Mental Health Nurse Perspectives and a Need for Education and Training - Essay Example

?Article under review: Coombs, T., Deane, F., Lambert, G., & Griffiths, R. (2003). What Influences Patients’ Medication Adherence? Mental Health Nurse Perspectives and a Need for Education and Training. International Journal of Mental Health Nursing. 12, 148-152. Mental health is an issue that affects the world more each day. The human mind has to come to terms with some situations that were not present a few years ago, increasing the amount of stress that individuals deal with each day. It is the responsibility of the medical community to ensure that these individuals receive proper care to ensure that they receive the same quality of life as their healthier counterparts. In prescribing drugs to combat these ailments, medical care providers place the responsibility of following the patient’s progress upon themselves. Patients, however, are susceptible to flawed human reasoning and do not always adhere to their prescriptions. With the rising cases of mental health issues, it is imperative that we understand the shortcomings of the health sector that impede delivery of health care. Coombs et al. (2003) analyze the impact of nurses on the prescription process and its subsequent effect on the adherence to medications. In the paper, they analyze the issue from the standpoint of a mental health worker. In the study, they aim to analyze the reactions of health workers on their opinions on the issue of prescription. The introductory analysis of previous works is commendable, in that the writers identify the significance of supporting the medication process since even little changes have drastic results (Coombs et al.2003). The methodology of a piece of research is dependent on the field of study on which the research is based. It also determines the approach and eventual results of the study. In their research, Coombs et al. adopted a case study approach, in which they identified a qualitative based framework. They used questionnaires as their main data collection tool and I believe that this was the most suitable approach owing to the experimental nature of their research. This is because their aim was deterministic, reducing the complexity of the research methods and requiring the exploratory framework provided by the case study approach. The sample size comprises of 76 mental health workers. Sampling was purposive as the researchers wanted to evaluate the experiences of mental health workers on patient adherence to prescription medicine. The sample size is appropriate for the theoretical approach of this study as well as the exploratory study into the effects of staff education. The questions, however, are subject to misinterpretation by the respondents of the survey because they are vague in the area of training and expertise. In employing questionnaires though, they ensured that the data collected allowed for the variability of responses. The results of the article present a well-documented manner with tabulated representations of the responses and the standard deviation between records. The researchers also noted the relation between increased monitoring by nurses and adherence to medication. Nurses’ training and experience in prescription also increases their effectiveness in dealing with medication and side effect issues (Coombs et al, 2003). However, the majority of nurses (88.5%) indicated that their medical training did not include lessons on prescription. In regards to the patients, the survey found that side effects had a negative effect on compliance to prescriptions. The conclusion of their article indicates the complexity of the issue at hand. Many factors influence the adherence to medication, primarily the side effects experienced when under the said medication. The opinions of the people closest to the patients also influence their decision to adhere to their medication. Prior education of the medical practitioners also ranks high on the list of necessities for increasing prescription adherence. The article, however, did not monitor the practitioners at the workplace. This creates the possibility of incorrect results and indicates a need to conduct further and more in-depth research into understanding the various risk factors around medication adherence. In conducting any type of research, the issue of ethics and ethical responsibility come to mind. It is recommended that the person in a position of power, in this case the researcher, follow ethical paths in dealing with the respondents in their research (Adams, 2006). Due to the exploratory nature of this research and the fact that the questions were more technical than personal, Coombs et al. (2003) had little ethical responsibility. The ethical issues in this case were those of confidentiality, which is necessary for the continuation of unbiased research. In their report, they included only the relevant data from their study, shielding the respondents and fulfilling their ethical responsibility. Graphical Representation They identify the issue of prescription adherence and a practical look at an applicable solution (nurse-based medicare). Their literature review consists of 10 referenced articles which emphasize the iddue on morbidity rates and medication adherence. They also indicate the significance of these articles in their identification of a research question. Employ the use of questionnaires due to the exploratory nature of this research. They engaged a sample size of (n=96). Created a ROMI table to present their results in a tabulated manner, with emphasis on the ordering depending on the most influential cause of non-adherence. Identify lack of proper training for nurses as the primary cause of their inability to contribute to increased adherence. Research Source Matrix Author(s) Source Date (year) Research Type (experimental, quasi-experimental, case series, ethnographic, etc) Population / Sample size Outcome measures Pertinent data from results Suggested Conclusions Comments Adams, J. Nurse Prescriber 2006 Case study International Ethical issues affecting the role of prescribers Nurses face ethical dilemmas when prescribing Legal and ethical bottleneck affects effectiveness of treatments Restructure framework surrounding prescribing Allsop, A., Brooks, L., & Bufton, L. Nursing Standard 2005 Case study 9 nurses Nurses’ competence in prescribing medication Prescribing competence based on personal responsibility More training for nurses to improve medicare Replicate research with larger sample space Banta, J., Haskard, K. B., Haviland, M. G., Williams, S. L., Werner, L. S., Anderson, D. L., et al. American Journal of Health Behavior 2009 Survey 43 counties Adherence to medication Indicators include lack of insurance, illiteracy citizenship Better medical care improves medication adherence Relevant in the entire medical community in regards to prescribing Buck, K. D., & Lysaker, P. H. Perspectives in Psychiatric Care 2010 Report Entire medical field Role of prescriber’s own mental fortitude Self-trust leads to better service provision and follow-up Training and emphasis on self-awareness in students is vital Commendable report, findings are vital for the success of future efforts Byrne, M. K., & Deane, F. P. International Journal of Mental Health Nursing 2011 Case study 49 clinicians Medication adherence Better attitudes from caregivers increases chances of adherence Patient mental health reliant on caregivers Train caregivers on better patient relations Chaston, D., & Seccombe, J. Perspectives in Psychiatric Care 2009 Case study 2 countries Perspective authority for nurses Better services in England than New Zealand Quality of care proportional to adherence Nurses more hands-on in prescription process Courtenay, M. Journal of Community Nursing 2007 Exploratory International Progression of culture of prescribing nurses Increased success when prescribed by nurse Nurse-led care more effective Increase instances of nurse-led care Milner, K. K., Healy, D., Barry, K. L., Blow, F. C., Irmiter, C., & Chavez, P. D. Psychiatric Services 2009 Experiment 3000 patients Implementation of computerized prescription system Better success rate when monitored by database Single instance of adherence is an indicator for future adherence Adopt this system side by side with nurse-led care Outlook, M. C. Managed Care Outlook 2009 Ethnographical National Economic aspects of adherence Economic burden from unused medication Increase adherence to reduce medicare costs Adherence results in lower costs for industry due to non-recurrent prescriptions Snowden, A. W. Nursing Standard 2006 Case Study International Issues affecting adherence to nurses’ prescription Reservations still exist on the eligibility of nurses’ prescription Increase training to influence acceptance of prescriptions There is a need to build up patient confidence in the prowess of nurses Annotated Bibliography Adams, J. (2006). Prescribing: The Ethical Dimension. Nurse Prescriber. 1(7), 1-3. This is an article that contributes insight into the culture of prescribing and the ethical issues that face medical practitioners at the workplace. Although it generalizes the effects of ethical decision making on the whole industry, it indicates some factors that govern the patient’s acceptance of a prescription and their consequent relationship with the prescriber. Ethics come into question every time an individual is placed in a position of power, such as the case of the nurse having oversight over the patient. Adams (2006) brings to light the ethical implications of selecting drugs for the patient, the follow up and the conflicts that arise when these two parties disagree. The prescribers should do complete and detailed follow-ups on the prescriptions they give. As a result of this extended interaction, it is imperative that we understand the ethical challenges that face the process of providing and ensuring the full use of the prescribed medications. Allsop, A., Brooks, L., & Bufton, L. (2005). Supplementary Prescribing in Mental Health and Learning Disabilities. Nursing Standard. 19(30),54-58. Allsop et al. (2005) discuss the nature of including nurses in the prescription process. Their exploratory research is based on the experiences of nine nurses and involves an analysis of their training and experience. They indicate that it is imperative that we offer more prescription training to nurses due to the proximity of their role in relation to the patient’s outpatient care. However, their sample space is limited to 9 which will reduce the effectiveness of this article as an accurate depiction of the situation across demographic and geographic boundaries. The results of the research indicate that given the same rudimentary prescription education as doctors increased the involvement of these nurses in the prescription process (Allsop et al. 2005). This article brings to light the need to train nurses in order for us to increase the chances of patients’ adherence to medication. It also recognizes the increased interaction that nurses have with their patients, indicating a possibility for adhering to medications based on their trust in the nurse prescribing it (Allsop et al. 2005). Banta, J., Haskard, K. B., Haviland, M. G., Williams, S. L., Werner, L. S., Anderson, D. L., et al. (2009). Mental Health, Binge Drinking, and Antihypertension Medication Adherence. American Journal of Health Behavior. 33, 158-170. The objective of this article is to identify whether self-reported mental health cases rare related to drinking, healthcare access indicators and the adherence to medication that these patients exhibit. The study is limited to 43 counties, a sample space that improves the credibility of its findings (Banta et al., 2009). It takes into consideration the fact that the problem is spread globally and interviews respondents from varying demographic and geographic boundaries. The study is directed towards patients suffering from hypertension and the results indicate that adherence is directly related to the quality of care that patients receive (Banta et al., 2009). It also noted that African Americans were more likely to adhere to prescriptions, indicating an area to which we can direct further research. The conclusion of this study advocates the need for more comprehensive follow-ups to the prescriptions offered by medical caregivers to increase the effectiveness of their services. Buck, K. D., & Lysaker, P. H. (2010). Clinical Supervision for the Treatment of Adults With Severe Mental Illness: Pertinent Issues When Assisting Graduate nursing Students. Perspectives in Psychiatric Care. 1, 234-242. In many circles, mental health patients are believed to be afflicted for life. This is a fallacy that is mostly perpetuated by the non-adherence to medication that is displayed by mental health patients. In order for us to fully utilize the power of the medicare system, the paper notes a need to include training in the curriculum for nurses. This would provide a platform to build self-confidence in providing prescriptions and enable the nurses to act as alternative prescribers (Buck & Lysaker, 2010). Increasing supervision and utilizing methods to provide empathy and understanding of the varying situations that the patients are in also increase the success rates of medication adherence. Byrne, M. K., & Deane, F. P. (2011). Enhancing Patient Adherence: Outcomes of medication Alliance Training on Therapeutic Alliance, Insight, Adherence and Psychopathology with Mental Health Patients. International Journal of Mental Health Nursing. 20(4),284-295. Deane’s participation in this study helps increase its validity in the analysis of the factors influencing medical adherence. It offers further insight into the psychopathological relationship between adherence and the therapeutic effects of maintained relations between the clinician and patient. Byrne and Deane (2011) also analyze the link between re-hospitalization rates and adherence to medication. They found that adherence rates in the range of the fourth percentile (over 80%) dramatically reduced re-hospitalization by up to 40%, indicating the need to enforce such measures. Owing to its age, this article complements Deane’s previous work and the subject of our review, in that he now recognizes the necessity of change in public health policy just as his first case study had demonstrated. Chaston, D., & Seccombe, J. (2009). Mental Health Nurse Prescribing in New Zealand and the United Kingdom: Comparing the Pathways. Perspectives in Psychiatric Care. 1, 17-22. The scope of this article makes it the perfect analysis tool for identifying the impact of nurse-given care. England started its community-based approach to nursing over a decade ago and provides an appropriate specimen for the effectiveness of this approach. New Zealand, on the other hand only recently adopted this culture. This provides an insight into the effect of nurse-based care and its evolution over the years. This kind of paper is especially efficient in analyzing changes in policy and the changes that are influenced by the experience that caregivers gain over time. Chaston and Seccombe (2009), also emphasize the importance of increased education on prescription practices and its effect on the healthcare system. Courtenay, M. (2007). Prescribing 2007. Journal of Community Nursing. 21(11), 11-14. Nurses in developed countries have more control over the prescription practices that their hospitals adopt. In this research paper, Courtenay suggests that the development of the health sector leads to more involving tasks for nurses, expanding the reach of medical centers. However, results differ even across several developed countries. The UK, for example, has the best practices based on the educational level at which such courses are offered. The US and Canada on the other hand limit access to such knowledge to the Masters’ level and this reduces the permeation and effectiveness of these trainings. This article provides insight into the relationship between knowledge access and medication adherence. Milner, K. K., Healy, D., Barry, K. L., Blow, F. C., Irmiter, C., & Chavez, P. D. (2009). Implementation of Computerized Medication Prescribing Algorithms in a Community Mental Health System. Psychiatric Services.60(8),1010-1012. Humans are susceptible to error and our health systems are not immune to this fault, thus the automation of systems. Milner et al. (2009) analyze a prescription system implemented to handle prescriptions in Michigan. This system incorporates algorithms that follow TMAP guidelines in subscribing medication to consumers with severe and persistent mental illness. The ability to track prescriptions comes in line with the subject study’s objectives by increasing the success rate of prescriptions conferred by nurses. It will, however, take a while for these technologies to be fully accepted and trusted by the society. Outlook, M. C. (2009). For Patients with Mental Health Disorders, Medication Adherence is Critical to Improving Health, Reducing Costs. Managed Care Outlook. 1, 3-7. This is a report that investigates the relationship between the adherence to prescriptions and the consequent economic implications. In many cases, patients do not indicate to their doctor that they quit taking their medication. Subsequently, the symptoms get more severe and as a result, the doctors prescribe different drugs in lieu of the ineffectiveness of the previous prescription. This creates a health system that spends money creating drugs that are just going to go down the patient’s drain. To combat this, they suggest an electronic system that tracks a patient’s prescription and informs the caregiver on the state of their refill (Outlook, 2009). Increasing the quality and efficiency of the prescription system will not only create a sizeable reduction in the number if drugs prescribed, it will also reduce the economic drain caused by double prescription. Snowden, A. W. (2006). Nurse Prescribing in Mental Health. Nursing Standard. 20(29),41-46. This article tackles the issue of nurse-prescribed medication and its popularity with mental health patients. Although it is based on a study of the elderly, I feel that its findings are relevant in any case that involves a nurse as the prescribing officer. Nursing culture and the prescriptions that they write are subject to issues such as informed consent and patient safety. In the article, Snowden indicates the importance of patient well-being as the primary objective for caregivers, with the focus being directed towards the nurses and their interaction with outpatient care. Evidence Summary Coombs et al. (2006) identify the efficacy of nurses in enduring that patients adhere to medications. As we take a look at other research in the field, the results of their research are confirmed and the importance of applying their reccommendations becomes a vital issue. The apparent healthcare differences of countries at different implementation stages show the impact of nurse-based care (Chaston & Seccombe, 2009). Combining this with the adoption of a computerized prescription system would also help to drastically improve adherence rates (Milner et al., 2009). A look at the costs of maintaining our current system cements the need for change, primarily due to the massive drain that double and unused prescriptions place on the costs of running our countries (Outlook, 2009). If we take away anything from the analysis of these research pieces, it is that the field of medical research is still in its infancy stage. The medical industry in many countries still struggles to deal with common ailments. The constant changes in the world of science also mean that research will change and be fine-tuned almost indefinitely. As a result, theoretical tools and models of research, such as those used by the Coombs et al. (2009) are the best way to conduct the exploratory research necessary in the medical industry. Their results indicate specific patterns of thought and behavior, which help shape a new dimension of tackling the problems faced by the medical society. The use of surveys, questionnaires and adopting probability analysis tools helps create a clear picture of the state of the medical field. The fact that some researchers in our case traversed international boundaries, utilized the same tools and came to the same conclusions also helps cement the validity of these tools in the field of nursing. In our case, the issue of nurse-based care and its impact on healthcare is analyzed from a theoretical point of view. The researchers identify the problem as inadequate training and sensitization to the role of nurses in healthcare. The results, as well as the compilation of evidence on the same, indicate a need to shift our approach to medicare and include nurses in every aspect of outpatient medicare. References Adams, J. (2006). Prescribing: The Ethical Dimension. Nurse Prescriber. 1(7), 1-3. Allsop, A., Brooks, L., & Bufton, L. (2005). Supplementary Prescribing in Mental Health and Learning Disabilities. Nursing Standard. 19(30),54-58. Banta, J., Haskard, K. B., Haviland, M. G., Williams, S. L., Werner, L. S., Anderson, D. L., et al. (2009). Mental Health, Binge Drinking, and Antihypertension Medication Adherence. American Journal of Health Behavior. 33, 158-170. Buck, K. D., & Lysaker, P. H. (2010). Clinical Supervision for the Treatment of Adults With Severe Mental Illness: Pertinent Issues When Assisting Graduate nursing Students. Perspectives in Psychiatric Care. 1, 234-242. Byrne, M. K., & Deane, F. P. (2011). Enhancing Patient Adherence: Outcomes of medication Alliance Training on Therapeutic Alliance, Insight, Adherence and Psychopathology with Mental Health Patients. International Journal of Mental Health Nursing. 20(4),284-295. Chaston, D., & Seccombe, J. (2009). Mental Health Nurse Prescribing in New Zealand and the United Kingdom: Comparing the Pathways. Perspectives in Psychiatric Care. 1, 17-22. Coombs, T., Deane, F., Lambert, G., & Griffiths, R. (2003). What Influences Patients’ Medication Adherence? Mental Health Nurse Perspectives and a Need for Education and Training. International Journal of Mental Health Nursing. 12, 148-152. Courtenay, M. (2007). Prescribing 2007. Journal of Community Nursing. 21(11), 11-14. Milner, K. K., Healy, D., Barry, K. L., Blow, F. C., Irmiter, C., & Chavez, P. D. (2009). Implementation of Computerized Medication Prescribing Algorithms in a Community Mental Health System. Psychiatric Services.60(8),1010-1012. Outlook, M. C. (2009). For Patients with Mental Health Disorders, Medication Adherence is Critical to Improving Health, Reducing Costs. Managed Care Outlook. 1, 3-7. Snowden, A. W. (2006). Nurse Prescribing in Mental Health. Nursing Standard. 20(29),41-46. Read More