Evidence Synthesis and Tables Comprehensive Nursing Paper Example

Evidence Synthesis and Tables Comprehensive Nursing Paper Example

Purposed statement

This paper aims to develop an evidence synthesis on motivational interviewing supported by technology as an evidence-based intervention for medication nonadherence.(Evidence Synthesis and Tables Comprehensive Nursing Paper Example)

The practice problem that this DNP project seeks to solve is treatment nonadherence among Schizophrenia patients. The majority of literature documents a high prevalence of nonadherence among patients diagnosed with Schizophrenia taking antipsychotic medication. A recent narrative review showed that Schizophrenia patients remain uninformed about medication, yet they value talks related to medications provided by healthcare professionals (Salzmann-Erikson & Sjödin, 2018). Remaining uninformed about medication is a significant barrier to treatment adherence, and practitioners are encouraged to adopt mechanisms to involve patients in their care.(Evidence Synthesis and Tables Comprehensive Nursing Paper Example)

Practice Problem

Evidence-Base Intervention (EBI)

The proposed intervention involves implementing technology with motivational interviewing (MI). Motivational interviewing will utilize OAR Model skills of open-ended questions, affirmations, reflective listening, and summary periods. MI is a long-standing EBI that primarily guides individuals to implement some changes (Mullen et al., 2020). MI utilizes the four principles of EDRS: expressing sympathy, developing discrepancy, rolling with client resistance, and supporting self-efficacy. In this regard, MI is considered direct and patient-centered counseling to help patients identify and resolve their ambivalent selves.(Evidence Synthesis and Tables Comprehensive Nursing Paper Example)

National Context

Nonadherence is a serious problem that affects patients and the healthcare system globally and in the United States. Globally, the rate of nonadherence to Schizophrenia treatment is 50% (Viveiros et al., 2020). Conversely, between 26.5% and 58.8% of patients diagnosed with Schizophrenia report nonadherence (Salzmann-Erikson & Sjödin, 2018). Nonadherence to the associated psychotic relapse, worsening of the disease, mortality, increased suicide risk, hospital readmission, and increased healthcare costs. The cost of nonadherence for schizophrenia medication with reference to the impact on health, resources, and costs is estimated at $116434 (Cutler et al., 2018).(Evidence Synthesis and Tables Comprehensive Nursing Paper Example)

Evidence Synthesis

            Researchers have used motivational interviewing as an EBI for various clinical issues, including medication adherence. Zomahoun et al. (2017) evaluated the efficacy of MI on medication adherence among adults diagnosed with chronic illnesses. The study found that MI interventions successfully promote medication adherence in adults diagnosed with chronic diseases, including Schizophrenia. Harmaci & Budak (2022) assessed the effect of psychoeducation through motivational interviewing on medication adherence, psychological/psychosocial well-being, and a sense of hope among schizophrenia patients. The findings showed that using motivational interviewing techniques to provide psychoeducation effectively promotes medication adherence.(Evidence Synthesis and Tables Comprehensive Nursing Paper Example)

Dobber et al. (2018) evaluated the interactions of MI among Schizophrenia patients. The study identified aspects of MI such as trusting relationships, integration of patients’ values, ability to adapt Motivational interviewing to patients’ situations, and their association with improved medication adherence among schizophrenia patients. Ertem & Duman (2019) assessed the effect of MI on insight levels and treatment adherence among schizophrenia patients. The findings showed improved medication adherence with MI. Chien et al. (2019) assessed the impact of adherence therapy through motivational interviewing among schizophrenia patients. The study findings revealed the cost-effectiveness of MI for medication adherence among schizophrenia patients, reduced rehospitalization, and positive psychosocial outcomes. The central theme highlighted across the studies is the positive role of MI on medication nonadherence. However, the different studies highlight the additional impact of MI on treatment-related factors such as patient insight, psychological/psychosocial well-being, and reduced rehospitalization.(Evidence Synthesis and Tables Comprehensive Nursing Paper Example)

Conclusion

The practice problem that this DNP project seeks to solve is treatment nonadherence among Schizophrenia patients. Most of the literature documents a high prevalence of nonadherence to medication among Schizophrenia patients taking antipsychotic medication (Salzmann-Erikson & Sjödin, 2018). Existing literature supports the effectiveness of MI on medication adherence and associated benefits, including psychosocial well-being, reduced rehospitalization, and insight (Zomahoun et al., 2017; Harmaci & Budak, 2022; Ertem & Duman, 2019; Chien et al., 2019). Therefore, the present hypothesizes enhanced medication adherence among participants.(Evidence Synthesis and Tables Comprehensive Nursing Paper Example)

References

Chien, W. T., Cheung, E. F., Mui, J. H., Gray, R., & Ip, G. (2019). Adherence therapy for Schizophrenia: A randomized controlled trial. Hong Kong Med J, 25(Suppl 2), 4-9(Evidence Synthesis and Tables Comprehensive Nursing Paper Example). https://pubmed.ncbi.nlm.nih.gov/30674700/

Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication nonadherence by disease groups: a systematic review. BMJ open, 8(1), e016982.(Evidence Synthesis and Tables Comprehensive Nursing Paper Example) https://doi.org/10.1136%2Fbmjopen-2017-016982

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.(Evidence Synthesis and Tables Comprehensive Nursing Paper Example) BMC Psychiatry, 18(1), 1-10. https://doi.org/10.1186/s12888-018-1724-9

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. (Evidence Synthesis and Tables Comprehensive Nursing Paper Example)https://doi.org/10.1177/10547738211046438

Mullen, A., Isobel, S., Flanagan, K., Key, K., Dunbar, A., Bell, A., & Lewin, T. J. (2020). Motivational interviewing: Reconciling recovery-focused care and mental health nursing practice. Issues in Mental Health Nursing, 41(9), 807-814. (Evidence Synthesis and Tables Comprehensive Nursing Paper Example)https://doi.org/10.1080/01612840.2020.1731891

Salzmann-Erikson, M., & Sjödin, M. (2018). A narrative meta-synthesis of how people with schizophrenia experience facilitators and barriers in using antipsychotic medication: Implications for healthcare professionals. International Journal of Nursing Studies, 85, 7-18. https://doi.org/10.1016/j.ijnurstu.2018.05.003

Viveiros, C. P., Tatar, C. R., Dos Santos, D. V. D., Stefanello, S., & Nisihara, R. (2020). Evaluation of nonadherence to treatment among patients with Schizophrenia attending psychosocial care centers in the south region of Brazil. Trends in psychiatry and psychotherapy, 42, 223-229.(Evidence Synthesis and Tables Comprehensive Nursing Paper Example) https://doi.org/10.1590%2F2237-6089-2019-0072

Zomahoun, H. T. V., Guenette, L., Gregoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., … & Moisan, J. (2017). 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.

Practice Question: For adults with a history of Schizophrenia in the inpatient setting, does implement technology with motivational interviewing (MI), compared with current practice, impact medication nonadherence in 8-10 weeks?

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