Date of Conferral

8-17-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Melissa Rouse

Abstract

This Doctor of Nursing Practice (DNP) project addressed a practice gap in an outpatient behavioral health setting involving inconsistent use of structured communication strategies to support medication adherence among psychiatric patients. Although nurses routinely provided medication instructions, approaches such as motivational interviewing and psychoeducation were underutilized, limiting patient engagement, understanding, and adherence, and ultimately affecting care continuity and outcomes. The purpose of the project was to improve psychiatric nurses’ knowledge and intent to use motivational interviewing and psychoeducation to enhance medication adherence. The guiding practice-focused question examined whether a structured educational intervention could strengthen nurses’ competencies in these communication strategies. A pretest–posttest design was used to evaluate effectiveness. Four psychiatric nurses participated in a structured, site-based training program. Data collected through questionnaires showed knowledge scores increased from 55% to 92.5%, while intent scores improved from 30% to 45%, demonstrating the effectiveness of the staff education on the nurses’ knowledge and intent on the use of motivational interviewing and psychoeducation to improve medication adherence. The primary product was a structured staff education program for integration into routine practice. Sustaining this initiative through ongoing training is recommended to enhance nurse–patient communication, improve engagement, and promote consistent medication adherence. 2 Background Medication nonadherence among psychiatric patients remains a persistent and complex problem in outpatient behavioral health settings, contributing to poor clinical outcomes, relapse, and increased healthcare utilization. Despite the availability of effective pharmacological treatments, many patients do not follow prescribed regimens consistently, leading to avoidable deterioration in mental health status. Nonadherence is influenced by practical, psychological, and systemic factors, including forgetfulness, medication side effects, stigma, lack of insight, and limited engagement with healthcare providers (Harmanci & Budak, 2022; Semahegn et al., 2020). These challenges highlight a critical gap in nursing practice in addressing adherence during routine patient interactions. Traditional approaches to improving medication adherence have relied on reminders, written instructions, or brief counseling. While these strategies may address surface-level barriers, they often fail to target underlying motivational and cognitive factors influencing behavior. Evidence suggests adherence improves when interventions incorporate strategies that enhance patient engagement, autonomy, and intrinsic motivation (Loots et al., 2021). This underscores the importance of equipping nurses with advanced communication techniques that support patient-centered care and shared decision-making. Motivational interviewing and psychoeducation have emerged as effective, complementary approaches to addressing medication nonadherence. Motivational interviewing is a collaborative communication style that strengthens motivation for 3 change by exploring ambivalence while emphasizing empathy, active listening, and patient autonomy (Gülcü & Kelleci, 2022). Psychoeducation provides structured, evidence-based information about mental illness and treatment, improving understanding and reducing stigma (Loots et al., 2021). Together, these approaches address both emotional and cognitive dimensions of adherence, creating a more comprehensive intervention. Emerging literature highlights the role of health literacy, cultural beliefs, and communication quality in adherence behaviors. Patients from diverse backgrounds may hold differing beliefs about mental illness and treatment, influencing their willingness to engage in pharmacotherapy. Limited health literacy can further hinder understanding of medication instructions and consequences of nonadherence (Semahegn et al., 2020). These factors emphasize the need for culturally sensitive, individualized communication. Motivational interviewing supports this by tailoring discussions to patient values, while psychoeducation ensures clarity and consistency of information. The therapeutic relationship between patients and healthcare providers is another critical determinant of adherence. Patients are more likely to follow treatment recommendations when providers are perceived as empathetic, collaborative, and supportive (Alizioti & Lyrakos, 2021). In contrast, directive communication styles may lead to mistrust and disengagement. Integrating motivational interviewing into routine care can strengthen therapeutic relationships and improve engagement. Medication- related factors also contribute to nonadherence. Psychiatric medications often require long-term use and may involve undesirable side effects or delayed benefits. Patients may 4 discontinue use prematurely when symptoms improve or side effects occur. Psychoeducation addresses these challenges by helping patients understand illness progression, treatment expectations, and the importance of continued adherence (Murad et al., 2022). When combined with motivational interviewing, patients are better equipped to make informed decisions about their care. Organizational and system-level factors further influence adherence interventions. Nurses in outpatient settings often face time constraints, competing priorities, and inconsistent training in evidence-based communication strategies (Schroeder & Seegert, 2023). These barriers contribute to variability in care and missed opportunities to support patients. Implementing structured staff education programs can address these gaps by providing consistent training in motivational interviewing and psychoeducation. The evidence supporting combined behavioral and educational interventions is strong. Studies show that integrating motivational interviewing and psychoeducation improves patient engagement, medication adherence, and clinical outcomes (Gülcü & Kelleci, 2022; Loots et al., 2021). These findings highlight the importance of addressing both knowledge and motivation to improve adherence. Guided by this evidence, the project question for this initiative was “To what extent will nurses’ knowledge and intent related to motivational interviewing and psychoeducation improve following a structured educational intervention?” Intended outcomes include improved staff knowledge, increased intent to use motivational interviewing, and enhanced delivery of psychoeducation. In conclusion, this project has important nursing implications, as it emphasizes the role of nurses in delivering patient-centered, evidence-based communication strategies that directly impact medication adherence and mental health outcomes. By strengthening nurses’ competencies in motivational interviewing and psychoeducation, the initiative supports improved therapeutic relationships, patient engagement, and consistency in care delivery. Additionally, integrating diversity, equity, and inclusion principles is essential, as culturally responsive communication and attention to health literacy ensure that interventions are accessible and effective for diverse patient populations. Addressing disparities in mental health care requires nurses to recognize and respect cultural beliefs, reduce stigma, and tailor interventions to meet individual patient needs. Through a combined focus on clinical skill development, organizational support, and culturally inclusive care, this initiative aims to promote equitable, sustainable improvements in both nursing practice and patient outcomes in outpatient behavioral health settings. 5 Staff Education Project Development This staff education project was developed in an outpatient behavioral health setting using the ADDIE (Analysis, Design, Development, Implementation, Evaluation) instructional model to ensure a structured, evidence-based approach aligned with improving nurses’ knowledge and intent to use motivational interviewing and psychoeducation. During the Analysis phase, a practice gap was identified in the inconsistent use of evidence-based communication strategies to support medication adherence. Staff relied on routine instruction, and no standardized training existed, highlighting the need for targeted education. In the Design phase, learning objectives focused on increasing understanding of motivational interviewing and promoting its integration into patient care. A pretest– posttest design was established. The Development phase included creation of training materials covering motivational interviewing techniques, psychoeducation principles, case-based scenarios, pre/post knowledge assessments (Appendix A) and PowerPoint presentations (Appendix B). During the Implementatin phase, four psychiatric nurses participated in the training over four weeks, engaging in reflection and applying strategies to practice with supporting materials provided. The Evaluation phase assessed effectiveness using pre- and post-intervention surveys measuring knowledge and intent, with descriptive statistics used to compare outcomes. 6 Results The purpose of this project was to improve psychiatric nurses’ knowledge and intent to use motivational interviewing and psychoeducation to enhance medication adherence in an outpatient behavioral health setting. In the knowledge assessment, the score range of 0-10 was based on the accuracy of the answers provided by the nurses on the 10-item questionnaire. For instance, if the staff provided four correct answers, their score would be 40%. Pre-implementation results demonstrated moderate baseline knowledge and relatively lower intent to consistently apply motivational interviewing and 7 psychoeducation strategies. Knowledge scores ranged from 4 to 7 out of 10, with a mean score of 55% (SD = 1.29). Intent scores ranged from 2 to 4 on the 5-point Likert scale, with a mean of 30% (SD = 0.82). Table 1 Descriptive Statistics Before the Implementation of Staff Education Item N Minimum Maximum M SD Knowledge (0–10 scale) 4 4.00 7.00 55% 1.29 Intent (1–5 Likert scale) 4 2.00 4.00 30% 0.82 Following the educational intervention, post-implementation results showed substantial improvement in both knowledge and intent. Knowledge scores ranged from 8 to 10 out of 10, with a mean of 92.5% (SD = 0.96). Intent scores also improved, ranging from 4 to 5 on the Likert scale, with a mean of 45% (SD = 0.58), demonstrating an increased willingness and commitment to integrating these strategies into routine clinical practice. These findings indicate that the educational intervention was effective in enhancing both cognitive understanding and behavioral intention, which are critical precursors to practice change. Table 2 Descriptive Statistics After the Implementation of the Staff Education Item N Minimum Maximum M SD Knowledge (0–10 scale) 4 8.00 10.00 92.5% 0.96 Intent (1–5 Likert scale) 4 4.00 5.00 45% 0.58 8 Figure 1 Mean Difference for Knowledge and Intent in Pre and Post Implementation The impact of these findings on the organization is significant. Improved nurse knowledge and intent to use motivational interviewing and psychoeducation can lead to more consistent, patient-centered communication across the outpatient behavioral health setting. As nurses play a central role in patient education and engagement, enhancing their competencies is expected to improve patient understanding of treatment, strengthen therapeutic relationships, and support better adherence to medication regimens. Over time, these changes have the potential to contribute to improved patient outcomes, reduced relapse rates, and more efficient use of healthcare resources. Despite these positive outcomes, several limitations must be considered. The small sample size (N = 4) limits the generalizability of the findings and restricts the ability to conduct inferential statistical testing. The short duration of the project limited the ability to assess long-term retention of knowledge and sustained behavioral change. Additionally, the use of self-reported measures for intent may introduce response bias. 9 The project is important beyond the local site due to the widespread challenge of medication nonadherence in psychiatric populations. Many outpatient behavioral health settings face similar gaps in the use of structured, evidence-based communication strategies. This project demonstrates that a focused staff education intervention can effectively improve both knowledge and intent. The structured approach used in this project can be adapted and implemented in other settings to enhance nursing practice and support patient-centered care. Conclusions The results of this project indicate that the educational intervention was effective in improving psychiatric nurses’ knowledge and intent to use motivational interviewing and psychoeducation. The outcomes support the value of targeted staff education in addressing practice gaps and promoting evidence-based communication strategies. By strengthening nurses’ competencies, this project contributes to improved quality of care and has the potential for broader application across behavioral health settings. 10 References Alizioti, A., & Lyrakos, G. (2021). Measuring the effectiveness of psychoeducation on adherence, depression, anxiety, and stress among patients with diagnosis of schizophrenia: A control trial. Current Psychology, 40(8), 3639–3650. https://doi.org/10.1007/s12144-019-00255-4 Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., Reimer, W. S., & de Haan, L. (2020). Active ingredients and mechanisms of change in motivational interviewing for medication adherence. Frontiers in Psychiatry, 11, 78. https://doi.org/10.3389/fpsyt.2020.00078 Gülcü, Z. G., & Kelleci, M. (2022). The effect of motivational interviewing and telepsychiatric follow-up on medication adherence of patients with bipolar disorder. Journal of Psychiatric Nursing, 13(2), 101. https://doi.org/10.14744/phd.2022.24582 Harmanci, P., & Budak, F. K. (2022). Psychoeducation based on motivational interview techniques in schizophrenia patients. Clinical Nursing Research, 31(2), 202–216. https://doi.org/10.1177/10547738211046438 Loots, E., Goossens, E., Vanwesemael, T., Morrens, M., Van Rompaey, B., & Dilles, T. (2021). Interventions to improve medication adherence in psychiatric disorders. International Journal of Environmental Research and Public Health, 18(19), 10213. https://doi.org/10.3390/ijerph181910213 Murad, H., Basheikh, M., Zayed, M., Albeladi, R., & Alsayed, Y. (2022). The association between medication nonadherence and early and late readmission rates for 11 patients with acute coronary syndrome. International Journal of General Medicine, 6791–6799. https://doi.org/10.2147/IJGM.S376926 Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence: A systematic review. Systematic Reviews, 9, 1–18. https://doi.org/10.1186/s13643-020-1274-3 Schroeder, M. N., & Seegert, M. L. (2023). Motivational interviewing improves medication adherence in psychiatric education: A quality improvement study. Journal of Healthcare Management and Administration, 1(1), 48–57. https://zapjournals.com/Journals/index.php/jhma/article/view/244 12 Appendix A: Pretest/Posttest Survey: Motivational Interviewing and Psychoeducation Participant’s Code: Role at the Project Site: Title: Staff Education on Improving medication adherence among patients with mental health disorders using staff education on motivational interviewing and psychoeducation. Knowledge and Intent assessment questions for measuring motivational interviewing and psychoeducation Knowledge Assessment (Select one correct answer for each question) Q1. What is the “righting reflex” in motivational interviewing? A. Encouraging patients to make their own decisions B. The urge to correct or fix the patient’s behavior C. Ignoring patient concerns D. Providing medication instructions only Q2. What is the primary goal of motivational interviewing (MI)? A. To persuade patients to follow instructions B. To explore and resolve ambivalence about change C. To provide education only D. To diagnose mental illness 13 Q3. Which of the following is a core principle of motivational interviewing? A. Confrontation B. Authority C. Collaboration D. Persuasion Q4. What does the “spirit” of motivational interviewing include? A. Control, direction, authority B. Collaboration, evocation, autonomy C. Instruction, compliance, discipline D. Diagnosis, treatment, evaluation Q5. Which communication technique is part of MI? A. Giving direct advice without permission B. Open-ended questioning C. Interrupting the patient D. Ignoring emotional responses Q6. What is the purpose of reflective listening? A. To correct the patient B. To show understanding and clarify meaning C. To shorten the conversation D. To give instructions Q7. What is “change talk” in motivational interviewing? A. Patient resistance to treatment 14 B. Statements supporting behavior change C. Provider instructions D. Medication education only Q8. Why is patient autonomy important in motivational interviewing? A. It reduces provider responsibility B. It encourages patient engagement and ownership of decisions C. It limits patient involvement D. It speeds up treatment Q9. What is the primary purpose of psychoeducation in mental health care? A. To replace medication B. To provide patients with knowledge about their condition and treatment C. To reduce provider workload D. To avoid patient questions Q10. How does psychoeducation improve medication adherence? A. By forcing compliance B. By increasing understanding and reducing misconceptions C. By limiting patient involvement D. By shortening appointments Intent to Change Practice (Post-Test) After attending this education session, please rate your intent to use motivational interviewing and psychoeducation strategies to improve medication adherence in your practice. (1 = Highly Unlikely, 2 = Unlikely, 3 = Neutral, 4 = Likely, 5 = Highly Likely) 15 Appendix B: Staff Education PowerPoint Background of Medication Non-Adherence • High prevalence in psychiatric populations • Nearly half of patients show non-adherence • Early discontinuation common within 3 months • Leads to relapse and rehospitalization • Multiple contributing barriers (practical and psychological)  Significant healthcare cost burden Importance of Staff Education • Staff influence patient adherence behaviors • Communication gaps reduce adherence success • Inconsistent use of MI and psychoeducation • Need for standardized training • Enhances patient-centered care delivery  Supports evidence-based practice implementation Motivational Interviewing Overview • Collaborative, patient-centered communication style • Explores ambivalence toward change • Enhances intrinsic motivation • Uses open-ended questions • Supports autonomy and empathy  Evidence-based behavioral intervention Psychoeducation Overview • Structured education about mental illness • Explains medication purpose and benefits • Addresses side effects and concerns • Improves illness insight • Enhances treatment adherence  Can be delivered individually or in groups Resisting the Righting Reflex • Avoid correcting or persuading patients • Resist “telling” patients what to do • Explore patient motivation instead • Partner with patient expertise • Encourage self-reflection  Build collaborative relationships Listening with Empathy • Active listening is essential • Use reflective statements • Allow patient to express concerns • Balance listening and speaking • Avoid interrupting or directing  Build therapeutic trust 16 Understanding Patient Motivation • Identify personal reasons for change • Explore patient values and goals • Link medication to life goals • Evoke “change talk” • Strengthen internal motivation  Support readiness for adherence Empowering Patients • Respect patient autonomy • Support shared decision-making • Reinforce patient strengths • Avoid coercive communication • Encourage self-efficacy  Promote independence in care • Combine education with motivational strategies • Tailor information to patient readiness • Use collaborative communication • Address ambivalence directly • Reinforce understanding and motivation • Improve adherence outcomes • Combine education with motivational strategies • Tailor information to patient readiness • Use collaborative communication • Address ambivalence directly • Reinforce understanding and motivation • Improve adherence outcomes • Medication adherence remains a major challenge • Staff communication is a key intervention point • MI and psychoeducation are evidence-based • Training improves staff effectiveness • Patient-centered care improves outcomes • Supports long-term recovery in mental health References • Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., ... de Haan, L. (2020). Active ingredients and mechanisms of change in motivational interviewing for medication adherence. Frontiers in Psychiatry, 11 , 78. https://doi.org/10.3389/fpsyt.2020.00078 • Gülcü, Z. G., & Kelleci, M. (2022). The effect of motivational interviewing and telepsychiatric follow-up on medication adherence of patients with bipolar disorder. Journal of Psychiatric Nursing, 13 (2), 101. https://doi.org/10.14744/phd.2022.24582 • Harmanci, P., & Budak, F. K. (2022). Psychoeducation based on motivational interview techniques in schizophrenia patients. Clinical Nursing Research, 31 (2), 202–216. https://doi.org/10.1177/10547738211046438 • Loots, E., Goossens, E., Vanwesemael , T., Morrens, M., Van Rompaey , B., & Dilles, T. (2021). Interventions to improve medication adherence in psychiatric disorders. International Journal of Environmental Research and Public Health, 18 (19), 10213. https://doi.org/10.3390/ijerph181910213 • Semahegn, A., Torpey , K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non -adherence: A systematic review. Systematic Reviews, 9 , 1–18. https://doi.org/10.1186/s13643 -020-1274-3

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