Patient participation in pro re nata medication in psychiatric inpatient settings: An integrative review

Hipp, Kirsi; Kuosmanen, Lauri; Repo-Tiihonen, Eila; Leinonen, Minna; Louheranta, Olavi; Kangasniemi, Mari

doi:10.1111/inm.12427

Cited by 12 publications

(19 citation statements)

References 43 publications

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“…Participants in this study perceived that PRN medication was sometimes used as a means to keep patients quiet and to maintain calm on the unit and were given in the absence of any needs assessment. Issues of power and control over patients in the administration of medication have been identified previously (Baker et al, 2006;Duxbury, Wright, Bradley, & Barnes, 2010;Hipp et al, 2018). Service users have reported receiving PRN medication without knowing why which resulted in anger and a perceived lack of control around their care (Cleary et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…It is far removed from the recovery-orientated care which is the preferred model of mental health nursing practice in Ireland (Cusack et al, 2017) and in many countries internationally (Lim, Wynaden, & Heslop, 2018). Hipp et al (2018) identify how service users report feeling disempowered and frustrated when given medication which they do not feel they need.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported an uncoordinated approach of prescribing within the team (Barr et al, 2018) and have called for greater collaboration between doctors, nurses and patients when it comes to the prescription and administration of PRN medication (Stewart et al, 2012;Duxbury et al, 2010). In particular, patient education about the purposes and potential benefits of PRN medication is important so that they can be involved in making an informed decision about taking them (Cleary et al, 2012;Hipp et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

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The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

Jimu¹,

Doyle

2019

Issues in Mental Health Nursing

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Pro re nata (PRN) medication is medication administered by nurses as required commonly in response to a patient's symptoms or behaviour including insomnia, agitation or anxiety. There is a paucity of research around the process of PRN administration in mental health settings in Ireland and international evidence suggests inconsistencies in practices. This study aimed to explore the process of PRN medication administration by mental health nurses. Using a qualitative descriptive design, semi-structured interviews were undertaken with 19 mental health nurses in three acute inpatient units in one mental health service in Ireland. Most participants reported undertaking an assessment of the patient before administering PRN medication however many also reported having observed incidents of poor practice. There was evidence of some interdisciplinary sensitivities around instructions regarding the use of PRN medications between doctors who prescribed them and nurses who dispensed them. A need for service improvements were also identified including the use of alternative strategies to PRN use such as de-escalation techniques and education around psychopharmacology. PRN medication is commonly used in mental health settings however this study suggests that there is potential for improvement in relation to how it is prescribed and administered. Overuse of PRN medication has been associated with increased morbidity. Mental health nurses are required to carefully consider whether PRN medication is warranted in the first instance and how its use might impact on patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

Jimu¹,

Doyle

2019

Issues in Mental Health Nursing

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“…In PRN medication treatment, as in health care in general, patient participation is a guiding principle (Castro et al., 2016). Patient participation in PRN means that patients have opportunities to take the initiative in PRN administrations, they are engaged in decision‐making concerning PRN and its alternatives, and their feedback on medication is observed (Hipp et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Patient participation in pro re nata medication in forensic psychiatric care: A nursing document analysis

Hipp

Repo-Tiihonen

Kuosmanen

et al. 2020

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject As‐needed medication is commonly used for psychiatric inpatients’ acute psychiatric and physical symptoms. Both patients and staff can initiate such medication. Earlier studies have focused on what and how as‐needed medication has been used for psychiatric reasons. Little is known about how patients participate in planning, administration and evaluation of as‐needed medication and its alternatives. Nursing documentation provides an insight into these practices. What this paper adds to existing knowledge Long‐term inpatients have an active role in initiating as‐needed medication. However, patients and staff may have divergent opinions on the need for medication. Alternatives to medication are mostly proposed by staff, and the feedback on as‐needed medication events is usually provided from nurses’ point of view. What are the implications for practice Patients’ views on decision‐making and evaluation should be noticed and documented more. Patient participation can be promoted by planning as‐needed medication and its alternatives beforehand. Abstract Introduction Pro re nata (PRN) medication is unscheduled and used for acute physical and psychiatric symptoms. Previous studies have focused on the what and how of psychotropic PRN administration. Initiators of PRN events and occasions in which PRN was denied have rarely been studied. Thus, knowledge of patient participation in PRN is fragmented. Aim We aimed to describe and explain long‐term psychiatric inpatients’ participation in relation to planning and initiation of, as well as decisions and feedback on their PRN medication treatment. Methods We retrieved data from patients’ (n = 67) nursing documentation in a Finnish forensic psychiatric hospital in 2018. Data were analysed using statistical methods. Results All patients were prescribed PRN, and they initiated half of the 8,626 PRN events identified, in a 1‐year period. Non‐pharmacological strategies were rarely (6%) documented, and most of them were initiated by staff (76%). Feedback on PRN was usually from a nurse's viewpoint (71%). Nurses’ feedback was positive (80%) more often than patients’ (50%). Discussion Patient participation needs to be recognized throughout the PRN process. Future research could continue to explore patient participation in planning and evaluating their PRN medication. Implications for practice Patients participate in PRN by requesting medication. Their participation can be developed by supporting patients to communicate their choice of non‐pharmacological methods, take the initiative for medication when needed and disclose their viewpoint on the effects of PRN.

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“…The paper published by Bonding et al is not unique in terms of the bias that results from excluding all papers in languages other than English. There is a number of other recent reviews referring to topics of inpatient services that defined the inclusion criterion as 'limited to material published in English' (2)(3)(4), and the application of this criterion is not only found among authors from English-speaking countries (5). As to the paper by Bonding et al, the bias cannot be compensated by the authors' statement that a more exhaustive review should also include publications in other languages.…”

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confidence: 99%

Potential language bias in systematic reviews on the use of coercion in psychiatry

Steinert¹

2020

Acta Psychiatr Scand

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Gooding et al. (1) present an international scoping review on studies that examined measures to reduce coercion in mental health services. The topic is of high interest, and they conducted a wide search in a reasonable set of databases, yielding eventually 121 empirical research papers. 65 out of these papers, more than the half, stem from countries where English is spoken as native or official language (the latter applies to countries such as India or Ghana). In contrast, none stems from a French-speaking country. So it may be worthwhile to reflect what that means for the obtained results and their dissemination. The results suggest that research on aspects of coercion mostly takes place in a small number of Englishspeaking countries, while there is a relative paucity of research (and, seemingly, interest) in most other countries. However, the authors restricted their comprehensive search efforts to papers published in English language. Most or all so-called 'international' journals are in English language nowadays. Undoubtedly, using a common language has considerable advantages for the international community. In biomedical research, there are good reasons to assume that relevant research papers will be published in English language journals. In psychiatry, this applies, among others, for pharmacological research, genetics, and neuroimaging. But does it also apply for other topics such as community services, legal aspects, or coercion? Definitely not. Coercion is not a biomedical phenomenon but is placed in the interface between psychiatry, law, policy, ethics, and social and medical services. Empirical research is therefore consulted with high interest-not only by researchers and clinicians, but also by lawmakers (including High Courts) and policymakers. The language for these kind of reports will always be the national. Reports about an inquiry to a French Ministry will be available in French, to a Brasilian Ministry in Portuguese, and to a Mexican Ministry in Spanish. These research reports are closely related to national or regional conditions of Mental Health Care and to national law, hence frequently difficult to interpret for people who are not acquainted with these contexts. At least the bigger countries have a considerable set of psychiatric journals in national language where this type of research is published. It is also no wonder that some small countries like Denmark are relatively strongly represented in the paper of Gooding et al. In small countries, the national psychiatric community is very limited, so that a higher proportion of relevant papers will be published in English. Yet, papers on guidance in mental health issues directed to policymakers will be published in the national language nearly everywhere. In English-speaking countries, the conditions of publishing research in the area of mental health care are basically the same. However, the difference is that their 'national' journals are mostly the 'international' ones, simultaneously. This has some strange consequences. For example, inte...

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Patient participation in pro re nata medication in psychiatric inpatient settings: An integrative review

Cited by 12 publications

References 43 publications

The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

Patient participation in pro re nata medication in forensic psychiatric care: A nursing document analysis

Potential language bias in systematic reviews on the use of coercion in psychiatry

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