Improving patient outcomes in schizophrenia

These symptoms significantly interfere with the patient’s day to day functioning and must not be as a result of a medical condition or substance abuse. The etiology of schizophrenia remains largely unknown with a multifactorial cause which includes genetics, environmental and neural causes as being the major causes relating to the occurrence of schizophrenia. Dopamine and glutamate dysregulation have been related or implicated largely to the occurrence of both positive and the negative symptoms of schizophrenia in patients (Haller, Padmanabhan, Lizano, Torous & Keshavan, 2014). The rates of patient follow-ups and medication adherence in patients with schizophrenia is low leading to poor quality of life and patient relapse. Due to the nature of schizophrenia and the demand for continuous patient management through follow-ups and support, nurses have a crucial role to play in the management of schizophrenic patient through providing both psychosocial support to the patients and helping the patient cope with the illness and medication management.

The nurse can also utilize their skills as patient educators to educate the patients on the available management interventions ad their benefits, risks and help the patients in considering the most preferable care (Haddad, Brain & Scott, 2014). Educating the patient on the patients on the available medications, the mediation delivery mode whether oral of injectables, short term or long acting antipsychotics among others help the caregivers and patients to understand the management approaches and interventions available for care. Caregiver education and support is also crucial in mitigating the caregiver burden by empowering the patient to develop self-efficacy hence reducing the patient’s dependency on the care giver (Geriani, 2015). Motivational interviewing Motivational interviewing is a client-centered counseling approach that is aimed at impacting behavior change in patients through addressing ambivalence.

Motivational interviewing is a directed approach in counseling that encourages the patients to make changes to adapt to enhanced better functioning. The effectiveness of patient involvement in care decision making is imperative so as to ensure that the improvement in patient care and follow-through which ensures not only effective adherence to medication but also positive experience of the patient of the care (Haddad, Brain & Scott, 2014). Nurses utilize their communication skills and collaborative communication skills and patient education to engage the patients or their caregivers. Through the patient education and utilization of decision-making tools, psychiatric nurses are able to engage the schizophrenic patients in discussions on their preferential care through comparing the options for the patient’s treatment in the context of the available treatments, patient’s experiences and values.

Nurses as educators can utilize the shared decision model or approach to management of schizophrenic patients by providing the patients with information on their care decisions such as the options of the medications that are available, the possible side effects and adverse effects of the medications, the possible treatment adherence concerns utilizing individualized patient needs of care approach among others(Haddad, Brain & Scott, 2014). This involvement in care for the patients more so in the choices of medication empowers the patients and enhances the quality of their management and minimizes patient lack of adherence (Haddad, Brain & Scott, 2014). Advocacy and interdisciplinary team coordination also play a significant role in minimizing the occurrence of other illness in schizophrenia such as depression through the provision of adequate counseling and medication management of depressive symptoms or occurrences.

Nurses can also utilize their negotiating skills and abilities to negotiate for better or additional care needs for patients with schizophrenia (Ganguly, Soliman & Moustafa, 2018). Utilizing effective negotiation skills enables the nurses to effectively advocate and bring to the fore the needs of schizophrenic patients and minimizing oversights in care delivery. The advancement of nursing roles and education has also inculcated research skills among nurses. The continuity of care for the schizophrenic patients as well as team-based/interdisciplinary care can be enhanced through evidence-based approaches to care. Evaluation of medication adherence for these patients is important because of it a strong indicator of the patient's understanding of their medication regimen, their understanding of the disease process and the risks of poor medication adherence such as relapse (Lam & Fresco, 2015).

Drug adherence can be measured using patient-centered approaches trough assessing the medication refill frequencies to determine the effectiveness of adherence or by educating patients on medication journals which detail the patient’s practices on medication (Lam & Fresco, 2015). The patient journals to enhance patient-centered care is an effective tool to measure adherence with the patient maintaining a record of each medication day, the effects, side effects, and any adverse events observed. The journal is then reviewed by the psychiatric nurse on follow-up and compared to other adherence monitoring approaches such as refill or direct methods such as the monitoring of patient’s responses to care (number of emergency room visits or relapses). (Lam & Fresco, 2015). The Patient Health Engagement (PHE) Scale is a useful tool in measuring the level of patient engagement in care (Graffigna, Barello, Bonanomi & Lozza, 2015).

The tool provides insights on various indicators of the level of patient involvement which include among others; the patient’s medication adherence, patient’s understanding of the disease process and care and the patient’s social demographics and their clinical characteristics (Graffigna, Barello, Bonanomi & Lozza, 2015). In measuring the patient-centeredness of care, the approach also aims to evaluate the level of effectiveness of the shared-decision making approach in care (Bouniols, Leclère & Moret, 2016). Effectiveness in shared decision making in care encompasses the assessment of the patient’s willingness and understanding of their care interventions, their level of involvement in decision making and implications such involvement has n the management and recovery (Bouniols, Leclère & Moret, 2016). Key indicators for the evaluation of shared decision-making approaches include among others the patient’s self-directedness in care, adherence levels and patient’s understanding and involvement in their care (Bouniols, Leclère & Moret, 2016).

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