The first journal article by Happellâ€¦(2002) discusses responsibilities of mental health nurses to enhance medication adherence to patients. It also discusses about nurses learning methods related to antipsychotic medications, boundaries of effectiveness of patient adherence and delivery of medication management. Based on a variety of published articles, books related to adherence to antipsychotic medication, nurses’ role of managing medications the article suggests recommended proposals to these issues specifically for mental health nurses.
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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). To prevent this to happen the article especially stresses importance of education and trainings for nursing staffs related to side-effect of antipsychotic medications, monitoring side-effects and relationship between the nurses and the patients. 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. 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 point 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. However as mentioned on the first article 22 participants from three mental hospitals do not provide statistical figure for a firm decision making but it is enough to find out problems about adherence to medications. Another limitation is that the article mainly emphasize on education for the medical staff rather than for the client.
It is essential that the role of mental health nurses include enhancing and facilitating adherence to medication. However there are a number of obstacles in retaining adherence associated with nursing and social environment. This can be solved by suitable and structured education programs. The second article will focus more on education and training for mental health professionals in order to supplement the limitation in which is mentioned above and the last article will discuss focusing on education and training for the patients.
In the second journal article, the authors provide similar aspect from the first journal article however this article focuses more on education and training of mental health nurses. The authors also emphasize the importance of nurses’ role in managing adherence to medications for people with mental problems.
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 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 inâ€¦). 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 number of sample used in the second article is more than that of first article also the survey method is more credible one which is ROMI.
In conclusion this journal article provides the readers understanding of necessity of more education and training program about adherence to medication for the mental health nurses. However this suggestion is considerably ambiguous for mental health professionals to fulfil so more specific and structured solution might be needed for them to improve level of skills of care. The example of that is regular in-service education program accompanied by mental health professionals, community nurse and patient in hospital settings regularly.
The authors of the third journal article provide an interesting viewpoint based on a research in managing antipsychotic medication. That is the authors focused on education and training more for consumers themselves than mental health professionals. Normally insufficiency of consumers’ education and training regarding antipsychotic medication regimens from the medical staff bring about negative result and frustration or resentment of the treatment. Generally mental health nursing staff had not obtained proper education and trainings related to strategies for medication adherence. This paper also stresses the consumers’ participation in making decision about their medication regimens.
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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. 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. By means of the relationship nursing staffs can provide correct information and can give advices to consumers about their medication regimens. It can encourage consumers to enhance their autonomy.
In conclusion, education and training programs regarding the medication regimens are vital medical intervention from not only mental health professionals but also for consumers. If consumers have an appropriate education and training program, if they participate in making decision with medical professionals, they can reach their optimal goal of keeping up with the medication.
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