Irma H. Mahone

Shared Decision Making and Serious Mental Illness

This study examined medication decision making by 84 persons with serious mental illness, specifically examining relationships among perceived coercion, decisional capacity, preferences for involvement and actual participation, and the outcomes of medication adherence and quality of life (QoL). Multiple and logistic regression analysis were used in this cross-sectional, descriptive study, controlling for demographic, socioeconomic, and utilization variables. Appreciation was positively related to medication adherence behaviors for the past 6 months. Women, older individuals, and those living independently were more likely to have taken all their medications over the past 6 months. Neither client participation, preference, nor preference-participation agreement was found to be associated with better medication adherence or QoL.

Shared Decision Making in Mental Health Treatment: Qualitative Findings from Stakeholder Focus Groups

PURPOSE This article reports on findings from seven stakeholder focus groups conducted in exploring shared decision making (SDM) between provider and consumer in mental health (MH) treatment in public MH. BASIC PROCEDURES Seven focus groups were conducted with stakeholders-consumers, family members, prescribers, MH clinicians, and rural providers. Each of the focus groups was recorded digitally, transcribed into text, and analyzed qualitatively for recurring themes. MAIN FINDINGS Provider barriers to SDM include history of the medical model, MH crises, lack of system support, and time. Consumer-related barriers included consumer competency, fears, insight, literacy, and trauma from past experiences. Information-exchange issues include consumer passivity, whether consumers could be viewed as experts, and importance of adequate history information. New skills needed to practice SDM included providers knowledge about alternative treatments, mastery of person-first language, and listening skills; consumers ability to articulate their expert information; and computer skills for both providers and consumers. Outcomes expected from practice of SDM include greater sharing of power between provider and consumer, greater follow-through with treatment plans, greater self-management on the part of consumers, and improved therapeutic alliances. PRINCIPAL CONCLUSIONS Implementing SDM in public MH will impact consumers and their families, providers, prescribers, and administrators. More SDM trials in public MH are needed to answer some of the many questions that remain.

Improving the quality of rural nursing care.

The purpose of this chapter is to review the literature on quality of care in rural areas. Keywords related to rural quality of care were used to search CINAHL and MEDLINE databases for articles published between 2005 and 2007 (limited to studies occurring in the United States). The review consisted of a total of 46 articles. Limitations include inconsistent definitions of rural, the use of only articles available to the reviewers, an unclear understanding of the context of many of the studies, and lack of a clear operational definition of quality. The studies were grouped and discussed according to quality of workforce, practice, treatment, interventions, and technology in rural areas. Each study’s contribution to the understanding of quality health care in rural areas and to determining what was effective in improving staff, patient, or organizational outcomes in rural areas was considered. This chapter also offers a discussion of ethical issues and data quality in rural research. Issues for future research include a focus on patient safety, mental health issues, and the use of technology to improve quality of care in rural areas. Future research should also focus on demonstration studies of model applications. The nursing profession has a unique opportunity to conduct research that will contribute to the development of knowledge that will ultimately improve the quality of health and health care for individuals in rural communities.

Electronic Screening for Mental Health in Rural Primary Care: Implementation

The goals of this study were to develop a computer-based electronic screening tool (eScreening) and determine the feasibility of implementing eScreening for rural users of primary care. This descriptive pilot adapted existing screening measures for depression and alcohol abuse to a portable computer-based format and examined the feasibility of its adoption and use. This was a three-step design using convenience samples for (1) a focus group with providers, (2) usability testing with selected rural patients using the computerized touch screen, and (3) implementing the touch screen platform with a small sample in primary care to determine feasibility. This paper reports on Phase III, which assessed consumer response to eScreening.

eScreening: Developing an Electronic Screening Tool for Rural Primary Care

The Rural Health Care Research Center at the University of Virginia, School of Nursing, conducted a pilot study to develop a computer-based electronic screening tool that screens for alcohol abuse and depression among rural patients in a primary care setting. The eScreening tool provides a graphical user interface with audio outputs for users who may be functionally or computer illiterate. The interface is a macromedia flash movie shown on a Web site. A database automatically and anonymously records the screening data. Two phases of user-testing for a prototype of the eScreening tool were conducted in June and July 2005. Future work on the eScreening tool entails expanding administrative controls, including screenings for other disorders, and providing a Spanish version

Electronic Screening for Mental Health in Rural Primary Care: Feasibility and User Testing

Despite attention to prevention and screening for depression and alcohol use, Healthy People 2010 objectives continue to include goals to increase the detection of depression and decrease the rates of alcohol abuse. These problems remain significant. The overall goal of this study was to develop a computer-based electronic screening (eScreening) tool and determine the feasibility of implementing computer-based eScreening technology for rural visitors to a primary care clinic. The study called specifically for an electronic touch screen with voice prompts. This tool, called the eScreening tool, screens for alcohol abuse and depression among rural patients in a primary care setting. The screening was offered to rural adults who are not in acute distress and not at end of life, regardless of their stated reason for seeking medical care. Phase 1 of the pilot was used to determine the perceptions of nurses, other providers, and consumers regarding the acceptability and perceived usefulness of an eScreening tool. Phase 2 involved user testing of the eScreening tool. The longer term goals of the research program are to work with rural nurses to improve patient outcomes and develop interventions and for educational, consultation, and/or direct clinical care.

Effective Strategies for Nurses Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery.

Clients with schizophrenia require maintenance treatment with antipsychotic medication and psychosocial therapy to maintain symptom control. Rates of medication adherence or follow-through are low in clients with schizophrenia. This increases the risk of relapse and contributes to poor quality of life. As educators and advisers, psychiatric nurses can collaborate with clients to improve adherence and other outcomes using shared decision-making techniques and tools that engage and empower clients to actively participate in decisions about their treatment. This article outlines effective strategies used by psychiatric nurses to improve outcomes in clients with schizophrenia and uses a case example for demonstrating this strategy in a client with schizophrenia.