Week 4DNP Project Manuscript: Data Collection and Analysis Plan, Barriers, Facilitators, Ethical Considerations, Resources, and Budget

A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

Assignment 1

Purpose

The purpose of this assignment is to continue the DNP Project Manuscript that you started in NR702. This assignment will allow you to present the data collection and analysis plan, barriers and facilitators, ethical considerations, project resources, and budget. These sections will further define the project design and plan and permit you to compose a meaningful DNP Project Manuscript.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Instructions

The information for this assignment has already been written in the NR730 DNP Practicum Readiness Form and the DNP IRB Prescreening Supplement Form. Take the information from these documents and expand upon the content to provide an organized and well-written plan.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Open the DNP Project Manuscript you began in NR702. This DNP Project Manuscript should be the last version submitted in NR702 with faculty feedback. Review the sections marked NR705 in the header as these are the areas that will need to be completed for this assignment.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Follow the instructions on the template for the following sections that need to be completed as a part of this assignment. Contact your course faculty if you have questions.

1. Barriers, Facilitators, and Ethical Considerations: Describe the impact these items will have on your project implementation. Important elements for this section include the following:
   1. Assess barriers and state your plan to overcome these obstacles.
   2. Assess the facilitators and ways to leverage support.
   3. Evaluate changes with leadership that might impact the project.
   4. Analyze ethical considerations and your plan to protect private health information and/or data collected.
   5. State the IRB requirements from the university and practicum site.
   6. Explain if there is a need for informed consent or assent.
2. Data Collection and Analysis Plan: Describe your plan. Important elements for this section include the following:
   1. Create your detailed data collection plan with a description of how you plan to collect data and when.
   2. If a retrospective chart audit will be used, explain how will you collect pre- and post-intervention data?
   3. If a data collection instrument or tool is being used, describe the instrument or tool and provide validity and reliability for this tool with a citation and matching reference.
   4. Is permission to use the instrument or tool required? If so, state that you have permission and include the permission in the Appendix. permission? If the instrument or tool is in the public domain, provide this information.
   5. Explain the planned statistical analysis of the data collected.
   6. Summarize how the analysis of the outcome data will determine the practice change project outcome and answer the practice question.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
3. Resources and Proposed Budget: Describe the resources needed to implement your project. Include these resources in your proposed budget for the project. The proposed budget should be balanced.
4. References(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
   1. Each completed section of the template must be substantiated by citations from current peer-reviewed journals (within the last 5 years), government websites, such as the Centers for Disease Control and Prevention and the World Health Organization, and credible national and global organizations related to the problem.
   2. You may add to the references currently presented in the DNP Project Manuscript you began in NR702, to support your work in NR705.
   3. For the statistical data about incidence, prevalence, and mortality, students may use research and non-research such as peer-reviewed articles, government, and national registries on websites such as the CDC, AHRQ, World Health Organization, Kaiser Family Foundation, and Robert Wood Johnson (see resources in the course readings).
   4. Reference publication dates must be within the last 5 years.
   5. References must be from peer-reviewed journals, government websites, and credible national and global organizations related to the problem.
   6. In-text citations should align with the reference page.
   7. References must be in the current APA format.
5. Scholarly Writing Criteria(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
   1. Use the current APA style and format throughout the DNP Project Manuscript.
   2. Use the headers provided in the template.
   3. Use the Chamberlain Guidelines for Writing a Professional Paper (located in the Student Resource Center) to complete this assignment.
   4. Turn on Grammarly to check the grammar, sentence structure, and punctuation as you write (Note: if you have not already done so, please download the free version at Grammarly.com before construction of the assignment.)

Writing Requirements (APA format)

• Continuation of the DNP Project Manuscript started in NR702
• Length: 5-7 pages
• 1-inch margins
• Double-spaced pages
• 12-point Times New Roman or 11-point Arial font
• Headings & subheadings
• In-text citations
• Table of contents updated with new page numbers
• References page(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
• Standard English usage and mechanics
• Organized presentation of ideas

Course Outcomes

This assignment enables the student to meet the following course outcomes:

1. Demonstrate effective project management strategies. (POs 2, 3, 6, 7, 8)
2. Explore the contribution of the DNP within collaborative teams across diverse healthcare systems. (PO 1)
3. Apply theory and evidence from management, policy, and clinical perspectives to support quality improvement and patient safety in healthcare systems. (POs 3, 4, 5, 6)(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Due Date

• By 11:59 p.m. MT on Sunday
• Late Assignment Policy applies

Rubric

Week 4 Assignment 1 Grading Rubric

Week 4 Assignment 1 Grading Rubric

CriteriaRatingsPts

This criterion is linked to a Learning OutcomeBarriers, Facilitators, and Ethical Considerations

Requirements:1. Assess the barriers and state your plan to overcome these obstacles.2. Assess the facilitators and ways to leverage support.3. Evaluate changes with leadership that might impact the project.4. Analyze the ethical considerations and your plan to protect private health information and/or data collected.5. State the IRB requirements from the university and practicum site.6. Explain if there is a need for informed consent or assent. If yes, Include those documents in the appendix and refer to the appendix in this section.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

50 pts

Includes all requirements and provides an in-depth barriers, facilitators, and ethical consideration discussion.

45 pts

Includes all requirements and creates a suffiecent barriers, facilitators, and ethical consideration discussion.

40 pts

Includes fewer than all requirements and/or creates a partial barriers, facilitators, and ethical consideration discussion.

0 pts

Includes fewer than all requirements and/or provides an undeveloped barriers, facilitators, and ethical consideration discussion.

50 pts

This criterion is linked to a Learning OutcomeData Collection and Analysis Plan

Requirements:1. Create your detailed data collection plan, including how you plan to collect data and when.2. If a retrospective chart audit will be used, explain how will you collect pre- and post-intervention data?3. If a data collection instrument or tool is being used, describe the instrument or tool and provide the validity for this tool with a citation and matching reference.4. Is permission to use the instrument or tool required? If so, state that you have permission and include the permission in the Appendix. permission? If the instrument or tool is in the public domain, provide this information.5. Explain the planned statistical analysis of the data collected.6. Summarize how the analysis of the outcome data will determine the practice change project outcome and answer the practice question.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

50 pts

Includes all requirements and provides an in-depth data collection and analysis plan.

45 pts

Includes all requirements and provides a sufficient data collection and analysis plan.

40 pts

Includes fewer than all requirements and/or provides a partial data collection and analysis plan.

0 pts

Includes fewer than all requirements and/or provides an undeveloped data collection and analysis plan.

50 pts

This criterion is linked to a Learning OutcomeResources and Proposed Budget

Requirements:1. Describe the resources needed to implement your project.2. Include these resources in your proposed budget for the project.3. Balance your proposed budget to zero or a positive balance.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

30 pts

Includes all requirements and provides an in-depth budget.

27 pts

Includes all requirements and provides a sufficient budget.

24 pts

Includes fewer than all requirements and/or provides a partial budget.

0 pts

Includes fewer than all requirements and/or provides an undeveloped budget.

30 pts

This criterion is linked to a Learning OutcomeReferences

Requirements:1. Reference publication dates must be within the last 5 years.2. References must be from peer-reviewed journals, government websites, and credible national and global organizations.3. In-text citations should align with the reference page.4. References must be in the current APA format.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

30 pts

Includes all requirements and provides excellent references.

27 pts

Includes all requirements and provides sufficient references.

24 pts

Includes fewer than all requirements and/or provides partial references.

0 pts

Includes fewer than all requirements and/or provides poor references.

30 pts

This criterion is linked to a Learning OutcomeScholarly Writing Criteria

Requirements:1. Use the current APA style and format throughout the DNP Project Manuscript.2. Use the headers provided in the template.3. No error patterns in APA formatting.4. Paper length is 5-7 pages (excluding reference pages).(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

20 pts

Includes all requirements and provides excellent scholarly writing.

18 pts

Includes all requirements and provides sufficient scholarly writing.

16 pts

Includes fewer than all requirements and/or provides basic scholarly writing.

0 pts

Includes fewer than all requirements and/or provides poor scholarly writing.

20 pts

This criterion is linked to a Learning OutcomeClarity of Writing

Requirements:1. Standard English usage and mechanics2. No spelling or typographical errors3. Organized presentation of ideas(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

20 pts

Includes all requirements and demonstrates excellent clarity of writing.

18 pts

Includes all requirements and provides sufficient clarity of writing.

16 pts

Includes fewer than all requirements and/or provides partial clarity of writing.

0 pts

Includes fewer than all requirements and/or provides poor clarity of writing.

20 pts

Total Points: 200

PreviousNext

A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay

Abstract

Background: The project aims to evaluate the impact of technology with motivational interviewing on medication adherence among inpatient schizophrenia patients.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Problem: The project addresses medication adherence among schizophrenia patients.

Methods: The project adopts a pre-test and post-test analysis approach. Fifty consecutive schizophrenia patients following up with treatment will participate in the study.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Intervention: This DNP project pursues a nurse-led intervention to improve medication adherence and symptom management.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Results:

Conclusions:

Keywords:  Medication non-adherence, Schizophrenia, motivational interviewing, success factors influencing motivational interviewing positive effects, motivational interviewing impact on medication adherence, motivational interviewing strategies.

Table of Contents

Abstract 2

Dedication (NR 709) 3

Acknowledgment (NR 709) 4

Introduction. 7

Problem.. 7

Project Aim and Supporting Objectives (NR 702) 9

Practice Question (NR 702) 9

Research Synthesis and Evidence-Based Intervention. 10

Evidence-Based Intervention. 10

Evidence Synthesis. 11

Main Themes in the Research. 11

Contrasting Elements in the Research. 12

Research Support for the Evidence-Based Interventions. 13

Evidence-Based Intervention Implementation. 13

Explanation of the Evidence-Based Intervention. 13

Steps in the Intervention Implementation. 14

Participant Engagement during Intervention Implementation. 14

Organizational Setting. 15

Population. 16

Translational Science Model and Project Management Plan. 16

Project Management Plan. 18

Formative Evaluation Plan. 19

Plans for Sustainability. 19

Anticipated Outcomes. 20

Expected Change after Implementing Motivational Interviewing. 20

Barriers, Facilitators, and Ethical Considerations. 21

Data Collection and Analysis Plan. 23

Resources and Propose Budget 24

References. 26

Appendices, Tables, and Figures. 30

Appendix A.. 30

Johns Hopkins Nursing Evidence-Based Practice. 30

Table 1: Implementation Plan. 36

Table 2: Formative Evaluation Plan. 37

Appendix D.. 41

Informed Consent for Participation in a DNP Project 41

Appendix E.. 43

Budget 43

A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

Introduction

Schizophrenia is a mental disorder that impairs thought processes, patterns, perceptions, emotional responses, and social interactions (NIMH, n.d.). Schizophrenia is persistent and can be severe and disabling when symptoms are not adequately managed (NIMH, n.d.). This DNP project pursues a nurse-led intervention to improve medication adherence and symptom management. Mucci et al. (2020) recommend a person-centered approach to healthcare that encompasses building therapeutic relationships between providers and patients and collaboration between providers when working with schizophrenia patients to achieve compliance. Specifically, the project aims to evaluate the impact of technology with motivational interviewing on medication adherence among inpatient schizophrenia patients. This DNP Project Manuscript provides the introduction, background, problem, project aim, supporting objectives, practice question, literature synthesis, and methodology.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Problem

Numerous studies have shown a varying prevalence of Schizophrenia globally and in the US. The global prevalence of Schizophrenia among non-institutionalized persons ranges between 0.33% and 0.75%, while in the United States, Schizophrenia is 0.25% to 0.64% (NIMH, n.d.). Non-adherence to medication among Schizophrenia patients is well documented in the United States (US) and globally. Desai and Nayak (2019) suggest most schizophrenia patients are non-compliant with medication, a national and global problem that affects 70% of patients.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Non-adherence increases the use of outpatient and hospital-related resources, while comorbidities and demographic factors exacerbate the problem. Additionally, it affects health outcomes among schizophrenia patients, increasing the risk of premature death compared to the general population, making it a significant health problem at the practicum site. The average life lost in the US due to Schizophrenia is about 28.5 years (NIMH, n.d.). Most comorbid conditions associated with Schizophrenia, including liver disease, heart disease, and diabetes, increase the risk of premature and go unrecognized. Over 50% of schizophrenia patients have additional behavioral and mental health problems. According to NIMH (n.d.), an estimated 4.9% of individuals diagnosed with Schizophrenia commit suicide, significantly higher than the general population, estimated at 14.2 per 100,000 people or 0.0142%.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

The financial costs of managing Schizophrenia increase exponentially with co-occurring mental, physical, and behavioral health conditions. The direct costs include those related to the hospital stay and medication due to worsening symptoms and general health conditions. In contrast, the indirect costs include costs due to social service needs, lost productivity, involvement of criminal justice, and issues beyond healthcare. The total cost of managing Schizophrenia and co-occurring health problems averages $2,004 to 94,229 per person per year (Kotzeva et al., 2022). Per Kotzeva et al. (2022), indirect costs make up 50-60% of the total cost, making it the primary cost driver, averaging $1,852 to $62,431 per person per year.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Non-adherence to medication among schizophrenia patients is a significant problem at the practicum site, associated with an increased risk of premature death compared to the general population, hospital stays, frequent readmissions, and increased healthcare burden for the family and the system. Family and patient education help address non-adherence, but no evidence indicates desired success because it continues to be a problem among this patient population. In addition, there is no documentation of other interventions to address the non-adherence at the practicum site. This project is an opportunity to adopt motivational interviewing and technology, evidence-based interventions with indicated benefits, and high success rates in addressing non-adherence.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Project Aim and Supporting Objectives (NR 702)

The DNP project aims to determine the impact of motivational interviewing and technology on medication adherence among inpatient schizophrenia patients. The project objectives are as follows:

1. To evaluate the role of technology on medication adherence among inpatient schizophrenia patients.
2. To assess the impact of motivational interviews on medication adherence among inpatient schizophrenia patients.
3. To compare the impact of technology and motivational interviewing on medication adherence and the current interventions for enhancing medication adherence at the practicum site(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Practice Question (NR 702)

The following practice question will serve as the basis of the DNP project: For adults with a history of Schizophrenia (P) in the inpatient setting, does the implementation of technology with motivational interviewing (I), compared with current practice (C), impact medication non-adherence (O) in 8-10 weeks (T)?(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Research Synthesis and Evidence-Based Intervention

Evidence-Based Intervention

Motivational Interviewing (MI) is an evidence-based intervention to encourage behavioral change. MI is a collaborative, goal-oriented communication approach that focuses on the language of change to help people bolster personal or intrinsic motivation for and commitment to a particular objective by considering the individual’s need for change in an accepting and compassionate atmosphere. MI guides communication, balancing good listening and offering information and advice to empower individuals to change by eliciting their meaning, need, and capacity for change. Its foundation is a respectful and curious approach to interacting with people to promote a natural change process while honoring the patient’s autonomy. MI is primarily used for patients unwilling or ambivalent to change, combining different evidence-based interventions from cognitive and social psychology. It assumes that individuals with problematic attitudes and behaviors have varying readiness for change levels. Not recognizing the ambivalence would lead to patients rendering well-intentioned medical advice threatening their autonomy and freedom of choice, increasing their will to exercise their freedom to make choices and increasing non-adherence. The DNP project adopts MI as an evidence-based intervention to increase personal motivation for and committed attitudes and behaviors to help schizophrenia patients find their meaning and need for change in an accepting and empathetic atmosphere, aiming to improve medication adherence. The Motivation Interviewing Network of Trainers (MINT) endorses this intervention to encourage behavioral change.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Evidence Synthesis

This evidence-based synthesis of research supports the intervention, motivational interviewing, and its impact on medication adherence. Ten articles fit the inclusion criteria, which required articles to be five years old or less, evidence-based, peer-reviewed, and demonstrate the efficacy of the chosen intervention, i.e., technology with motivational interviewing (MI) in improving medication adherence. Both qualitative and quantitative studies supporting the intervention were selected for this paper. The ten articles selected for review include Ertem and Duman (2019), Dobber et al. (2020), Harmacnci and Budak (2022), Chen et al. (2019), Pupus et al. (2022), Palacio et al. (2019), Hogan et al. (2020), Aubeeluck et al. (2021), Khadoura et al. (2021), and Abughosh et al. (2019). (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Of the selected articles, six were level I, one was level II, and three were level III. The types of evidence included in level I evidence are clustered randomized controlled trials, experimental studies, and systematic reviews of RCT with or without meta-analysis. Types of evidence in level II evidence is a prospective study. Finally, level III evidence includes a qualitative multiple case study, mixed method study, and secondary data analysis. All studies were high quality, with consistent, generalizable findings, a sufficient sample size for the respective designs and study purpose, adequate control, definitive conclusions, and pervasive recommendations based on the results.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Main Themes in the Research

The primary themes include success factors influencing MI’s positive effects, the association between MI techniques and medication adherence, and MI’s impact on medication adherence. Ertem and Duman (2019) and Dobber et al. (2020) established that trusting relationships between patients and therapists, the therapist’s ability to adopt or tailor MI strategy to a patient’s issues, and incorporating the patient’s values, needs, and perceptions of long-term medication adherence can increase MI-intervention success for medication adherence in schizophrenia patients; a positive success factor. Furthermore, a trusting relationship and empathy can help trigger mechanisms of change and enhance medication adherence. On the association between MI techniques and medication adherence, various MI techniques, including telephonic MI, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation, improve medication adherence (Palacio et al., 2019; Abughosh et al., 2019; Hogan et al., 2020; Harmanci & Budak, 2022). Regarding MI’s impact on medication adherence, Papus et al. (2022), Chen et al. (2019), Aubeeluck et al. (2021), and Khadoura et al. (2021) established a positive association between MI and medication adherence and associated factors of self-efficacy and patients’ intrinsic motivation. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)  

Contrasting Elements in the Research

Regarding MI-based telephone intervention, Palacio et al. (2019) found varying effects across various categorical measures, implying that telephonic MI impacted different groups or measures differently. However, Abughosh et al. (2019) findings across all patient groups were consistent, indicating better results for those who received two or more calls. Themes vary across the studies. Dobber et al. (2020) address the success factors influencing MI’s positive effects. Ertem and Duman (2019) assess the effect of MI on treatment adherence and insights into Schizophrenia patients. Palacio et al. (2019), Abughosh et al. (2019), Hogan et al. (2020), and Harmanci and Budak (2022) address specific MI techniques adopted to address medication adherence, including telephonic MI, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Papus et al. (2022), Aubeeluck et al. (2021), and Khadoura et al. (2021) address MI in general and its effectiveness in improving medication adherence. Chen et al. (2019) evaluated the effects and cost-effectiveness of MI therapy on medication adherence among patients diagnosed with Schizophrenia spectrum disorders.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Research Support for the Evidence-Based Interventions

MI was selected because of its adaptability to many settings (Pupus et al., 2022). Moreover, MI has significantly impacted medication adherence (Ertem and Duman, 2019; Dobber et al., 2020; Harmacnci and Budak, 2022; Chen et al., 2019; Pupus et al., 2022; Palacio et al., 2019; Hogan et al. 2020; Aubeeluck et al., 2021; Khadoura et al., 2021; Abughosh et al., 2019). MI is also associated with various mental health outcomes that promote medication adherence, such as hope and mental well-being (Harmacnci & Budak, 2022). These aspects of MI suggest that the intervention is evidence-based and can help mitigate medication non-adherence among schizophrenia patients in an inpatient facility.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Evidence-Based Intervention Implementation

Explanation of the Evidence-Based Intervention

Across the research studies, MI is an evidence-based, collaborative tool for improving medication adherence. The studies acknowledge MI focuses on patient ambivalence and lack of the individual’s motivation and commitment to change. Patients are aware of the positive effects of medication, such as preventing psychotic relapse and readmission but are burdened by the side effects and the need to take medication as prescribed. The therapist is at the center of implementing MI in healthcare organizations and deliberately influences patients’ motivation for change by adopting strategies such as change talk elicitation, sustain talk, developing trusting relationships with patients, adopting empathetic attitudes, and communicating partnerships with patients. The therapist can intervene through the four overlapping processes of MI. The processes include engaging or relation building, focusing or identifying a patient’s change, evoking or eliciting change talk and the client’s need for change, and planning or helping the patient create a comprehensive change plan. The therapists are integral across studies in implementing MI techniques such as telephonic MI, calling and communicating with the patients, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Generally, the studies consider the therapist imperative in implementing MI and the patient and patient perspectives as the drivers of MI.  (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Steps in the Intervention Implementation

Across the research studies, MI and MI techniques have been adopted using the four processes of MI: engaging, focusing, evoking, and planning. The first process, engaging, allows the therapist to develop a good trusting and working relationship with the client to understand the problem, using reflective listening to understand the client and the ambivalent attitude. The second process is focusing, which involves identifying a clear objective and goal, including identifying target behavior, exploring ambivalence and barriers, and establishing discrepancy. The project’s intervention target behavior is medication adherence. In the evoking process, the therapist tries to evoke the client’s internal motivation and needs for change and reinforce the overall motivation for change. This process involves the change talk that stimulates desire and motivation for change, mobilizes commitment, and sustains dialogue, ensuring the target behavior is sustained over time.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Participant Engagement during Intervention Implementation

Motivational interviewing is more patient-centered, promoting the patient’s autonomy while eliciting motivation, the need for change, and commitment to change. The practitioner will engage patient perspectives through the implementation and the MI processes to ensure continuous patient engagement. Practitioners involved will continuously ask questions, reinforce responses using affirmations, and adopt a lot of reflective listening to ensure the patients feel heard and engaged, encouraging their involvement through the intervention implementation. A good and trusting relationship will precede every activity to establish good engagement before beginning the change conversation. The therapists will use the guiding style to engage participants, clarify strengths, motivation, and need for change, and foster autonomy in decision-making to ensure full involvement throughout the implementation.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Methodology

            This section describes the organizational setting, project population, translation science model and project management, plans for sustainability, and anticipated outcomes.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Organizational Setting

The healthcare setting is a mental health facility in Los Angelos, California. The organization adopts mental health teams based in communities offering daily support and treatment while helping schizophrenia patients gain independence. The teams include nurses, therapists, psychiatrists, psychologists, and social workers.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

The study focuses on patients with Schizophrenia as the primary diagnosis. Schizophrenia is associated with significant thinking or cognitive, behavioral, and emotional problems. Individuals between 16 and 25 are the most vulnerable, although new schizophrenia cases increase in their teenage years. Most patients present with hallucinations, delusions, and confused or disturbed thoughts that impact behavior and social and occupational functioning. About 150-230 schizophrenia patients are seen monthly at the facility or in their respective homes by the mental health teams based in the communities. On average, a hospitalized schizophrenia patient can stay between 11 and 23 days, depending on the severity of the condition and symptoms. An experienced psychiatrist coordinates a team consisting of a combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers and contributes to patient health management and outcome.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Population

The first 50 consecutive schizophrenia patients that fit the inclusion criteria will be involved in the study. The project population includes schizophrenia patients experiencing thinking or cognitive, behavioral, and emotional problems, both men and women reporting at the facility or requesting home visits from the mental health team based in the communities. The inclusion criteria comprise patients diagnosed with Schizophrenia according to the International Statistical Classification of Diseases-10 criteria, between 18 and 65 years, and receiving treatment for the last six months. The follow-up patients, patients with multiple schizophrenia episodes, and patients with recent psychotic relapses after non-adherence to therapy meet the inclusion criteria and will be considered for the project. The research invites existing users of health services at the facility to participate in the study. Participants will provide informed consent before collecting data as an inclusion requirement. In addition, the study will recruit any follow-up schizophrenia patient attending psychiatric evaluation in the inpatient or outpatient departments after consent. The exclusion criteria include acutely psychotic patients during the interview and patients with cognitive deficits impacting the interview or data collection. The researchers will first communicate participation requests and study details via text messages, suitable even for older patients.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay) 

Translational Science Model and Project Management Plan

The Iowa model of evidence-based practice will help implement motivational interviewing to enhance medication adherence among schizophrenia patients. It supports evidence-based practice implementation, research utilization, and knowledge transformation processes (Duff et al., 2020). Per the Iowa model, the DNP practice project development and implementation include the following steps:(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

1. I identified medication non-adherence among schizophrenia patients as warranting EBP adoption.
2. Medication non-adherence is a priority for the organization due to increased treatment failure, hospitalization, readmission, and mortality rates. Addressing this problem would improve hospital and patient health outcomes.
3. I developed a team of a combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers to develop, examine, and implement motivational interviewing to address medication non-adherence among schizophrenia patients.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
4. The project practice question is: “For adults with a history of Schizophrenia (P) in the inpatient setting, does the implementation of technology with motivational interviewing (I), compared with current practice (C), impact medication non-adherence (O) in 8-10 weeks (T)?” to guide literature search and the DNP project. The search for peer-reviewed articles includes databases like PubMed, MEDLINE, and CINAHL. The articles address the impact of motivational interviewing on medication adherence.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
5. I reviewed the articles based on their abstract, research purpose, methodology, research findings, evidence level, and quality and presented the results of 10 articles on the evidence synthesis summary tool/table. Based on the evidence, motivational interviewing is scientifically supported, sound, and clinically significant.
6. I identified ten articles that provide the best evidence to help answer the research question. Based on the assessment, the evidence is sufficient to guide and inform the implementation of motivational interviewing at the healthcare facility.
7. The project team and I will implement motivational interviewing into a pilot program that includes follow-up schizophrenia patients only.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)
8. The team and I will evaluate the implementation results to determine the impact of motivational interviewing on medication adherence among schizophrenia patients. Clinically significant results will warrant the implementation of motivational interviewing organization-wide.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Project Management Plan

The DNP project implementation will take 12 weeks to complete. Week 1 will involve identifying participants and collecting pre-implementation data. Week 2 will include steps 1 through 3, problem identification, priority determination, and team development. Week 3 will concentrate on steps 4 through 6, involving evidence gathering and analysis, research articles critiquing and synthesis, and evidence assessment for adequacy will be completed. The implementation of motivational interviewing will begin in week four and through week 11. Finally, in week 12, step 8 of the project implementation will occur after intervention implementation. Post-summative data will be collected, and outcomes will be evaluated to determine the effectiveness of motivational interviewing in addressing medication adherence among schizophrenia patients. The summative data will inform whether the project suits the rest of the organization and patient populations. (See Appendix B). (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Formative Evaluation Plan

The formative evaluation includes individual evaluation conducted before, during, and after intervention implementation, which aims to improve project development and implementation design and performance and ensure activities are completed effectively and efficiently. This formative evaluation will help understand why and how the project works and other factors at work during project development and implementation and increase the likelihood of successful results or outcomes through continuous improvements informed by evaluation results at different project implementation steps. (See Appendix C).(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Plans for Sustainability

The sustainability objective is to ensure motivational interviewing’s organization-wide adoption and that patients continue to benefit from improving medication adherence over time. The project manager will use a checklist that maintains alignment with the organization’s mission and vision statements and continues achieving the project goals and objectives. The checklist will include critical success factors, including medication adherence measures that will help assess the continued effectiveness of the intervention. The sustainability plan adopts continuous quality and performance improvement, requiring consistent data collection after project implementation. The project team will gather data on MI from patient records and the organization’s medical data. Information includes treatment failure, hospitalization, readmission, and mortality rates over time, and patients’ self-reported surveys and interviews on changes in medication adherence behavior over time that measure intervention effectiveness. The project team will conduct project auditing and feedback on the performance of MI post-implementation. Providers, patients, family members, caregivers, and opinion leaders will participate in the auditing process. The project team assigned for sustainability will analyze the data and feedback to inform continuous quality improvement initiatives to ensure project sustainability. Additionally, in the future, ongoing provider and patient education will help ensure MI improvement in medication adherence.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Anticipated Outcomes

Expected Change after Implementing Motivational Interviewing

Motivational interviewing implementation will improve medication adherence behavior, indicated by decreased treatment failure, readmission, hospitalization, and mortality rates, associated with Schizophrenia. According to Aubeeluck et al. (2021), MI interventions significantly improved medication adherence in five RCT research studies and systolic blood pressure in one RCT study. Khadoura et al. (2021) found that MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group. According to Papus et al. (2022), MI improved medication adherence in 23 RCT studies and risky behaviors and disease symptoms in 19 RCT studies. Ertem and Duman (2019 established that treatment adherence and patient insight increases. Lastly, Chen et al. (2019) established that MI improves medication adherence, insight into treatment/illness, symptom severity, patient functioning, rate of re-hospitalizations, and cost of treatment. The evidence indicates a positive relationship between motivational interviewing and medication adherence, although measures used vary for the different studies. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Barriers, Facilitators, and Ethical Considerations

The project implementation face is expected to encounter certain barriers and facilitators, which require ethical considerations. According to Wright et al. (2022), DNP project challenges are experienced across phases, including planning, implementation, and evaluation. In this project, the barriers that the project may encounter during the implementation phase include resistance from the nursing staff, lack of participant interest or engagement, lack of access to technology, language barriers, and participant safety concerns.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

To overcome these obstacles, I will address the concerns of the nursing staff by providing them with training on the purpose of the project, the protocol, and the methodology. This will allow them to understand the project’s significance, make them feel part of it, and contribute to its implementation through expert opinion and any other relevant input throughout the implementation. Furthermore, I will work with the mental health facility (the practicum site) to identify the potential participants who might be interested and engage them in the project voluntarily at the beginning. Lastly, I will ensure participant safety of the participants by obtaining clearance for the Chamberlain and health facility’s institutional review board or relevant authority for the later and develop a safety plan that includes monitoring and follow-up to identify concerns, such as a barrier to medication adherence and signs of relapse, which could lead to adverse health outcomes.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

The project’s facilitators may include support from my mentor and the nursing staff, participant interest or engagement, and the facility’s commitment to patient care. Mentors are essential in promoting the academic-practice partnership, which is vital in progressing through the DNP project (Staffileno et al., 2019). I will work closely with my mentor, consulting with her on every decision made during the project implementation and seeking her opining on how to go about aspects of the project. Besides, I will leverage participants and nursing staff support by regularly communicating with nursing staff and participants, providing ongoing training and support, and collaborating with the facility to ensure that the project aligns with the facility’s goals and objectives.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Leadership at the practicum site is crucial for the success of the project. Leadership changes that might impact the project at the practicum site include changes in staff, budget cuts, or changes in the facility’s priorities. Budget cuts may lead to reduced resources available for the project at the practicum site, including the number of nursing staff to consult and help recruit participants and support the project’s monitoring. I will address these challenges by regularly communicating with the facility leadership and adapting the project to align with any changes in priorities and resources.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

The ethical considerations of the project include the need for informed consent and confidentiality of participant information. The provision of informed consent requires the potential participants to have the capacity to understand the project, risks, and benefits. Therefore, there is a need to provide consent forms using simple words that potential participants can understand (Deshpande et al., 2020). Participants’ belief that the intervention would positively impact their care would influence their choice to participate in the study. Furthermore, I will assess the participant’s decision-making capacity to provide informed consent to participate in the project. The informed consent is shown in Appendix D.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

The participants’ confidentiality includes protecting the health information and data collected. I will uphold confidentiality by safeguarding private health information and data by obtaining clearance from the health facility’s relevant authority and the university’s IRB. I will also encrypt the participants’ identifying information and secure data storage with only access to authorized personnel. Informed consent will ensure that the participants know the project’s purpose and roles and are willing to participate voluntarily.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

The IRB requirements include the IRB prescreening form, the DNP project protocol, IRB informed consent, IRB approval from the practicum site, data tools for the project, i.e., the BMQ questionnaire, and approval for using the questionnaires from the authors. In this case, the BMQ tool and the Mango health app are available in the public domain and do not require any approval. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Data Collection and Analysis Plan

I will collect data using the Brief Medication Questionnaire (BMQ) tool. The participants will complete the BMQ at baseline and end-line to measure medication adherence for schizophrenia treatment. I will journal the participants’ concerns and experiences with medication that act as barriers and provide necessary support during weekly phone calls and in-person meetings. The baseline data will be collected during week one, while the end-line data will be collected in week 8. The nursing staff will help monitor the intervention’s implementation by providing expert opinion and information on participant treatment regimen changes.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

The BMQ will be the primary tool for data collected in the study. It is a free and precise tool for assessing general medication adherence. The BMQ is highly accurate and validated in multiple languages and settings (Nassar et al., 2022). The tool has nine questions that assess medication-taking behavior to determine adherence, self-efficacy, and barriers to medication adherence. No permission is required to use the BMQ as the tool is public.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

A two-sample Student’s t-test will be performed to compare medication adherence data at baseline and end based on the qualitative and quantitative nature of the study variables on SPSS. The data will be analyzed using SPSS software, a widely used statistical software package. SPSS software requires permission to use, guaranteed after the authorized purchase and installation of the software on my computer. Student t-test is a statistical test that compares the mean of two independent groups. The comparison is to evaluate if the difference between them is significant (Mishra et al., 2019). DNP project, the two groups being compared are the medication adherence data collected at baseline and end-line. The Brief Medication Questionnaire (BMQ) will be used to collect data on medication adherence among schizophrenia patients at these two-time points. The mean adherence scores for each group will be calculated and compared using the t-test to determine if a statistically significant difference exists. If the p-value of the t-test is less than the predetermined significance level (usually set at 0.05), it indicates a significant difference between the two data sets. The outcome data from the t-test will help determine the impact of the intervention on medication adherence among schizophrenia patients. If there is a significant difference between the baseline and end-line medication adherence scores, it suggests that the intervention was effective in improving medication adherence.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

The results of the t-test will also help answer the project’s research questions and objectives regarding the impact of motivational interviewing and technology on medication adherence among inpatient schizophrenia patients and how they compare to the current interventions for enhancing medication adherence at the practicum site. The statistical analysis will provide information on the effectiveness of the intervention, and I will use this information to make recommendations for improving medication adherence among inpatient schizophrenia patients.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Resources and Propose Budget

The resources needed to implement the project include nursing staff to help me monitor the project by providing expert opinion and support during the recruitment of participants and implementation of the project. I will also need a laptop and software (SPSS and MS Office) to prepare and administer MI. The participants will need smartphones with the mango app installed for medication adherence reminders. The proposed budget is shown in Appendix E.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Top of Form

References

Abughosh, S., Wang, X., Serna, O., Esse, T., Mann, A., Masilamani, S., Holstad, M. M., Essien, E. J., & Fleming, M. (2019). A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence. Journal of Managed Care & Specialty Pharmacy, 23(5), 549–560. https://doi.org/10.18553/jmcp.2019.23.5.549(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Aubeeluck, E., Al-Arkee, S., Finlay, K., & Jalal, Z. (2021). The impact of pharmacy care and motivational interviewing on improving medication adherence in patients with cardiovascular diseases: A systematic review of randomized controlled trials. International Journal of Clinical Practice, 75(11), e14457. https://doi.org/10.1111/ijcp.14457

Cabarrus College of Health Sciences. (2023, February 3). Cabarrus College of Health Sciences Library: IOWA Model. https://cabarruscollege.libguides.com/c.php?g=465666&p=5283295

Desai, R., & Nayak, R. (2019). Effects of medication non-adherence and comorbidity on health resource utilization in Schizophrenia. Journal of Managed Care & Specialty Pharmacy, 25(1), 37-46. https://doi.org/10.18553/jmcp.2019.25.1.037

Deshpande, S. N., Mishra, N. N., Bhatia, T., Jakhar, K., Goyal, S., Sharma, S., … & Jadhav, S. (2020). Informed consent in psychiatry outpatients. The Indian Journal of Medical Research, 151(1), 35. https://doi.org/10.4103/ijmr.ijmr_1036_18

Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., … & de Haan, L. (2020). Active ingredients and mechanisms of change in motivational interviewing for medication adherence. A mixed methods study of patient-therapist interaction in patients with Schizophrenia. Frontiers in Psychiatry, 11, 78. https://doi.org/10.3389/fpsyt.2020.00078(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: an interpretive description. Implementation Science Communications, 1, 85. https://doi.org/10.1186/s43058-020-00070-0

Ertem, M. Y., & Duman, Z. Ç. (2019). The effect of motivational interviews on treatment adherence and insight levels of patients with Schizophrenia: A randomized controlled study. Perspectives in Psychiatric Care, 55(1), 75-86. https://doi.org/10.1111/ppc.12301

Harmanci, P., & Budak, F. K. (2022). The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients. Clinical Nursing Research, 31(2), 202-216. https://doi.org/10.1177/10547738211046438

Hogan, A., Catley, D., Goggin, K., & Evangeli, M. (2020). Mechanisms of Motivational Interviewing for Antiretroviral Medication Adherence in People with HIV. AIDS and Behavior, 24(10), 2956–2965. https://doi.org/10.1007/s10461-020-02846-w

Iowa Model Collaborative, Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp-Reimer, T., Tucker, S., & Authored on behalf of the Iowa Model Collaborative (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182. https://doi.org/10.1111/wvn.12223

Khadoura, K. J., Shakibazadeh, E., Mansournia, M. A., Aljeesh, Y., & Fotouhi, A. (2021). Effectiveness of motivational interviewing on medication adherence among Palestinian hypertensive patients: a clustered randomized controlled trial. European Journal of Cardiovascular Nursing, 20(5), 411–420. https://doi.org/10.1093/eurjcn/zvaa015

Kotzeva, A., Mittal, D., Desai, S., Judge, D., & Samanta, K. (2022). Socioeconomic burden of Schizophrenia: A targeted literature review of types of costs and associated drivers across ten countries. Journal of Medical Economics, (just-accepted), 1-18. https://doi.org/10.1080/13696998.2022.2157596(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Mishra, P., Singh, U., Pandey, C. M., Mishra, P., & Pandey, G. (2019). Application of student’s t-test, analysis of variance, and covariance. Annals of Cardiac Anaesthesia, 22(4), 407. https://doi.org/10.4103%2Faca.ACA_94_19

Mucci, A., Kawohl, W., Maria, C., & Wooller, A. (2020). Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making. Frontiers in Psychiatry, 11, 761. https://doi.org/10.3389/fpsyt.2020.00761

Nassar, R. I., Basheti, I. A., & Saini, B. (2022). Exploring Validated Self-Reported Instruments to Assess Adherence to Medications Used: A Review Comparing Existing Instruments. Patient Preference and Adherence, 503-513. https://doi.org/10.2147/PPA.S352161(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

National Institute of Mental health. (No date). Schizophrenia. Available at: https://www.nimh.nih.gov/health/statistics/schizophrenia (Accessed January 14, 2023)

Palacio, A., Garay, D., Langer, B., Taylor, J., Wood, B. A., & Tamariz, L. (2019). Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis. Journal of General Internal Medicine, 31(8), 929–940. https://doi.org/10.1007/s11606-016-3685-3

Papus, M., Dima, A. L., Viprey, M., Schott, A. M., Schneider, M. P., & Novais, T. (2022). Motivational interviewing to support medication adherence in adults with chronic conditions: a systematic review of randomized controlled trials. Patient Education and Counseling.

Staffileno, B. A., Murphy, M. P., Hinch, B., & Carlson, E. (2019). Exploring the Doctor of Nursing Practice project facilitator/mentor role. Nursing Outlook, 67(4), 433-440. https://doi.org/10.1016/j.outlook.2019.01.005

Wright, R., Lee, Y. J., Yoo, A., McIltrot, K., VanGraafeiland, B., Saylor, M. A., … & Han, H. R. (2022). Doctor of Nursing Practice project: key challenges and possible solutions. Journal of Professional Nursing, 41, 53-57. https://doi.org/10.1016/j.profnurs.2022.04.004 

Appendices, Tables, and Figures

Appendix A

Johns Hopkins Nursing Evidence-Based Practice

Individual Evidence Summary Tool

Ó The Johns Hopkins Hospital/The Johns Hopkins University

Article #	Author & Date	Evidence Type	Sample, Sample Size & Setting	Study findings that help answer the EBP question	Limitations	Evidence Level & Quality
1.	Chien, W. T., Cheung, E. F. C., Mui, J. H. C., Gray, R., & Ip, G. (2019).	Randomized controlled trial.	Participants aged 18 to 65 were diagnosed with Schizophrenia, intervention (20 participants) and control (20 participants), university hospital psychiatric outpatient clinic. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	Increased treatment adherence Increased patient insight.	Poor internal consistency of self-reported measure of medication adherence Limited sample size Inability to evaluate multidimensional treatment adherence (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	Level III/Quality A
2.	Palacio, A., Garay, D., Langer, B., Taylor, J., Wood, B. A., & Tamariz, L. (2019)	Systematic Review and Meta-analysis (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	17 RCTs were included in the review	Telephonic MI and fidelity-based feedback were significantly linked to medication adherence. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	Included a few studies focusing on non-minority populations. Most studies were on antiretroviral medications, limiting generalizability. The small sample size limited the power of analyses.	Level I/Quality A
3.	Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., … & de Haan, L. (2020).	A Mixed Methods Study	14 cases of schizophrenia patients were included in the study.	A trusting relationship and empathy can help trigger mechanisms of change.	A small sample size limits generalizability. Limited visibility and measurability of most patient factors and change mechanisms. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	Level III/Quality A
4.	Papus, M., Dima, A. L., Viprey, M., Schott, A. M., Schneider, M. P., & Novais, T. (2022).	A systematic review of randomized controlled trials (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	The study included 54 RCTs.	MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	The study focused on chronic conditions limiting generalizability for other disease conditions.	Level I/Quality A
5.	Ertem, M. Y., & Duman, Z. Ç. (2019).	Mixed method study	67 participants were diagnosed with Schizophrenia in two community psychiatric nursing services centers. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	MI can improve the severity of schizophrenia symptoms, medication adherence, individual functioning, and insight into treatment/illness, reducing re-hospitalizations. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	Small and geographically limited sample size Medication side effects, refusal rate, medication type, and changes in dosage were not analyzed Potential subjective bias due to lack of blinding	Level I/Quality A
6.	Hogan, A., Catley, D., Goggin, K., & Evangeli, M. (2020).	A secondary analysis of data	62 HIV adult patients were included in the study. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	MI-consistent (MICO) method was positively associated with change and sustained talk. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	The historic nature of the data and limited statistical control limits the study. In addition, one MI session was used, and there was no variable manipulation, limiting the establishment of causality.	Level III/Quality A
7.	Aubeeluck, E., Al-Arkee, S., Finlay, K., & Jalal, Z. (2021).	A systematic review of randomized controlled trials	8 RCTs were included in the study.	MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	Small sample size limited generalizability.	Level I/Quality A
8.	Khadoura, K. J., Shakibazadeh, E., Mansournia, M. A., Aljeesh, Y., & Fotouhi, A. (2021).	A clustered randomized controlled trial	355 hypertensive patients were included as participants. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	The focus on one disease condition can limit generalizability. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	Level I/Quality A
9.	Abughosh, S., Wang, X., Serna, O., Esse, T., Mann, A., Masilamani, S., Holstad, M. M., Essien, E. J., & Fleming, M. (2019)	A prospective study	11 students were included in implementing the intervention, and 743 patients were the subjects.	MI-based telephone intervention is promising in improving medication adherence. Patients who completed the initial call and at least two fall calls were likelier to adhere.	The effects were short-term, and more research is required for longer periods.	Level II/ Quality A
10.	Harmanci, P., & Budak, F. K. (2022)	A pretest-posttest control group design	150 schizophrenia patients participated in the study. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	MI-techniques-based psychoeducation significantly enhanced medication adherence, hope, and psychological well-being for patients in the experimental group.  (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	The effects were short-term, and clinicians should be careful when adopting the results. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	Level I/Quality A

Appendix B

Table 1: Implementation Plan

Week	Activity
Week 1	Pre-implementation data collection.
Week 2	Step 1: Problem identification Step 2: Determining whether the problem is a priority to the organization Step 3: Team development
Week 3	Step 3: Evidence gathering and analysis Step 4: Research articles critique and synthesis Step 5: Evidence assessment for the adequacy
Week 4	Step 7: Intervention implementation
Week 5	Step 7: Intervention implementation
Week 6	Step 7: Intervention implementation
Week 7	Step 7: Intervention implementation
Week 8	Step 7: Intervention implementation
Week 9	Step 7: Intervention implementation
Week 10	Step 7: Intervention implementation
Week 11	Step 7: Intervention implementation
Week 12	Post-summative data collection Step 8: Outcome evaluation

Appendix C

Table 2: Formative Evaluation Plan

Week	When	Why	How (Oversight)
Week 1	Pre-project implementation	·         Understand the need for the project	·         Leadership meetings
Week 2	Project development	·         Clarify the need for the project	·         Problem tree analysis ·         Priority Matrix ·         Stakeholder analysis
Week 3	Project development	·         Clarify the need for the problem ·         Identify problem impact ·         Clarify intervention selected	·         Literature review ·         Solution tree analysis
Week 4	Project implementation	·         Develop project design before roll-out (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	·         Focus group ·         Discussions
Week 5	Project implementation	·         Improve project design as it is rolled out	·         Semi-structured interview ·         ORID ·         Project diary
Week 6	Project implementation	·         Ensure project implementation activities are delivered efficiently and effectively. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	·         Schedule tracking ·         Budget tracking ·         Observation ·         Dartboard ·         Questionnaire ·         Huddles
Week 7	Project implementation	·         Ensure project implementation activities are delivered efficiently and effectively. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	·         Schedule tracking ·         Budget tracking ·         Observation ·         Dartboard ·         Questionnaire ·         Huddles
Week 8	Project implementation	·         Ensure project implementation activities are delivered efficiently and effectively. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	·         Schedule tracking ·         Budget tracking ·         Observation ·         Dartboard ·         Questionnaire ·         Huddles
Week 9	Project implementation	·         Ensure project implementation activities are delivered efficiently and effectively. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	·         Schedule tracking ·         Budget tracking ·         Observation ·         Dartboard ·         Questionnaire ·         Huddles
Week 10	Project implementation	·         Ensure project implementation activities are delivered efficiently and effectively.	·         Schedule tracking ·         Budget tracking ·         Observation ·         Dartboard ·         Questionnaire ·         Huddles and meetings
Week 11	Project implementation	·         Ensure project implementation activities are delivered efficiently and effectively. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	·         Schedule tracking ·         Budget tracking ·         Observation ·         Dartboard ·         Questionnaire ·         Huddles and discussions
Week 12	Post-project implementation	·         Ensure the project is completed successfully. (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)	·         Leadership meetings ·         Project team discussions ·         Schedule tracking ·         Budget tracking ·         Observation ·         Dartboard ·         Questionnaire

Appendix D

Informed Consent for Participation in a DNP Project

Project Title: A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

Project Manager: Mary Jane Evangelista(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Project Location: A mental health facility in Los Angelos, California

What is the purpose of this project?

The DNP project aims to determine the impact of motivational interviewing and technology on medication adherence among inpatient schizophrenia patients.

What will I be asked to do if I choose to be in this project?

Provide information on medication adherence by com(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

How much time will I be asked to devote to this project?

Participants will use around an hour to complete the pre-implementation self-reported questionnaire and an hour and a half to complete the post-implementation questionnaire.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

What are the possible risks or discomforts that I might experience?

Discomfort associated with the project includes opening up about the barriers to and behaviors related to medication non-adherence during weekly meetings.  (A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

What are the possible benefits for me or others?

Maintain medication adherence and achieve positive health outcomes.

What alternatives are available?

Recommend participants.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Do I have to participate?

Participation is voluntary.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

What will happen if I do not participate?

No consequences for failure to participate in the project.

What will happen if I leave the project?

Participants can withdraw from the study at any time.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Will it cost me anything to participate?

Participants shall participate in the project voluntarily.

Will I get paid anything if I participate?

No incentives are provided for participating in the project.

How will my confidentiality and privacy rights be protected?

1. Personal data will be coded
2. Data will only be shared with a relevant party with permission from the participant.
3. Data will be safely stored in password-protected files.(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

In this project:

• Identifiable private information or specimens (private information or specimens that can be traced back to you) will be collected:

✓

Yes                  No

If yes:

• Identifiable private information or specimens may be used for future quality improvement projects without gaining further permission:(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Yes                  No

• Identifiable private information or specimens may be used for future quality improvement projects, but only with your permission:(A Nurse Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance Essay)

Yes                  No

• Identifiable private information or specimens will not be used for future quality improvement projects:

Yes                  No

Appendix E

Budget

Item	Cost
Nursing Staff Time (training, monitoring)	$1000
Printing and Supplies (consent forms, surveys, journals)	$500
Travel Expenses (transportation, lodging)	$1,500
Technology Equipment (smartphone and Mango Health App)	$1,500
SPSS Software License	$850
Microsoft Office	$250
Contingency Fund (unforeseen expenses)	$1,000
Total Cost	$6,600