Mental Health Nursing

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The use of cognitive behavioural interventions to involve patients in their treatment and to encourage them to examine the range of factors affecting compliance have been researched by Hayward et al. (1995) and Kemp et al. (1996, 1998). Medication self-management (Hayward et al., 1995) was based on motivational interviewing and aimed to allow patients and clinicians to work collaboratively to examine medication issues. Although no improvements in compliance were found, there was sufficient interest in the potential of the intervention to develop it further into a more structured one. Kemp et al. (1996, 1998) devised compliance therapy based on medication self-management and drawing from motivational interviewing and cognitive behavioural techniques. Key principles included working collaboratively, emphasising personal choice and responsibility, and focusing on patients’ concerns about treatment. The intervention was divided into three phases, which acknowledges that readiness to change is on a continuum. Phase 1 deals with patients’ experiences of treatment by helping them review their illness history. In phase 2 the common concerns about treatment are discussed and the good and the bad things about treatment are explored. Phase 3 deals with long-term prevention and strategies for avoiding relapse. The intervention was evaluated by a large-scale randomised controlled trial (Kemp et al., 1996, 1998). Compliance therapy significantly enhanced treatment adherence and resulted in improved community tenure. Implications for practice Medication management 229 Non-compliance with anti-psychotic medication is clearly a major preventable cause of relapse in patients with psychotic disorders. The causes of non-compliance are unclear but the evidence does suggest that a number of factors have a role to play and that individuals’ reasons for stopping medication are idiosyncratic. A range of different pragmatic interventions to enhance compliance have been tested. Patient education enhances knowledge and behavioural tailoring improves compliance. Compliance therapy principles and techniques also seem to be particularly effective. Medication management practice in the British National Health Service Standards 4 and 5 of the National Service Framework (NSF) for mental health (Department of Health, 1999) aim to ensure that people with severe mental illnesses receive care and treatment that has a sound empirical
230 Acute Mental Health Nursing basis. Good medication management, as described above and including assessment with valid and reliable measures and the application of compliance therapy techniques, is clearly identified within the framework as being integral to achieving these standards. Much of the care and treatment that people with schizophrenia receive is delivered by mental health nurses. The SNMAC (1999) report indicated that, if NSF standards are to be achieved, there is an urgent need to improve the medication management skills of mental health nurses through training and the development of evidence-based policies and guidelines. As has already been discussed, part of good medication management is the rigorous assessment of psychopathology, side-effects and subjective factors such as beliefs about treatment and insight. Mental health nurses’ practice, especially in the assessment of side-effects, has been explored. For example, in a small survey of CPNs practice, Bennett et al. (1995) observed that on average CPNs screened patients for only three or four of the possible side-effects they might experience and there was no evidence of assessment using techniques other than an unstructured self-report. Gray (1998b) observed that mental health nurses do not ask patients about certain side-effects, such as sexual dysfunction, that may have a substantial impact on patients’ decisions about taking medication. Examining the impact of using valid and reliable assessment tools on the detection of EPS, Wieden et al. (1986) demonstrated that clinicians trained in using such measures were significantly more accurate at detecting side-effects than clinicians in routine practice. A survey by Gray et al. (2001) compared the reported practice of mental health nurses who had and had not received psychosocial intervention (PSI) training. Nurses who had received PSI training were significantly more likely to report using recognised measures of side-effects than those who were not. Medication management: chapter summary Medication management is a core skill of acute mental health nursing. Non-compliance with medication is a major preventable cause of relapse. The reasons why people do not take their medication are complex. The evidence suggests that good medication should consist of the following: • a collaborative approach to working with patients; • use of valid and reliable assessment tools to measure psychopathology, anti-psychotic side-effects, attitudes towards treatment, insight and compliance; • logical prescribing of anti-psychotic medication; • effective management of anti-psychotic side-effects;
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EDITED BY Marc Harrison David Howar
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Acute Mental Health Nursing From Ac
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Contents List of contributors vii F
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List of Contributors Ian Baguley qu
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List of Contributors ix background
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Foreword When I first started my ca
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An introduction to acute mental hea
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• Care management • Management
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organisations providing it. Followi
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works, and to be understanding of t
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Introduction ONE Acute psychiatric
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Assessment framework Acute psychiat
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Evidence suggests that the quality
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‘Can you tell me something about
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negative thoughts, anxiety may sugg
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attempting to observe behaviours th
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These scales are often used as ‘s
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thoughts as and when they occur. Th
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Acute psychiatric in-patient assess
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Acute psychiatric in-patient assess
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Introduction TWO Measuring health a
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Measuring health and social functio
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have timely, accurate and appropria
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easy to see why many staff have bec
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Acknowledgements Parts of this chap
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Introduction THREE Social inclusion
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Social inclusion and acute care 53
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Health Consortium (GPMH, 1989) desc
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professionals, belief in the value
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in relation to the people who are a
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networks that we can hope to help t
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ward, and activities that they can
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• Current adjustment: physical he
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Strategies for surviving acute care
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patients said they did not get enou
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involvement can certainly be approa
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to exert a measure of control or ch
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Case management: perspectives of th
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Introduction SIX Integrated care pa
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outcomes to help identify alternati
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services. Pre-formulation helps sec
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nature of pathway documentation can
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Integrated care pathways: the ‘ac
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11. Referred for neurology opinion
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36. 11 point assessment completed B
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Stage 13 Stage 14 Integrated care p
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evealed and analysed, and change of
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SEVEN Risk assessment and managemen
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Risk assessment and management in a
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Observation 163 of people who had c
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towards others. For nurses, having
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no evaluative work conducted to ass
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Observation 169 All local trusts an
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Table 8.1 Four levels of observatio
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most intensive level of observation
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Observation 175 (DoH, 1999a, 2001);
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strongly influenced by cultural iss
Page 192 and 193: who conducted the special observati
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Page 196 and 197: Observation 183 Bowers, L. and Park
Page 198 and 199: Introduction NINE Cognitive behavio
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Page 202 and 203: provided a great deal of hope for a
Page 204 and 205: Assessment of Need (Phelan et al.,
Page 206 and 207: 3. Changing cognitive processes. 4.
Page 208 and 209: hallucinations, which are so common
Page 210 and 211: nurse practitioner. Until very rece
Page 212 and 213: Psychosocial interventions 199 clie
Page 214 and 215: Psychosocial interventions 201 a fi
Page 216 and 217: levels of staff sickness. If workin
Page 218 and 219: Psychosocial interventions 205 for
Page 220 and 221: Problem list and assessment Psychos
Page 222 and 223: should be introduced until the pati
Page 224 and 225: Psychosocial interventions 211 rece
Page 226 and 227: Psychosocial interventions 213 Barr
Page 228 and 229: Psychosocial interventions 215 Barr
Page 230 and 231: Psychosocial interventions 217 Rix,
Page 232 and 233: emphasises the need for mental heal
Page 234 and 235: encountered with their use. Anti-ps
Page 236 and 237: can be almost exclusively attribute
Page 238 and 239: to establish a link between EPS and
Page 240 and 241: Interventions to enhance compliance
Page 244 and 245: • giving patients information abo
Page 246 and 247: Medication management 233 Bennett,
Page 248: Medication management 235 Meltzer,
Page 251 and 252: 238 Index institutionalisation, 63-
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Mental Health Nursing

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