Dec 14, 2020
By Michelle Danda

Hearing the patient voice: why nurses must document the side effects of antipsychotics

istockphoto.com/asiseeitMedication side effects are one of the major risks that nurses needed to assess to ensure safe care of patients and also to support their transition from hospital back to the community and their lives.

Takeaway messages

  • Side effects are a significant reason why patients who are prescribed antipsychotic medications stop taking them.
  • Nurses need to ask patients about their side effects, not simply observe them; this holds true for all medications, not just antipsychotics.
  • The side effects of medication can be so severe and debilitating that they outweigh the benefits.

Psychopharmacological interventions are a large part of the mental health nurse’s role in the inpatient setting. Acute inpatient mental health admission is often focused on the stabilization of a person’s acute crisis and symptoms, necessitating consideration of psychotropic medications. Antipsychotic medications are a particularly important intervention, especially for people who are experiencing symptoms of psychosis.

Early in my nursing career, I noted that nurses often assessed and documented the reduction of psychotic symptoms, but less frequently documented medication side effects. Side effects are a significant reason why patients who are prescribed antipsychotic medications stop taking them (Semahegn et al., 2020).

In mental health care, collecting evidence and practising effectively require patient collaboration and inclusion of patient perspectives. Within this framework, it seems intuitive that nurses would prioritize understanding patients’ experience of antipsychotic side effects. However, I did not recognize the importance of assessing, understanding, and recording patient perspectives of antipsychotic side effects in the health record until years into my career.

The research

My perspective changed after reading the qualitative research of Morrison, Meehan, and Stomski (2015) that focused on understanding patients’ experience of antipsychotic medication side effects. Their research shaped my understanding of the need to ask patients about their experience with side effects — not simply observe them. Ultimately, this perspective extends to all medications, not just antipsychotics.

In mental health care, collecting evidence and practising effectively require patient collaboration and inclusion of patient perspectives.

Morrison et al. (2015) conducted qualitative interviews with people taking antipsychotic medications who experienced side effects. Their findings suggested that these patients experienced adverse effects that affected their physical, social, and emotional lives. Beyond that, the researchers found that side effects resulted in experiences of fear and suffering that patients could not fully explain to the clinicians assessing them or even to their own social support system.

To deal with their suffering, patients used numerous coping strategies such as denial or displacement of the cause, or they learned to accept the side effects to appear compliant within the structure of the mental health system. The research offered a different perspective than the medical, psychiatry-driven one that valued symptom reduction as the hallmark of recovery.

These researchers’ novel perspective showed that medication side effects could significantly diminish patients’ willingness and ability to not only engage and continue in treatment programs, but also to participate in meaningful activities that allow them to enjoy life. As a result, it became clear that medication side effects were one of the major risks that nurses needed to assess to ensure safe care of patients and also to support their transition from hospital back to the community and their lives.

Heeding the patient’s voice

For people experiencing psychotic symptoms, medications can decrease positive symptoms, such as hallucinations and cognitive disorganization, and improve negative symptoms, such as amotivation, anhedonia, and cognitive slowness. However, nurses must understand patients’ experience of medication side effects, which can be so severe and debilitating that they outweigh the benefit of taking these medicines.

Until we start asking questions about medication side effects, we will not be able to build an effective relationship with patients. We must understand how medication affects their lives. We must understand the barriers that patients experience once they leave the hospital setting and continue on their journey to recovery.

Nurses’ assessment of side effects, as well as symptom reduction, can be included in documenting our patients’ experience in standard and structured ways. This approach will ensure that this information clearly and effectively brings the patient’s voice to the forefront by highlighting their perspective.

References

Morrison, P., Meehan, T., & Stomski, N. J. (2015). Living with antipsychotic medication side-effects: The experience of Australian mental health consumers. International Journal of Mental Health Nursing, 24(3), 2015, p. 253-261. doi:10.1111/inm.12110

Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis. Systematic Reviews , 9(1), 2020, p. 17. doi:10.1186/s13643-020-1274-3

Michelle Danda, RN, MN, MPN, CPMHN(C), graduated from the Bachelor of Nursing Accelerated Track program at the University of Calgary in 2008. She currently lives and practises mental health nursing at Lion’s Gate Hospital in North Vancouver, BC. She has four beautiful children with her partner, who is also a mental health nurse. She is also a fulltime doctoral student in the PhD Nursing program at the University of Alberta.

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