Mark is a 37-year-old client with a 15-year history of
schizophrenia. When he was first diagnosed, he was
prescribed a second-generation antipsychotic medication. He
complained about drowsiness and difficulty concentrating. He
experienced a 40 lb. weight gain over a year. His girlfriend
complained about his reduced sex drive and ended their
relationship. He tried several different medications alone and
in combination but found the side effects intolerable. He
stopped taking his medications and started self-medicating
with alcohol. Over time, he experienced several relapses, and
his condition declined markedly. He lost his housing and
began living in his car. After being involuntarily committed
following a psychotic episode, he was referred to the PMHNP
at the outpatient clinic. When he presented for his
appointment, he told the PMHNP that he stopped taking his
medications due to their side effects.
What is the most appropriate response by the PMHNP?
You have had some difficult medication side effects that negatively
impact your life and relationship.
How can the PMHNP support adherence for this client?
Patient adherence is the patient’s behavioral response to health care
provider’s treatment recommendation and medication prescription.
(Panahi et al., 2022). Adherence to a treatment plan is associated
with positive health outcomes such as reduction in rehospitalization,
symptom control, increased quality of life, increased survival rate and
productivity (Rashidi et al., 2020). Some factors that drive patient
adherence include patient’s socio- economic status, healthcare
access, provider-patients discordance, and patient’s chronic health
condition (Panahi et al., 2022). The PMHNP could support adherence
for this client by involving the patient in the treatment decision
making process, reviewing the possible side effects of prescribed
medication(s) that they jointly agreed upon, encourage client to
schedule proper follow-up to monitor new medication side effects and
referral to social worker to assist with housing.
What are the ethical and legal obligations for the
PMHNP in the above situation?
The ethical obligation of the PMHNP in this situation should be the
same as with any other patient. The American Nurse Association
(ANA) code of ethics for nurses provide ethical guideline to guide our
practice. The provision includes providing care with compassion and
respect, commitment to the patient and protecting the rights of the
patient, among others (American Nurses Association, n.d.).
