NURS FPX 9000 Assessment 4 Topic Report: Secondary Review

Topic Report: Secondary Review

Student name

Capella University

NURS FPX9000

Professor Name

Submission Date

Topic Report With CITI Training

The subject matter of the doctoral project is to address the non-adherence of medication among patients with anxiety disorders. The problem of the project, evidence-based interventions that are suggested, and the expected outcomes are also outlined in the report. The multicomponent adherence interventions of trained nursing staff in the form of structured interventions are very effective in enhancing medication-taking habits and clinical outcomes in psychiatric patients (Leon et al., 2022). The whole ethical research training requirements have been met under the institutional training initiative program. Instructions on meeting the requirements regarding human subject protection: CITI training transcript is in the appendix that proves the ability to meet the requirements regarding the human subject protection requirements.

Project Problem and Relevant Evidence

One of the major barriers to the optimal psychiatric performance of patients with anxiety disorders is non-pharmacological adherence. In America, the non-adherence to medication prescriptions is already observed among 57 percent of the patients who were prescribed an antidepressant treatment plan to manage anxiety (Dibato et al., 2022). The Chicago, Illinois, outpatient mental health clinic has a patient population of about 150 per month with a diagnosis of anxiety-related patients. The baseline data available show that 55 percent of patients have a poor level of medication adherence at the project site, meaning that only 45 percent show a good level of adherence. The estimates by the World Health Organization show that the medication compliance rate among chronic disease treatment in the whole world is about 50 percent (National Council for Mental Wellbeing, 2020).

Centers for Medicare and Medicaid Services determined the quality benchmark of medication adherence in chronic disease management as 80 percent, and recent results have shown that optimal levels of minimizing healthcare expenditures and hospitalization are around 90 percent (Parikh et al., 2025). The 45 percent adherence rate in the project site is a difference of 35 percentage points short of the quality target and 45 percentage points short of ideal adherence levels. It was proven that medication nonadherence causes more symptoms, higher relapse rates, and high healthcare expenditures of approximately $100-300 billion a year, which needs to be systematically addressed (Religioni et al., 2025; Reid, 2023). The existing standard practices on the project site are premised on mere verbal education on medication and do not implement the assessment of adherence and a regular intervention plan.

The comprehensive examination of baseline measures will ensure that the intervention outcome is measured properly and that there is an area of improvement in measurements in the future. Current site measures include prescription refill rates that are checked with the help of electronic health records and self-assessed adherence measures of patients. The medication possession ratio provides objective information on medication adherence, and a percentage higher than 80 indicates that there is adequate medication-taking behavior. Though self-report measures are good sources of information about patients, the method is too optimistic regarding adherence by approximately 20 percent when compared to objective methods. By implementing the Brief Adherence Rating Scale, the assessment of adherence will be standardized, and the validity of the measurement will be enhanced (National Council for Mental Wellbeing, 2020). The process measures combined with the outcome measures will optimise quality improvement efforts and sustainability of practice change.

Evaluation of Metrics and Areas for Improvement

Current indicators of the site include prescription refill rates, which are tracked with the help of the electronic health records and patient self-assessed adherence measurement. The medication possession ratio provides objective information on medication adherence, and a percentage higher than 80 indicates that there is adequate medication-taking behavior. The use of the adherence rating brief will harmonize the assessment of adherence and enhance the validity measurement (National Council for Mental Wellbeing, 2020). The process measures combined with the outcome measures will optimise quality improvement efforts and sustainability of practice change.

The Project Site

The setting of the proposed project is a community-based outpatient mental health clinic, which will help a wide range of patients with psychiatric conditions. The identification of medication non-adherence as a critical issue that needed evidence-based intervention and the strong support of project implementation by the organizational leadership and the preceptor within the proposed timeline have been mentioned. The clinic is a one-board-certified psychiatric mental health nurse practitioner clinic, which is privately owned and small. Adjunctive psychotherapy services are provided by licensed therapists as part of the provision of extensive behavioral health care to patients with complex needs.

The practice setting offers primary psychiatric car,e including diagnostic care, medication care, and ongoing response to treatment. The clinic is located in an urban community within a big metropolis in the Midwest region where there is the presence of diverse demographic. The working days are 8:00 AM -6:00 PM, and Saturdays are only possible to some extent (10:00 AM-2:00 PM). Research determined that multicomponent adherence interventions are more appropriate in the community-based mental health settings (Sedeno et al., 2024). There exist both in-person and telehealth modalities to promote the greatest accessibility to patients with transportation or scheduling constraints. The clinic has a client base of around 150 patients per month, and anxiety disorders are a significant percentage of patients.

Project Support at the Project Site

Good collaborative working relations between the project leaders and the site stakeholders on matters of quality improvement implementation and sustainability require intensive collaborative working relationships. The preceptor is a psychiatric mental health nurse practitioner who is board-certified and with a clinical experience of over 22 years. The weekly meetings with the preceptor assist the project to proceed with planning the project, revising the interventions, and establishing potential barriers to project implementation. The preceptor provided access to patient information, electronic health records systems, and clinic workflow processes needed to provide interventions. The stakeholder interview with clinical personnel members was conducted regularly (every two weeks) to receive comments on the implementation of interventions.

As research has shown, the role of preceptors, along with the organizational support, is one of the essential factors that determine the success of quality improvement projects (Sedeno et al., 2024). The feedback of the stakeholders indicated the need to have a short, realistic intervention, which is easily integrated into the existing clinical procedures and does not disrupt care. Time limitation and alternate priorities were also mentioned as potential barriers that should be addressed by the clinical workers. It was proven that healthcare professionals refer to the lack of patient education and absence of systematic follow-ups as essential obstacles to medication adherence (Kohn et al., 2022). Thus, the multicomponent toolkit intervention was chosen due to the ability to offer structured adherence measures, motivational interviewing, and full psychoeducation (National Council for Mental Wellbeing, 2020). The preceptor also recommended that motivational interviewing techniques be used, which would be in line with the philosophy of patient-centered care and the philosophy that has been embraced by the clinic.

Areas for Preparation Enhancement

The gaps are the gaps in knowledge and the aspects of preparation that should be given more attention so that the implementation of the project will become more efficient and overcome the potential obstacles. The enhanced ability of the nursing staff to address patient ambivalence and knowledge gaps in relation to medication adherence would be strengthened with the help of advanced training in the elements of the National Council Toolkit, such as motivational interviewing, psychoeducation, and systematic adherence assessment. Additional knowledge concerning cultural beliefs on medication-taking behavior would help to improve the tailoring of interventions to different groups of patients served.

Cultural competence training, according to policy, is capable of affecting the outcomes of healthcare providers in the sphere of medication adherence barriers in a positive manner (National Council for Mental Wellbeing, 2020). Additional information on insurance reimbursement programs in relation to long-term counseling sessions would facilitatethe long-term application of practice to operations. Further training on change management strategies would ease the process of negotiating organizational resistance and change into the working process in the implementation.

Proposed Interventions

One of the most important ways of improving medication adherence among patients with a psychiatric diagnosis is basing the interventions on competencies associated with healthcare providers. The primary intervention will entail the application of the National Council on Mental Wellbeing organizational toolkit on medication adherence among the nurses. The intervention is a multicomponent intervention that is coupled with systematic adherence measurement through the application of a brief adherence rating scale, motivational interviewing, and systematic psychoeducation.

In a randomized controlled trial, the intervention of enhancing adherence by the nurse was shown to significantly increase the medication-taking behaviors, which were between 43.9% and 70.7% at the end of the intervention (Peterson, 2025). Studies proved that multicomponent interventions (knowledge transfer, i.e., psychoeducation, motivational interviewing, and BARS assessment) can significantly enhance medication adherence at the 6-month follow-up in psychiatric sample populations (Sedeno et al., 2024). In a comprehensive meta-analysis of 46 randomized controlled trials (n=24,324) it was found that interventions with psychoeducational, behavioral, and shared decision making as the main elements of the National Council toolkit produced an improved medication adherence (Leon et al., 2022).

The qualitative data established that mental health nurses use psychoeducation, cognitive-behavioral, and motivational methods sequentially to enhance adherence (Lin et al., 2022). The implementation of structured medication adherence programs by psychiatric nurses reduced the relapses and enhanced the treatment outcome by far (Deng et al., 2022). The findings of the meta-analysis were applied to propose that multicomponent interventions, including psychoeducation and behavioral intervention, offeran odds ratio of 1.33 to improve adherence (Leon et al., 2022). One of them was a cluster randomized controlled trial that demonstrated that the knowledge transfer and behavior modification interventions were effective in the context of promoting drug use among depressive disorders (Sedeno et al., 2024).

The sentiments of the medical workers have revealed that the primary reason behind non-compliance with medicines in severe mental conditions is the absence of aftercare and a lack of resources (Deng et al., 2022). The study had demonstrated that nurse-led telephonic medication adherence programs are effective in adherence promotion and the required emotional support during the post-discharge period (Peterson, 2025). The presented study has found that motivational interviewing among nurses is an effective intervention method that promotes medication adherence among psychiatric patients in different clinical setups (Dellafiore et al., 2023). Interventions based on motivational interviewing, when provided by nurses, demonstrate significant differences between self-care practices and treatment adherence to different groups of people with chronic diseases (Dellafiore et al., 2023). The long-term solution to the problem of psychiatric medication outcomes is the introduction of systematic evidence-based adherence interventions by trained nursing personnel.

Educational Interventions

The educational intervention gives the nursing personnel the mechanisms of an evidence-based toolkit, methods regarding systematic training in motivational interviewing, and shared decision-making. Nursing staff represent the target audience of the mandatory learning factor, which is accomplished prior to the project implementation. Healthcare providers can promote treatment engagement and adherence outcomes in psychiatric patients by training them in motivational interviewing (Herrera et al., 2024). Research discovered that mental health professionals should have a full education on the barriers to adherence and the evidence-based intervention strategies (Kohn et al., 2022). Motivational interviewing approaches training of staff has proven to be effective in enhancing healthcare usage and adherence to treatments in vulnerable groups (Reinauer et al., 2021).

Mental health nurses were identified to utilise tacit knowledge as an outcome of their clinical experience and theoretical training in implementing adherence strategies in qualitative research (Lin et al., 2022). Motivational interviewing reads like a healthcare career whereby professionals can be found who demonstrate better communication that can influence patients in adhering to medicines and treatment adherence positively (Herrera et al., 2024). Intervention programs created considering the adherence barriers through the lens of healthcare workers improve intervention adherence and clinical outcomes in the context of mental health (Kohn et al., 2022).

The evidence has shown that the training of motivational interviewing will enable healthcare professionals to effectively overcome patient ambivalence and enhance intrinsic motivation to change (Reinauer et al., 2021). The competencies of nurses who are trained in the context of extensive education programs are high in the area of patient-centered adherence interventions in a diverse population of individuals who receive clinical attention (Deng et al., 2022). The educational intervention will offer a knowledge base where the nursing staff will be able to impart aspects of the toolkit in a feasible manner as the implementation process unfolds.

Additional Information

The highly developed intervention strategies would enable the nursing staff to excel in addressing the intricate adherence obstacles among the various patients. The motivation and development of interviewing skills could be reinforced by the better time spent in training in comparison to the regular types of workshops, and the intervention fidelity could be increased during the process of implementation (Kohn et al., 2022). Cultural competence in medication counseling is also covered in other materials, which would be useful in providing interventions to patients with other ethnic backgrounds in a more personalized way. Continued mentoring and skill development would be an excellent option as a means of consulting with more experienced motivational interviewing professionals throughout the implementation process.

Comparisons

Quality improvement initiatives should be clear-cut regarding how the existing trends of practice might be contrasted with the evidence-based desired position to assess the desired outcomes of meaningful improvements. The condition that prevails in the project site encompasses the customary verbal medication education that is undertaken in brief clinical visits. The existing staffing approach by nurses involves general medicine education without the systematic assessment of adherence, systematic psychoeducation, and evidence-based behavioral intervention plans.

According to the baseline statistics, 45 percent of patients who have anxiety disorders achieve satisfactory drug compliance in the current practices. The measurement of adherence barriers is not being done methodically in the project site, but by the use of standardized measuring instruments, such as the brief adherence rating scale. The gap in performance and the evidence-based standard of 80 percent compliance is 35 percentage points wide (National Council for Mental Wellbeing, 2020). The current records do not have systematic compliance testing and custom intervention programs to address the said barriers to taking medication actions.

The optimum situation is the systematic use of the ingredients of National Council of Mental Wellbeing’s organizational toolkit by trained nursing staff. The approach to be employed is that the nursing personnel will participate in systematic assessment of adherence with the use of a brief adherence rating scale at every medication management appointment. Evidence-based motivational interviewing and shared decision-making will be incorporated in all medication counseling discussions with the patients.

The national level of indicators of the best psychiatric treatment results is target adherence rates (more than 80 percent) (Neiman et al., 2017). The study revealed that interventions with numerous elements that involve systematic evaluation, psychoeducation, and behavioral strategies have a significant positive impact in terms of adherence as compared to regular care (Leon et al., 2022). The intended condition implies the evidence-driven practice change of the unstructured, variable medication teaching to the structured, toolkit-based adherence interventions.

Desirable Outcomes

The systematic review of quality improvement programs can be observed, and clear results can be achieved, resulting in the change of the practice in the healthcare facilities based on the evidence. The main output is higher rates of medication adherence in the patients, and the aim is to increase the adherence rates from a baseline is 45% to a minimum of 70% at the end of the implementation period, which will be measured by the medication possession ratio calculated on the basis of pharmacy refill records. The enhanced rates of patient medication adherence are one of the most important project outcomes, which will be expected to improve the current rates of 45% baseline, and at least 70% after the implementation.

Potential Impact

The successful realization of the project has a high potential of transforming the competence of the nursing personnel and developing a long-term evidence-based approach to medication management practices. These competencies of systematic adherence assessment would make nursing staff more efficient in revealing the obstacles and offering patient-specific interventions. The training of medical workers on evidence-based communication strategies can be used to improve the treatment engagement outcomes and therapeutic relationship (Herrera et al., 2024). The long-term outcomes are improved job satisfaction of the nursing personnel, compliance with the best practices standards of the organization, and professional development.

Learner’s Role for the Project

The ideal execution of the doctoral project involves the provision of leadership positions clearly with proper mentorship that would ensure the change of evidence-based practice is successful. The learner will be the primary project leader in reference to the planning, implementation, and evaluation of all aspects of interventions in the initiative. The leadership functions will involve general training of all the personnel regarding the national council toolkit strategies, motivational interviewing methods, and the brief adherence rating scale.

Research also demonstrated that the rates of success of high-quality improvement were high when the project leadership that engaged stakeholders and planned the implementation were put into action (Sedeeno et al., 2024). The clinical mentor will be the preceptor who will provide guidance and site and consultation accessibility on the organizational barriers. The efficient implementation of the organized project management methods, along with the efficient role specification, facilitates the conversion of sustainable practice in the health care setting (Leon et al., 2022). The comprehensive leadership in planning, implementation and assessment procedures will position the learner in a platform to achieve the effective changes in the medication adherence results.

Project Question

The PICOT question forms a systematic model that leads evidence-based quality improvement efforts and a clear parameter on which the outcome can be assessed. The population (P) is a population of nursing staff that directly takes care of adult patients with anxiety disorders in an outpatient environment. Intervention (I) will be the systematic application of National Council of Mental Wellbeing organizational toolkit on medication adherence by providing extensive training to staff and implementing the practices as well. The toolkit includes various evidence-based ingredients the nursing personnel will provide to patients, such as systematic adherence assessment on the brief adherence rating scale, motivational interviewing, shared decision-making to promote patient autonomy, psychoeducation, and practical adherence supports (National Council for Mental Wellbeing, 2020).

The comparison (C) is current standard practices, which are short-term verbal medication education, lacking systematic assessment of adherence, and evidence-based behavioral interventions. The outcome (O) aims at increasing the rates of patient medication adherence in the population with anxiety disorder under the care of trained nursing staff, as well as at least 70 percent improvement in the rates at the baseline of 45 percent, measured by Medication Possession Ratio (MPR) based on the pharmacy refills data provided by the electronic health records (Moreira et al., 2023). The time (T) is a period of 12 weeks, where eight weeks will be dedicated to the implementation time, when the nursing staff will actively provide the components of the toolkit to patients.

Conclusion

The evidence-based quality improvement effort will address the current gap between the current medication practices and the national adherence standards. The introduction of the National Council of Mental Wellbeing organizational toolkit in a systematic manner will equip the nursing staff with proven measures in enhancing compliance. The implementation phase (12 weeks) will also entrench permanent infrastructure in the management of psychiatric drugs in outpatient mental health institutions in an evidence-based manner. The fact that the successful completion of the project will be achieved will demonstrate good translation of the research evidence into clinical practice improvements that are beneficial to patients with anxiety disorders.

Related assessments for this class: NURS FPX 9000 Assessment 1 and NURS FPX 9000 Assessment 2