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Research Proposal

Medication Compliance: The relationship between the schizophrenic patient and their home environment.
By:
Cristal Denner (Student Nurse) 00026891
Josanne Julien (Student Nurse)
Safya Mohaed (Student Nurse)
Su!itted to:
Mrs" Beryl Bre#ster
(Senior $e%turer)
Colle&e o' Nursin& and (llied )ealth
*n +artial 'ulfllent o'
,he re-uireents 'or the
De&ree o'
Ba%helor o' S%ien%e in Nursin&
Mar%h. 201/
Title: Medication Compliance: The relationship between the schizophrenic patient and their home environment.
Background/ ntroduction
The purpose of this study is to examine if there is a link between prescribed medication compliance and the
patients home environment of patients who were readmitted at least three (3 times within the past two (! years
on ward six (" the admission ward of #t. $nns %ospital. This analysis would explore the psycholo&ical'
psychosocial' cultural and economic aspects that would result in non compliance of medication.
#chizophrenia is a severe form of mental illness affectin& about ( per )*** adults &lobally. $lthou&h the
incidence is low' the prevalence of schizophrenia is hi&h as it is a lon&+term chronic illness (,orld %ealth
-r&anization' !*)). $ntipsychotic medication plays an important role in schizophrenia treatment and symptom
control. .ffective mana&ement of schizophrenia re/uires continuous lon& term treatment in order to keep
symptoms under control and to prevent relapse ($merican 0sychiatric $ssociation' !**". 1espite the critical
importance of medication' non adherence to prescribed dru& treatments has been reco&nized as a problem
worldwide and may be the most challen&in& aspect of treatin& patients with schizophrenia (2arbato' !*)).
3on adherence to medication includes a ran&e of patient behaviours' from treatment refusal to irre&ular use or
partial chan&e of daily medication doses. 0artial adherence to medication is at least as fre/uent as complete non
adherence (#vestka and 2itter' !**(. There is no sin&le theory that explains adherence issues' but rather a ran&e
of theories with their own stren&ths and limitations (,eiden' !**(. 0otential factors for non adherence may be
related to disease severity' treatment characteristics or even external environmental factors such as therapeutic
support (4lorca' !**5. $dherence factors may also be uni/ue to the characteristics of schizophrenia6 factors
such as co&nitive impairment or lack of illness insi&ht may play an important role.
!e" #ords:
Medication Compliance: 7efers to the de&ree or extent of conformity to the recommendations about day to day
treatment by the provider with respect to the timin&' dosa&e' and fre/uency. 8t may be defined as 9the extent to
which a patient acts in accordance with the prescribed interval' and dose of a dosin& re&imen (:oyce.$' !**5.
$ome %nvironment: $ccordin& to thedictionary.com' this is the totality of circumstances surroundin& an
or&anism or &roup of or&anisms' especially the combination of external physical conditions that affect and
influence the &rowth' development' and survival of or&anisms
&chizophrenia: $ccordin& to thedictionary.com' #chizophrenia is a psychotic disorder (or a &roup of disorders
marked by severely impaired thinkin&' emotions' and behaviors. #chizophrenic patients are typically unable to
filter sensory stimuli and may have enhanced perceptions of sounds' colors' and other features of their
environment. Most schizophrenics' if untreated' &radually withdraw from interactions with other people' and
lose their ability to take care of personal needs and &roomin&.
'itrature Review
3oncompliance is an important predictor of hospitalization risk. ;ollowin& inpatient treatment and dischar&e
from the community' many patients become poorly compliant with therapy. #everal reasons for poor compliance
have been hypothesized' includin& disease symptoms (e.&.' &randiosity' paranoia' problems with accurate recall'
treatment+emer&ent side effects' substance abuse' lack of support systems to encoura&e medication compliance'
psychostressors' and poor patient+provider relationships. $ccordin& to the article 9Medication adherence and
utilization in patients with schizophrenia or bipolar disorder receivin& aripiprazole' /uetiapine' or ziprasidone at
hospital dischar&e: $ retrospective cohort study< (2er&er' !*)!' #upport for family education in mental health
leadin& to medication adherence in mentally ill clients' has been hi&hli&hted in the literature review.
98nterventions like family therapies and psycho+education can collaborate towards successful treatment
adherence' si&nificantly reducin& relapse and re+hospitalization (Colom' ; et al' !**=.< Cardoso' 4 et al' !*))'
su&&est that 9health education can also influence clients and families> involvement in health care.< Conse/uently'
considerin& clients> and families> knowled&e and beliefs on maintainin& the prescribed psychiatric treatment can
help health professionals to provide better orientations and health care to these clients (Cardoso' 4 et al' !*)).
-ther studies shows over the course of a year' about three+/uarters of patients prescribed psychotropic
medication will discontinue' often comin& to the decision themselves and without informin& a health
professional. $ccordin& to the article 9,hy don>t patients take their medicine?< written by Mitchell @ #elmes
(!**( it is stated that the rate of non+adherence with psychotropic medication are difficult to summarise
because they vary by settin&' dia&nosis and type of adherence difficulty. %owever' found that non+adherent
individuals with schizophrenia have a 3.(+fold &reater risk of relapse than those who are adherent over "A!=
months. ,here medication (or appointments are missed for predominantly illness+related reasons such as lack
of insi&ht' there is a particularly hi&h risk of readmission. Bet illness severity probably accounts for a minority of
cases of poor adherence in the community (Maddox et al' )CC=. ;urther' the impact may be ameliorated if
patients who have further symptoms seek help. Dnfortunately' adverse experiences with medication may
preEudice willin&ness to attend in the future (Fonzalez et al' !**G. This proposal would explore the causes on
non+adherence' whether intentional or not' and discusses patients> reasons for failure to concord with medical
advice' and predictors of and solutions to the problem of non+adherence. The health belief model views
compliance as a decisions made by the patients after wei&hin& the perceived risks and benefits of treatment
(:Clin0sychiatry' !**!. The health belief model describes a personHs health behaviour as an expression of health
beliefs. The model was desi&ned to predict a personHs health behaviour' includin& the use of health services' and
to Eustify intervention to alter maladaptive health behaviour. Components of the model include the personHs own
perception of susceptibility to a disease or condition' the perceived likelihood of contractin& that disease or
condition' the perceived severity of the conse/uences of contractin& the condition or the disease' the perceived
benefits of care and barriers to preventive behaviour' and the internal or external stimuli that result in appropriate
health behaviour by the person' (;arlex' !*)!.
8n addition' 1r. 0earl 2rown (C. Moe' Trinidad Fuardian !*)! stated that she has 9clients who have mental
illness (schizophrenia' and with that understands that it>s very important for those around them to be
supportive.< Copin& with schizophrenia is a challen&in& task' not only for the patient but the entire family' as the
behavior of schizophrenic patients is difficult to predict. #he also mentioned that 9these clients need not only
medication but counselin&. 9The family has to adapt to the illness and be aware of its conse/uences. Therefore'
these support &roups are aimed at improvin& the lives of the mentally ill clients and their families.
Medication adherence is important in the ability to adapt' as well as' the capacity to function. $s nursin& students
we have often observed the clients unwillin&ness to adhere to their treatment re&ime' resultin& in multiple
hospital admissions' which causes a &reat deal of turmoil for themselves and their relatives. 8n this proposed
study' we seek to look at the causation of the patient>s unwillin&ness to utilize take their medications &iven to
them to try to curb relapse' rehospitalisation' poor outcomes and hi&h income costs. 2y embarkin& upon what are
the causes of compliance' we can be more successful in devisin& strate&ies for a successful result.
This study is needed' to show whether or not the patients home environment i.e. if they have the
recommend meals that should be taken with their medication' the family and community support and acceptance
of their illness and the necessary patient education about medication compliance' as well as' its side effect can
contribute to compliance of medication by the schizophrenic community.
Research (uestion
8s there a relationship between schizophrenic patients home environment and compliance with prescribed
medication which leads to a relapse or readmission to the psychiatric hospital?
)im*&+/,b-ectives
8dentify the causes of non compliance of prescribed medication for schizophrenic patients
8dentify and utilize strate&ies to curb non compliance of prescribed medication and curb rehospitalisation.
To educate participants about the importance of adherence to prescribed medication
To assist family members in developin& copin& mechanisms to provide ade/uate care for the mentally ill
relatives.
Method
$s stated in the back&round' This proposal would examine the results of compliance to medication of
schizophrenic patients and evaluate if the home environment is a contributin& factor to these patients
rehospitalisation. #ome schizophrenic patients do not fully comply with treatment and thus this compliance links
to relapse' rehospitalisation' poor outcomes and hi&h income costs. $ patient>s compliance to medication is an
important and real+world problem. ,e believe that as nursin& students takin& the initiative to try to curb this
problem' it would be beneficial to the families' the clients' their respective communities and to us as well.
Research .esign
;or the purpose of our research /uestion we chose to use a descriptive research desi&n in hope of
explorin& the patients and their realives or care&ivers perception and experiences on medication compliance in
relation to their home environment. $ccordin& to #mith !*))' phenomenolo&y is the study of structures of
consciousness as experienced from the first+person point of view6 as such a phenomenolo&ical approach would
be used for this research as it allows for us the researchers to understand the participant>s perception of the
phenomenon of non compliance of medication in relation to their home environment. 2y usin& this paradi&m' we
are be able to &et an insi&ht of the situation from the persons involved' and as a result create better solutions to
the problem as we would have an understandin& of the issue from the patients and their relatives or care &iver>s
perspective. 0atton ()CC* stated the purpose of interviewin& specifically as Ito find out what is in and on
someone elseHs mindI' and that is exactly what the tar&et of the phenomenolo&ical study focuses on' i.e. the
perception of lived experience" This approach challen&es customary structures of thinkin& and researchin& and
can &ive the medical team assi&ned to these patients a deeper insi&ht of the problem thus helpin& solve or reduce
the incidence of rehospitalization. The phenomenolo&ical approach seeks to limit and prevent researcher bias'
the maEor concern of phenomenolo&ical analysis is to understand Ihow the everyday' inter+subEective world is
constitutedI (#chwandt' !***.
Population: The population for the study includes all schizophrenic patients who were rehospitalized for at least
three (3 times in the past two (! years.
&ample: ;ifteen ()G #chizophrenic patients and their relatives or care&ivers from the admission ward' ward six
(" in #t. $nns who have been readmitted for at least three (3 times within the past two (! years. The samplin&
method we would be usin& would be purposive samplin& because of the purpose of the study and that we have
prior knowled&e of the population bein& studied.
nclusion criteria
). 0articipants must be a patient and their relatives or care&ivers of ward six (" #t $nns %ospital 0atient
!. 0atient must have been readmitted to ward six (" at least three (3 times with the past two (! years.
3. 0atients can have had at least one re&ular visitin& relative or care&iver for them durin& visitin& days and
hours.
=. 0atients that &ave consent to participate
G. 1#M+888+7 dia&noses of schizophrenia or schizoaffective disorder ($merican 0sychiatric $ssociation
)C5(
%/clusion Criteria
). 0atents who are not schizophrenic patients
!. 0atients who refused consent to participate
3. 0atients who were not readmitted to ward six(" at least three (3 times within the past two (! years.
=. 0atients of other wards besides ward six (" of #t $nn>s %ospital.
%lements o0 the .esign
ndependent 1ariable: The patient>s home environment.
.ependent 1ariable: Compliance of medication
.ata Collection
The principal method for our data collection would be prearran&ed J informal interviews with &uided /uestions.
This would help us to &ather some versatility and allow the participants to communicate their knowled&e and
views on the topic.The interviews would start at 5am and would be completed by three in the afternoon over a
;ive (G day period because of the size of the sample. My two colle&ues and myself would each interview a
patient maximizin& the utilization of time..ach interview should not be more than one hour lon& and would be
documented via writin&. 3o recordin& would be done as it would be a&ainst hospital policy. -ur reason for usin&
the interviewin& method is because it is flexible and we would have control over who is the respondent' as well
as' over se/uence of /uestions.
Pilot &tud"
The timeframe in which the research is to be completed is insufficient for one to be conducted.
.ata )nal"sis *nterpretative Phenomenological )nal"sis+
1urin& our analysis of the data received we would suspend our reflection upon our own preconception about the
data and focus in &reat detail on the participants interpretations of the phenomenon. Transcripts are coded in
considerable detail' with the focus shiftin& back and forth from the key claims of the participants' to the
researchers> interpretation of the meanin& of those claims.
8nterpretative 0henomenolo&ical $nalysis hermeneutic stance is one of in/uiry and meanin& makin& (7eid.k'
!**G' and so we would attempt to make sense of the participants> attempts to make sense of their own
experiences. This analysis would be 9bottom up.< This means that we would &enerate codes from the data rather
than usin& pre A existin& theory to identify codes that may be applied to the data. This system encoura&es an
open+ended dialo&ue between the us and the participants and' may therefore' lead us to see thin&s in a new li&ht.
$fter transcribin& the data' we would work closely and intensively with the text' annotatin& it closely (Hcodin&H
for insi&hts into the participantsH experience and perspective on their world. $s the analysis develops' we would
catalo&ue the emer&in& codes' and subse/uently be&in to look for patterns in the codes. These patterns are called
HthemesH. Themes are recurrin& patterns of meanin& (ideas' thou&hts and feelin&s throu&hout the text. Themes
are likely to identify both somethin& that matters to the participants (takin& the medication and also convey
somethin& of the meanin& of that thin&' for the participants. ..&. when we study we may find that patients don>t
take their medications because of the side effects of such prescribed medication (where one key psychosocial
understandin& of the meanin& medication compliance' is that it marks a socioeconomic for the patients and
relatives or care&ivers involved.
#ome themes will eventually be &rouped under much broader themes called Hsuper ordinate themesH. ;or
example' 9patients not havin& anythin& to eat in order to take their medication would result in ne&ative side
effects or relatives or care&ivers that do not &ive the patients the prescribed medication would observe ne&ative
emotional effect< mi&ht be a super ordinate cate&ory which would capture a variety of patterns in participantsH
embodied' emotional and co&nitive experiences' where we mi&ht expect to find sub themes. The final set of
themes are typically summarised and placed into a table or similar structure where evidence from the text is
&iven to back up the themes produced by a /uote from the text.
#ork Plan/ Time &cale
The time frame for the completion of this research is ten weeks' the followin& table illustrates the approximate
time frame allocated to the completion of the various aspects of this research.
,..K ) ,..K
!@3
,..K =@G ,..K
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,..K
(@5
,..K C ,..K )*
;ormulation
of research
/uestion and
problem
statement
;ormulate
research
proposal
#eek le&al
permission to
conduct
research
;ormulate
/uestionnaire
Collect
data
$nalyse
data
,rite up
findin&s and
conclusion
0resent
research
%thical Consideration
$ccordin& to 0olit and 2eck (!*)*' researchers must deal with ethical issues when their intended research
involves human bein&s. .thical approval will be re/uested in writin& from the 1irector of 3ursin& and the
%ospitals .thics Committee. The director of 3ursin& must be made aware of all nursin& research takin& place in
the or&anization to monitor the effect of all such proEects takin& place. They will also need to be convinced of the
value of the research and the competency of the researcher (4ee !**G.
The main ethical principles that will be considered in conductin& this research study are respect for persons'
confidentiality and beneficence Jnon+maleficence
Respect 0or persons
$s individuals are autonomous bein&s they will have the ri&ht to decide whether or not they participate in this
research. This fact will be stated clearly at the be&innin& of the interviews. 8nformed consent would be sou&ht
from research participants. 2efore consent is sou&ht the researcher will &ive details of the nature and purpose of
the research' the potential subEects' who will have access to the data and the proposed outcome of the research.
Completion of the interview process by participants will be taken as their consent to participate in the study.
0articipants will be &iven ade/uate time to consider their participation. The participants would have the
assurance that the interview will be terminated at any point of the interview process upon their re/uest to
withdraw themselves from the research
Con0identialit"
To maintain anonymity and privacy of the respondents pseudo names would be used to protect the identity of the
participants' this would encoura&e participants to speak freely without fear of victimization.
Bene0icence/non2male0icence
,hile interviews tend to be intrusive and would create a level of discomfort for the participants' it is possible for
sensitive and hi&hly personal /uestions to be threatenin& if they tri&&er feelin&s of &uilt when the respondent is
alone. #hould the interviewer sense any discomfort on the part of the interviewee durin& the interview' the
interview would be terminated unless the respondent wishes to continue. 0arahoo (!**" maintains that
/uestions on knowled&e' behavior or experience may also be threatenin& to health professionals if data can be
accessed by their employers. $ written and verbal &uarantee will be &iven to the participants that the data
collected will remain confidential and that only the researchers will have access to it. $dditionally the interview
tapes and data would be coded in that instead of the respondents names a pseudo name would be used for
example participant $ dated )!J=J)3' this way their responses would not be identifiable. The interview would be
conducted in a private area6 no identifiable information would be printed or recorded in this research.
3ustice
3o fabricated information would be recorded in our findin&s' the results presented would be factual as stated in
the interview by the respondents and would not be tweaked in any way to satisfy the researchers involved. The
final report will be factual and free of accusations
'imitations
The research /uality is heavily dependent on the our skills and can more easily be influenced by the our
personal biases and idiosyncrasies.
7i&or is more difficult to maintain' assess' and demonstrate.
The volume of data makes analysis and interpretation time consumin&.
-ur presence durin& data &atherin&' which is often unavoidable in /ualitative research' can affect the
subEectsH responses.
8ssues of anonymity and confidentiality can present problems when presentin& findin&s
;indin&s can be more difficult and time consumin& to characterize in a visual way.
Resources
Resources 4eeded 5 $uman6 Material/ %7uipment6 8inancial
$uman Resources
Cristal 1enner
:osanne :ulien
#afiya Mohammed
,e all collaborated in the research proposal:
+ Title
+ 2ack&roundJ 8ntroduction
+ 4iterature 7eview
+ 7esearch /uestion
+ $imsJobEectives
+ 0lan of 8nvesti&ationJMethod
.ach part would be shared e/ually with an input from all researchers accordin& to our stren&ths and weaknesses.
.ffective communication would be utilized throu&h scheduled meetin&s and social media. $ll parts would be
reviewed and discussed before the final draft was done.
The study will be directed by Mrs. Cristal 1enner responsibility would entail &ettin& the approval from the
hospital and ward sister of ward six (" of #t. $nns %ospital' interviewin& and data collection.
Ms. :osanne :ulien responsibility would entail interviewin& and data collection
Ms. #afiya Mohammed responsibility would entail interviewin& and data collection
The data analysis would be collaboratively done by all three of us as well as the medical team assi&ned to ward
six (" of #t. $nns %ospital
T"pes o0 Resources used:
These resources would be used after consent is obtained from the relevant sources to carry out the research.
.lectronic 1ata 2ases would also be used to find articles and Eournals on a variety of topics relatin& to our
investi&ation' as well as periodicals from professional or&anizations and &overnmental a&encies. $lso' several
educational texts &eared towards the purpose of the study would be sourced and used to increase the depth of
knowled&e.
&upport and Training:
$t C-#T$$TT' the #enior 4ecturerJLualified 3urseJ.xperienced 7esearcher' Mrs. 2eryl 2rewster was
available every week to extend support' assistance and &uidance in our endeavor of completin& our research
proposal. $s inexperienced researchers we will seek assistance and support from the nurses and other health care
workers of the #t $nn 0yschiatric %ospital.
Budget
Pro-ect %/penses:2 duration o0 the pro-ect 5 Ten weeks
7esearch staff salaries ()3!*.** x 3 M3C'"**.**
Transportation:+ To and from destinations (per team member N
M3**.**
#tationery:+
0en
0encils
.raser
7uler
3otepads
Computer
.ducational aids
0rintin& paper
Materials and #upplies:+
envelopes'
0osta&e
#tapler @ staples
-ther expenses:+ Misc.
Consultant to review
9rand total
Re0erences
0aula 2alls' 0. 2. (!**C. 0henomenolo&y in nursin& research: methodolo&y' interviewin& and
transcribin&. nursin& times ' )*G:!).
Oicki $. Keou&h' 0. 7.+2. (!*)). #urvey 7esearch: $n .ffective 1esi&n for Conductin& 3ursin&
7esearch. :ournal of 3ursin& 7e&ulation ' 3(+==.
0atton' M. L. ()CC*. Lualitative .valuation and 7esearch Methods ( !nd ed.. 3ewbury 0ark' C$:
#a&e
Schwandt, T. A. (2000). Three epistemological stances for qualitative inquiry !nterpretivism,
hermenutics, and social construction. !n ". #. $en%in & '. S. (incoln, ()ds). *and+oo, of
qualitative research, p. -./0 2-1. Thousand 2a,s, 3A Sage
#mith' 1avid ,oodruff' I0henomenolo&y4, The Stanford )ncyclopedia of 5hilosophy (6all 20--
)dition), )dward ". 7alta (ed.), 89( :
;http<<plato.stanford.edu<archives<fall20--<entries<phenomenology<=..
0olit 1.;. @ 2eck C.T. (!*)* )ssentials of "ursing 9esearch Appraising )vidence for
"ursing 5ractice, (th edn. ,olters Kluwer %ealth J 4ippincott ,illiams@ ,ilkins' 0hiladelphia.
rhttp:JJwww.tcd.ieJ4ibraryJsupportJsubEectsJnursin&+midwiferyJassetsJFeneralP!*7esearch
P!*0roposalQ).pdf
0arahoo K. (!**" "ursing 9esearch 5rinciples, 5rocess and !ssues' !nd edn.
0al&rave Macmillan' %oundsmill.
4ee 0. (!**G The process of &ate keepin& in health care research. 3ursin& Times )*)
(3!' 3".
7eid.k' ;. a. (!**G. .xplorin& lived experience: $n introduction to 8nterpretative 0henomenolo&ical
$nalysis. The 5sychologist, ' )5:)' !*+!3.
:oyce. $. (!**5. Medication Compliance and 0ersistence:. www.ispor.org ' volume )) issue ).
$merican 0sychiatric $ssociation. (!**". .videnced 2ased Treatments for #chizophrenia: information
for families and other #upporters. $rlin&ton: O$: $merican 0sychiatric $ssociation"
2arbato' $. (!*)). Shi%oprenia and pu+lic health. Feneva: world health or&anization.
$1%.7.3C. T- 4-3F+T.7M T%.7$08.#: .O81.3C. ;-7 $CT8-3. (n.d.. >*2. 7etrieved
March )(' !*)=' from http:JJwww.who.intJchpJknowled&eJpublicationsJadherenceQreportJenJ
4lorca' 0. (!**5. 0artial compliance in schizophrenia and the impact on patient outcomes. 5sychiatry
9esearch' -?-(!' !3G+!=(.
7esult ;ilters. (n.d.. "ational 3enter for @iotechnology !nformation. 7etrieved March )(' !*)=' from
http:JJwww.ncbi.nlm.nih.&ovJpubmedJ)5!5=!(3
#vestka' E.' @ 2itter' 8. (!**(. 3onadherence to antipsychotic treatment in patients with schizophrenic
disorders. 5u+Aed' 2.' CG+))". 7etrieved March )(' !*)=' from the pubmed database.
environment. (n.d.. The 6ree $ictionary. 7etrieved March )(' !*)=' from
http:JJwww.thefreedictionary.comJenvironment
)ppendi/ :
C;RRC;';M 1T)% ,8 R%&%)RC$%R&
&a0i"a Mohammed
R"5 #u&ar 7oad. 0rinces Town
Tel R: ("5+5=!G
.mail: safiyamohd(5"Noutlook.com
)ge: !3 years
%ducation:
Colle&e of #cience' Technolo&y and $pplied $rts of Trinidad and Toba&o+ C-#T$$TT !**C + 0resent
#t Kevin Colle&e. !*** A !**!
#te Madeleine #econdary #chool
:ordan %ill 0resbyterian 0rimary #chool )CC*+)CCG
(uali0ications:
2#c 3ursin& !**C + 0resent
Certificate of $chievement :Feriatric $dolescent 0artnership 0ro&ramme
Caribbean .xaminations Council #econdary .ducation Certificate: .n&lish $' Mathematics' %uman and
#ocial 2iolo&y' 0rinciples of 2usiness' Feo&raphy' #ocial #tudies' %istory' 4iterature
#ork e/perience:
#tudent 3urse !**C A present
0rinces Town 7e&ional Corporation (Clerk
Trinidad 8ndustrial ;rabic ;ilters (Clerk
Research e/perience:
Classes in preparation for research proEect: 4ibs )G* 8ntroduction to 7esearch' #tatistics' .pidemiolo&y'
3ursin& 8nformatics' 3ursin& #cience' 3ursin& Communication.
Fuidance was also &iven by Mrs. 2eryl 2rewster' #enior 4ecturer at C-#T$$TT and 7esearcher.
Cristal Denner
Summary of Qualifications
Mathematics 3
.n&lish 3
#ocial #tudies 3
0rinciples of 2usiness !
#ork %/perience
&enior Cashier
;ebruary !**( to March !**5
&uper Pharm + Fulf Oiew' 4a
7omaiin Mainly cashin& duties
2alance draw at end of sales
%elp re + shelf merchandise in store
)pprentice Customs Clerk
1ecember !**" to March !**(
General Marketers - Marabella, san Fernando
Clearance of ship spheres off the port
Preparation of customs document
getting the customs documents approved
Apprentice Customs Clerk/ Shipping Manager
January 2005 to March 200
Brokerage Solutions Ltd - !rangue", #an Juan
clearance of items on the ports
shipping items to clients in the C!$%C&M
Preparation of customs document
getting the customs documents approved
Sales Clerk
'ecember 200(
After Nine Clothing Store - )ulf *ie+, ,a $omaine
$estoc-ing Clothes after sale
#ales to customer
.nsuring the store is Cleaned and ready for ne/t day
012 .verglade !venue, Maloney )ardens, '2!badie, !rima 33
4ome5 nil - Cell5 672 - -3( 5 cristalcthomas8gmail9com
0rinciples of $ccounts 3
$&ricultural #cience !
%ome Mana&ement !
;ood and 3utrition 3
Specialied !raining
Bachelor of Science 5 "sychiatric Nursing, 2016
C#S!AA!! - .ldorado, :acarigua, :rinidad
Currently pursuing full time and i am currently in my final year
Research e/perience:
+ Classes in preparation for research proEect: 4ibs )G* 8ntroduction to 7esearch' #tatistics' .pidemiolo&y'
3ursin& 8nformatics' 3ursin& #cience' 3ursin& Communication.
+ Fuidance was also &iven by Mrs. 2eryl 2rewster' #enior 4ecturer at C-#T$$TT and 7esearcher.
$osanne $ulien
"rofessional Summary
Morne Coco $oad , Maraval, Port of #pain 33
4ome5 2;-711 - Cell5 (77-3336 < 6665(1 5 =osanne=ulien8yahoo9co9u-
% consider myself to be proficient at fle/ing and bending +ith change, practiced in resolving customer concerns in a
professional and calm manner, and balancing customer2s needs +ith company demands9 :herefore % believe that % +ill be
an asset to your business if given the chance9
Licenses
My C>C passes include5
.nglish ! %%
.nglish ? %%
4uman and social biology ?
&ffice procedure %%
Principals of accounts %%%
Principal of business %%%
Mathematics %%%
Skill %ighlights
i am dependable
i am a fast learner
i give attention to
detail i am easy going
"rofessional &'perience
Self &mployed ( )ood Catering*
January 200( to !ugust 200;
"art !ime "atient Care Assisstant
January 200; to @ovember 2011
.ffective team player
#uperior communication s-ills
Cheerful and energetic
Fle/ible scheduling
.ffective team player
The Relationship Between Schizophrenia Patient Home
Environment And Compliance With Prescribed Medication
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&ducation and !raining
Bachelor of Science 5 General Nursing, 2016
C#S!AA!! - .ldorado, :acuarigua, :rinidad
Additional +nformation
% +ill be begin my final year as a student at this collage in January 2016 to become a registered
nurse9 :he goal of this collage is to transform one student at a time, and % can say +ithout a
doubt, that % have been transformed for the better because % have prove to myself that % could do
anything that % put my mind too9
Research e/perience:
+ Classes in preparation for research proEect: 4ibs )G* 8ntroduction to 7esearch' #tatistics'
.pidemiolo&y' 3ursin& 8nformatics' 3ursin& #cience' 3ursin& Communication.
+ Fuidance was also &iven by Mrs. 2eryl 2rewster' #enior 4ecturer at C-#T$$TT and
7esearcher.
)ppendi/ <
The Relationship Between Schizophrenia Patient Home
Environment And Compliance With Prescribed Medication
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Treatment 4on2)dherence )ssessment Tool
). Patient Perspective:
). 1o you feel you have a mental illness? Bes 3o
!. ,hat symptoms do you experience?
3. 1o you believe you re/uire medications? Bes 3o
=. %ave you taken medications in the past? 8f so' which ones and for how lon&?
G. 1o you feel these medications helped mana&e your symptoms? Bes 3o
". %ave you ever taken medications that caused problems for you' such as' makin& you
experience stran&e movements' sleepiness' wei&ht &ain' sexual problems' blurred vision'
or other problems? Bes 3o (%ave patient explain' if yes.
(. 1id your mental health provider explain the reasons for takin& medications and what
heJshe expected the medications to do for you? Bes 3o
5. $re you willin& to start medications' continue current medications' or try different
medication(s? #tart Continue Current Try 1ifferent
C. %ave you ever discontinued your medications by yourself' or Eust allow yourself to run
out of medication(s? 8f so' why?
)*. %ave you ever skipped doses of your medication(s? Bes 3o
)). %ave you ever been &iven a prescription that you decided not to fill? Bes 3o
)!. %ave you ever decided to use dru&s or alcohol instead of takin& your medication(s? Bes
3o
)3. 1o you often for&et to take your medication(s? Bes 3o
)=. 1o you ever feel like you are bein& forced to take medications a&ainst your will? Bes 3o
)G. 1o you ever say you are takin& your medications to please your provider? Bes 3o
The Relationship Between Schizophrenia Patient Home
Environment And Compliance With Prescribed Medication
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)". %ave you ever purposefully discontinued takin& your medication because you were no
lon&er in the hospital? Bes 3o
B. 8amil"6 8riends6 &igni0icant ,ther Perspective:
). 1o you feel the patient understands the need for hisJher medications(s? Bes 3o
!. 1o you have to monitor the patient to ensure heJshe takes the medications?
3. Bes 3o
=. 1o you have to &o to the pharmacy with the patient to fill hisJher medication to make
sure it &ets done? Bes 3o
G. 1o you feel current medications are helpin& the patient' makin& himJher worse' or havin&
no effect? %elpin& ,orsenin& 3o .ffect
". 8s the patient willin& or unwillin& to keep appointments with his mental health provider?
,illin& Dnwillin&
(. %ave you noticed' or has the patient verbalized to you any si&nificant adverse effects
heJshe has experienced since bein& prescribed the medication(s? Bes 3o
5. 1o you know if this patient>s diet contains ade/uate nutritional content' specifically
ade/uate protein? Bes 3o
)ppendi/ =
Criteria for the Diagnosis of Schizophrenia
*.&M212TR6 <>>>6 p.=:<+.
The Relationship Between Schizophrenia Patient Home
Environment And Compliance With Prescribed Medication
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$. Characteristic &"mptoms: Two (or more of the followin&' each present for a
#i&nificant portion of time durin& a one+month period (or less if successfully treated:
() delusions
(! hallucinations
(3 disor&anized speech (e.&. fre/uent derailment or incoherence
(= &rossly disor&anized or catatonic behavior
(G ne&ative symptoms (affective flattenin&' alo&ia' or avolition.f
3ote: -nly one criterion $ symptom is re/uired if delusions are bizarre or hallucinations consist
of a voice keepin& up a runnin& commentary on the person>s behavior or thou&hts' or two or
more voices conversin& with each other.
2. &ocial/,ccupational ."s0unction: ;or a si&nificant portion of the time since the
-nset of the disturbance' one or more maEor areas of functionin& such as work'
8nterpersonal relations' or self+care are markedly below the level of achieved prior to the onset
(or when the onset is in childhood or adolescence' failure to achieve expected level of
interpersonal' academic' or occupational achievement.
C. .uration: Continuous si&ns of the disturbance persist for at least " months. This "+month
period must include at least one month of symptoms (or less if successfully treated that meet
Criterion $ (i.e.' active+phase symptoms and may include periods of prodromal or residual
symptoms. 1urin& these prodromal or residual periods' the si&ns of the disturbance may be
manifested by only ne&ative symptoms' or two or more symptoms listed in Criterion $ present in
an unattenuated form (e.&.' odd beliefs' unusual perceptual experiences.
The Relationship Between Schizophrenia Patient Home
Environment And Compliance With Prescribed Medication
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1. &chizoa00ective and Mood .isorder %/clusion: #chizoaffective 1isorder and Mood
1isorder with 0sychotic ;eatures have been ruled out because either () no MaEor 1epressive'
Manic' or Mixed ;eatures have occurred concurrently with active+phase symptoms6 or (! if
mood episodes have occurred durin& active+phase and residual periods.