MEDICATION CONCORDANCE AMONGST PERSONS WITH A DIAGNOSIS OF
BIPOLAR AFFECTIVE DISORDER: AN EXPLORATION OF PSYCHIATRIC NURSES’
PERCEPTIONS IN AN ACUTE PSYCHIATRIC IN-PATIENT SETTING
Sharon McSweeney
Introduction
Bipolar affective disorder is a severe enduring mental illness that is associated with high rates
of medication non-concordance, which consequently increases relapse and readmissions to
acute in-patient settings. Psychiatric nurses working in acute in-patient settings have a
significant role in facilitating medication concordance amongst persons with a diagnosis of
bipolar affective disorder. Concordance therapy has been proven to increase concordance,
reduce relapse rates and increase positive patient outcomes (Kemp et al 1996, 1998; Gray et
al 2004). The groundwork for concordance therapy must be initiated within the acute inpatient setting by the service providers to give the patient the best chance of successfully
concording with their medication upon discharge.
Rationale for Study
However, whilst there is some evidence available on psychiatric nurses’ perceptions of
facilitating medication concordance amongst patients with a diagnosis of schizophrenia.
There is a dearth of research which has explored psychiatric nurses’ perceptions of their role
in facilitating medication concordance amongst persons with a diagnosis of bipolar affective
disorder. The aim and objectives of this study is to explore psychiatric nurses’ perceptions of
the barriers, enabling factors and the interventions used in the promotion of medication
concordance amongst persons with a diagnosis of bipolar affective disorder in an acute inpatient setting.
Research Design
A qualitative study design was conducted where 10 registered psychiatric nurses working in
one acute in-patient unit within the Health Service Executive (HSE) participated in the
research study. Data was collected using semi-structured interviews which were taperecorded and transcribed verbatim, with participants consent, to facilitate data analysis.
Burnard (1991) thematic analysis framework was used to analyse the data collected.
Findings
The five main themes that emerged from the data analysis were:
 Experiences of medication concordance
 Challenges to medication concordance
 Facilitating factors that promote medication concordance
 Concordance strategies utilized to promote medication concordance
 Professional development
Conclusions
 Psychiatric nurses in this study expressed that medication concordance is a
prominent issue for persons with bipolar affective disorder which frequently
results in hospital admission.
 The therapeutic relationship and the development of a collaborative care plan with
patients was viewed as a significant promoting factor for concordance.
 Nurses identified specific attributes which include openness, honesty, respect,
self-awareness, use of humour, presence, development of trust, being genuine,
being non-judgemental and listening to patients were considered essential
elements in promoting concordance.
 The therapeutic milieu and the busy ward environment was perceived to create
significant challenges for nurses to facilitate the promotion of medication
concordance.
 Nurses perceived that educating patients, about their illness, prescribed
medication and possible side effects that may be experienced, was perceived as an
essential strategy to promote medication concordance.
 Providing education to family members was also viewed as significant in enabling
patients’ concordance and recovery.
 Interestingly, although nurses working in the acute in-patient unit were using
elements of concordance therapy in the promotion of medication concordance.
However, they were unaware of the terminology to justify the strategies they were
using.
 There is corresponding evidence within the literature and this study’s findings that
more education and training is needed for nurses to effectively facilitate the
promotion of medication concordance.
 No participant indicated receiving specific training on concordance therapy.
Participants considered that educational programmes are required to enhance their
professional development in promoting medication concordance.
 The study’s findings indicate that participants lack awareness of concordance
therapy used as a psychosocial intervention in medication concordance. Due to the
proven results of this intervention and adaptability to busy clinical settings, it is
recommended that in-service education; training and clinical supervision needs to
be provided to enhance nurses’ professional development within this area.
Implications
It was found that psychiatric nurses require more education to increase their knowledge and
skills to facilitate the promotion of medication concordance amongst persons with a diagnosis
of bipolar affective disorder. In-service education, training and clinical supervision are
recommended to enhance psychiatric nurses role in facilitating medication concordance.
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