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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 19
| Issue : 1 | Page : 61-65 |
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Effectiveness of structured teaching program on nurses' knowledge on safe handling of psychotropic drugs
SV Harsharaja1, Radhakrishnan Govindan1, Rajalakshmi Ramu1, Dinakaran Damodharan2, Arun Kandasamy2
1 Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| Date of Submission | 31-Jan-2022 |
| Date of Decision | 07-May-2022 |
| Date of Acceptance | 20-May-2022 |
| Date of Web Publication | 05-Jul-2022 |
Correspondence Address:
Dr. Radhakrishnan Govindan
Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/iopn.iopn_9_22
Background: Nurses play a major role in the management of psychiatric patients including the administration and handling of psychotropic drugs. They are in a pivotal position to educate the patient and family members about the medication and they should possess knowledge and competencies of psychotropic drugs to ensure safety. Materials and Methods: The authors have applied quantitative approach, preexperimental design, one group pre-test and post-test design for this study. Fifty-two newly recruited nursing officers were participated in this study. The authors have assessed the nurses' baseline knowledge on psychotropic drugs and the safe handling of such drugs. Followed by that, structured Teaching Program (STP) was designed, developed, and imparted to improve the nurses' knowledge and skills on psychotropic drugs by the authors. A post-STP assessment was conducted to identify the change in nurses' knowledge. Results: Baseline assessment revealed that the nurses were obtained poor scores in knowledge on psychotropics scale and safe handling of psychotropics scale. The median pretest score was seven on knowledge of psychotropics scale and four on the safe handling of the psychotropics scale. Two weeks' posttest scores were 15 and 11, respectively. The results showed significant difference between pre-test and posttest median scores and Wilcoxon signed-rank test (P < 0.001). Sociodemographic variable such as the age of the participants was correlated positively with baseline scores of safe handlings of psychotropic drugs and their post-graduate training in psychiatric nursing was associated with knowledge score. Conclusion: The results of the study revealed that the STP me about knowledge on psychotropic drugs and safe handling of psychotropic drugs was effective in improving the knowledge of newly recruited staff nurses. Continuing nursing education on psychotropic drugs and its safe handling skill among nurses may result in better psychiatric nursing care outcomes.
Keywords: Knowledge, medication errors, nursing care, psychotropics
How to cite this article:
Harsharaja S V, Govindan R, Ramu R, Damodharan D, Kandasamy A. Effectiveness of structured teaching program on nurses' knowledge on safe handling of psychotropic drugs. Indian J Psy Nsg 2022;19:61-5 |
How to cite this URL:
Harsharaja S V, Govindan R, Ramu R, Damodharan D, Kandasamy A. Effectiveness of structured teaching program on nurses' knowledge on safe handling of psychotropic drugs. Indian J Psy Nsg [serial online] 2022 [cited 2023 Apr 2];19:61-5. Available from: https://www.ijpn.in/text.asp?2022/19/1/61/349897 |
| Introduction | |  |
The drugs that have significant effects on mental functions are called psychotropic drugs.[1] Psychopharmacology is the gold standard in the treatment of neurobiological disorders.[2] The advent of psychopharmacology has brought the treatment of psychiatric disorders within the realm of modern medicine. Since 1853 sedatives and hypnotics were used in the treatment of psychosis. However, the discovery of modern psychotropic drugs began in the year 1950 with the introduction of chlorpromazine, lithium, and imipramine.[3] Psychotropics are primarily classified based on their intended use as antidepressant, antipsychotic, and sedatives. Psychotropic medications are not intended to provide cure to the mental illness. They act by balancing the level of the neurotransmitters and achieve stability in the activity of the patient.[1],[2] The side effects of psychotropic drugs may be fatal or nonfatal. Common side effects are drowsiness, weight gain, and extrapyramidal symptoms such as muscular rigidity, akathisia, tardive dyskinesia, motor inertia, dystonia, and tremors.[4]
Nurses play a major role in the management of psychiatric patients including administration of drugs, handling of psychotropic drugs, and psychoeducation of family members. They should possess a wealth of knowledge and competencies to manage their duties efficiently. A nurse is in a pivotal position to educate the patient and family members about the medication. The nurses can assume the important role of continuing a therapeutic alliance with a patient on drug maintenance.[1] Psychiatric nurses play an important role in the early detection and monitoring of side-effects.[5] It is widely believed that medication error in nursing practice occurs due to human errors, though system errors have recently been accepted as a contributing factor. To ensure patient safety and provide better health services, medication errors should be curbed. There are several reports that indicate that nurses contribute to medication errors.[1] The factors responsible for such errors are insufficient knowledge about drugs,[5] lack of proper training, nonreporting of medication errors committed by their colleagues and health-care professionals[6] and mere negligence during the administration of drugs.[5] Previous studies from India reported poor knowledge scores regarding psychotropics among nurses[7] and in 66% of the medication error instances, nurses were reportedly responsible. The current study aimed to assess the knowledge and safe handling of psychotropics among nurses working in a tertiary care neuropsychiatric center. This study also assessed the effectiveness of a Structured Teaching Program (STP) on nurses' knowledge about psychotropic drugs and subsequent knowledge in handling it for their practice.
| Materials and Methods | | |
In this study, we had used a pre-experimental one-group (pretest and posttest) design. We involved 52 newly recruited nursing officers working in the psychiatric wards of a tertiary care neuropsychiatric center. All the newly recruited Registered Nurses in 2018 with the qualification of Diploma and BSc Nursing, MSc Nursing were included in the study. Nurses in administrative positions were excluded from the study. The data were collected between November 2018 and December 2018.
The Institute ethics committee had approved (No. NIMH/DO/IEC (BEH. Sc. DIV) 2016 dated March 8, 2018) the study and informed consent were obtained from participants. Sociodemographic data were collected using a self-administered questionnaire. Knowledge on psychotropics (20 items scale) and safe handling of psychotropics (15 items scale) were assessed through structured questionnaires prepared exclusively for this study. The total score of knowledge on the psychotropics scale ranged from 0 to 20 while the safe handling of psychotropics scale ranged from 0 to 15. Knowledge on Psychotropics scale is multiple choice type of questionnaire, each correct answer carry 1 mark the wrong answer carry 0 and the safe handling questionnaire responses are true or false, each correct answer carry 1 mark. Higher the score indicated higher the knowledge. The content of the scales was validated by four experts in the field. Scales were found be reliable too (for both the scale Cronbach's alpha – 0.776) through test re-test reliability. STP was developed based on expert opinion and extensive literature review. STP was delivered to the newly recruited nurses over six consecutive sessions. All the sessions were didactic and conducted on the morning hours, 1 h/day over six consecutive days. Nurses' knowledge and safe handling practices of psychotropic drugs were assessed before the first session and 2 weeks after the last session of STP. The data were processed, analyzed, and presented using descriptive and inferential statistics through the Statistical Package for the Social Sciences IBM SPSS Statistics for Windows, Version 26.0. (Armonk, NY: IBM Corp).
| Results | | |
The study included 52 newly recruited nursing officers of which 29 (55.8%) males and 23 (44.2%) female nurses. The median age of the sample population was 26 years. The sample included nurses who have completed diploma (n = 6, 11.5%), graduation (n = 34, 65.4%), and postgraduation (n = 12, 23.1%) in nursing. Nearly one-third (n = 17, 33%) of nurses had no relevant experience of working in a general/psychiatric hospital. They were newly recruited and 2–3 months before this study to this current Institute. The sample characters and their work experiences are given in [Table 1] and [Table 2]. As per [Table 3], the Median pre-STP score was 07 on the knowledge of psychotropics scale and 04 on the safe handling of psychotropics scale. After 2 weeks of post-STP scores were 15 and 11, respectively. Post-STP scores were significantly (P < 0.001) better than the pre-STP scores in Wilcoxon signed-rank test for both knowledge questionnaires. | Table 1: Distribution of the study sample based on the personal profile (n=52)
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 | Table 2: Distribution of the study sample based on age and work experience (months) profile (n=52)
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 | Table 3: Comparison of pre- and posttest knowledge scores on psychotropic drugs and safe handling psychotropic drugs (n=52)
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Chi-square tests revealed no significant associations were found between knowledge on the psychotropics scale among gender. However, female nurses scored significantly better on safe handling of psychotropics scale (P = 0.021). Nurses with postgraduation in nursing degree (P < 0.001) (P < 0.001) and especially post-graduation in psychiatric nursing (P = 0.004) (P = 0.014) had significantly better scores in both scales, respectively. The age of the participants positively correlated with the baseline scores on safe handling of psychotropics scale (spearman's rho = 0.465, P = 0.001). Participants' scores on knowledge on psychotropics scale correlated positively with the scores on the safe handling of psychotropics scale (Spearman's rho = 0.513, P < 0.001). However, there was no significant correlation between past clinical experience and safe handling of psychotropics. The results are summarized in [Table 4], [Table 5], [Table 6]. | Table 4: Association of pretest knowledge on psycho-trophic drugs and safe handling of psychotrophic drugs with sociodemographic variables (n=52)
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 | Table 5: Correlation between the knowledge on psychotropic drugs and safe handling of psychotropic drugs with sociodemographic variables; age and experience (n=52)
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 | Table 6: Relationship between knowledge on psychotropic drugs and safe handling psychotropic drugs scores (n=52)
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| Discussions | | |
The author identified and recruited almost equal number of male and female nurses who were newly recruited at a tertiary care hospital and from a younger age group. The baseline scores suggest an average to below-average level of knowledge of the participants. After six sessions of the didactic STP, the scores on both knowledge scales had improved to higher median scores. The study suggests a significant improvement on the overall understanding of psychotropic drugs and their handling by the participants and presents the preliminary evidence of STP's efficiency in imparting the necessary knowledge and skill. The above findings showed that there was significant differences found between pretest and posttest scores of knowledge on psychotropic drugs and handling of the same at the level of P < 0.05. Therefore, the hypotheses stated as; “there will be statistically significant differences between pre-test and posttest scores of knowledge on psychotropic drugs and handling practice of among nurses after STP” at the level of P < 0.05 was accepted.
Both male and female nurses scored similarly (P = 0.141) on the knowledge on psychotropic drugs scale, but female nurses had significantly better (P = 0.021) scores on the safe handling of psychotropics scale. Nurses with postgraduation in nursing degree, especially in psychiatric nursing than other specialties, had scored significantly better on both scales. It shows a better baseline knowledge as well as better handling of psychotropics by these nurses. This result is also validated by the positive correlation of age of the participants with baseline scores on the safe handling of psychotropics scale. This study found that the improved performance on these scales may be secondary to the increased exposure and knowledge gained during postgraduate psychiatric nursing training and experience gained with age in handling psychotropics.
Maliyakal (1998)[8] conducted a similar study with the same design among the staff nurses on the efficacy of in-service education program about psychotic drugs in altering the knowledge among staff nurses. Drori et al.[9] and De Hert et al.[10] have conducted a study on staff nurses to assess the knowledge on their use of strategies to improve medication adherence and potentially lethal side-effects of clozapine, respectively with the same design like cross-sectional study. Sahithi et al.[11] conducted the observational study among staff nurses on the assessment of medication error in psychiatry practice at a tertiary care hospital. These above-said study results were similar to this current study. To our knowledge, this is the first study that assessed the baseline level of knowledge and safe handling of psychotropic drugs by nurses. There was a positive correlation found between the scores of two scales designed and used in the assessment. This indirectly shows both scales were necessarily measuring the presence of, lack of knowledge, and safe handling of drugs correspondingly and appropriately. This study highlights the effectiveness of STP in imparting the necessary knowledge and skills on handling psychotropic drugs. The designed STP can meaningfully improve the overall knowledge of the participants.
However, the study has certain limitations. The study was conducted in a tertiary care neuropsychiatric teaching institute with convenient sampling with relatively younger age participants and the results may not be generalized to other general hospital settings. The lack of matched control group is a serious limitation. The scales used for assessment were reliable but were not rigorously standardized. Improvement in the nurses' post-STP test knowledge scores, would transform into meaningful clinical efficiency and help the nurses to avoid medication errors. However, it needs longitudinal follow-up and further research. Despite all the mentioned limitations, this novel attempt in assessing and training the newly recruited nursing staff is an essential step in improving the overall quality of nursing care. Further, multicenter studies with large sample sizes, standardized scales, enhanced teaching programs, and follow-up assessments may shed light on the way forward. The standardized teaching program may be expanded to other teaching institutes, clinical practice, and nursing education to supplement or augment the psychopharmacology curriculum and national/district mental health programs.
| Conclusion | | |
This study provided the baseline assessment of knowledge and safe handling of psychotropics of newly recruited nursing staff. The improvement in knowledge and skills attained through the program may translate into better nursing care. The results of the study revealed that the STP toward knowledge and safe handling of psychotropic drugs was effective in improving the knowledge of newly recruited staff nurses. Continuing nursing education on psychotropic drugs and their safe handling may result in better psychiatric nursing care outcomes.
Acknowledgement
The authors are thankful to the nurses, who have taken part in this study by providing their valuable time.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Lieberman JA, Tasman A. Handbook of Psychiatric Drugs. England: John Wiley & Sons Publishers; 2006.  |
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| 3. | Sathyanarayana Rao TS, Andrade C. Classification of psychotropic drugs: Problems, solutions, and more problems. Indian J Psychiatry 2016;58:111-3. |
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| 5. | Vallerand AH. Davis's Drug Guide for Nurses. 16 th ed. Philadelphia: FA Davis Publishers; 2018. |
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| 8. | Malliakel JJ. Study conducted on efficacy of in service education about psychotropic drugs in altering the knowledge of staff nurses working at NIMHANS. 1998. [Unpublished dissertation, NIMHANS]. |
| 9. | Drori T, Guetta H, Ben Natan M, Polakevich Y. Effect of mental health nurses' beliefs and knowledge of medication on their use of strategies to improve medication adherence. Int J Ment Health Nurs 2014;23:374-80. |
| 10. | De Hert M, De Beugher A, Sweers K, Wampers M, Correll CU, Cohen D. Knowledge of psychiatric nurses about the potentially lethal side-effects of clozapine. Arch Psychiatr Nurs 2016;30:79-83. |
| 11. | Sahithi KH, Mohammad I, Reddy JM, Kishore GN, Ramesh M, Sebastian J. Assessment of medication errors in psychiatry practice in a tertiary care hospital. Int J Pharm Sci Res 2015;6:226-32. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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