Strategies for Medication Adherence - Case Study Example

? Case Study Lecturer: Case Study Introduction/Background The client a child aging five years old in one of the elementary school and she is in grade two. When she was one year old, she seemed to be developing normally like any other normal children; however after one year old, her parents started to notice some strange behaviors. The client developed acute illness and immediately after she received vaccinations, she lost memory; hence started exhibiting unique repetitive behaviors. The situation became worse because she socially withdrew from other kids and spent a lot of time alone rather than playing with other kids or socializing with the family members. After the first week of her admission in school, the teacher realized that she had socially clumsy and always offensive to most of teachers or other student’s comments. The client seemed not interested in making friendship with other kids and even learning was difficult. Parents and relatives also experienced difficulties in trying to cope up with the client; thus some of them became stressed up with the situation of the client. However, while in school, the teacher decided to implement an individualized education program for the client in order to help her reduce learning difficulties and also enable the client to cope up in the learning environment; thus helping the child to achieve future goals effectively. Strategies for Medication Adherence The client has received proper medication attention that has enabled her to improve the repetitive behaviors. The significant aspects of health care provided especially the methods of interventions that can be employed to improve medication adherence have been of great significant to the client. One of the significant intervention measures is the educational interventions and this may involve educating the client or family members or both as this can help in improving medication adherence. Employing effective strategies for improving dosing schedules is also of the significant intervention measures that have enabled the child to improve the health condition. Reminding the client to take medications or organizing the daily doses is vital because it can improve the dosing schedules. Improving communication between the parents of the child and physicians is also an effective strategy for medication adherence. Patients who miss appointments are often those who need the most significant help to improve their ability to adhere to medication routine; thus improving communication will improve their ability to adhere to medication procedure. Researchers have attempted to focus on strategies for improving medication adherence and this is through employing effective techniques vital for helping patients with autism problems. One of the effective strategies is patient interview technique and this includes offering basic nursing education and increasing patient communication. Listening and employing open ended questions, as well as, discussions about sensitive topics is vital. The attitude of physicians towards patient can impact patient communication because many of them will not be open to discuss sensitive matters concerning their health. Although patients cannot answer open questions, inviting them to share their stories is vital. Secondly, employing motivational interviewing strategy and this strategy takes into considerations the perception of the problems affecting patients; thus encouraging the patient to find the solution. Motivational interviewing is a strategy or technique, which involves counseling the patient of family of patient and this method, is vital because it is client-centered. The most widespread healthcare intervention technique is the prescription of medicine but medication adherence is a multifaceted and fascinating behavioral issue. Health attitudes are perceived to be a helpful and significant indicator of medication adherence and a great predictor of medication adherence. The research study conducted about patient behavioral approaches has been employed to examine medication taking behavior. The ultimate objective of medication adherence interventions is to advance health related results of the patients suffering from autism. The research evidence from systematic review indicates that interventions employed to enhance patient or service user interaction such as nurse involvement can be effective; however, these interventions are resource intensive (Aron and Loprest, 2012). Another strategy employed is the implementation of behavioral change and this is a vital technique for improving medication adherence. Many psychologists have made significant attempt of helping patient to change their behaviors in order to improve their medication adherence. One of the ways through which psychologists help patient to change behaviors is through motivating them. Motivation is a significant procedure for creating change because some behaviors affect adherence; thus motivation techniques is one way of creating behavioral change. In this case, there is need for internal motivation because motivation of patients’ needs to be from within the client; thus nurses should help their clients to recognize the change process. Historical Review of the Client, the Significant Aspects of Health and Care Provided and Need for Intervention When the client was three years old, she started developing repetitive behaviors during her childhood development. The parents took her to hospital after she fell sick; thus she was diagnosed of an acute illness. Although at first the parents of the client taught that the vaccines that the client received after she fell sick had contributed to her repetitive behavior that became apparent at the age of five years, it was discovered that the client genetically inherited the disease from the family members. Although the research study has not yet clearly revealed the cause of autism, it is a neurological disorder, which is perceived to be genetically inherited (Taylor and Mudford, 2012). The disorder begins earlier in childhood development and it is characterized by repetitive behaviors especially poor social interaction and communication skills (Delano and Snell, 2006). In addition, the client started early treatment after the symptoms of autism were identified; thus care provision plan was designed for her. The planning procedure involves setting objectives, identifying the priorities and implementing an effective intervention plan. Intervention may be taken into considerations because this is one the effective plan that may reduce the disorder. In this case, education intervention strategy can be employed with an aim of increasing understanding and promoting compliance about autism spectrum. According to Taylor, DeQuinzio and Stine (2013), the aim of education intervention is to offer autism patients with adequate information regarding their illness and medication with the aim of increasing understanding and also promoting compliance. Many psychiatric patients or family of autism patients lack knowledge about proper medication prescribed to them; thus education intervention strategy will benefit autism patients on medication compliance (Matson, Matson and Rivet, 2007). Autism effects sensitivity and cognitive abilities of children during their development process; thus employing effective education intervention strategy is vital. Ingvarsson and Hollobaugh (2010) argue that implementing efficient learning strategies are crucial way of improving the education programs of the autism child. One of the effective teaching or education intervention strategies for teaching children with autism problems is employing early intervention programs. Rous and Hallam (2012) point out that early intervention practices are effective measures for improving the learning skills of children with mental health disorders. The authors further argued that children with mental disorders who receive early intervention programs tend to perform better in schools; thus they improve communication and overall social skills. Furthermore, the research survey conducted revealed that early intervention programs improves cognitive ability of autism students; thus contributes to advanced social and learning skills (Rodriguez, Thompson, Schlichenmeyer and Stocco, 2012). Offering earlier intervention programs can improve cognitive behavior and psychological behaviors of the client; thus improving communication, learning and social interaction skills. There are varied intervention program that can be employed for improving social interactions and communication skills of autism child; thus among them include as peer coach approaches, integrated participation groups and group oriented incident (Scattone, Tingstrom and Wilczynski, 2006). According to Sy and Vollmer (2013), in order to improve cognitive behavior of autism patients, employing cognitive behavioral therapy (CBT) is vital. CBT is an effective psychotherapeutic treatment employed in order to help patients with mental health problems to improve their thoughts and feelings that influence behaviors. CBT is commonly employed to treat a variety of disorders such as autism, stress or anxiety, depression and many others (Taylor and Mudford, 2012). Cognitive behavioral therapy is based on the notion that problems are not caused by situations only but also behaviors or the way people interpret their thoughts; thus impacting their feeling and actions. Psychological theories suggest that people learn the negative thinking patterns by a negative reinforcement process; thus using CBT technique can create significant change (McCartney and Phillips, 2006). Ommeren, Begeer, Scheeren and Koot (2012) argue that treatment or education intervention method that may work in one child suffering from autism may not work in another. However, the common treatment or intervention method is earlier intervention because this method dos work to any autism child because it improves the prognosis. CBT is primarily employed as an effective treatment or intervention measure for helping individuals with autism disorder to regulate their emotions, develop impulse control and improve their behavior (Batshaw, Pellegrino and Roizen, 2007). Other therapy such as speech language therapy and social skill training therapies can be employed but this aim in improving the social skills through training. Barry and Burlew (2004) argue that speech-language therapy and use of social stories can contribute to better social interaction and learning skills. Sometimes, autism kids may have strong language skills; thus teaching social skills to autism children such as use of visual tools and many other techniques can be of great benefit to children. In addition, applying behavioral intervention therapy is imperative because this can improve the psychological performance of the client. Therefore, there is a need to focus on those behaviors or factors contributing to psychological child development. According to Amaral, Dawson and Geschwind (2011), behavioral intervention therapy has become of the effective techniques for molding the behavior of the autism child; thus enabling the child to achieve his or her learning needs. For example, developing cognitive and psychological behavior of autism child can alter the behavior of the kid. Behavioral intervention analysis is one of the significant strategies that were established by B.F Skinner when he conducted experiments in operant conditions. Skinner wanted to determine the positive or negative reactions or consequences when employing behavioral intervention analysis; thus it was found out that this approach enable the punisher to increase or reduce the like hood of the repetitive behaviors of the autism kid. Employing this approach is vital because it can enable the client to change the repetitive behaviors; hence improve communication and social interaction skills effectively. Collaborative Approaches Taken  Most strategies of improving adherence have involved combinations of behavioral interventions and reinforcement behaviors in addition to increasing the convenience of care, provision of education information about the conditions of the client and other attention measures. Successful intervention strategies are multifaceted and labor intensive; and inventive strategies will need to be executed that are realistic for usual clinical practices. Therefore, the use of collaborative approaches should be taken into considerations in order to meet the needs of the client effectively. Collaboration between the parents or guardians of the client and physicians can best serve the interest of the child since this can enable the client to improve her social interaction and communication skills. Rodriguez (2011) argues that collaboration between parents and professions is vital in improving or meeting the demanding needs of children with autism. Varied professionals advocated collaborative approach top support services for autism children in the society because collaboration with the community can contribute to better improvement of autism children in the society. Developing joint autism teams is also significant collaborative approach and this involves working together with the community including parents, social workers such as nurses and teachers in order to improve the health of autism children. Counselors, educator and nurses among other varied teams can work together in order to help autism children improve their status. Therefore, these teams can work together towards helping autism children to communicate their feelings and this is through employing effective strategies. Collaborative approach is vital because working together as a team can enable the client to improve her repetitive behaviors. Collaborative approach is crucial because decisions are made faster and it can enable stakeholders such as parents, nurse, teachers and other community members to improve the adherence of patients. For instance, many autism kids can do better in learning institutions when employing effective intervention strategies or implementing individualized education program. Developing effective medical treatment and teaching methods has become highly significant as autism is experiencing a dramatic rise; thus working as a team can contribute to better results. Therefore, providers and educators must have specific training, which should be carried out as a team to effectively treat and work with children with autism spectrum. Moreover, a multifactorial approach is also necessary given that many factors contributing to poor medication adherence for many autism children since a single approach will not be only effective to the client. The significant approach of treatment employed in treating autism patients is focused on treating the disease symptoms and utilizing effective treatment in order to reduce the disorder. However, employing effective collaborative approaches can enable nurses or psychologists to work together towards achieving the necessary goals or meeting the demanding needs of autism clients. The multifactorial approach is among the effective approaches employed in the managing health care environment. This approach is vital because it identifies the major stakeholders and embraces the legitimate values of all the stakeholders while at the same time acknowledging the investable and ethical values of stakeholders. In this collaborative approach, the physician or psychologist not only advocates for the patient or family but also acknowledges the legitimacy of other competing interest and values in healthcare decision making process. Outcome Measures The researchers on medication adherence have typically focused on varied barriers autism patients face when taking their medication process. Most of the common barriers to medication adherence are under the control of clients; thus attention to them is necessary and significant step towards improving medication adherence (Leaf, Oppenheim-Leaf, Leaf, Courtemanche, Taubman, McEachin, Sheldon and Sherman, 2012). Sometimes, nurses contribute also to poor medication adherence by prescribing complex medication routine, failing to explain the side effects and benefits of medication, as well as, not offering considerations the lifestyles of clients or the cost of medications or having poor therapeutics relationships with the clients are all among the barriers to medication adherence. Therefore, employing effective approaches can help in addressing these issues; thus improving medication adherence for autism patients. Evaluation of the Outcomes and Recommendations for Further Care During the research review process of the outcomes, it was found that the three are most common barriers to medication adherence some of which are contributed by nurses and others are under control of clients. Therefore, it was suggested that there should be use of effective strategies for improving medication adherence. One way through which medication adherence can be improved is through employing motivational interviewing technique. This method is vital because it is client-centered and it involves encouraging patients through counseling them to change their behaviors. There are also other recommendable ways of improving medication adherence and this include patient interviewing and also helping patients to change their behaviors in order to improve medication adherence. It is the significant roles for nurses to be in an ideal position of helping their clients to identify barriers to medication adherence; thus implement plans vial for dealing with the barriers in order to improve medication adherence. Therefore, employing appropriate strategies for improving medication adherence is vital because it contribute to behavioral change (Matson, Matson and Rivet, 2007). It is recommendable to implement effective approach to improve medication adherence to individuals with autism issues. Although autism does not have treatment, employing effective intervention strategies and improving medication adherence is imperative. Provision of varied therapies such as applied behavioral and cognitive behavior therapies, as well as, supplementing vitamins and mineral supplements can create significant change to the autism child. It is also recommendable to carry out compliance therapy in order to improve the client’s medication. Green (2001) argues that intervention strategy does not necessarily have to focus on other factors, which influence compliance in case improvement of clients understanding about their medication does not promote compliance. Therefore, one of such interventions is compliance therapy, which is an intervention strategy based on motivational interviewing and cognitive behavioral techniques (Brooke, 2009). Compliance therapy is vital in improving therapy to prescribed medication treatment among patients with autism problems. Further intervention programs including provision of earlier intervention and implementation of individualized education programs should be employed in addition to medication provision. The use of earlier intervention programs is vital during earlier child development for children with mental health problems. The use of individualized education program is one of the significant intervention programs for improving the social interaction and communication skills of the child. The use of effective techniques such as functional behavior analysis, cognitive behavior and applied behavioral intervention programs are all significant towards improving the welfare of the autism child. These programs are necessary because they not only alter the behavior of the autism child but also advance her cognitive and social skills. Conclusion In conclusion, the research study focused on autism disorder, which is one of the neurological disorders, which are characterized by impaired social and communication problems. Varied strategies for medication adherence were provided including the implementation of behavioral change, motivational interviewing and patient interview technique and this includes offering basic nursing education and increasing patient communication. The research project provided the historical review of the client and analyzed the significant care provided to the client including varied intervention strategies employed. The intervention strategies included the CBT, applied therapy, earlier intervention programs and the implementation of individualized education program with an aim of improving social interactions skills of autism child. The collaborative approached that was taken into considerations were examined and the outcome measures also examined. Lastly, the outcomes were evaluated and varied recommendations included for improving medication adherence and for improving communication and social interaction of the client. References Aron, L., & Loprest, P. (June 06, 2012). Disability and the Education System. Future of Children, 22, 1, 97-122. Amaral, D., Dawson, G., & Geschwind, D. H. (2011). Autism Spectrum Disorders. New York, NY: Oxford University Press. Batshaw, M. L., Pellegrino, L., & Roizen, N. J. (2007). 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Discrimination Acquisition in Children with Developmental Disabilities under Immediate and Delayed Reinforcement. Journal of Applied Behavior Analysis, 45, 4, 667-684. Taylor, B. A., DeQuinzio, J. A., & Stine, J. (March 08, 2013). Increasing Observational Learning of Children with Autism: A Preliminary Analysis. Journal of Applied Behavior Analysis, 45, 4, 815-820. Read More