3. Chapter three: Research methodology
5.3 Knowledge on antipsychotic medication’ health education
The lack of knowledge in the differentiation of adverse effects of classical and new generation of antipsychotic may be associated by the fact that at Ndera Neuro-psychiatric hospital they have a limited number of new antipsychotics as evidenced by their 2011 annual report where they reported have only Risperdal in their stock (Hopital Neuro-Psychiatric Caraes Ndera, 2011:31).
Adewuya et al (2006:210) found that Nigerian patients were treated with old generation medication due to lack of alternative treatment. However, these findings are alarming as only 32.9% are knowledgeable. The adverse effects of antipsychotic medication may be life threatening if not well monitored (Neuhut et al., 2009, Berman, 2011, Strauw et al., 2007), and may cause irrevocable symptoms (Pandya, 2009, Muench and Hamer, 2010) expose to metabolic (Newcomer and Haupt, 2006, Lambert et al., 2005, Osborn et al., 2008), cardiac (Koponen et al., 2008, Healey, 2010) and other risks especially to some special groups such as old people (Panula et al., 2009, Knol et al., 2008), pregnant women (Galbally et al., 2010) and children ((Fritz, 2006, Self et al., 2010).
The possible risks of antipsychotic medication must be discussed with patients openly and accurate information should be given (Jones and Jones, 2008:54). Moreover, the studies by King (2004:365); Manias and Bullock (2002:779), indicated that nurses knowledge on pharmacological theories are essential for monitoring adverse effects and identifying patients’
needshence, knowledge of adverse effects was perceived as crucial to nursing role.
Lan, Shiau and Lin (2003:372) maintained that monitoring of patients under antipsychotic medication requires cautiousness and knowledge especially when teaching patients about adverse effects as they may be reluctant to take medication. The results of this study are encouraging as 65.8% (n=48) of participants are very knowledgeable and 27.4% (n=20) are knowledgeable.
Though, past research has demonstrated that nurses did not dedicate enough time to deliver information to the patients (Kendall et al., 2007:176). In a study by Honey and Lim (2008:15) only 13% of the graduate nurses reported that they used their pharmacology knowledge patient monitoring.
In this study, the responses ranged from 0-100%, the answers (strongly disagree, disagree and neutral) were rated as negative and scored as zero and few participants did not agreed or strongly agreed with all statements. This may be linked to hesitation or lack of confidence on behalf of our participants. Early studies highlighted nurses’ lack of confidence in pharmacology related issues (Sodha et al., 2002:312).
5.3.1 Nurses knowledge on monitoring patients’ compliance
Participants in this study showed a very good level of knowledge in this regards as evidenced by the mean score of 83.75% and the highest score of 100%. These findings are inconsistent with the results of a study by Manias and Bullock (2002:783)which found that nurses, graduate nurses and experienced nurses lacked pharmacological knowledge especially in pragmatic clinical situations. Also in a study by (Happell et al., 2002:254), the relevance to correlate surveillance of medication and patient life style was not perceived by nurses who worked in inpatient services.
According to Janssen et al. (2006:234) nurses must adjust their treatment model to individual patient, prevent and monitor adverse effects, establish good relationship with patient, thus promote therapeutic alliance. Byrne et al (2005:517) found that poor knowledge hinder nurses’
capacity to implement adherence strategies. The score on the level of knowledge on monitoring compliance also showed high knowledge as the majority (n=55, 75.3%) scored high marks. As the questions asked in this study were related to everyday practice about medication related issues and adherence promotion, we may be sure that the majority of nurses are aware of strategies to promote patients’ compliance. However, the asked question may not be exhaustive
and their knowledge may be related to the statements used for this study. Different strategies have been highlighted in literature such as rationalisation of the antipsychotic medication regimens (Rummel-Kluge et al., 2008: 386) motivational interviews (Drymalski and Campbell, 2009:12) cognitive-behavioural therapy associated with psychosocial interventions (Patel et al., 2010:273). All those strategies require nurses to possess a strong knowledge base in theoretical as well as practical psychopharmacology. It is stressed that the clinical effectiveness of antipsychotic medication can only be observed if patients remain on medication (Davies et al., 2010: 103). Therefore, nurses must remember and update their knowledge on how to ensure that the medication they administer to the patient is taken.
5.3.2 Knowledge on patient and family education practices
From the conceptual point of view, education of patients and their family is at the centre of nursing role in management of medication and that requires knowledge on mediation and patient variables as well as interaction which occur between both parties (Aschenbrenner and Venable, 2009:3). The results of this study suggest that nurses had good knowledge; the mean score was 74.54% which is considered as average in this study. These results are consistent with others studies where nurses’ knowledge was good (Eisenhauer et al., 2007:85, Vogelsmeier et al., 2007:10, Hemingway et al., 2011:373). However in most studies nurses’ knowledge about patient education was poor (Lim et al., 2010:104, Sodha et al., 2002:313, Ndosi and Newell, 2009:577, Dilles et al., 2010:178).
Patient and family education was perceived by nurses as a core responsibility in a study by Happell, Manias and Pinikahana (2002:254), especially with regards to information given about adverse effects and how medication could be managed in daily life. The research on psychosis also found that the family of the patient plays a vital role in patient functioning and urged to build and maintain relationships with them by giving information about symptoms and medication and providing emotional support (Uys and Middleton, 2004:386-387). It is clear that understanding of medication therapeutic actions and adverse effects contraindication and follow up will be at the base of accurate and valuable education. The results of this study are therefore promising as the majority of participants have a high level of knowledge about family and patient education (61.6%, n=45 very knowledgeable) and 26% (n=19), knowledgeable.
Although, nurses are knowledgeable about patient and family education the researcher is not sure of the transfer of this theoretical knowledge into practice. It was found that nurses working with inpatients found their environment particularly demanding with no time to dedicate to patient and family education even though they were aware of its importance (Happell et al., 2002:255, Ellenbecker et al., 2004:166) and the study does not ignore that the lowest score in the study was 0% and 12.3% (n=9) of the participants had poor knowledge.