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NR705-WEEK 2 Discussion-Prescreening Process

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NR705-WEEK 2 Discussion-Prescreening Process

Practice Question

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 nonadherence (O) in 8-10 weeks (T)?

NR705-WEEK 2 Discussion-Prescreening Process

Process of Completing IRB Prescreening Supplement Form

Any project involving human participants requires IRB approval (Rooney et al., 2019). Chamberlain’s Institutional Review Board’s permission is needed to collect and or implement the DNP project, which involves schizophrenia patients, at the practicum site. The approval requires the filling of the IRB Prescreening Supplement. To complete the form, personal details are required, including student name, email, ID, project working title, practicum site name, preceptor’s name and contact, and key decision-makers’ contact details. The form is completed in various sections. Section I requires a description of the practice problem and the need for the project. Section II requires the provision of the practice question and the definition of the population. In section III, the student should provide a weekly implementation plan or protocol, generally, what will be done each week of the project implementation phase and the resources needed. Section IV requires describing a plan for educational offerings. Section V is the IRB completion that requires the student to thoroughly explain the data collection plan, measurable outcome identified in the practice question, names of tools and instruments used and their validity and reliability. In this section, the student should also elaborate a data analysis plan, identify statistical tests, plan to ensure participant’s confidentiality and safeguard data over time, and results dissemination plan.   The steps for the IRB prescreening review form include determining whether the project is “Research” as defined by the IRB, whether the project involves human subjects, whether the practice setting requires IRB review, and whether the project interacts with a vulnerable population. The last section of the IRB Prescreening Supplement Form involves confirmation of the various project aspects after completion.

(NR705-WEEK 2 Discussion-Prescreening Process)

Project Status

The project is still in the approval stage, but the research team is working with participants towards data collection, which will only be completed after IRB approval. However, the preparation is necessary, including explaining to participants what is expected of them, the method, instruments and duration of data collection. Generally, the team is in the initial stages of the implementation, and the organization I am working with is already aware of the project implementation, the intervention, and the involvement of schizophrenia patients in the study.

References

Rooney, L., Covington, L., Dedier, A., & Samuel, B. (2019). Measuring IRB Regulatory Compliance: Development, Testing, and Use of the National Cancer Institute StART Tool. Journal of empirical research on human research ethics: JERHRE, 14(2), 95–106. https://doi.org/10.1177/1556264619831888

 
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NR705-WEEK 3 Discussion-The DNP Practice Change Project

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NR705-WEEK 3 Discussion-The DNP Practice Change Project

The Data Collection and Analysis Plan

Practice Question

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 nonadherence (O) in 8-10 weeks (T)?

NR705-WEEK 3 Discussion-The DNP Practice Change Project

Plan to Protect Participant’s Confidentiality and Identity

Confidentiality involves the protection of human participants’ personal identifiers or personally identifiable data. It is an agreement between the researchers and the participants provided via informed consent as a guarantee that the participant’s identity and private or personal details and responses are not disclosed to unauthorized individuals or people outside the research team without consent (Purdue University, 2019). It is difficult for researchers to guarantee confidentiality when collecting identifiable details because there are limitations to confidentiality, including mandatory reporting laws and inspection of research data and records by IRB or the sponsor (Turcotte-Tremblay et al., 2018). Nonetheless, participants should know how their information will be stored during and after research (Purdue University, 2019). To protect participants’ data in this research and protect their identity, the project team will encrypt computer-based files, store documents like signed consent forms in locked file cabinets, and avoid using personal identifiers in study documents. Additionally, codes will be substituted for participant identifiers.

The information collected during the project development and implementation will be used over time and stored for future reference. The project team will establish a data management plan to protect and maintain the data over time. Physical documents will be stored in an environment with controlled access and under industry regulations such as HIPPA, SOC-2, and PIPEDA (University of Nevada, 2021). Staff authorized to access and utilize the data will receive routine security training to ensure best practices regarding participants’ data protection, including identifying new security threats, enforcing data protection regulations, and identifying better ways to secure the data (Turcotte-Tremblay et al., 2018). The data will be backed up to protect it from loss, system failure, or potential destruction. The data will be stored securely after this project, and it can be retrieved in future for similar projects.

References

Purdue University. (2019). Important considerations for protecting human research participants. https://www.purdue.edu/research/dimensions/important-considerations-for-protecting-human-research-participants/

Turcotte-Tremblay, A. M., & Mc Sween-Cadieux, E. (2018). A reflection on the challenge of protecting confidentiality of participants while disseminating research results locally. BMC medical ethics, 19(Suppl 1), 45. https://doi.org/10.1186/s12910-018-0279-0

University of Nevada. (2021, July 13). 410. Maintaining Data Confidentiality. https://www.unr.edu/research-integrity/human-research/human-research-protection-policy-manual/410-maintaining-data-confidentiality

 
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NR705-WEEK 2 Discussion-Prescreening Process

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NR705-WEEK 2 Discussion-Prescreening Process

Practice Question

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 nonadherence (O) in 8-10 weeks (T)?

NR705-WEEK 2 Discussion-Prescreening Process

Process for Completing the IRB Prescreening Supplement Form

The project involves human participants; hence an IRB approval is necessary. The IRB will examine all the supporting documents, including applications, consent documents, recruitment materials, study instruments, and data collection instruments, such as surveys, interview questions, stimuli, and other forms or documents that the human participants will utilize (Rooney et al., 2019). The IRB Prescreening Supplement Form requires elaborating and specifying the expected duration of the participant’s participation, describing the procedures required or to be followed in the project, identifying procedures that might be experimental, and describing any reasonably foreseeable risks or discomforts to the participants. The IRB will review the consent forms and the informed consent process to ensure that the research study provides adequate details and in a language that is easily and readily understandable to the individuals volunteering to be the research participants (Rooney et al., 2019). The IRB application also requires a clear description of the research design and its suitability for human participants.

Project Status

The project is still at the approval stage, but the research team is working with participants towards data collection, which will only be completed after IRB approval. However, the preparation is necessary, including explaining to participants what is expected of them, how the data will be collected, for how long the data will be collected, and the methods and instruments that will be used to collect the data. Generally, the team is in the initial stages of the implementation, and the organization I am working with is already aware of the project implementation, the intervention, and the involvement of schizophrenia patients in the study.

References

Rooney, L., Covington, L., Dedier, A., & Samuel, B. (2019). Measuring IRB Regulatory Compliance: Development, Testing, and Use of the National Cancer Institute StART Tool. Journal of empirical research on human research ethics : JERHRE, 14(2), 95–106. https://doi.org/10.1177/1556264619831888

 
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Week 6 Final DNP Project Manuscript

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Week 6 Final DNP Project Manuscript

(Week 6 Final DNP Project Manuscript)

Methodology

This section describes organizational setting, project population translation science model and project management, plans for sustainability, and anticipated outcomes.

Week 6 Final DNP Project Manuscript

Organizational Setting

The healthcare setting is a general mental health facility for treating various mental health disorders. The organization adopts mental health teams based in communities, especially for schizophrenia patients, that offer daily support and treatment while helping schizophrenia patients gain as much independence as possible. Mental health teams based in communities are more suitable for the patient population because most schizophrenia patients live with their families. The teams include nurses, therapists, psychiatrists, psychologists, and social workers. The healthcare organization is located in Los Angeles, California. The healthcare organization is located in Los Angeles, California.

The study focuses on schizophrenia patients with schizophrenia as the primary diagnosis. Schizophrenia is associated with significant thinking or cognitive, behavioral, and emotional problems. Individuals between the ages of 16 and 25 years are the most vulnerable, although new schizophrenia cases begin increasing 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 each month either 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 for days, ranging between 11 days to 23 days, depending on the condition and symptoms severity. A full-team approach is adopted in addressing schizophrenia at the healthcare organization. A combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers contributes to patient health management and outcome. The psychiatrist experienced or specialized in treating schizophrenia guides disease treatment and management, supported by other members of the treatment team that help coordinate care. (Week 6 Final DNP Project Manuscript)

Population

The project population typically includes schizophrenia patients experiencing thinking or cognitive, behavioral, and emotional problems. The patient population consists of both men and women reporting at the facility or requesting home visits from the mental health team based in the communities. The study will include 50 consecutive schizophrenia patients following up with treatment at the facility or home. The inclusion criteria required patients diagnosed with schizophrenia according to the International Statistical Classification of Diseases-10 criteria, patients aged between 18 and 65 years, patients receiving treatment for the last 6 months, follow-up patients, patients with multiple schizophrenia episodes, and patients with recent psychotic relapse after nonadherence to treatment. The exclusion criteria include acutely psychotic patients during the interview and patients with cognitive deficits impacting the interview or data collection. Existing users of health services at the facility will be requested to participate in the study. Informed consent will be required to collect data on the participants. Any follow-up schizophrenia patient attending psychiatric evaluation in the inpatient or outpatient departments will be recruited for the study after consent. The first 50 consecutive schizophrenia patients that fit the inclusion criteria will be involved in the study. Participation requests and details of the study will first be communicated via text messages, which are suitable even for older patients. (Week 6 Final DNP Project Manuscript)

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). The Iowa model offers a systematic approach to synthesizing knowledge and research findings transformation to enhance patient outcomes and quality of care. The primary purpose of this model is to increase research findings’ meaningfulness and utility in clinical decision-making (Iowa Model Collaborative et al., 2017). The Iowa model is an application-oriented EBP process guide with the following primary steps:

  1. Identifying either a knowledge-focused or problem-focused trigger that warrants EBP adoption.
  2. Determining if the identifying problem is a priority for the institution, practice, department, or clinical setting (Cabarrus College of Health Sciences, 2023).
  3. Establishing a team to develop, examine, and implement the required EBP change. This must be representative and interdisciplinary to evaluate and adopt the EBP change better.
  4. Gathering and analyzing evidence related to the identified change, including developing the research question and performing a literature search using identified keywords.
  5. Critiquing and synthesizing the collected research evidence to determine whether the EBP change is scientifically supported, sound, and clinically significant.
  6. Assessing whether the evidence is sufficient to implement the EBP change.
  7. Implementing the EBP change into a pilot program rather than a full practice change, for instance, implementing the change in a single nursing unit rather than the entire organization.
  8. Evaluating outcomes or results to determine whether the change achieves its objectives, is feasible, and if it is appropriate to adopt it within the organization. Implementation results’ observation, evaluation, and analysis should continue even after full-practice implementation (Cabarrus College of Health Sciences, 2023).

Per the Iowa model, the DNP practice project development and implementation includes the following steps:

  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 comprised 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.
  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 nonadherence (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.
  5. I reviewed the articles based on their abstract, research purpose, methodology, research findings, evidence level and quality and presented 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.
  7. The project team and I will implement motivation interviewing into a pilot program that include follow-up schizophrenia patients only.
  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. (Week 6 Final DNP Project Manuscript)

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, which include problem identification, determination of priority, 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. 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. (Week 6 Final DNP Project Manuscript)

Table 1: Implementation Plan

Week Activity
Week 1 Pre-implementation data collection.
Week 2 Step 1: Problem identification

Step 2: Determining whether the problem is priority to the organization

Step 3: Team development
Week 3 Step 3: Evidence gathering and analysis

Step 4: Research articles critique and synthesis

Step 5: Evidence assessment for adequacy
Week 4 Step 7: Intervention implementation
Week 5 Step 7: Intervention implementation
Week 6 Step 7: Intervention implementation
Week 7 Step 7: Intervention implementation
Week 8 Step 7: Intervention implementation
Week 9 Step 7: Intervention implementation
Week 10 Step 7: Intervention implementation
Week 11 Step 7: Intervention implementation
Week 12 Post-summative data collection

Step 8: Outcome evaluation

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. This evaluation plan will increase the likelihood of attaining successful results or outcomes through continuous improvements informed by evaluation results at different project implementation steps. (Week 6 Final DNP Project Manuscript)

Table 2: Formative Evaluation Plan

Week When Why How (Oversight)
Week 1 Pre-project implementation ·         Understand the need for the project ·         Leadership meetings
Week 2 Project development ·         Clarify the need for the project ·         Problem tree analysis

·         Priority Matrix

·         Stakeholder analysis
Week 3 Project development ·         Clarify the need for the problem

·         Identify problem impact

·         Clarify intervention selected

 ·         Literature review

·         Solution tree analysis
Week 4 Project implementation ·         Develop project design before roll-out ·         Focus group

·         Discussions
Week 5 Project implementation ·         Improve project design as it is rolled out ·         Semi-structured interview

·         ORID

·         Project diary
Week 6 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 7 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 8 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 9 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 10 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles and meetings
Week 11 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles and discussions
Week 12 Post-project implementation ·         Ensure project is completed successfully. ·         Leadership meetings

·         Project team discussions

·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

 

Plans for Sustainability

The sustainability objective is to ensure motivational interviewing is adopted organization-wide and the organization continues to enjoy its benefits in improving medication adherence over time. The sustainability plan will ensure the sustainability objective is achieved. Continuous quality and performance improvement is a post-implementation objective to help ensure the project’s sustainability. First, critical success factors will be developed, including medication adherence measures that will help assess the continued effectiveness of the intervention. Critical success factors include a substantial decrease in treatment failure, hospitalization, readmission, and mortality rates among schizophrenia patients. Consistent improvement of medication adherence and persistent behavior, including patient motivation, self-efficacy, and change and sustain talk, are critical success factors that will also help determine sustainability.

Data collection, observation, and analysis will allow the organization to measure the continual effectiveness of the intervention. Patient records and the organization’s medical data will provide information regarding treatment failure, hospitalization, readmission, and mortality rates over time. Self-reported surveys and interviews will help gather qualitative data to determine changes in medication adherence behavior over time. Project auditing and feedback collection from various stakeholders will also offer insights into the performance of the intervention after implementation and over time. The team selected for patients’ health management and outcome, patients, leaders, and observers will offer feedback regarding the project to help with continuous improvement. Opinion leaders’ involvement and evaluation will help improve the intervention and ensure sustainability. Opinion leaders include external and internal experts, educators, and organizations that advocate for the project; their insights will be critical. The data from these data and insight sources will inform sustainability strategies for continuous quality improvement. Additionally, continuous quality and performance improvement and suitability over time will be achieved through continuous patient and provider education on motivational interviewing and medication management and summative evaluation of education outcomes. Ongoing provider and patient education will help ensure the sustainability of project benefits over time. (Week 6 Final DNP Project Manuscript)

Anticipated Outcomes

Relationship between Motivational Interviewing and Medication Adherence

The primary purpose of motivational interviewing is to enhance medication adherence among schizophrenia patients. Motivation interviewing and medication adherence have a direct relationship, which involves one value directly affecting another, such as variables increasing and decreasing together. In this case, motivational interviewing has no values that increase or decrease, and the presence or absence of it will be analyzed in this paper. Data will be collected for medication adherence measures, which include treatment failure rate, readmission rates, hospitalization rates, and mortality rates, before implementing motivational interviewing and after the implementation. The expectation is a direct causal relationship such that when motivational interviewing is implemented, medication adherence behavior, which will be measured using the indicated medication adherence measures. This direct causal relationship is described as “the implementation of motivational interviewing improved medication adherence” or “motivational interviewing was positively associated with medication adherence.” (Week 6 Final DNP Project Manuscript)

Expected Change after Implementing Motivational Interviewing

Implementing motivational interviewing is expected to improve medication adherence behavior, which is indicated by measures including treatment failure rate, readmission rates, hospitalization rates, 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. (Week 6 Final DNP Project Manuscript)

References

https://www.ncbi.nlm.nih.gov/books/NBK20369/#:~:text=There%20are%20many%20different%20mental,or%20behaviors%20in%20distinct%20ways.

 
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PRE250397 Week 7: The Value of Peer Review

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Week 7: The Value of Peer Review

(PRE250397  Week 7: The Value of Peer Review)

 Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

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 nonadherence (O) in 8-10 weeks (T)? (PRE250397  Week 7: The Value of Peer Review)

PRE250397 Week 7: The Value of Peer Review

The Value of the Peer Review Process of offering Feedback as a Future DNP-Prepared Nurse Leader

Peer review refers to team-based learning adopted to encourage reflection on individual behavior, offer professional skills development opportunities, and encourage people to contribute effectively to discussions or teamwork. Students can offer meaningful and positive Feedback, but some may be shy or reluctant to correct their peers or indicate areas of improvement (Burgess et al., 2021). Peer review is adopted to improve peer engagement, incorporate peer feedback in discussions, monitor outcomes, and adequate knowledge, skills, and competency development and acquisition (Lerchenfeldt et al., 2019). It allows peers to be accountable, not only to their educators but also to their peers. It requires learners to work in teams, help each other synthesize information, and communicate with one another. Offering and getting Feedback ensures a practical learning experience among learners, developing reflective learners who can analyze their and peers’ performance (Burgess et al., 2020). Furthermore, it helps create positive views and attitudes towards change and has a more significant impact than Feedback offered by faculty. (PRE250397  Week 7: The Value of Peer Review)

Describe a time when you provided a peer review to a colleague.

As a future DNP-prepared nurse leader, peer review allows learners to develop multiple professional skills relevant to professional practice, including communication, organizational skills, problem-solving, teamwork, and individual and team accountability. These skills are critical to a successful career and fulfilling expected roles and responsibilities. I have had the opportunity to offer peer review in topic discussion responses. In most courses, students must complete weekly discussions and respond to at least two classmates, critiquing, supporting, reflecting on, and offering more insights regarding their peers’ discussion posts. These peer responses taught me many concepts and expounded my understanding of course concepts. I appreciate every opportunity I get to learn from others or offer positive and meaningful Feedback to my peers. (PRE250397  Week 7: The Value of Peer Review)

References

Burgess, A., Roberts, C., Lane, A. S., Haq, I., Clark, T., Kalman, E., … & Bleasel, J. (2021). Peer review in team-based learning: influencing feedback literacy. BMC medical education, 21(1), 426. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-021-02821-6

Burgess, A., van Diggele, C., Roberts, C., & Mellis, C. (2020). Feedback in the clinical setting. BMC medical education, 20(Suppl 2), 460. https://doi.org/10.1186/s12909-020-02280-5

Lerchenfeldt, S., Mi, M., & Eng, M. (2019). The utilization of peer feedback during collaborative learning in undergraduate medical education: a systematic review. BMC medical education, 19(1), 321. https://doi.org/10.1186/s12909-019-1755-z

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

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

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

 Abstract

Background: The project aims to evaluate the impact of technology with motivational interviewing on medication adherence among inpatient schizophrenia patients.

Problem: The project addresses medication adherence among schizophrenia patients.

Methods: The project adopts a pre-test and post-test analysis approach. Fifty consecutive schizophrenia patients following up with treatment will participate in the study.

Intervention: This DNP project pursues a nurse-led intervention to improve medication adherence and symptom management.

Results:

Conclusions:

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

Dedication (NR 709)

Acknowledgment (NR 709)

Table of Contents

Abstract 2

Dedication (NR 709) 3

Acknowledgment (NR 709) 4

Introduction. 7

Problem.. 7

Project Aim and Supporting Objectives (NR 702) 9

Practice Question (NR 702) 9

Research Synthesis and Evidence-Based Intervention. 10

Evidence-Based Intervention. 10

Evidence Synthesis. 11

Main Themes in the Research 11

Contrasting Elements in the Research 12

Research Support for the Evidence-Based Interventions. 13

Evidence-Based Intervention Implementation. 13

Explanation of the Evidence-Based Intervention. 13

Steps in the Intervention Implementation. 14

Participant Engagement during Intervention Implementation. 14

Methodology. 16

Organizational Setting. 16

Population. 16

Translational Science Model and Project Management Plan. 17

Project Management Plan. 19

Formative Evaluation Plan. 19

Plans for Sustainability. 20

Anticipated Outcomes. 21

Expected Change after Implementing Motivational Interviewing. 21

References. 22

Appendices, Tables, and Figures. 25

Appendix A.. 25

Johns Hopkins Nursing Evidence-Based Practice. 25

Table 1: Implementation Plan. 31

Table 2: Formative Evaluation Plan. 32

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

Introduction

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

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.

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%.

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.

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

Project Aim and Supporting Objectives (NR 702)

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

  1. To evaluate the role of technology on medication adherence among inpatient schizophrenia patients.
  2. To assess the impact of motivational interviews on medication adherence among inpatient schizophrenia patients.
  3. To compare the impact of technology and motivational interviewing on medication adherence and the current interventions for enhancing medication adherence at the practicum site

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. It assumes that individuals with problematic attitudes and behaviors have varying readiness for change levels. Not recognizing the ambivalence would lead to patients rendering well-intentioned medical advice threatening their autonomy and freedom of choice, increasing their will to exercise their freedom to make choices, and increasing non-adherence. The DNP project adopts MI as an evidence-based intervention to increase personal motivation for and committed attitudes and behaviors to help schizophrenia patients find their meaning and need for change in an accepting and empathetic atmosphere, aiming to improve medication adherence. The Motivation Interviewing Network of Trainers (MINT) endorses this intervention to encourage behavioral change. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

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).

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

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

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

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

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. 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.

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.

Participant Engagement during Intervention Implementation

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

 Methodology

This section describes the organizational setting, project population, translation science model and project management, plans for sustainability, and anticipated outcomes.

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.

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 psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers contributes to patient health management and outcome.

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 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.

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:

  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.
  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.
  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.
  7. The project team and I will implement motivational interviewing into a pilot program that includes follow-up schizophrenia patients only.
  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.

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.

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.

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

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

 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

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

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

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

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

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

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

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

Kotzeva, A., Mittal, D., Desai, S., Judge, D., & Samanta, K. (2022). Socioeconomic burden of Schizophrenia: A targeted literature review of types of costs and associated drivers across ten countries. Journal of medical economics, (just-accepted), 1-18. https://doi.org/10.1080/13696998.2022.2157596

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

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.

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

 Appendices, Tables, and Figures

Appendix A

Johns Hopkins Nursing Evidence-Based Practice

Individual Evidence Summary Tool

Ó The Johns Hopkins Hospital/The Johns Hopkins University

 

Article

#

 Author & Date Evidence Type Sample, Sample Size & Setting Study findings that help answer the EBP question  

Limitations

 Evidence Level & Quality
1. Dobber, J., Latour, C., de Haan, L., Scholte op Reimer, W., Peters, R., Barkhof, E., & van Meijel, B. (2018). A qualitative multiple case study 14 cases of schizophrenia patients were used in the study

 

 Trusting relationships between patients and therapists, the therapist’s ability to use MI-strategy in the patient process, and considering patient values in long-term medication adherence can increase MI-intervention success for medication adherence in schizophrenia patients. A small sample size can limit generalizability Level III/Quality A
2. Palacio, A., Garay, D., Langer, B., Taylor, J., Wood, B. A., & Tamariz, L. (2019) Systematic Review and Meta-analysis 17 RCTs were included in the review

 

 

 Telephonic MI and fidelity-based feedback were significantly linked to medication adherence. Included a few studies focusing on non-minority populations.

Most studies were on antiretroviral medications, limiting generalizability.

The small sample size limited the power of analyses.

 Level I/Quality A
3. Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., … & de Haan, L. (2020). A Mixed Methods Study 14 cases of schizophrenia patients were included in the study.

 

 

 A trusting relationship and empathy can help trigger mechanisms of change. A small sample size limits generalizability.

Limited visibility and measurability of most patient factors and change mechanisms.

 Level III/Quality A
4. Papus, M., Dima, A. L., Viprey, M., Schott, A. M., Schneider, M. P., & Novais, T. (2022). A systematic review of randomized controlled trials The study included 54 RCTs.

 

 

 MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs. The study focused on chronic conditions limiting generalizability for other disease conditions. Level I/Quality A
5. Zomahoun, H. T. V., Guénette, L., Grégoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., Huiart, L., & Moisan, J. (2018). A systematic review and meta-analysis The meta-analysis included 16 RCTs.

 

 

 MI interventions might help improve medication adherence for chronic conditions in adults. The sample size was small, limiting generalizability.

 

 Level I/Quality A
6. Hogan, A., Catley, D., Goggin, K., & Evangeli, M. (2020). A secondary analysis of data 62 HIV adult patients were included in the study.

 

 

 MI-consistent (MICO) method was positively associated with change and sustained talk. The historic nature of the data and limited statistical control limits the study. In addition, one MI session was used, and there was no variable manipulation, limiting the establishment of causality. Level III/Quality A
7. Aubeeluck, E., Al-Arkee, S., Finlay, K., & Jalal, Z. (2021). A systematic review of randomized controlled trials 8 RCTs were included in the study.

 

 

 MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. Small sample size limited generalizability. Level I/Quality A
8. Khadoura, K. J., Shakibazadeh, E., Mansournia, M. A., Aljeesh, Y., & Fotouhi, A. (2021). A clustered randomized controlled trial 355 hypertensive patients were included as participants.

 

 

 MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group. The focus on one disease condition can limit generalizability. Level I/Quality A
9. Abughosh, S., Wang, X., Serna, O., Esse, T., Mann, A., Masilamani, S., Holstad, M. M., Essien, E. J., & Fleming, M. (2019) A prospective study 11 students were included in implementing the intervention, and 743 patients were the subjects.

 

 

 MI-based telephone intervention is promising in improving medication adherence. Patients who completed the initial call and at least 2 fall calls were more likely to be adherent. The effects were for a short period, and more research is required for longer periods. Level II/ Quality A
10. Harmanci, P., & Budak, F. K. (2022) A pretest-posttest control group design 150 schizophrenia patients participated in the study. MI-techniques-based psychoeducation significantly enhanced medication adherence, hope, and psychological well-being for patients in the experimental group. The effects were short-term, and clinicians should be careful when adopting the results. Level I/Quality A

Appendix B

Table 1: Implementation Plan

Week Activity
Week 1 Pre-implementation data collection.
Week 2 Step 1: Problem identification

Step 2: Determining whether the problem is a priority to the organization

Step 3: Team development
Week 3 Step 3: Evidence gathering and analysis

Step 4: Research articles critique and synthesis

Step 5: Evidence assessment for the adequacy
Week 4 Step 7: Intervention implementation
Week 5 Step 7: Intervention implementation
Week 6 Step 7: Intervention implementation
Week 7 Step 7: Intervention implementation
Week 8 Step 7: Intervention implementation
Week 9 Step 7: Intervention implementation
Week 10 Step 7: Intervention implementation
Week 11 Step 7: Intervention implementation
Week 12 Post-summative data collection

Step 8: Outcome evaluation

Appendix C

Table 2: Formative Evaluation Plan

Week When Why How (Oversight)
Week 1 Pre-project implementation ·         Understand the need for the project ·         Leadership meetings
Week 2 Project development ·         Clarify the need for the project ·         Problem tree analysis

·         Priority Matrix

·         Stakeholder analysis
Week 3 Project development ·         Clarify the need for the problem

·         Identify problem impact

·         Clarify intervention selected

 ·         Literature review

·         Solution tree analysis
Week 4 Project implementation ·         Develop project design before roll-out ·         Focus group

·         Discussions
Week 5 Project implementation ·         Improve project design as it is rolled out ·         Semi-structured interview

·         ORID

·         Project diary
Week 6 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 7 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 8 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 9 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 10 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles and meetings
Week 11 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles and discussions
Week 12 Post-project implementation ·         Ensure the project is completed successfully. ·         Leadership meetings

·         Project team discussions

·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

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

 
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Week 7: The Value of Peer Review

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Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

Week 7: The Value of Peer Review

Week 7 The Value of Peer Review

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 nonadherence (O) in 8-10 weeks (T)? (Week 7: The Value of Peer Review)

The Value of the Peer Review Process of offering Feedback as a Future DNP-Prepared Nurse Leader

Peer review refers to team-based learning adopted to encourage reflection on individual behavior, offer professional skills development opportunities, and encourage people to contribute effectively to discussions or teamwork. Students have an amazing ability to offer meaningful and positive feedback, including helping their peers identify areas of improvement. But some students or peers might be shy or reluctant to correct their peers or indicate areas of improvement (Burgess et al., 2021). Peer review is an approach adopted to improve peer engagement, incorporate peer feedback in discussions, monitor outcomes and adequate knowledge, skills, and competency development and acquisition. It allows peers to be accountable, not only to their educators but also to their peers. It requires learners to work in teams, help each other synthesize information, and communicate with one another. Offering and getting feedback ensures effective learning experience among learners, developing reflective learners who can analyze their own and peers’ performance. Furthermore, it helps develop positive views and attitudes towards change and has a greater impact than feedback offered by faculty.

As a future DNP-prepared nurse leader, peer review allows learners to develop multiple professional skills relevant to professional practice, including communication, organizational skills, problem-solving, teamwork, and individual and team accountability, which are critical to a successful career and fulfilment of expected roles and responsibilities. I have had the opportunity to offer peer review in topic discussion responses. In most courses, students are required to complete weekly discussions and respond to at least two classmates, critiquing, supporting, reflecting on, and offering more insights regarding their peers’ discussion posts. I have learned many concepts and expounded my understanding of course concepts from these peer responses, and I appreciate every opportunity I get to learn from others or offer positive and meaningful feedback to my peers. (Week 7: The Value of Peer Review)

References

Burgess, A., Roberts, C., Lane, A. S., Haq, I., Clark, T., Kalman, E., … & Bleasel, J. (2021). Peer review in team-based learning: influencing feedback literacy. BMC medical education, 21(1), 426. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-021-02821-6

 

 
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