Date of Conferral

2-5-2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Barbara Barrett

Abstract

Medication nonadherence among adults with mental illness remains a persistent problem in outpatient behavioral health care and contributes to psychiatric relapse, emergency department utilization, preventable hospitalizations, increased healthcare costs, and reduced quality of life. The purpose of this Doctor of Nursing Practice (DNP) project was to develop and obtain expert panel approval of an evidence-based clinical practice guideline (CPG) to improve medication adherence among adults with mental illness receiving outpatient behavioral health services. A comprehensive review of peer-reviewed literature from 2019 to 2025 was conducted using CINAHL, PubMed, and ScienceDirect to identify effective adherence-focused interventions, including nurse-led strategies, structured psychoeducation, family involvement, collaborative care planning, and adherence monitoring tools. Evidence strength ranged from moderate to high. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument guided formal evaluation of guideline quality by an expert panel of three psychiatric nurse practitioners. Appraisal findings demonstrated strong methodological quality across all six AGREE II domains, with standardized scores ranging from 98.6% to 100% and a mean stakeholder involvement score of 99.4%. Each expert rated overall guideline quality at the highest level and recommended the CPG for clinical use. Development and approval of the guideline support organizational readiness for implementation and provide a structured, evidence-based approach to improving medication adherence, promoting consistency in psychiatric nursing practice, and advancing equitable outpatient mental health care

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