Pharmacological plan Assignment

Pharmacological plan Assignment

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What problems can be identified in this patient? Please provide a list of differential diagnoses, as well as indication of your primary diagnosis. What is your pharmacological plan for your primary diagnosis including the medication, dose, and mechanism of action?

Source: https://www.homeworkjoy.com/questions/health-care/576938-nr508-Week-6-discussion-1/

a qualitative approach was employed, using Symbolic Interactionism as the theoretical and Grounded Theory as the methodological framework. The research was developed between 2008 and 2010 at three community mental health services in the interior of the State of São Paulo – Brazil. Thirty-six patients and thirty-six family members were selected through theoretical sampling. The data were mainly collected through open interviews and observation and simultaneously analyzed through open, axial and selective coding.
RESULTS:
the meaning of the pharmacotherapy is centered on the phenomenon “Living with a help that bothers”, which expresses the patients’ ambivalence towards the medication and determines their decision making. The insight, access, limitations for self-administration of the drugs and interactions with family members and the health team influenced the patient’s medication-related behavior.
CONCLUSION:
the theory presented in this study provides a comprehensive, contextualized, motivational and dynamic understanding of the relation the patient experiences and indicates potentials and barriers to follow the medication treatment.
Keywords: Schizophrenia, Self Medication, Interpesonal Relations, Patient Satisfaction, Psychotropic Drugs, Medication Adherence
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Introduction
Schizophrenia is a potentially disabling chronic condition that causes a great impact on the patients, families and society. Besides the subjective experience of psychotic symptoms, the disorder affects the individual’s quality of life and is associated with significant functional losses( 1 ).

Continuous medication treatment is fundamental to control the symptoms of the disorder( 2 ) when associated with other therapeutic modalities, such as psychotherapy, psychoeducation, sociotherapy, occupational therapy, among others.

The lack of adherence to the pharmacological treatment is associated with the exacerbation of symptoms, worse prognosis, repeated internment, high costs and unnecessary adjustments in the medical prescription( 2), justified by a supposed inefficacy of the drug which, in fact, was not used appropriately, which can compromise the patient’s safety in the medication treatment.

Patient safety( 3 ) and adherence( 4 – 6 ) to the pharmacological treatment are important challenges in care practice and require efficient nursing interventions. To plan and implement these actions, the patients’ subjectivity, needs, motivations and difficulties need to be considered, more than how precisely they follow the health team’s recommendations( 7 ).

In the domestic context, the family serves as a privileged space for care practice and social support, which influence the treatment adherence( 8 ). Patients and family members play a decisive role in the monitoring of the pharmacological treatment.

The construction of a theoretical model about the meaning of the medication treatment for schizophrenia patients permits a comprehensive, contextualized, motivational and empathetic understanding of the reality these individuals experience. It can facilitate the integration between their context, the meaning attributed to the drug therapy, the motivations, decision making and behaviors related to coping with the disorder, besides the identification of potentials and problems to follow the medication therapy.

Thus, this study aimed to understand the meaning of the medication treatment for schizophrenic patients and to build a theoretical model about the study phenomenon.

Symbolic Interactionism was employed as the theoretical framework. This framework presupposes that behavior (observable external act and internal experience) is guided by the individual’s definitions of reality. These definitions, in turn, derive from the social interactions in which active individuals exert mutual influence( 9 ).
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Method
A qualitative study was undertaken. Grounded Theory (GT) was used as the methodological framework. The systematic procedures of GT were designated to produce concepts and provide a multivariate and consistent theoretical explanation of the social phenomenon studied( 10 ).

Thirty-six patients and 36 family members were selected to participate in the study, in a theoretical sampling process in which the sample structure is gradually defined during the data collection and simultaneous analysis, as recommended by the GT( 10 ). Three sample groups were constituted, which came from community mental health services that attended to patients with distinct treatment experiences. These services were public and located in the interior of the State of São Paulo – Brazil.

The first sample group consisted of 15 patients and 15 family members from a tertiary psychiatric outpatient clinic that preferably attended to clinically more complex cases. The second sample group included 13 patients and 13 family members followed at a mental health service (secondary level), so as to include people with less problems due to the schizophrenia. In the construction process of the theoretical model, the need emerged for a third sample group, followed at a Psychosocial Care Center, as this service is based on another care model that, besides the medication treatment, includes other therapeutic modalities, psychosocial rehabilitation and users’ active participation. The inclusion of participants from distinct services was important to consolidate a more comprehensive theoretical model.

In the construction of the sample, internal variation in the sample groups was sought in terms of personal characteristics and experiences that could influence the construction of the meaning attributed to the medication use, such as: time of diagnosis, gender, age range, education, position in family group, socioeconomic layer, religious belief, medication use, drug administration route, family supervision, among others. This variation in the composition of the groups facilitated the construction of the properties and dimensions in the categories( 10 ).

The criteria to include patients in the study were: being diagnosed with schizophrenia (established by psychiatrist) and taking psychotropic medication(s). The diagnosis was confirmed with the health team and by consulting the patient’s history.

The criterion to include the family members in the study was: being mentioned by a schizophrenic patient who participated in the study as the family members most involved in the treatment. Inaptitude to verbally express oneself in Portuguese was used as an exclusion criterion for patients and relatives. The inclusion of family members in this study is justified by their potential to contribute to the understanding of the research phenomenon, as these participants made it possible to confirm and complement information obtained from the patients and the collection of additional information.

Between 2008 and 2010, data collection and analysis were undertaken simultaneously, as recommended by the GT. Recorded open interviews and observation were the main strategies to obtain the data, but were complemented by consultations of patient histories, home visits and case discussion with the health team. The participants could choose to be interviewed at home or in a private environment at the health service.

The first interview held was based on the guiding question: “Tell me what it is like for you to use the medication prescribed by the doctor from the psychiatric service” and, for the relative: “Tell me what it is like for your relative to use the medication prescribed by the doctor from the psychiatric service”. The guiding question only directed the aspect that was to be explored. New questions were added to clarify and support the experience.