Coerced Medication Compliance in Psychiatric Patients, Essay Example

Introduction

In modern healthcare environments, there are situations involving psychiatric patients that may interfere with their health and wellbeing. If these patients are not of sound mind and body, it is possible that they will be resistant to taking medications and will not comply with the required treatment recommendations. In these instances, it is important to address the responsibility of healthcare providers to offer high quality care and treatment to psychiatric patients, using indicators of safety and quality as a guide. However, this often requires clinicians to coerce patients into taking their medications to achieve the desired effects. The challenges of evidence-based practice represent an opportunity to develop new strategies for this practice setting to improve quality and safety on a consistent basis. Healthcare providers must seek new strategies to expand knowledge and evidence to support safe and high quality medication administration for psychiatric patients at all times. There are considerable efforts required to achieve the desired results and to demonstrate the importance of new measures that will positively impact patient outcomes. The following discussion will address the challenges of medication administration for psychiatric patients in greater detail and the issues related to quality and safety that occur with this process. Most importantly, these measures must align with the IOM Aims for quality care in order to establish effective evidence-based practice solutions for patients on a continuous basis.

Analysis

Psychiatric patients who are unwilling to adhere to medication administration guidelines may require coercion in order to obtain these pharmacologics in a timely manner. Some patients who are coerced into taking medication possess low satisfaction rates with the care that they receive, as coercion has a negative impact on patient perceptions and outcomes, particularly for psychiatric patients (Strauss et.al, 2013). These issues are relevant because they impact quality of care and the level of treatment that patients receive in mental health settings (Strauss et.al, 2013). Quality of care is often compromised and limits the ability of healthcare providers to be successful in treating patients under safe and high quality conditions when they force patients to take their medications (Strauss et.al, 2013). These factors are instrumental in enabling healthcare providers to offer improved quality of care to this patient population (Strauss et.al, 2013).

Patients in psychiatric settings often require extended care and treatment which typically involves one or more forms of medication (Newton-Howes et.al, 2011). Most importantly, it is necessary to evaluate the conditions under which this type of treatment is provided and how to address the need for coercion in some situations (Newton-Howes et.al, 2011). Many patients feel dehumanized under these conditions and do not feel comfortable under duress, even when the intervention is absolutely necessary (Newton-Howes et.al, 2011). These factors play an important role in shaping how nurses address patient quality and safety in psychiatric care and treatment (Newton-Howes et.al, 2011). When coercion is involved, it may compromise key ethical principles that impact quality of care and may also risk the safety of patients (Newton-Howes et.al, 2011). In spite of the need for this type of action and intervention for some psychiatric patients, it nonetheless infringes upon personal freedoms and does not provide any real benefits to patients; on the contrary, it is likely to contribute to lack of trust and support for the psychiatric intervention under consideration (Newton-Howes et.al, 2011).

Patients are not likely to accept coercion as a viable method for patient care; however, it continues to occur in psychiatric settings on a rather consistent basis (Georgieva et.al, 2011). Therefore, patient preferences should be considered under these situations in order to ensure that patient outcomes are positive and meaningful (Georgieva et.al, 2011). Nurses working with patients in psychiatric settings who force medications onto patients may experience difficult challenges as a result of these activities (Aldridge, 2012). It is known that “Nurses are called to be at the leading edge of innovation, always challenging the status quo and taking responsibility for creating new solutions” (Aldridge, 2012, p. 2). In this context, it is important to identify the resources that are necessary to support favorable patient outcomes and medication adherence without coercion (Aldridge, 2012). Under these conditions, quality of care and patient safety must always be considered for their value and contributions to patient care and treatment under specific conditions (Aldridge, 2012).

The Institute of Medicine (IOM) has established a number of key principles that are critical in providing successful, high quality, and safe care to all patients (Health Matters, 2011). Each of these principles should be considered in the context of coercion in medication administration for psychiatric patients in order to achieve effective outcomes for this population. To be specific, 1) safety is of critical importance in the development of nursing care and treatment that involves minimal risk or harm to patients, including coercion and its potential influence on patient care and wellbeing (Health Matters, 2011). This practice also demonstrates the ability of mental health patients to be treated respectfully at all times, even when they are unwilling to comply with medication requirements. Furthermore, 2) patient care and treatment should always be effective and utilize existing practice methods and best practice approaches to enable patients to recover as best as possible (Health Matters, 2011). This also encourages the utilization of knowledge and existing resources to meet the desired needs of the population being served (Health Matters, 2011). Patient care should also be 3) efficient, whereby it is supported by a framework that prevents inefficiencies that may be attributed to human error or poor judgment (Health Matters, 2011). It is also expected that patient care should be 4) timely, whereby healthcare providers show respect for the time that their patients must provide during the care and treatment process, as they should not be wasteful with this time and limit distractions as much as possible (Health Matters, 2011). In addition, care should be 5) patient-centered, which provides an opportunity to focus on the patient’s needs above all else and to refrain from making decisions that are not in the patient’s best interests (Health Matters, 2011). This is particularly true in cases involving psychiatric patients who face the risk of coercion when medication noncompliance is evident. Finally, patient care should be 6) equitable at all levels, whereby it requires a greater understanding why healthcare disparities exist and how to refrain from these disparities when providing care to patients (Health Matters, 2011). Unfortunately, mental health patients often face significant disparities and are not treated with the level of respect that they deserve, and this often contributes to significant disparities that are difficult to overcome. Based upon these considerations, the IOM Aims for Quality Care are of critical importance in providing an opportunity to improve the quality and safety of patient care using a number of critical indicators that support effective outcomes for patients, particularly those who face mental health challenges on a regular basis.

Throughout the mental health environment, there are considerable issues associated with the level of risk that occurs within this patient population. Many patients pose a danger to themselves and to other patients; therefore, they must be provided with a framework to enhance their level of safety at all times. Most importantly, risk management must be addressed on a regular basis to prevent harm to patients and to recognize when coercion and other activities may pose a danger to patients if they experience any type of perceived threat that could reduce their quality of life. In mental health nursing, it is important to identify the issues that are most important to address the issue of coercion in medication administration because this places additional strain on patients who already face serious challenges relative to their mental health status. These conditions are instrumental in shaping patient outcomes and in determining the strategies that are necessary for nurses to take when working with patients who experience severe mental health limitations. Measuring quality performance as a mental health nurse must take these issues into consideration and provide a basis for exploring the nature of mental health conditions and how they impact patient care. Performance indicators should align with these approaches so that patient care is not compromised and patient safety is not an issue.

Conclusion

Mental health nurses must demonstrate their ability to work with patients effectively and with optimal performance in mind. It is often difficult for mental health nurses to meet performance standards when patients require intense measures such as coercion in order to administer medications. However, this is a significant issue that requires ongoing attention to improve patient outcomes and greater wellbeing. A number of quality performance measures must be considered on a regular basis in order to establish a precedent for greater quality of care and patient safety. These measures should be evaluated in the context of mental health nursing, which is often a very difficult and challenging specialty area in which to conduct operations. Organizations must develop new strategies for improvement that will have a positive impact on Mental health nurses must recognize the importance of improving patient outcomes through quality measures and to minimize coercion and other negative behaviors as best as possible. This group of nurses must work collaboratively in an effort to produce effective outcomes for patients and to address the challenges that this patient population faces on a regular basis. This will encourage patients to be treated with dignity and respect at all times so that their level of care is of the highest possible quality.

References

Aldridge, M. A. (2012). Addressing non?adherence to antipsychotic medication: a harm?reduction approach. Journal of psychiatric and mental health nursing, 19(1), 85-96.

Georgieva, I., Mulder, C. L., & Wierdsma, A. (2012). Patients’ preference and experiences of forced medication and seclusion. Psychiatric Quarterly, 83(1), 1-13.

Health Matters (2011). IOM: Six Aims of Quality Health Care. Retrieved from http://healthmatters4.blogspot.com/2011/06/iom-six-aims-of-quality-health-care.html

Newton-Howes, G., & Mullen, R. (2011). Coercion in psychiatric care: systematic review of correlates and themes. Psychiatric Services, 62(5), 465-470.

Strauss, J. L., Zervakis, J. B., Stechuchak, K. M., Olsen, M. K., Swanson, J., Swartz, M. S., … & Oddone, E. Z. (2013). Adverse Impact of Coercive Treatments on Psychiatric Inpatients’ Satisfaction with Care. Community mental health journal, 49(4), 457-465.