A structured observation of the interaction between nurses and patients during the administration of medication in an acute mental health unit

Authors

  • Joy A Duxbury,

    1. Authors:Joy A Duxbury, PhD, MA, BSc, PG Cert, RMN, RGN, RNT, Reader in Mental Health Nursing, University of Central Lancashire, School of Nursing & Caring Sciences; Karen Margaret Wright, MA, PG Cert PD, RGN, RMN, Principal Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences; Anna Hart, PhD, MSc, MA, BA, CStat, Principal Lecturer, University of Central Lancashire, School of Public Health & Clinical Sciences; Diane Bradley, MA, BSc, DPSN, RMN, RGN, Senior Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire; Pamela Roach, BSc, MRC Research Fellow, University of Manchester, School of Nursing, Midwifery & Social Work; Neil Harris, PhD, Senior Lecturer/Nurse Consultant, University of Manchester, School of Nursing, Midwifery & Social Work, Manchester, Greater Manchester; Bernie Carter, PhD, PGCE, BSc, RSCN, SRN, Professor of Children’s Nursing, Children’s Nursing Research Unit, Alder Hey Children’s NHS Foundation Trust, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire, UK
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  • Karen Margaret Wright,

    1. Authors:Joy A Duxbury, PhD, MA, BSc, PG Cert, RMN, RGN, RNT, Reader in Mental Health Nursing, University of Central Lancashire, School of Nursing & Caring Sciences; Karen Margaret Wright, MA, PG Cert PD, RGN, RMN, Principal Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences; Anna Hart, PhD, MSc, MA, BA, CStat, Principal Lecturer, University of Central Lancashire, School of Public Health & Clinical Sciences; Diane Bradley, MA, BSc, DPSN, RMN, RGN, Senior Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire; Pamela Roach, BSc, MRC Research Fellow, University of Manchester, School of Nursing, Midwifery & Social Work; Neil Harris, PhD, Senior Lecturer/Nurse Consultant, University of Manchester, School of Nursing, Midwifery & Social Work, Manchester, Greater Manchester; Bernie Carter, PhD, PGCE, BSc, RSCN, SRN, Professor of Children’s Nursing, Children’s Nursing Research Unit, Alder Hey Children’s NHS Foundation Trust, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire, UK
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  • Anna Hart,

    1. Authors:Joy A Duxbury, PhD, MA, BSc, PG Cert, RMN, RGN, RNT, Reader in Mental Health Nursing, University of Central Lancashire, School of Nursing & Caring Sciences; Karen Margaret Wright, MA, PG Cert PD, RGN, RMN, Principal Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences; Anna Hart, PhD, MSc, MA, BA, CStat, Principal Lecturer, University of Central Lancashire, School of Public Health & Clinical Sciences; Diane Bradley, MA, BSc, DPSN, RMN, RGN, Senior Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire; Pamela Roach, BSc, MRC Research Fellow, University of Manchester, School of Nursing, Midwifery & Social Work; Neil Harris, PhD, Senior Lecturer/Nurse Consultant, University of Manchester, School of Nursing, Midwifery & Social Work, Manchester, Greater Manchester; Bernie Carter, PhD, PGCE, BSc, RSCN, SRN, Professor of Children’s Nursing, Children’s Nursing Research Unit, Alder Hey Children’s NHS Foundation Trust, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire, UK
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  • Diane Bradley,

    1. Authors:Joy A Duxbury, PhD, MA, BSc, PG Cert, RMN, RGN, RNT, Reader in Mental Health Nursing, University of Central Lancashire, School of Nursing & Caring Sciences; Karen Margaret Wright, MA, PG Cert PD, RGN, RMN, Principal Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences; Anna Hart, PhD, MSc, MA, BA, CStat, Principal Lecturer, University of Central Lancashire, School of Public Health & Clinical Sciences; Diane Bradley, MA, BSc, DPSN, RMN, RGN, Senior Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire; Pamela Roach, BSc, MRC Research Fellow, University of Manchester, School of Nursing, Midwifery & Social Work; Neil Harris, PhD, Senior Lecturer/Nurse Consultant, University of Manchester, School of Nursing, Midwifery & Social Work, Manchester, Greater Manchester; Bernie Carter, PhD, PGCE, BSc, RSCN, SRN, Professor of Children’s Nursing, Children’s Nursing Research Unit, Alder Hey Children’s NHS Foundation Trust, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire, UK
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  • Pamela Roach,

    1. Authors:Joy A Duxbury, PhD, MA, BSc, PG Cert, RMN, RGN, RNT, Reader in Mental Health Nursing, University of Central Lancashire, School of Nursing & Caring Sciences; Karen Margaret Wright, MA, PG Cert PD, RGN, RMN, Principal Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences; Anna Hart, PhD, MSc, MA, BA, CStat, Principal Lecturer, University of Central Lancashire, School of Public Health & Clinical Sciences; Diane Bradley, MA, BSc, DPSN, RMN, RGN, Senior Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire; Pamela Roach, BSc, MRC Research Fellow, University of Manchester, School of Nursing, Midwifery & Social Work; Neil Harris, PhD, Senior Lecturer/Nurse Consultant, University of Manchester, School of Nursing, Midwifery & Social Work, Manchester, Greater Manchester; Bernie Carter, PhD, PGCE, BSc, RSCN, SRN, Professor of Children’s Nursing, Children’s Nursing Research Unit, Alder Hey Children’s NHS Foundation Trust, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire, UK
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  • Neil Harris,

    1. Authors:Joy A Duxbury, PhD, MA, BSc, PG Cert, RMN, RGN, RNT, Reader in Mental Health Nursing, University of Central Lancashire, School of Nursing & Caring Sciences; Karen Margaret Wright, MA, PG Cert PD, RGN, RMN, Principal Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences; Anna Hart, PhD, MSc, MA, BA, CStat, Principal Lecturer, University of Central Lancashire, School of Public Health & Clinical Sciences; Diane Bradley, MA, BSc, DPSN, RMN, RGN, Senior Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire; Pamela Roach, BSc, MRC Research Fellow, University of Manchester, School of Nursing, Midwifery & Social Work; Neil Harris, PhD, Senior Lecturer/Nurse Consultant, University of Manchester, School of Nursing, Midwifery & Social Work, Manchester, Greater Manchester; Bernie Carter, PhD, PGCE, BSc, RSCN, SRN, Professor of Children’s Nursing, Children’s Nursing Research Unit, Alder Hey Children’s NHS Foundation Trust, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire, UK
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  • Bernie Carter

    1. Authors:Joy A Duxbury, PhD, MA, BSc, PG Cert, RMN, RGN, RNT, Reader in Mental Health Nursing, University of Central Lancashire, School of Nursing & Caring Sciences; Karen Margaret Wright, MA, PG Cert PD, RGN, RMN, Principal Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences; Anna Hart, PhD, MSc, MA, BA, CStat, Principal Lecturer, University of Central Lancashire, School of Public Health & Clinical Sciences; Diane Bradley, MA, BSc, DPSN, RMN, RGN, Senior Lecturer, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire; Pamela Roach, BSc, MRC Research Fellow, University of Manchester, School of Nursing, Midwifery & Social Work; Neil Harris, PhD, Senior Lecturer/Nurse Consultant, University of Manchester, School of Nursing, Midwifery & Social Work, Manchester, Greater Manchester; Bernie Carter, PhD, PGCE, BSc, RSCN, SRN, Professor of Children’s Nursing, Children’s Nursing Research Unit, Alder Hey Children’s NHS Foundation Trust, University of Central Lancashire, School of Nursing & Caring Sciences, Preston, Lancashire, UK
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Joy A Duxbury, Reader in Mental Health Nursing, University of Central Lancashire, School of Nursing & Caring Sciences, Brook Building, Brook Street, Preston PR1 2HE, Lancashire, UK. Telephone: 01772 895110.
E-mail:JDuxbury@uclan.ac.uk

Abstract

Aims.  This aims of this study are to describe current practice in the administration of medication in an acute psychiatric unit and explore factors that influence nurses’ decisions regarding the administration of medication during ‘rounds’.

Background.  Medication ‘rounds’ form part of the ward routine in many inpatient mental health settings. Nurses make several clinical decisions about administrating medication; yet, concerns have been raised about the poor assessment of patients’ needs and the quality of the information exchanged.

Design.  A structured non-participant observational design was used for this research.

Method.  This study involved the observation of 20 medication ‘rounds’ over three months. The Ward Administration of Medication Schedule was used to report on the interactions between nurses and patients and aspects of their communication during each round.

Results.  From the rounds observed nurses appeared adept at communicating a positive interpersonal style but less so in demonstrating skills portraying collaboration and information giving. For example whilst nurses communicated warmth in 97% of cases, using non-verbal behaviours such as good eye contact, the provision of information was only initiated in 46% of cases. Enquiries regarding the patient’s general health and medication taking (35% and 17% respectively) were less commonly observed. Verbal consent was sought in only 25% of cases. Procedural matters were adhered to overall.

Conclusions.  Findings suggest limited collaboration between nurses and patients and the poor monitoring of health status and medication effects. Information exchange could be improved; however, this may be related to medication procedures that make it difficult to explore sensitive information with patients, rather than nursing skills and behaviour.

Relevance to clinical practice.  The Ward Administration of Medication Schedule can be used as a clinical or educational tool in the administration of medication. In both instances, it may be self-administered and used to reflect on personal skills or employed as an observational tool during peer review and audit.

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