Improving Medication Adherence Compliance in Schizophrenia Patients

Assignment

Purpose

The purpose of this assignment is to write the final DNP Project Manuscript for NR702. This assignment will allow you to present your edited sections in Part 1 and Part 2 of the Manuscript and add the final methodology sections with the appendices for the final DNP Project Manuscript submission. Turnitin will be applied to this assignment.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Instructions

Use the DNP Project Manuscript Template in the current APA format. Start with the edited Part 2 Manuscript Assignment, complete all the edits received, and add the Methodology section and appendices as described below.

Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.

1. The final manuscript will be graded on the quality of information, use of current research, use of Standard English and grammar, proper sentence structure, APA format, and overall organization based on the required components as summarized in the guidelines and grading criteria/rubric.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
2. Review the grading rubric carefully and consider how to incorporate each required criterion into Part 2 of the DNP Project Manuscript Template.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
3. Review the tutorial on the use of the DNP Project Manuscript Template in the Week 2 lesson.

Please make all the course faculty recommended revisions to your previous papers first.  All course faculty recommended revisions must be completed to receive full points in the final assignment.  Start working early on this assignment so you can ask your course faculty any questions you may have about the revisions required. (Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Your final submission will have the following sections:

1. Introduction/Background/ Purpose, Problem
2. Project Aim and Supporting Objectives
3. Practice Question
4. Evidence-Based Intervention with Research Synthesis
5. Methodology
   1. Organizational Setting
   2. Population
   3. Translational Science Model and Project Management Plan
   4. Plans for Sustainability
   5. Anticipated Outcomes Section

Follow the instructions on the template for the organizational setting, population, and methodology sections. Include the appendices in this final manuscript per the instructions. Submit your edited Part 2 DNP Project Manuscript with the new sections added for this assignment.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

1. Organizational Setting
   1. Provide a detailed description of the setting for the project including the following:
      1. State the type of healthcare setting or community setting.
      2. Describe the location.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
      3. Explain the typical patient and typical diagnoses.
      4. Identify how many patients or participants are seen monthly and- If applicable- state the average length of stay.
      5. Describe the interdisciplinary care team that contributes to the patients’ health management and outcomes.
2. Population
   1. Describe the details of your specific project population.
   2. Estimate the approximate total number of participants.
   3. Explain inclusion and exclusion criteria for the project.
   4. Describe how you will enroll the participants and if informed consent is needed.
3. Translational Science Model and Project Management Plan(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
   1. Identify the theory or model that will serve as the framework for the project; translational science models are recommended.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
   2. Identify the primary concepts or steps of the model.
   3. Create the steps in your DNP practice change project that coincide with the theoretical concepts.
   4. Include the timeframe for each step in your project plan (e.g., “in week 1 the data before intervention implementation will be collected”). Describe the project management plan by starting with the timeline of weeks for the project (usual projects are 8-12 weeks, keeping in mind the requirement to implement the intervention for at least eight weeks).(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
   5. The implementation plan must include a full eight weeks of intervention implementation.
   6. Include the plan for the pre-and post- summative data collection.
   7. Include the weekly plan for the formative evaluation to ensure high intervention fidelity. Develop a week-to-week formative evaluation plan utilizing observation, 1:1 discussions, huddles, leadership meetings, or other processes to describe your project management oversight during implementation.
   8. For each step or activity in the intervention plan, identify the intervention week in which that activity will occur.
4. Plans for Sustainability
   1. Create your detailed plan to sustain the project over time.
   2. Identify the specific strategies used to ensure the project has ongoing evaluation and modification as needed to ensure its success after your implementation phase is complete.
5. Anticipated Outcomes(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
   1. Provide an in-depth discussion connecting the outcome(s) you will measure with the intervention. Connect the intervention to your project outcome. The research articles supporting the intervention can also provide evidence that the intervention changes the outcomes. Describe how researchers have tested the intervention on the specific outcome and the research results demonstrate that the intervention effectively changes the outcome.
6. Appendices
   1. Johns Hopkins Evidence Table with a minimum of 10 research studies leveled and graded
   2. Data Collection Tools (if applicable)
   3. Compliance Checklist(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
   4. Educational Offering Table (outline)
   5. Informed Consent (if applicable)
7. References
   1. Information in this manuscript must be substantiated by citations.
   2. Reference publication dates must be within the last 5 years.
   3. References must be from peer-reviewed journals, government websites, and credible national and global organizations.
   4. In-text citations should align with the reference page.
   5. In-text citations and references must be in the current APA format.
8. Scholarly Writing Criteria
   1. Submit the paper on the DNP Project Manuscript Template
   2. Use the headers in the template.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
   3. Use the current APA style and format throughout this assignment.
   4. Use the Chamberlain Guideline for Writing Professional Papers (located in Student Resources) to complete this assignment.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
   5. 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.)
   6. Use third person in this DNP Project Manuscript. However, per APA, you can use first person in the project management section when you are talking about what you will do during implementation.

Notes:

• Make sure to include the edited Part 1 and 2 manuscript items.
• The nomenclature when saving the file should be Last name_First name_ DNP Project Manuscript_ NR 702_Date.

Writing Requirements (APA format)

• Length: 10-12 pages (not including title page or references page)
• 1-inch margins
• Double-spaced pages
• 12-point Times New Roman font or 11-point Arial
• Headings & subheadings
• In-text citations(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
• Title page
• References page (without permalinks)
• Standard English usage and mechanics
• Organized presentation of ideas

Course Outcomes

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

1. Synthesize scientific knowledge, theory, and practice expertise to inform evidence-based practice and impact outcomes. (POs 1, 3, 4, 5, 6, 9)(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
2. Design an evidence-based translational science project to address a practice problem. (POs 1, 2, 3, 4, 5, 6, 7, 8, 9)
3. Apply effective strategies in project design for managing practice problems in healthcare delivery at the micro, meso, and macro-system levels. (POs 1, 2, 3, 4, 5, 6, 7, 8, 9)
4. Demonstrate project management and leadership skills in the design process for the evidence-based translational science project. (POs 1, 2, 5, 6, 7, 8, 9)
5. Create collaborative relationships with interprofessional and intraprofessional groups to champion organizational improvements through project design. (POs 2, 4, 6, 8)(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Due Date

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

Rubric

Week 6 Assignment Grading Rubric

Week 6 Assignment Grading Rubric

CriteriaRatingsPts

This criterion is linked to a Learning OutcomePart I and Part 2 Revisions Completed

Requirements:1. All faculty recommended revisions to Part I and Part 2 of the DNP Project Manuscript are completed.

40 pts

Includes all requirements and provides in-depth revisions.

36 pts

Includes all requirements and provides sufficient revisions.

32 pts

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

0 pts

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

40 pts

This criterion is linked to a Learning OutcomeOrganizational Setting

Requirements:Provide a detailed description of the setting for the project, including the following:1. State the type of healthcare setting or community setting.2. Describe the location3. Explain the typical patient and typical diagnoses.4. Identify how many patients or participants are seen monthly and- If applicable- state the average length of stay.5. Describe the interdisciplinary care team that contributes to the patients’ health management and outcomes.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

20 pts

Includes all requirements and provides an in-depth organizational setting description.

17 pts

Includes all requirements and provides a sufficient organizational setting description.

14 pts

Includes fewer than all requirements and/or provides a partial organizational setting description.

0 pts

Includes fewer than all requirements and/or provides an undeveloped organizational setting description.

20 pts

This criterion is linked to a Learning OutcomePopulation

Requirements:1. Describe the details of your specific project population.2. Estimate the approximate total number of participants.3. Explain inclusion and exclusion criteria for the project.4. Describe how you will enroll the participants and if informed consent is needed.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

20 pts

Includes all requirements and provides an in-depth description of the population.

17 pts

Includes all requirements and provides a sufficient description of the population.

14 pts

Includes fewer than all requirements and/or provides a partial description of the population.

0 pts

Includes fewer than all requirements and/or provides an undeveloped description of the population.

20 pts

This criterion is linked to a Learning OutcomeTranslational Science Model and Project Management Plan

Requirements:1. Identify the theory or model that will serve as the framework for the project; translational science models are recommended.2. Identify the primary concepts or steps of the model.3. Create the steps in your DNP practice change project that coincide with the theoretical concepts.4. Include the timeframe for each step in your project plan (e.g. “in week 1 the data before intervention implementation will be collected” ). Describe the project management plan by starting with the timeline of weeks for the project (usual projects are 8-12 weeks, keeping in mind the requirement to implement the intervention for at least eight weeks).5. The implementation plan must include a full eight weeks of intervention implementation.6. Include the plan for the pre-and post- summative data collection.7. Include the weekly plan for the formative evaluation to ensure high intervention fidelity.8. For each step or activity in the intervention plan, identify the intervention week in which that activity will occur.9. Identify the theory or model that will serve as the framework for the project. Translational science models are recommended.10. Identify the primary premises or steps of the model and how they apply to your project design.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

40 pts

Includes all requirements and provides an in-depth description of the Translational Science Model and project management plan.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

36 pts

Includes all requirements and provides a sufficient description of the Translational Science Model and project management plan.

32 pts

Includes fewer than all requirements and/or provides a partial description of the Translational Science Model and project management plan.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

0 pts

Includes fewer than all requirements and/or provides an undeveloped description of the Translational Science Model and project management plan.

40 pts

This criterion is linked to a Learning OutcomePlans for Sustainability

Requirements:1. Create your detailed plan to sustain the project over time.2. Identify the specific strategies used to ensure the project has ongoing evaluation and modification as needed to ensure its success after your implementation phase is complete.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

20 pts

Includes all requirements and provides an in-depth plan for sustainability.

17 pts

Includes all requirements and provides a sufficient plan for sustainability.

14 pts

Includes fewer than all requirements and/or provides a partial plan for sustainability.

0 pts

Includes fewer than all requirements and/or provides an undeveloped plan for sustainability.

20 pts

This criterion is linked to a Learning OutcomeAnticipated Outcomes

Requirements:1. Provide an in-depth discussion connecting the outcome(s) you will measure with the intervention. Connect the intervention to your project outcome. The research articles supporting the intervention can also provide evidence that the intervention changes the outcomes. Describe how researchers have tested the intervention on the specific outcome and the research results demonstrate that the intervention effectively changes the outcome.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

40 pts

Includes all requirements and provides an in-depth discussion about the outcomes.

36 pts

Includes all requirements and provides a sufficient discussion about the outcomes.

32 pts

Includes fewer than all requirements and/or provides a partial discussion about the outcomes.

0 pts

Includes fewer than all requirements and/or provides an undeveloped discussion about the outcomes.

40 pts

This criterion is linked to a Learning OutcomeAppendices

Requirements:1. Johns Hopkins Evidence Table with a minimum of 10 research studies leveled and graded2. Data Collection Tools (if applicable)3. Compliance Checklist (Formative evaluation documents)4. Educational Offering Table (Outline)5. Informed Consent (if applicable)(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

30 pts

Includes all requirements and provides excellent appendices.

27 pts

Includes all requirements and provides a sufficient appendices.

24 pts

Includes fewer than all requirements and/or provides basic appendices.

0 pts

Includes fewer than all requirements and/or provides undeveloped appendices.

30 pts

This criterion is linked to a Learning OutcomeReferences

Requirements:1. Information in this manuscript must be substantiated by citations.2. Reference publication dates must be within the last 5 years.3. References must be from peer-reviewed journals, government websites, and credible national and global organizations.4. In-text citations should align with the reference page.5. In-text citations and references must be in the current APA format.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

10 pts

Includes all requirements and provides an excellent reference section.

9 pts

Includes all requirements and provides a sufficient reference section.

8 pts

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

0 pts

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

10 pts

This criterion is linked to a Learning OutcomeScholarly Writing Criteria

Requirements:1. Submit the paper on the DNP Project Manuscript Template.2. Use the headers in the template.3. Use the current APA style and format throughout the manuscript.4. Paper length is 10-12 pages.

10 pts

Includes all requirements and provides in-depth scholarly writing.

9 pts

Includes all requirements and provides a sufficient scholarly writing.

8 pts

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

0 pts

Includes fewer than all requirements of APA style and standards and/or provides undeveloped scholarly writing.

10 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

10 pts

Includes all requirements and demonstrates excellent clarity of writing.

9 pts

Includes all requirements and demonstrates sufficient clarity of writing.

8 pts

Includes fewer than all requirements and/or demonstrates basic clarity of writing.

0 pts

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

10 pts

Total Points: 240

Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example

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)(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example) 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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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%.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

The financial costs associated with 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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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:(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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)?

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(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example). 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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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 Dobber et al. (2018), Dobber et al. (2020), Harmacnci and Budak (2022), Zomahoun et al. (2017), 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). (Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Main Themes in the Research

The primary themes include success factors influencing MI positive effects, association between MI techniques and medication adherence, and MI impact on medication adherence. Regarding success factors influencing MI positive effects, Dobber et al. (2018) 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 and that a trusting relationship and empathy could help trigger mechanisms of change and enhance medication adherence(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example). 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 are associated with improved medication adherence (Palacio et al., 2019; Abughosh et al., 2019; Hogan et al., 2020; Harmanci & Budak, 2022). Regarding MI impact on medication adherence, Papus et al. (2022), Zomahoun (2018), Aubeeluck et al. (2021), and Khadoura et al. (2021) established a positive association between MI and medication adherence and associated factors self-efficacy and patients’ intrinsic motivation.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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. (2018) and Dobber et al. (2020) address the success factors influencing MI’s positive effects. 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), Zomahoun (2018), Aubeeluck et al. (2021), and Khadoura et al. (2021) address MI in general and its effectiveness in improving medication adherence.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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 (Dobber et al., 2018; Dobber et al., 2020; Harmacnci and Budak, 2022; Zomahoun et al., 2017; 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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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 is deliberately influencing 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(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example). 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 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.  (Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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’ 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 and mobilizes commitment, and sustain talk, which ensures the target behavior is sustained over time.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Methodology

            This section describes the organizational setting, project population, translation science model and project management, plans for sustainability, and anticipated outcomes.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Organizational Setting

The healthcare setting is a general mental health facility located in Los Angelos, California, for treating various mental health disorders. The organization adopts mental health teams based in communities, that offer daily support and treatment while helping schizophrenia patients gain independence. The teams include nurses, therapists, psychiatrists, psychologists, and social workers.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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 in the hospital between 11 days to 23 days, depending on the condition and symptoms severity. An experienced psychiatrist coordinates a team consisting of a combination of (Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers contributes to patient health management and outcome.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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 is: patients diagnosed with Schizophrenia according to the International Statistical Classification of (Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)Diseases-10 criteria, between 18 and 65 years, and receiving treatment for the last six months, follow-up patients, patients with multiple schizophrenia episodes, and patients with recent psychotic relapse after non-adherence to therapy will be considered. 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, which are suitable even for older patients. (Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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:(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

1. I identified medication non-adherence among schizophrenia patients as warranting EBP adoption.
2. Medication non-adherence is a priority for the organization as it is linked with 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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
4. I developed a practice question “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. I searched for peer-reviewed articles from various databases, including PubMed, MEDLINE, and CINAHL, addressing the impact of motivational interviewing on medication adherence.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
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. Ten articles were identified as providing 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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
7. The project team and I will implement motivational interviewing into a pilot program that includes follow-up schizophrenia patients only.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)
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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Project Management Plan

The DNP project implementation will take 12 weeks to complete. Week 1 will involve identifying participants and collecting pre-implementation data. In week 2, steps 1, 2, and 3 will be completed, including problem identification, priority determination, and team development. In week 3, steps 4, 5, and 5, 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 4 and through weeks 5, 6, 7, 8, 9, 10, and 11. Finally, in week 12, post-summative data after intervention implementation will be collected and outcomes evaluated, which is step 8 of the project implementation plan, to determine the effectiveness of motivational interviewing in addressing medication adherence among schizophrenia patients and whether it is suitable to implement in the rest of the organization and patient populations. See Appendix B for implementation plan table. (Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Formative Evaluation Plan

The formative evaluation will include individual evaluation conducted before, during, and after intervention implementation aiming 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 for formative evaluation plan table.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Plans for Sustainability

The sustainability objective is to ensure motivational interviewing’s organization-wide adoption and patients continues to enjoy its benefits in improving medication adherence over time. The project manager will have a checklist against which they will ensure that the intervention maintains alignment with the organization mission and vision statements and continues to achieve 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 that will require consistent data collection after project implementation. The project team will gather data on MI from patient records and the organization’s medical data regarding treatment failure, hospitalization, readmission, and mortality rates over time and patients’ self-reported surveys and interviews on changes in medication adherence behavior over time to measure the continual effectiveness of the intervention. The project team will continually conduct project auditing and feedback collection from providers, patients, family members, caregivers, and opinion leaders on the performance of MI post-implementation. The project team assigned with sustainability responsibilities will analyze the data and feedback to inform continuous quality improvement initiatives to ensure project sustainability. Additionally, ongoing provider and patient education will help ensure MI continues to improve medication adherence into the future.  (Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Anticipated Outcomes

Expected Change after Implementing Motivational Interviewing

Implementing motivational interviewing is expected to improve medication adherence behavior, which is indicated by measures including treatment failure, readmission, hospitalization, and mortality rates. The desired changes based on these measures include decreased treatment failure rate, reduced readmission rate, decreased hospitalization rates, and decreased mortality rate associated with Schizophrenia. Per Aubeeluck et al. (2021), MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. 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 RCTs and risky behaviors and disease symptoms in 19 RCTs. Additionally, Zomahoun (2018) established that MI interventions might help improve medication adherence for chronic conditions in adults. The evidence indicates a positive relationship between motivational interviewing and medication adherence, although measures used vary for the different studies. (Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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

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(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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

Dobber, J., Latour, C., de Haan, L., Scholte op Reimer, W., Peters, R., Barkhof, E., & van Meijel, B. (2018). Medication adherence in patients with Schizophrenia: a qualitative study of the patient process in motivational interviewing. BMC Psychiatry, 18(1), 1-10. https://doi.org/10.1186/s12888-018-1724-9(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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

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

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(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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

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

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(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

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.(Improving Medication Adherence Compliance in Schizophrenia Patients Essay Example)

Zomahoun, H. T. V., Guénette, L., Grégoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., Huiart, L., & Moisan, J. (2018). Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. International journal of epidemiology, 46(2), 589–602. https://doi.org/10.1093/ije/dyw273