The Relationship Between Schizophrenia Patient Home Environment
And Compliance With Prescribed Medication
Research ProposalMedication Compliance: The relationship between
the schizophrenic patient and their home environment.By:Cristal
Denner (Student Nurse)00026891Josanne Julien (Student Nurse)Safiya
Mohammed (Student Nurse)Submitted to:Mrs. Beryl Brewster(Senior
Lecturer)College of Nursingand Allied Health In partial fulfillment
of
The requirements for the
Degree of
Bachelor of Science in NursingMarch, 2014Title: Medication
Compliance: The relationship between the schizophrenic patient and
their home environment.
Background/ IntroductionThe purpose of this study is to examine
if there is a link between prescribed medication compliance and the
patients home environment of patients who were readmitted at least
three (3) times within the past two (2) years on ward six (6) the
admission ward of St. Anns Hospital. This analysis would explore
the psychological, psychosocial, cultural and economic aspects that
would result in non compliance of medication.
Schizophrenia is a severe form of mental illness affecting about
7 per 1000 adults globally. Although the incidence is low, the
prevalence of schizophrenia is high as it is a long-term chronic
illness (World Health Organization, 2011). Antipsychotic medication
plays an important role in schizophrenia treatment and symptom
control. Effective management of schizophrenia requires continuous
long term treatment in order to keep symptoms under control and to
prevent relapse (American Psychiatric Association, 2006). Despite
the critical importance of medication, non adherence to prescribed
drug treatments has been recognized as a problem worldwide and may
be the most challenging aspect of treating patients with
schizophrenia (Barbato, 2011).
Non adherence to medication includes a range of patient
behaviours, from treatment refusal to irregular use or partial
change of daily medication doses. Partial adherence to medication
is at least as frequent as complete non adherence (Svestka and
Bitter, 2007). There is no single theory that explains adherence
issues, but rather a range of theories with their own strengths and
limitations (Weiden, 2007). Potential factors for non adherence may
be related to disease severity, treatment characteristics or even
external environmental factors such as therapeutic support (Llorca,
2008). Adherence factors may also be unique to the characteristics
of schizophrenia; factors such as cognitive impairment or lack of
illness insight may play an important role.
Key Words:
Medication Compliance: Refers to the degree or extent of
conformity to the recommendations about day to day treatment by the
provider with respect to the timing, dosage, and frequency. It may
be defined as the extent to which a patient acts in accordance with
the prescribed interval, and dose of a dosing regimen (Joyce.A,
2008).Home Environment: According to thedictionary.com, this is the
totality of circumstances surrounding an organism or group of
organisms, especially the combination of external physical
conditions that affect and influence the growth, development, and
survival of organisms
Schizophrenia: According to thedictionary.com, Schizophrenia is
a psychotic disorder (or a group of disorders) marked by severely
impaired thinking, emotions, and behaviors. Schizophrenic patients
are typically unable to filter sensory stimuli and may have
enhanced perceptions of sounds, colors, and other features of their
environment. Most schizophrenics, if untreated, gradually withdraw
from interactions with other people, and lose their ability to take
care of personal needs and grooming.Litrature ReviewNoncompliance
is an important predictor of hospitalization risk. Following
inpatient treatment and discharge from the community, many patients
become poorly compliant with therapy. Several reasons for poor
compliance have been hypothesized, including disease symptoms
(e.g., grandiosity, paranoia, problems with accurate recall),
treatment-emergent side effects, substance abuse, lack of support
systems to encourage medication compliance, psychostressors, and
poor patient-provider relationships. According to the article
Medication adherence and utilization in patients with schizophrenia
or bipolar disorder receiving aripiprazole, quetiapine, or
ziprasidone at hospital discharge: A retrospective cohort study
(Berger, 2012), Support for family education in mental health
leading to medication adherence in mentally ill clients, has been
highlighted in the literature review. Interventions like family
therapies and psycho-education can collaborate towards successful
treatment adherence, significantly reducing relapse and
re-hospitalization (Colom, F et al, 2004). Cardoso, L et al, 2011,
suggest that health education can also influence clients and
families involvement in health care. Consequently, considering
clients and families knowledge and beliefs on maintaining the
prescribed psychiatric treatment can help health professionals to
provide better orientations and health care to these clients
(Cardoso, L et al, 2011). Other studies shows over the course of a
year, about three-quarters of patients prescribed psychotropic
medication will discontinue, often coming to the decision
themselves and without informing a health professional. According
to the article Why dont patients take their medicine? written by
Mitchell & Selmes (2007) it is stated that the rate of
non-adherence with psychotropic medication are difficult to
summarise because they vary by setting, diagnosis and type of
adherence difficulty. However, found that non-adherent individuals
with schizophrenia have a 3.7-fold greater risk of relapse than
those who are adherent over 624 months. Where medication (or
appointments) are missed for predominantly illness-related reasons
such as lack of insight, there is a particularly high risk of
readmission. Yet illness severity probably accounts for a minority
of cases of poor adherence in the community (Maddox et al, 1994).
Further, the impact may be ameliorated if patients who have further
symptoms seek help. Unfortunately, adverse experiences with
medication may prejudice willingness to attend in the future
(Gonzalez et al, 2005). This proposal would explore the causes on
non-adherence, whether intentional or not, and discusses patients
reasons for failure to concord with medical advice, and predictors
of and solutions to the problem of non-adherence. The health belief
model views compliance as a decisions made by the patients after
weighing the perceived risks and benefits of treatment
(JClinPsychiatry, 2002). The health belief model describes a
person's health behaviour as an expression of health beliefs. The
model was designed to predict a person's health behaviour,
including the use of health services, and to justify intervention
to alter maladaptive health behaviour. Components of the model
include the person's own perception of susceptibility to a disease
or condition, the perceived likelihood of contracting that disease
or condition, the perceived severity of the consequences of
contracting the condition or the disease, the perceived benefits of
care and barriers to preventive behaviour, and the internal or
external stimuli that result in appropriate health behaviour by the
person, (Farlex, 2012). In addition, Dr. Pearl Brown (C. Moe,
Trinidad Guardian 2012) stated that she has clients who have mental
illness (schizophrenia), and with that understands that its very
important for those around them to be supportive. Coping with
schizophrenia is a challenging task, not only for the patient but
the entire family, as the behavior of schizophrenic patients is
difficult to predict. She also mentioned that these clients need
not only medication but counseling. The family has to adapt to the
illness and be aware of its consequences. Therefore, these support
groups are aimed at improving the lives of the mentally ill clients
and their families.Medication adherence is important in the ability
to adapt, as well as, the capacity to function. As nursing students
we have often observed the clients unwillingness to adhere to their
treatment regime, resulting in multiple hospital admissions, which
causes a great deal of turmoil for themselves and their relatives.
In this proposed study, we seek to look at the causation of the
patients unwillingness to utilize take their medications given to
them to try to curb relapse, rehospitalisation, poor outcomes and
high income costs. By embarking upon what are the causes of
compliance, we can be more successful in devising strategies for a
successful result.
This study is needed, to show whether or not the patients home
environment i.e. if they have the recommend meals that should be
taken with their medication, the family and community support and
acceptance of their illness and the necessary patient education
about medication compliance, as well as, its side effect can
contribute to compliance of medication by the schizophrenic
community.Research Question Is there a relationship between
schizophrenic patients home environment and compliance with
prescribed medication which leads to a relapse or readmission to
the psychiatric hospital?Aim(S)/Objectives Identify the causes of
non compliance of prescribed medication for schizophrenic
patients
Identify and utilize strategies to curb non compliance of
prescribed medication and curb rehospitalisation.
To educate participants about the importance of adherence to
prescribed medication
To assist family members in developing coping mechanisms to
provide adequate care for the mentally ill relatives.MethodAs
stated in the background, This proposal would examine the results
of compliance to medication of schizophrenic patients and evaluate
if the home environment is a contributing factor to these patients
rehospitalisation. Some schizophrenic patients do not fully comply
with treatment and thus this compliance links to relapse,
rehospitalisation, poor outcomes and high income costs. A patients
compliance to medication is an important and real-world problem. We
believe that as nursing students taking the initiative to try to
curb this problem, it would be beneficial to the families, the
clients, their respective communities and to us as well. Research
Design
For the purpose of our research question we chose to use a
descriptive research design in hope of exploring the patients and
their realives or caregivers perception and experiences on
medication compliance in relation to their home environment.
According to Smith 2011, phenomenology is the study of structures
of consciousness as experienced from the first-person point of
view; as such a phenomenological approach would be used for this
research as it allows for us the researchers to understand the
participants perception of the phenomenon of non compliance of
medication in relation to their home environment. By using this
paradigm, we are be able to get an insight of the situation from
the persons involved, and as a result create better solutions to
the problem as we would have an understanding of the issue from the
patients and their relatives or care givers perspective. Patton
(1990) stated the purpose of interviewing specifically as "to find
out what is in and on someone else's mind", and that is exactly
what the target of the phenomenological study focuses on, i.e. the
perception of lived experience. This approach challenges customary
structures of thinking and researching and can give the medical
team assigned to these patients a deeper insight of the problem
thus helping solve or reduce the incidence of rehospitalization.
The phenomenological approach seeks to limit and prevent researcher
bias, the major concern of phenomenological analysis is to
understand "how the everyday, inter-subjective world is
constituted" (Schwandt, 2000).
Population: The population for the study includes all
schizophrenic patients who were rehospitalized for at least three
(3) times in the past two (2) years.Sample: Fifteen (15)
Schizophrenic patients and their relatives or caregivers from the
admission ward, ward six (6) in St. Anns who have been readmitted
for at least three (3) times within the past two (2) years. The
sampling method we would be using would be purposive sampling
because of the purpose of the study and that we have prior
knowledge of the population being studied.
Inclusion criteria 1. Participants must be a patient and their
relatives or caregivers of ward six (6) St Anns Hospital
Patient
2. Patient must have been readmitted to ward six (6) at least
three (3) times with the past two (2) years.3. Patients can have
had at least one regular visiting relative or caregiver for them
during visiting days and hours.4. Patients that gave consent to
participate
5. DSM-III-R diagnoses of schizophrenia or schizoaffective
disorder (American Psychiatric Association 1987)Exclusion
Criteria1. Patents who are not schizophrenic patients2. Patients
who refused consent to participate3. Patients who were not
readmitted to ward six(6) at least three (3) times within the past
two (2) years.4. Patients of other wards besides ward six (6) of St
Anns Hospital.
Elements of the Design
Independent Variable: The patients home environment.
Dependent Variable: Compliance of medication
Data Collection
The principal method for our data collection would be
prearranged / informal interviews with guided questions. This would
help us to gather some versatility and allow the participants to
communicate their knowledge and views on the topic.The interviews
would start at 8am and would be completed by three in the afternoon
over a Five (5) day period because of the size of the sample. My
two collegues and myself would each interview a patient maximizing
the utilization of time.Each interview should not be more than one
hour long and would be documented via writing. No recording would
be done as it would be against hospital policy. Our reason for
using the interviewing method is because it is flexible and we
would have control over who is the respondent, as well as, over
sequence of questions. Pilot Study The timeframe in which the
research is to be completed is insufficient for one to be
conducted.Data Analysis (Interpretative Phenomenological
Analysis)
During our analysis of the data received we would suspend our
reflection upon our own preconception about the data and focus in
great detail on the participants interpretations of the phenomenon.
Transcripts are coded in considerable detail, with the focus
shifting back and forth from the key claims of the participants, to
the researchers interpretation of the meaning of those claims.
Interpretative Phenomenological Analysis hermeneutic stance is
one of inquiry and meaning making (Reid.k, 2005), and so we would
attempt to make sense of the participants attempts to make sense of
their own experiences. This analysis would be bottom up. This means
that we would generate codes from the data rather than using pre
existing theory to identify codes that may be applied to the data.
This system encourages an open-ended dialogue between the us and
the participants and, may therefore, lead us to see things in a new
light.
After transcribing the data, we would work closely and
intensively with the text, annotating it closely ('coding') for
insights into the participants' experience and perspective on their
world. As the analysis develops, we would catalogue the emerging
codes, and subsequently begin to look for patterns in the codes.
These patterns are called 'themes'. Themes are recurring patterns
of meaning (ideas, thoughts and feelings) throughout the text.
Themes are likely to identify both something that matters to the
participants (taking the medication) and also convey something of
the meaning of that thing, for the participants. E.g. when we study
we may find that patients dont take their medications because of
the side effects of such prescribed medication (where one key
psychosocial understanding of the meaning medication compliance, is
that it marks a socioeconomic for the patients and relatives or
caregivers involved).
Some themes will eventually be grouped under much broader themes
called 'super ordinate themes'. For example, patients not having
anything to eat in order to take their medication would result in
negative side effects or relatives or caregivers that do not give
the patients the prescribed medication would observe negative
emotional effect might be a super ordinate category which would
capture a variety of patterns in participants' embodied, emotional
and cognitive experiences, where we might expect to find sub
themes. The final set of themes are typically summarised and placed
into a table or similar structure where evidence from the text is
given to back up the themes produced by a quote from the text.
Work Plan/ Time Scale
The time frame for the completion of this research is ten weeks,
the following table illustrates the approximate time frame
allocated to the completion of the various aspects of this
research.WEEK 1WEEK 2&3WEEK 4&5WEEK 6WEEK 7&8WEEK 9WEEK
10
Formulation of research question and problem statementFormulate
research proposalSeek legal permission to conduct research
Formulate questionnaireCollect dataAnalyse dataWrite up findings
and conclusionPresent research
Ethical Consideration
According to Polit and Beck (2010), researchers must deal with
ethical issues when their intended research involves human beings.
Ethical approval will be requested in writing from the Director of
Nursing and the Hospitals Ethics Committee. The director of Nursing
must be made aware of all nursing research taking place in the
organization to monitor the effect of all such projects taking
place. They will also need to be convinced of the value of the
research and the competency of the researcher (Lee 2005).
The main ethical principles that will be considered in
conducting this research study are respect for persons,
confidentiality and beneficence /non-maleficence
Respect for persons
As individuals are autonomous beings they will have the right to
decide whether or not they participate in this research. This fact
will be stated clearly at the beginning of the interviews. Informed
consent would be sought from research participants. Before consent
is sought the researcher will give details of the nature and
purpose of the research, the potential subjects, who will have
access to the data and the proposed outcome of the research.
Completion of the interview process by participants will be taken
as their consent to participate in the study. Participants will be
given adequate time to consider their participation. The
participants would have the assurance that the interview will be
terminated at any point of the interview process upon their request
to withdraw themselves from the research
Confidentiality
To maintain anonymity and privacy of the respondents pseudo
names would be used to protect the identity of the participants,
this would encourage participants to speak freely without fear of
victimization.Beneficence/non-maleficence
While interviews tend to be intrusive and would create a level
of discomfort for the participants, it is possible for sensitive
and highly personal questions to be threatening if they trigger
feelings of guilt when the respondent is alone. Should the
interviewer sense any discomfort on the part of the interviewee
during the interview, the interview would be terminated unless the
respondent wishes to continue. Parahoo (2006) maintains that
questions on knowledge, behavior or experience may also be
threatening to health professionals if data can be accessed by
their employers. A written and verbal guarantee will be given to
the participants that the data collected will remain confidential
and that only the researchers will have access to it. Additionally
the interview tapes and data would be coded in that instead of the
respondents names a pseudo name would be used for example
participant A dated 12/4/13, this way their responses would not be
identifiable. The interview would be conducted in a private area;
no identifiable information would be printed or recorded in this
research.
Justice No fabricated information would be recorded in our
findings, the results presented would be factual as stated in the
interview by the respondents and would not be tweaked in any way to
satisfy the researchers involved. The final report will be factual
and free of accusations
Limitations The research quality is heavily dependent on the our
skills and can more easily be influenced by the our personal biases
and idiosyncrasies.
Rigor is more difficult to maintain, assess, and
demonstrate.
The volume of data makes analysis and interpretation time
consuming.
Our presence during data gathering, which is often unavoidable
in qualitative research, can affect the subjects' responses.
Issues of anonymity and confidentiality can present problems
when presenting findings
Findings can be more difficult and time consuming to
characterize in a visual way.
Resources
Resources Needed Human, Material/ Equipment, Financial
Human Resources
Cristal Denner
Josanne Julien
Safiya Mohammed
We all collaborated in the research proposal:
Title
Background/ Introduction Literature Review
Research question
Aims/objectives
Plan of Investigation/Method
Each part would be shared equally with an input from all
researchers according to our strengths and weaknesses. Effective
communication would be utilized through scheduled meetings and
social media. All parts would be reviewed and discussed before the
final draft was done.
The study will be directed by Mrs. Cristal Denner responsibility
would entail getting the approval from the hospital and ward sister
of ward six (6) of St. Anns Hospital, interviewing and data
collection. Ms. Josanne Julien responsibility would entail
interviewing and data collection Ms. Safiya Mohammed responsibility
would entail interviewing and data collectionThe data analysis
would be collaboratively done by all three of us as well as the
medical team assigned to ward six (6) of St. Anns Hospital
Types of Resources used:
These resources would be used after consent is obtained from the
relevant sources to carry out the research. Electronic Data Bases
would also be used to find articles and journals on a variety of
topics relating to our investigation, as well as periodicals from
professional organizations and governmental agencies. Also, several
educational texts geared towards the purpose of the study would be
sourced and used to increase the depth of knowledge.
Support and Training:
At COSTAATT, the Senior Lecturer/Qualified Nurse/Experienced
Researcher, Mrs. Beryl Brewster was available every week to extend
support, assistance and guidance in our endeavor of completing our
research proposal. As inexperienced researchers we will seek
assistance and support from the nurses and other health care
workers of the St Ann Pyschiatric Hospital.
Budget
Project Expenses:- duration of the project Ten weeks
Research staff salaries (1320.00) x 3$39,600.00
Transportation:- To and from destinations (per team member) @
$300.00
Stationery:-
Pen
Pencils Eraser
Ruler
Notepads Computer Educational aids
Printing paper
Materials and Supplies:-
envelopes,
Postage
Stapler & staples
Other expenses:- Misc.
Consultant to review
Grand total
References
Paula Balls, P. B. (2009). Phenomenology in nursing research:
methodology, interviewing and transcribing. nursing times ,
105:21.
Vicki A. Keough, P. R.-B. (2011). Survey Research: An Effective
Design for Conducting Nursing Research. Journal of Nursing
Regulation , 37-44. Patton, M. Q. (1990). Qualitative Evaluation
and Research Methods ( 2nd ed.). Newbury Park, CA: Sage Schwandt,
T. A. (2000). Three epistemological stances for qualitative
inquiry: Interpretivism,
hermenutics, and social construction. In N. K. Denzin & Y.
S. Lincoln, (Eds). Handbook
of qualitative research, p. 189- 213. Thousand Oaks, CA: Sage
Smith, David Woodruff, "Phenomenology",The Stanford Encyclopedia of
Philosophy (Fall 2011
Edition), Edward N. Zalta(ed.), URL =
.. Polit D.F. & Beck C.T. (2010) Essentials of Nursing
Research: Appraising Evidence for
Nursing Practice, 7th edn. Wolters Kluwer Health / Lippincott
Williams& Wilkins, Philadelphia.
rhttp://www.tcd.ie/Library/support/subjects/nursing-midwifery/assets/General%20Research%20Proposal_1.pdf
Parahoo K. (2006) Nursing Research: Principles, Process and Issues,
2nd edn.
Palgrave Macmillan, Houndsmill. Lee P. (2005) The process of
gate keeping in health care research. Nursing Times
101 (32), 36. Reid.k, F. a. (2005). Exploring lived experience:
An introduction to Interpretative Phenomenological Analysis. The
Psychologist, , 18:1, 20-23. Joyce. A. (2008). Medication
Compliance and Persistence:. www.ispor.org , volume 11 issue 1.
American Psychiatric Association. (2006). Evidenced Based
Treatments for Schizophrenia: information for families and other
Supporters. Arlington: VA: American Psychiatric Association.
Barbato, A. (2011). Shizoprenia and public health. Geneva: world
health organization.
ADHERENCE TO LONG-TERM THERAPIES: EVIDENCE FOR ACTION. (n.d.).
WHO. Retrieved March 17, 2014, from
http://www.who.int/chp/knowledge/publications/adherence_report/en/
Llorca, P. (2008). Partial compliance in schizophrenia and the
impact on patient outcomes. Psychiatry Research, 161(2),
235-247.
Result Filters. (n.d.). National Center for Biotechnology
Information. Retrieved March 17, 2014, from
http://www.ncbi.nlm.nih.gov/pubmed/18284273
Svestka, j., & Bitter, I. (2007). Nonadherence to
antipsychotic treatment in patients with schizophrenic disorders.
PubMed, 28, 95-116. Retrieved March 17, 2014, from the pubmed
database.
environment. (n.d.). The Free Dictionary. Retrieved March 17,
2014, from http://www.thefreedictionary.com/environmentAppendix
1
CURRICULUM VITAE OF RESEARCHERSSafiya Mohammed
#68 Sugar Road. Princes Town
Tel #: 768-8425
Email: [email protected]: 23 yearsEducation:
College of Science, Technology and Applied Arts of Trinidad and
Tobago- COSTAATT 2009 - Present
St Kevin College. 2000 2002 Ste Madeleine Secondary School
Jordan Hill Presbyterian Primary School 1990-1995
Qualifications:
BSc Nursing 2009 - Present
Certificate of Achievement :Geriatric Adolescent Partnership
Programme Caribbean Examinations Council Secondary Education
Certificate: English A, Mathematics, Human and Social Biology,
Principles of Business, Geography, Social Studies, History,
LiteratureWork experience:
Student Nurse 2009 present
Princes Town Regional Corporation (Clerk) Trinidad Industrial
Frabic Filters (Clerk)Research experience:
Classes in preparation for research project: Libs 150
Introduction to Research, Statistics, Epidemiology, Nursing
Informatics, Nursing Science, Nursing Communication.
Guidance was also given by Mrs. Beryl Brewster, Senior Lecturer
at COSTAATT and Researcher.
Cristal DennerSummary of QualificationsMathematics 3
English 3
Social Studies 3 Principles of Business 2Work ExperienceSenior
CashierFebruary 2007 to March 2008Super Pharm - Gulf View, La
Romaiin Mainly cashing dutiesBalance draw at end of salesHelp re -
shelf merchandise in storeApprentice Customs ClerkDecember 2006 to
March 2007General Marketers - Marabella, san Fernando Clearance of
ship spheres off the port Preparation of customs documentgetting
the customs documents approvedApprentice Customs Clerk/ Shipping
ManagerJanuary 2005 to March 2006Brokerage Solutions Ltd -
Aranguez, San Juan clearance of items on the portsshipping items to
clients in the CARICOM Preparation of customs documentgetting the
customs documents approvedSales ClerkDecember 2003After Nine
Clothing Store - Gulf View, La Romaine Restocking Clothes after
saleSales to customer
Ensuring the store is Cleaned and ready for next day
#12 Everglade Avenue, Maloney Gardens, D'Abadie, Arima 868 Home:
nil - Cell: 472 - -6836 : [email protected] of
Accounts 3 Agricultural Science 2
Home Management 2 Food and Nutrition 3
Specialized Training
Bachelor of Science : Psychiatric Nursing, 2014COSTAATT -
Eldorado, Tacarigua, TrinidadCurrently pursuing full time and i am
currently in my final yearResearch experience:
Classes in preparation for research project: Libs 150
Introduction to Research, Statistics, Epidemiology, Nursing
Informatics, Nursing Science, Nursing Communication.
Guidance was also given by Mrs. Beryl Brewster, Senior Lecturer
at COSTAATT and Researcher.
Josanne JulienProfessional Summary
Morne Coco Road , Maraval, Port of Spain 868 Home: 629-6711 -
Cell: 377-8884 / 4644531 : [email protected] consider
myself to be proficient at flexing and bending with change,
practiced in resolving customer concerns in a professional and calm
manner, and balancing customer's needs with company demands.
Therefore I believe that I will be an asset to your business if
given the chance.LicensesMy CXC passes include:English A II English
B IIHuman and social biology B Office procedure II Principals of
accounts III Principal of business III Mathematics III
Skill Highlightsi am dependablei am a fast learner
i give attention to detail i am easy going
Professional ExperienceSelf Employed ( Food Catering)January
2003 to August 2009Part Time Patient Care AssisstantJanuary 2009 to
November 2011
Effective team playerSuperior communication skills Cheerful and
energetic Flexible schedulingEffective team playerEducation and
Training
Bachelor of Science : General Nursing, 2014COSTAATT - Eldorado,
Tacuarigua, TrinidadAdditional InformationI will be begin my final
year as a student at this collage in January 2014 to become a
registered nurse. The goal of this collage is to transform one
student at a time, and I can say without a doubt, that I have been
transformed for the better because I have prove to myself that I
could do anything that I put my mind too.Research experience:
Classes in preparation for research project: Libs 150
Introduction to Research, Statistics, Epidemiology, Nursing
Informatics, Nursing Science, Nursing Communication.
Guidance was also given by Mrs. Beryl Brewster, Senior Lecturer
at COSTAATT and Researcher.
Appendix 2Treatment Non-Adherence Assessment Tool A. Patient
Perspective:
1. Do you feel you have a mental illness? Yes No
2. What symptoms do you experience?
3. Do you believe you require medications? Yes No
4. Have you taken medications in the past? If so, which ones and
for how long?
5. Do you feel these medications helped manage your symptoms?
Yes No
6. Have you ever taken medications that caused problems for you,
such as, making you experience strange movements, sleepiness,
weight gain, sexual problems, blurred vision, or other problems?
Yes No (Have patient explain, if yes.)
7. Did your mental health provider explain the reasons for
taking medications and what he/she expected the medications to do
for you? Yes No
8. Are you willing to start medications, continue current
medications, or try different medication(s)? Start Continue Current
Try Different
9. Have you ever discontinued your medications by yourself, or
just allow yourself to run out of medication(s)? If so, why?
10. Have you ever skipped doses of your medication(s)? Yes
No
11. Have you ever been given a prescription that you decided not
to fill? Yes No
12. Have you ever decided to use drugs or alcohol instead of
taking your medication(s)? Yes No
13. Do you often forget to take your medication(s)? Yes No
14. Do you ever feel like you are being forced to take
medications against your will? Yes No
15. Do you ever say you are taking your medications to please
your provider? Yes No
16. Have you ever purposefully discontinued taking your
medication because you were no longer in the hospital? Yes No
B. Family, Friends, Significant Other Perspective:
1. Do you feel the patient understands the need for his/her
medications(s)? Yes No
2. Do you have to monitor the patient to ensure he/she takes the
medications?
3. Yes No
4. Do you have to go to the pharmacy with the patient to fill
his/her medication to make sure it gets done? Yes No
5. Do you feel current medications are helping the patient,
making him/her worse, or having no effect? Helping Worsening No
Effect
6. Is the patient willing or unwilling to keep appointments with
his mental health provider? Willing Unwilling
7. Have you noticed, or has the patient verbalized to you any
significant adverse effects he/she has experienced since being
prescribed the medication(s)? Yes No
8. Do you know if this patients diet contains adequate
nutritional content, specifically adequate protein? Yes No
Appendix 3
Criteria for the Diagnosis of Schizophrenia (DSM-IV-TR, 2000,
p.312). A. Characteristic Symptoms: Two (or more) of the following,
each present for a
Significant portion of time during a one-month period (or less
if successfully treated):
(1) delusions
(2) hallucinations
(3) disorganized speech (e.g. frequent derailment or
incoherence)
(4) grossly disorganized or catatonic behavior
(5) negative symptoms (affective flattening, alogia, or
avolition).f
Note: Only one criterion A symptom is required if delusions are
bizarre or hallucinations consist of a voice keeping up a running
commentary on the persons behavior or thoughts, or two or more
voices conversing with each other.
B. Social/Occupational Dysfunction: For a significant portion of
the time since the
Onset of the disturbance, one or more major areas of functioning
such as work,
Interpersonal relations, or self-care are markedly below the
level of achieved prior to the onset (or when the onset is in
childhood or adolescence, failure to achieve expected level of
interpersonal, academic, or occupational achievement).
C. Duration: Continuous signs of the disturbance persist for at
least 6 months. This 6-month period must include at least one month
of symptoms (or less if successfully treated) that meet Criterion A
(i.e., active-phase symptoms) and may include periods of prodromal
or residual symptoms. During these prodromal or residual periods,
the signs of the disturbance may be manifested by only negative
symptoms, or two or more symptoms listed in Criterion A present in
an unattenuated form (e.g., odd beliefs, unusual perceptual
experiences).
D. Schizoaffective and Mood Disorder Exclusion: Schizoaffective
Disorder and Mood Disorder with Psychotic Features have been ruled
out because either (1) no Major Depressive, Manic, or Mixed
Features have occurred concurrently with active-phase symptoms; or
(2) if mood episodes have occurred during active-phase and residual
periods.