Collaboration between Nurses and Pharmacists of Psychiatric Wards May Bring Some Changes ()
1. Introduction
Patients with mental health have increased worldwide, and the number of patients entering psychiatric hospitals has also increased. And the high number of accidents by nurses is related to medicine in Japan. Obtaining knowledge about medicine is needed by nurses. Collaboration was thought to be one of the methods to obtain knowledge about medicine.
Interprofessional collaborative approaches encourage patients’ engagement through assessment, education and monitoring [1], and enhance medication safety [2]. Medication safety is defined as the freedom from preventable harm with medication use [3]. Lyson et al. [4] said that patient-related factors, provider-related factors, and health care system-related factors influence medication safety. Provider-related factors include the skill levels of caregivers, number of caregivers, errors/discrepancies in medication user process, and so on. Collaborative interprofessional strategies, such as follow-up appointments, home visits, and counselling on medication adherence by providers working in community settings [5]. Sugimoto et al. [6] investigated the current status of collaboration between nurses and community pharmacists and investigated requests and expectations for nurses from community pharmacists. However, the place of collaboration was not for psychiatric wards and a questionnaire study. We needed to study the contents of collaboration focused on psychiatric wards in hospitals.
2. Method
2.1. Participants
We showed the background of participants (Table 1).
Table 1. Background of participants.
ID |
Gender |
Age (years) |
Total period of working |
Period of psychiatry ward |
Nurse 1 |
Female |
20 |
3 |
3 |
Nurse 2 |
Female |
20 |
5 |
5 |
Nurse 3 |
Male |
60 |
32 |
30 |
Nurse 4 |
Female |
30 |
9 |
5 |
Nurse 5 |
Female |
50 |
32 |
13 |
Nurse 6 |
Female |
30 |
8 |
8 |
Pharmacist 1 |
Female |
50 |
30 |
2 |
Pharmacist 2 |
Female |
50 |
36 |
34 |
Pharmacist 3 |
Male |
20 |
3 |
3 |
Participants were from two psychiatric hospitals. Before this research, we conducted a questionnaire study and some persons showed their intention whether they would receive an interview. Researchers confirmed that they would like to participate in the interview and we recorded them as participants. Eligibility criteria were that participants had experience over three years, because they could lean professional skills. And participants in this study were from different wards.
2.2. Procedure
The interview was conducted in the hospital or ZOOM about one hour. There were 4 questions about “Contents of collaboration”, “Difficult points and ingenuity points”, “Changes in the wards after collaboration”, and “Impressive cares”. We selected these questions in the following way. In the first questionnaire study, we prepared some questions referring to previous studies, and we got results such that there were some commonalities in how they perceive collaboration and influence of it. Then, we thought that these questions in this study were suitable.
We analyzed on another occasion about “Impressive cares”, because it was different from a stream of collaboration influence. We analyzed content analysis as qualitative study, code, sub-category, and categories. The first author made codes that had the shortest sentence with meaning, and similar codes were integrated into sub-categories. Similar sub-categories were integrated into categories. The second and third authors checked the code, sub-categories, and categories. When there were differences in categorization, they discussed until agreements.
2.3. Ethics
This study was approved by Nishikyuyu University. The interviewer explained in detail and got informed consent.
3. Results
3.1. Results of Contents Analysis of Nurses
We chose 12 categories for nurses (Table 2).
Table 2. Categories chosen by contents analysis from nurses’ interview.
Questions |
Sub-categories |
Categories |
Contents of collaboration |
*Nurses asked pharmacists for explanation for patients’ families. *Only pharmacists wear white coats. *Families were convinced. |
1) Families were convinced by explanation from pharmacists wearing white coats. |
*Patients were convinced about side effects much better by pharmacists than nurses. *Patients were convinced about side effects by pharmacists using data. |
2) Patients were convinced by explanation from pharmacists. |
*Nurses asked effects of medicine. *Nurses consulted with pharmacists from questions by a patient. |
3) Nurses consulted pharmacists about medicine or administration of it. |
*Pharmacists sorted medicine when elders went into hospital. *Pharmacist sorted medicine of elders with dementia. |
4) Pharmacists sorted medicines of patients. |
Difficulty and ingenuity |
*Nurses felt difficult when patents didn’t agree with child medication. |
5) Agreement of medicine for children by family was difficult. |
*Docters and pharmacies were busy. *Nurses asked for pharmacies explanation to a family by the doctor
or the pharmacist. |
6) Nurses looked for chances or time, and asked for explanations from doctors or pharmacists. |
*All staff received workshops about medicine. *Nurses sit together when a pharmacist confirmed medicine from patients’ family at going into hospitals. *Nurses studied medicine before taking with a pharmacist. |
7) Nurses tried to study medicine. |
*Nurses thought communication was important. *Nurses thought mutual understanding was important. |
8) Nurses valued communication and mutual understanding. |
Changes after collaboration |
*A pharmacist had many chances to meet a patient. *Nurses had chanced to collaborate with a pharmacist. |
9) A nurse felt pharmacist familiar. |
*A nurse consulted a pharmacist when a patient felt bad. *A patient became to take medicine. *Frequency of entering the hospital decreased. |
10) A patient could take medicine and frequency of entering the hospital decreased. |
*Multidisciplinary monitored effects of sleeping pill. *Multidisciplinary monitored effects of Clozaril. |
11) Medicine amount was adjusted by collaboration. |
*Multidisciplinary had a study group. *Consciousness for safety increased. |
12) Knowledge in the ward increased. |
3.2. Categories Chosen by Content Analysis of Pharmacist
We obtained 7 categories from pharmacist’ interview (Table 3).
Table 3. Categories chosen by contents analysis from pharmacist interview.
Questions |
Sub-categories |
Categories |
Collaboration contents |
*Some patients didn’t take medicine. *When a pharmacist explained instead of a nurse, they took. |
1) Patients could take medicine by explanation from pharmacists. |
*A nurse questioned about speed of antibiotics iv drip. *The pharmacist explained the reason for the speed thinking of doctor’s intention. |
2) A pharmacist collaborated with a nurse about iv drip. |
*A family member asked a pharmacist about life in the hospital at discharge guidance. *The pharmacist required a nurse to sit together. |
3) A pharmacist and a nurse collaborated at discharged guidance. |
Difficulty and ingenuity |
*A pharmacist did ward works during busy. *The number of pharmacists was few. *Soaking in medication counseling was difficult. |
4) Soaking in medication counseling by a pharmacist was difficult. |
*A pharmacist handed on instruction manual for high-risk medicine. *The pharmacist put on the instruction manual on table in the ward. *The pharmacist called out about instructions or by e-mail. |
5) A pharmacist let nurses know the instructions for high-risk medicine. |
*A pharmacist proposed a change of medicine because of falling down risk. *A pharmacist consulted doctors about refusal of taking medicine. |
6) A pharmacist contacted doctors and collaborated. |
Changes after Collaboration |
*A pharmacist talked with a patient regularly. *A doctor could not talk with her. *The doctor consulted the pharmacist how to talk with her. |
7) A pharmacist connected a patient and a doctor. |
4. Discussion
4.1. About Characteristics of Background
The number of participants was 2 males and 7 females. The range of years was 20 years (3 persons), 30 years (2 persons), 50 years (3 persons), 60 years (1 person). The working experience range was from 3 to 36 years, and it seems to be a large difference.
4.2. About Characteristics of Categories
As for the question < Contents of collaboration > , categories like “Families were convinced by explanation from pharmacist wearing white coat” or “Patients were convinced by explanation from pharmacists” showed that explanations about medicine from pharmacists were effective. On the other hand, about “A pharmacist and a nurse collaborated at discharge guidance” showed that the pharmacist didn’t know the patient’s state or appearance in the hospital life when they talked to families. This result supports Ichimura et al. [7], who found that pharmacies seek information about “patients’ state” or “patients’ family”. From these categories, there is a role for a nurse and a pharmacist clearly. Smith [8] showed that role clarity is vital. Celio et al. [9] said that the lack of role clarity and hierarchical nature of collaboration, nurse-pharmacist collaborators suffer as members feel that their scope of practice is encroached by the other profession.
As for the question < Difficulty and ingenuity > , a category “Nurses valued communication and mutual understanding” supported Lee et al. [10], in which a need of better communication channels, skill mix within varying scopes needs to be further examined, in terms of collaboration.
There are some differences in the results of this study and the previous study. Sugimoto et al. [6] showed categories about hopes from pharmacists to nurses, like “Hope for better collaboration”, “Hoping nurses will make the most of their profession”, and “Establishing a trusting relationship”. In this study, nurses and pharmacists collaborated and tried to make good relationships.
In Japan, the number of pharmacists may be small, and they have come to have another role of medicine guidance in psychiatric wards. In these situations, sharing information timely is difficult. New technology or ICT to promote communication or sharing information may be useful in the future. It supports a previous study [11].
Lastly, we referred to categories. In content analysis, we included both duplicated codes and a few codes, along with basic qualitative analysis, such that a few codes have meaning. Although each participant has various experiences, categories show the individual account.
4.3. Changes of Nurses and System in the Ward by Collaboration
Collaboration between nurses and pharmacists led to some changes.
“Patients were convinced by explanation by a pharmacist”, “Patients could take medicine by pharmacist’ explanation”, and “A patient could take medicine and frequency of entering the hospital decreased”. It shows that collaboration between a nurse and a pharmacist led patient’s quality of life. Similarly, about taking attentive medicine Clozaril, multidisciplinary monitored effects of this medicine, and the amount of Clozaril was increased, like the category “Medicine amount was adjusted by collaboration”. The facts that patients are beginning to take medicine or increase amount of medicine suggest that collaboration may promote patients’ well-being.
Moreover, nurses’ consciousness for risk or safety changed. Categories “A pharmacist let nurses know the instructions for high-risk medicine”, “Nurses tried to study about medicine”, and “Knowledge in the ward increases” showed that collaboration promoted nurses to study medicine. Then, studying medicine will prevent accidents and maintain safety. This supports Celio et al. [9] or Toivo et al. [12].
4.4. Limitation
There are some limitations. 1) The working experience range of nurses and pharmacists was so large, and it might influence the contents of interview. 2) Participants were volunteers who had intention to receive interviews in the previous study, they might have high consciousness for working as a profession. Then, this procedure might influence the results. 3) The number of participants of nurses and pharmacists is small and we can’t generalize. We need to include many more participants.
Acknowledgements
We appreciate nurses and pharmacists cooperating with this study. This study is supported by KAKENHI (22K10775).
Author Contributions
Michiyo Ando: Data collection and writing a paper; Hajime Miyazaki: Making concept of this research and data collection; Haruka Kurihara: Data collection; Ryo Nakamoto: Giving advice on this research; Yousuke Yamawaki: Giving advice from a pharmacist.