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IPE 7050 Evidence-Based Practice for Health Care Professionals Papers
IPE 7050 Evidence-Based Practice for Health Care Professionals Papers
This course provides an overview of the evidence-based practice process to prepare the health care professional as a consumer of scientific evidence for decision making. A process for formulating a practice question and conducting literature searches for existing evidence is included, as well as an overview of the research process for quantitative, qualitative, and mixed methods research with emphasis on the critical appraisal of evidence for determination of inclusion in a literature synthesis related to a practice question. The discussion of biostatistics focuses on determining the appropriateness of the statistical analysis and interpretation of the statistical results in the critically appraised research evidence. Finding and critically appraising research summaries, such as systematic reviews, meta-analyses, and meta-syntheses, and clinical practice guidelines is included. Effectively implementing, evaluating, and disseminating an evidence-based change process is discussed.
EFFECTS OF TELEMONITORING ON CHRONIC HEALTH CONDITIONS
Adult Learning Principles
University of Saint Augustine for Health Sciences IPE7050: Evidence-Based Practice for Healthcare Professionals
ADULT LEARNING PRINCIPLES
Adult learning principle was described by Malcolm Knowles as a method where adults learn through self-direction and self-motivation (Russw ). This principle explains that adults are goal oriented, they have various purposes for learning and they always focus on their goals of achieving more knowledge and education. It explains that there is an inward motivation to learn compare to a younger person. Learning is self-directed, when adults decide to learn, they are well involved in the learning and they have expectations to be met. According to (Russell), most adults choose adult learning to make advancement or modification to a way of life that can include skills, behavior, knowledge, status, level and even to add value to themselves.
Adult learning principle is a unique one because it is self-motivated, learners can learn at their own pace, this can sometimes be through an online class or in class. Instructors are more into trying to help the learners to achieve their goals rather than trying to make them fail or miserable. Adult Learners relies on past ability and motivation, they believe they can do it especially if they have done it in the past. The education and the experience they have had in the past assist them to achieve more in their learning. Adults don’t have to be pressurized like children, they understand why it is important to stay focused and engaged in other to achieve their goals.
Adult education is a way to improve oneself and add value to one’s life and career, the purpose of learning is for an indicated purpose and that is why it is so important to understand its benefits and purpose. Adult learn best when they know that the information and end result will be of positive result. Adult learning process is enhanced when there is full participation in the learning process and the learners have full control over the material. This encourages the learner to devote all attention and be physically involved in making sure that learning and assimilation is done. Self-evaluation is also important at the end of the task to assess if it is beneficial or not. This way the learner can retrace steps back to amend things such as focusing more or reviewing materials more.
Most Important Adult Learning Principles
Knowles principle of adult learning emphasizes on four points that include the need for adults to be well involved in the planning and evaluation of instruction. It also involves the experience as the basis for learning, this is whereby the experience that an adult has will guide in all decision making and making learning easier and successful. Another principle is that learning for adults is problem centered and not content oriented. The last principle says adults are most interested in learnings that will improve their skills either in education or in their career path. (Pappas, 2013).
The adult learning principle that I believe to be the most important is when the learner participates fully and deeply in the learning process. A learner is well involved in planning and evaluating the content. This is the foundation of the success of learning. If there is no strong participation, it makes the foundation of the learning weak thereby causing inefficiency. Putting a total involvement and concentration will increase productivity and enable the learner to be perfect in what is being learnt. I prefer this learning process because it is the basis that will develop into direct confrontation and self-evaluation where the learner assess the outcome of the learning.
Adult Learning Principles and Personal Learning Style
There are different learning styles that each adult prefers to use, some people prefer visual styles where they learn through written instructions. This is a process that enable adults to read their materials and learn by looking at different illustrations that will enhance their learning. This method is used by many people because it helps with storing information and being able to go back and retrieve the information through their learning materials.
Auditory learning style is another one that focuses on verbal instructions, this is also preferred by some adults that can learn fast through hearing. This method works best for some adults that don’t do well with written information, they tend to assimilate better once they hear the information. The information heard by these group of people remain intact and they develop it into bigger projects.
Another style is called the Kinesthetic learning style. This is where the learners involve their body in the learning process physically, this can be through group activities. Some adults prefer this method because learners here do not forget what is learnt easily. They demonstrate what is needed to learn and most people find this to be very interesting because they are so involved in activities that results to the outcome of the learning.
I am deeply involved in my learning because I believe that my input will determine the output I receive at the end of the day. Full participation is my goal in achieving my education, my learning style is the auditory learning because the verbal instruction keeps ringing in my ears. I learn best when I hear information over and over, this is my preferred learning style because it helps me to retain information. Adult learning process has made going back to school easy for people like me, am highly motivated by my career. The mission to add more values to myself and also be in a position to improve process and outcome has been my motivation for seeking adult learning.
Pappas, C. (2013). The adult learning theory – Andragogy – of Malcolm Knowles. eLearning Industry.
Russell, S. An Overview of Adult Learning Processes File . Urologic Nursing, 26(5), pp. 349-352.
Non-compliance also known as non-adherence to medication and treatment refers to the extent to which a patient is not willing to carry out the clinical recommendations as directed by the treating physician. Simply defined, this is the failure of an individual to follow the prescribed medication regimen. Non-compliance remains to be a significant issue affecting all patient population ranging from children to adults everywhere across the globe. It is common in almost every chronic disease known and setting, and it happens to worsen as the patients stay longer on drug therapy. Today, non-compliance among patients is considered as a major problem facing health industry both in developing and developed countries. Most patients only comply with treatment until halfway through medication, but when their conditions do not get better, they abandon their plans. The other set of patients will stop their drug therapy within the first year, and only a small fraction will continue taking their medication to the end of the dictated plans. Compliance to treatment is essential especially since it is directly linked to the prognosis of the health problem.
The issue of poor compliance to the therapeutic routine in psychiatric patients has been a matter of concern to many professionals and thus has prompted various studies to understand the behind this phenomenon. The main reason for this is that there has been an increase in the number of patients who have mental illness especially in the developed countries such as the United States. This paper aims to carry a study on the existing scientific works of literature concerning non-compliance to medication among psychiatric patients. The paper will, therefore, use a PICOT format to summarize research questions which will help in exploring the presented research problem within the study non-compliance to medication among psychiatry patients.
Significance of the Practice Problem
Compliance to therapy in psychiatry is essential for good prognosis; however, studies have shown that patients’ failure to adherence with medication is a major challenge in the cases of psychiatric patients. Both the patients and the healthcare providers share the responsibility of compliance, which is a rare all or none phenomenon. Bolon (2002) describes medication compliance as the extent to which an individual stays on the path of the prescribed treatment. The term noncompliance has been used in this study consistently, and the intention of this usage is non-judgmental as a way of ensuring that both health professionals and patients have the responsibility to encourage compliance to medical treatment of psychiatric patients.
The long-term benefit is the ultimate goal of adherence, but in cases where the patients are psychotic and disabled by the illness, then compliance remains to be the immediate objective. As already mentioned, compliance with medication is a significant problem, particularly in patients repeatedly hospitalized because of their psychiatric disorders. Despite its significance, adherence to medication in health care is not given the required attention, especially in clinical practices. According to existing works of literature, various factors are contributing to non-compliance to medication. Poor quality patient-doctor relationship limits the effectiveness and enhances the side-effects of the psychiatric medication (Shruthi, 2016). Substance abuse and cultural attitudes also affect an individual’s compliance with therapist’s plan. Forgetting or running out of medication as well as thinking that one can get better without the medication can easily make one give up on their medication. Another reason is lack of adequate awareness of the illness in addition to being embarrassed for taking the daily medication (Shruthi, 2016).
When the patients do not comply with treatment, it can create many problems affecting both their social, financial and psychological lives. Such problems include longer hospital stay which in turn elevates the cost of treatment and being a burden to their finances (Guzofski, 2008); additionally, non-compliance increases the chances of attempted and completed suicide among patients (Guzofski, 2008). Lastly, patients who do not stick by and complete their medication plans might suffer from impaired patient functioning, which can worsen the previous conditions (Guzofski, 2008). Poor adherence to antipsychotic therapy and treatment heightens the risk of relapse, and thus increases the probability for dangerous behaviors by the patients of psychiatry, specifically in the times of psychosis. Other attributes related to the failure of complying with prescribed treatment include decreased the quality of life, increased symptoms and potential for dangerous behaviors.
Health care practitioners have a responsibility if assessing the patients’ motivating factors in addition to potential barriers which might develop and hinder compliance. Motivation refers to the beliefs and values that an individual holds concerning possible outcomes, their intention and the perceived ability to initiate and maintain the behavioral change. Therefore, nurses and psychiatrists need to have knowledge of the patients’ motivations aspects such as the meaning of the behavior change to the patient as well as how it affects their general perspective and how personal values may get in between the patient and his well-being. Assessing patient’s knowledge of his conditions and the medication regimen involves: determining their understanding of the symptoms, and how they understand the regimen process. Evaluating such ideas helps the psychiatrists foresee potential barriers to medication compliance as well as learning the patient’s needs. Like previously mentioned, one of the factors driving patients’ noncompliance to medication is the relationship they have with the health care professionals; it is thus important for the practitioners to evaluate their own beliefs as a way of ensuring their attitudes and beliefs do not affect this relationship negatively.
The above discussion led to the following research question: It has been identified that patients diagnosed with mental illness have a high tendency of not complying with the medication regimen especially within their first year of prescription, what is the current evidence on intervention that can help in promoting medication compliance among black psychiatric population ins prisons to mental health treatment?
Psychiatric patients are individuals who have been professionally diagnosed with any category of mental illness under the DSM-5 system. Mental illness or disorder is a mental pattern that causes poor functionality of an individual and how he or she behaves. The features of mental illness can either be persistent, remitting or can sometimes appear as a single episode. The case of black males suffering from mental health within the American prison has been seen to be rising over the years and this is mainly because they are not consistent with their medication (Brandt, 2012). This inconsistency is what has led to the increase in the level of aggressiveness among incarcerated black males and Mexicans (Baillargeon et al., 2000; Osher & Steadman, 2007)). The onset of mental illness mostly occurs in adolescent and among young adults, majorly in males than women. Studies by Kraepelin illustrated that it is men who develop schizophrenia earlier than women and on the onset of men tend to be severe compared to women (Bota, Fraser & Groysman, 2017). Additionally, men develop mania disorder earlier than women, and this is because there is a close association between childhood antisocial behaviors and the male gender (Kennedy et al., 2005; Oostervink, Nolen & Kok, 2014). Development stage between 18-25 years is important, and men are mainly affected because of the quest to explore new ideas and independence. The fragility of these transitions often leads people to drug abuse which subsequently results to the development of chronic mental illnesses.
As previously mentioned, noncompliance to medication among psychiatric patients remains to be a major challenge in the field of medicine. It has thus been proposed that enhancing the effectiveness of adherence interventions may have a positive impact on the health of the patients than improving medical treatments. The problem is not with the treatment method but rather the effectiveness of adherence. There are a large number of trials concerning social, pharmacologic and psychological interventions and the results are mixed (Farooq, 2013). However, the interventions particularly designed to increase the adherence to a more focused approach utilizing elements from various approaches like community-based and family-based approaches have provided better outcomes. Most of the previous methods used in enhancing adherence largely relied on having a good therapeutic relationship and this required balancing aspects of drug treatment, this is known as a pharmacological intervention. Nevertheless, studies propose that it is important to consider psychosocial intervention (Farooq, 2013). Psychosocial intervention refers to many psychological and social measures that seek to alter the behaviors of the patients while encouraging them to comply with the medication regimen. Various theoretical backgrounds like motivational interviewing and cognitive-behavioral therapy underpin psychosocial interventions. Additionally, these interventions are considered effective since they can be offered in different formats like through family, electronic media, group or individual, and at the same time they are applicable in a different setting such as community or inpatient (Farooq, 2013). Psychosocial interventions engage patients in addition to treatment methods and thus improve compliance. It is important to explore the patient’s views concerning treatment as it fosters collaborative approach in the selection of medication (Cardoso, Aguiar, Byrne & Xavier, 2016).
The alternative method of curbing the problem of compliance to medication among psychiatric patients is the use of the pharmacological intervention. This alternative method relies mainly on the careful selection of drug with an optimal balance of safety, and in a case where the treatment is not effective, then the practitioners will switch the mode of treatment (Velligan et al., 2010). Pharmacological intervention has proven to be successful in the past, and that cannot be disregarded as ineffective. However, in increasing the effectiveness of compliance to medication, some patients may be uncomfortable with the idea of always switching drugs. The idea of constantly altering medication and drugs may discourage the patient who will assume that the practitioners are not sure of what the problem is, or even develop a belief that they will never get better and thus quit their treatment regimen (Cardoso, Aguiar, Byrne & Xavier, 2016). One of the methods used in this treatment is long-acting injection, but this is majorly useful in patients with schizophrenia as it has proven to enhance treatment adherence (Velligan et al., 2010).
Farooq and Naeem (2014) argue that engaging the psychiatric patients as partners through psychosocial interventions can enhance the outcomes. Engaging the patients in therapy regimen is the possible key compliance because this relies on building a relationship rather than a treatment pattern. Farooq and Naeem (2014) add that the health care practitioners should help the patients to take the active role in the management of their illness. The presented ideas rely on routine clinical observations and have been suggested by other studies on improving compliance in psychiatric patients and individuals with other physical health problems.
The timing for the efficiency of effectiveness has not yet been established; however, studies have shown that it averagely takes one year before a mentally ill patient goes against the medication regimen. This is not yet clinically proven but collected from some failed cases of noncompliance to medication among patients. The reason for this is that there are many factors that play behind this phenomenon of adherence such as the doctor-patient relationship, personal beliefs, and cultural influence. It is thus difficult to point out the specific time to expect changes within this intervention.
Search Strategy and Results – Medication Non Compliance Among Psychiatric Patients Essay
In the quest to develop research that would answer the developed PICOT questions, some keywords and databases were used in collecting the right and appropriate literature articles. I used the PICOT to generate the keywords which would gather the materials relating to the study, and this is as shown below.
P – Population or Patient Group: In this section, I searched for noncompliance to medication; black males, incarcerated inmates, mentally ill adults, and psychiatric patients; the search results are to be sorted according to risk groups on a grid.
I – Intervention: In this section, I assessed the existing and proposed methods to manage noncompliance to medication in general. The keywords used included noncompliance to medication; patients with psychotic disorders; contributing factors; epidemiology of non-adherence to therapy; and management strategies.
C- Comparison: This section aimed to find out the utilized methods and how efficient they have proven to be through time. The keywords used included no intervention; existing conventional interventions.
O – Outcomes: Though the section mainly was to show the efficiency of the current intervention, there were no search terms required for outcomes as the information was available on the intervention methods literature.
T- Time: The period of the search was from 1995 to current date as a way of assessing the developments of the issue in discussion.
Types of Research: The types of research used in the study were secondary research which entailed the systematic reviews and case control studies.
Context: The initial research mainly concentrated on the practices within the United States, but it was limited to the UK depending on the primary author or institution.
Data Base Used
- US National Library of Medicine National Institute of Health (NIH)
- Psychology Articles by American Psychology Association (PsycArticles)
- PsycINFO Journal Coverage List
- SAGE Journals
As shown in Figure 1, in total, I retrieved 16 articles, but only 12 matched the study criteria. The remaining four articles were limited and excluded after screening because they were not accurate to the study and therefore, the information was not accurate to the study.
This paper aims to explore how noncompliance to medication regimen affects the population of black males in prison while trying to assess the best management method for mitigating the effects of this problem. Noncompliance as already noted is a major challenge that continues to affect the mental health discipline because the side effects are grave and sometimes leads to death. It is thus imperative to develop an intervention that will encourage the psychiatric patients to stick to their medication plans, particularly in prison where studies have not yet assessed enough. The paper has thus proposed psychological intervention as one of the best ways to handle the menace of noncompliance to medication, by carrying out a study on the population of the black male patients within the prisons.
Baillargeon, J., Contreras, S., Grady, J., Black, S., & Murray, O. (2000). Compliance With Antidepressant Medication Among Prison Inmates With Depressive Disorders. Psychiatric Services, 51(11), 1444-1446. http://dx.doi.org/10.1176/appi.ps.51.11.1444
Bota, P., Fraser, S., & Groysman, R. (2017). Beyond schizophrenia: living and working with a serious mental illness. Mental Illness, 9(1). http://dx.doi.org/10.4081/mi.2017.6782
Brandt, A. (2012). Treatment of Persons With Mental Illness in the Criminal Justice System: A Literature Review. Journal Of Offender Rehabilitation, 51(8), 541-558.
Cardoso, A., Aguiar, P., Byrne, M., & Xavier, M. (2016). Assessing strategies to improve antipsychotic adherence: The Portuguese version of the difficulty implementing adherence strategies. European Psychiatry, 33, S478-S479. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1750
Farooq, S. (2013). Public health and physician focused strategies to improve medication adherence in psychotic disorders. World Psychiatry, 12(3), 238-239. http://dx.doi.org/10.1002/wps.20068
Farooq, S., & Naeem, F. (2014). Tackling nonadherence in psychiatric disorders: current opinion. Neuropsychiatric Disease And Treatment, 1069. http://dx.doi.org/10.2147/ndt.s40777
Guzofski, S. (2008). Patient Compliance With Medications: Issues and Opportunities. Psychiatric Services, 59(4), 452-453. http://dx.doi.org/10.1176/appi.ps.59.4.452-a
Kennedy, N., Boydell, J., Kalidindi, S., Fearon, P., Jones, P., van Os, J., & Murray, R. (2005). Gender Differences in Incidence and Age at Onset of Mania and Bipolar Disorder Over a 35-Year Period in Camberwell, England. American Journal Of Psychiatry, 162(2), 257-262.
Oostervink, F., Nolen, W., & Kok, R. (2014). Two years’ outcome of acute mania in bipolar disorder: different effects of age and age of onset. International Journal Of Geriatric Psychiatry, 30(2), 201-209. http://dx.doi.org/10.1002/gps.4128
Osher, F., & Steadman, H. (2007). Adapting Evidence-Based Practices for Persons With Mental Illness Involved With the Criminal Justice System. Psychiatric Services, 58(11), 1472-1478.
Shruthi, R. (2016). A Study of Medication Compliance in Geriatric Patients with Chronic Illnesses at a Tertiary Care Hospital. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH.
Velligan, D., Weiden, P., Sajatovic, M., Scott, J., Carpenter, D., Ross, R., & Docherty, J. (2010). Strategies for Addressing Adherence Problems in Patients with Serious and Persistent Mental Illness: Recommendations From the Expert Consensus Guidelines. Journal Of Psychiatric Practice, 16(5), 306-324.
Results of Search for Research Evidence
IPE 7050 Evidence-Based Practice for Health Care Professionals Papers