Effective Strategies for Nurses Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery.

Clients with schizophrenia require maintenance treatment with antipsychotic medication and psychosocial therapy to maintain symptom control. Rates of medication adherence or follow-through are low in clients with schizophrenia. This increases the risk of relapse and contributes to poor quality of life. As educators and advisers, psychiatric nurses can collaborate with clients to improve adherence and other outcomes using shared decision-making techniques and tools that engage and empower clients to actively participate in decisions about their treatment. This article outlines effective strategies used by psychiatric nurses to improve outcomes in clients with schizophrenia and uses a case example for demonstrating this strategy in a client with schizophrenia.

Participatory Action Research in Public Mental Health and a School of Nursing: Qualitative Findings from an Academic-Community Partnership.

An academic-community partnership between a school of nursing (SON) at a public university (the University of Virginia, or UVA) and a public mental health clinic developed around a shared goal of finding an acceptable shared decision making (SDM) intervention targeting medication use by persons with serious mental illness. The planning meetings of the academic-community partnership were recorded and analyzed. Issues under the partnership process included 1) clinic values and priorities, 2) research agenda, 3) ground rules, and 4) communication. Issues under the SDM content included: 1) barriers, 2) information exchange, 3) positive aspects of shared decision making, and 4) technology. Using participatory-action research (PAR), the community clinic was able to raise questions and concerns throughout the process, be actively involved in research activities (such as identifying stakeholders and co-leading focus groups), participate in the reflective activities on the impact of SDM on practice and policy, and feel ownership of the SDM intervention.

Shared decision making in mental health treatment: qualitative findings from stakeholder focus groups.

PURPOSE: This article reports on findings from seven stakeholder focus groups conducted in exploring shared decision making (SDM) between provider and consumer in mental health (MH) treatment in public MH. BASIC PROCEDURES: Seven focus groups were conducted with stakeholders-consumers, family members, prescribers, MH clinicians, and rural providers. Each of the focus groups was recorded digitally, transcribed into text, and analyzed qualitatively for recurring themes. MAIN FINDINGS: Provider barriers to SDM include history of the medical model, MH crises, lack of system support, and time. Consumer-related barriers included consumer competency, fears, insight, literacy, and trauma from past experiences. Information-exchange issues include consumer passivity, whether consumers could be viewed as experts, and importance of adequate history information. New skills needed to practice SDM included provider's knowledge about alternative treatments, mastery of person-first language, and listening skills; consumer's ability to articulate their expert information; and computer skills for both providers and consumers. Outcomes expected from practice of SDM include greater sharing of power between provider and consumer, greater follow-through with treatment plans, greater self-management on the part of consumers, and improved therapeutic alliances. PRINCIPAL CONCLUSIONS: Implementing SDM in public MH will impact consumers and their families, providers, prescribers, and administrators. More SDM trials in public MH are needed to answer some of the many questions that remain.

Pushing the envelope: shared decision making in mental health.

TOPIC: This article reviews the literature on shared decision making in health and mental health and discusses tools in general health that are proposed for adaptation and use in mental health. PURPOSE: To offer findings from literature and a product development process to help inform/guide those who wish to create or implement materials for shared decision making in mental health. SOURCES USED: Published literature and research on issues related to shared decision making in health and mental health, focus groups, and product testing. CONCLUSIONS: Structured shared decision making in mental health shows promise in supporting service user involvement in critical decision making and provides a process to open all treatment and service decisions to informed and respectful dialogue.

Electronic screening for mental health in rural primary care: implementation.

The goals of this study were to develop a computer-based electronic screening tool (eScreening) and determine the feasibility of implementing eScreening for rural users of primary care. This descriptive pilot adapted existing screening measures for depression and alcohol abuse to a portable computer-based format and examined the feasibility of its adoption and use. This was a three-step design using convenience samples for (1) a focus group with providers, (2) usability testing with selected rural patients using the computerized touch screen, and (3) implementing the touch screen platform with a small sample in primary care to determine feasibility. This paper reports on Phase III, which assessed consumer response to eScreening.

Electronic screening for mental health in rural primary care: feasibility and user testing.

Despite attention to prevention and screening for depression and alcohol use, Healthy People 2010 objectives continue to include goals to increase the detection of depression and decrease the rates of alcohol abuse. These problems remain significant. The overall goal of this study was to develop a computer-based electronic screening (eScreening) tool and determine the feasibility of implementing computer-based eScreening technology for rural visitors to a primary care clinic. The study called specifically for an electronic touch screen with voice prompts. This tool, called the eScreening tool, screens for alcohol abuse and depression among rural patients in a primary care setting. The screening was offered to rural adults who are not in acute distress and not at end of life, regardless of their stated reason for seeking medical care. Phase 1 of the pilot was used to determine the perceptions of nurses, other providers, and consumers regarding the acceptability and perceived usefulness of an eScreening tool. Phase 2 involved user testing of the eScreening tool. The longer term goals of the research program are to work with rural nurses to improve patient outcomes and develop interventions and for educational, consultation, and/or direct clinical care.

Shared decision making and serious mental illness.

This study examined medication decision making by 84 persons with serious mental illness, specifically examining relationships among perceived coercion, decisional capacity, preferences for involvement and actual participation, and the outcomes of medication adherence and quality of life (QoL). Multiple and logistic regression analysis were used in this cross-sectional, descriptive study, controlling for demographic, socioeconomic, and utilization variables. Appreciation was positively related to medication adherence behaviors for the past 6 months. Women, older individuals, and those living independently were more likely to have taken all their medications over the past 6 months. Neither client participation, preference, nor preference-participation agreement was found to be associated with better medication adherence or QoL.

Web technology for persons with serious mental illness.

Based on preliminary studies using staff focus groups and consumer interviews, a web-based homepage portal was developed for use by staff and consumers in community mental health clinics. Standard user-testing methods were used to interview and observe participants who were discharge-ready from a state psychiatric facility. As the participants navigated the portal, they "talked aloud" and were presented scenarios to gain their opinions about design and content. The final result was a web portal with communication, education and support features that was ready for further development to deal with issues of privacy, confidentiality, and security, with the ultimate goal of improving patient outcomes.

Medication decision-making by persons with serious mental illness.

The Interaction Model of Client Health Behavior (IMCHB) has been established as a useful model in guiding research and development of individually tailored clinical interventions. The constructs of client singularity, client-provider interaction, and health outcomes guided an examination of medication decision-making by persons with serious mental illness (SMI). Client motivation is discussed as it relates to participation in the client-provider interaction and subsequent medication adherence and quality of life. Decisional control, the specific element of the client-provider interaction that affects medication decision-making, is considered in relation to consumer roles and responsibility for medication management. As psychotropic medications remain the single most effective treatment for reducing the active symptoms of psychosis, this look at medication decision-making may have significant implications for nursing.