of interviewing research reflect that consumers normally do not receive enough information and details from the mental health nurses. Frequently mental health professionals have no regard for informing side-effects to the consumers. Furthermore giving the short length of time of administered antipsychotic medication is very difficult intervention. Because of the uncertainty of the finality in using medication consumers would fail to maintain adherence to medication. On the other hand, consumers had a tendency to be satisfied with their medical treatment when they have education and training about medication from the doctor. Moreover consumers indicated that they could prepare their side-effect when they had suitable medical information. Honesty and credibility between consumers and health professionals have a strong positive effect on adherence to medication. It can be found on the survey research that the role of the mental health nurse is normally focused on taking medication rather than evaluating and observing side-effects of the antipsychotic medication. The participants briefly mentioned that they are satisfied with interaction with the medical staff who works for private hospital rather than public one because they believed that private hospital medical staff worked more effectively as a team which also gives a positive effect. In addition they believed that community mental health nurse have more effective communication skills than inpatient nurses. High quality of communication skills and interaction between consumers and mental health professionals can promote in managing consumers’ medication regimens.
The result of the survey indicates that the mental health professionals tend to emphasize more on curing the symptoms of illness than on managing the adverse-effect of the medication. However not managing the adverse-effect repels consumers from taking the medication which results in relapse and readmission. A number of themes emerged from the survey including insufficient education and training program for consumers about side-effects which cause unsatisfactory results of medication adherence. Moreover a biased view about consumers from the mental health professionals also brings about negative results. On the other hand optimal interpersonal relationship between them is more likely to keep up with medications. Therefore by improving the relationship between nursing staffs and consumers can provide correct information and can give advices about their medication regimens which ultimately helps consumers better than only educating the medical staff. Hence the balanced education to both consumers and the medical staff is argued on the third article.
To sum up, these articles clearly helps to understand the importance of the role of mental health nurses in managing adherence medication and the necessity of education and training not only for the mental health professionals but also for the consumers throughout the review of the three journals articles above. From the first article, it is also clear to comprehend by the …(…) there are a number of barriers in relation to antipsychotic medications and adherence to medication. The general idea of the second journal article is more or less the same as that of the first journal article. However, the main subject theme of this article, by…( ), is much more focused on necessity of educations and trainings in enhancing medication adherence. Similarly, this article also mentioned that there are many difficulties in gaining the chances of having educations and training programs in the hospital setting. The main idea of the third article, by…(), is specifically emphasized on the necessity of the education and training for the consumers regarding decision making of their medication and treatment. Some people believe that blinding consumers such as tricking them or not providing full information bring better results for them however all authors from the three journal articles admit that the significance role of the mental health professionals in carrying out medication adherence, furthermore, they also stressed on the need of the specific and structured educations and trainings program for the better health professionals and consumers.
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