Agnes Okoro

Graduation Semester and Year




Document Type


Degree Name

Doctor of Nursing Practice



First Advisor

Diane Snow


The annual cost of medication non - adherence problems in United States (U.S.) is approximately $100 billion dollars (Heesch, 2013; Julius, Novitsky, & Dublin, 2009). Mental health providers often encounter psychotropic medication non adherence among incarcerated persons with schizophrenia despite their alliance- enhancing efforts, resulting in increased violence, hospitalization, and an impact on economy. Therapeutic alliance, an effective and collaborative relationship between the health care provider and the patient has a positive association with treatment adherence as supported by the result of many studies (Julius et al., 2009; Kvrgic, Cavelli, Beck, Rusch, & Vaulth, 2013 ; McCabe et al., 2012). The significance of the therapeutic alliance between mental health providers and their patients led to the key research question: What are the therapeutic strategies used by mental health providers to create a therapeutic alliance and effective patient- provider relationship with the incarcerated persons with schizophrenia? The pilot study was conducted using a descriptive non comparative design, to survey effective strategies for therapeutic alliance perceived by mental health care providers who work in Jester IV Correctional inpatient mental health facility in Richmond Texas through a self- administered questionnaire Results: The strategic items that received the highest score of "strongly agree" scale includes: team work (81.82%), acknowledging individuals' insight (72.73%), empathy (72.73%) patient education on illness and medication side effects 63 . 64%,, non-judgmental attitude towards delusion and hallucinations 63.64%, overall importance of strategies 63.64%, and provider factors 60%.Conclusion: Mental health providers identified therapeutic strategies for effective patient- provider relationship to encourage psychotropic medication adherence. Schizophrenia "is a severe mental illness characterized by delusions and hallucinations" (McIntosh, Conlon, Lawrie, & Stanfield, 2009, p. 1). Antipsychotic medications have shown efficacy in the treatment of the positive, negative, and cognitive symptoms (Gray, White, Schulz, & Abderhalden, 2010). Patients with schizophrenia have the highest rate of anti psychotic nonadherence; they are the most frequently committed to institutions because of violent behavior resulting from antipsychotic medication non adherence (Acosta et al., 2012; Canas et al., 2013; Shelton, Ehret, Wakai, Kapetanovic, & Moran, 2010). Failure to take effective medication as prescribed can be non- compliance when the provider has the role of providing solution to the patient's health belief barriers to compliance, or non-adherence when the patient's role is the most important determinant (McIntosh et al., 2009). Antipsychotic medication non-adherence affects the economy, resulting in increased relapse rates, and increased hospitalization (Hansen, Maciejewski, Yu-Isenberg, & Farley, 2012; Heesch, 2013 ; Julius, Novitsky, & Dublin, 2009). Therapeutic alliance is an affective and collaborative relationship between patient and provider (K vrgic, Cavelli, Beck, Rusch, & Vaulth, 2013 ). The quality of therapeutic alliance is one of the major factors identified to affect medication adherence (Julius et al., 2009; Sylvia et al., 2013). Poor therapeutic alliance has been identified as an impmiant factor affecting medication adherence; providers can directly influence the quality of therapeutic alliance (Sylvia et al., 2013). Developing a strong therapeutic relationship for patients with schizophrenia may be challenging for mental health providers because of poor insight and delusions associated with the illness. For the inmates with schizophrenia prison culture adds to the difficulty (K vrgic et al., 2013). Strategies for development of effective therapeutic alliance are evaluated in this project. The significance of the quality of therapeutic alliance in antipsychotic medication adherence for inmates with schizophrenia, the effect of anti psychotic nonadherence on the economy and safety of the public led to this project to identify the therapeutic strategies used by mental health providers for effective therapeutic alliance.


Medicine and Health Sciences | Nursing


Degree granted by The University of Texas at Arlington

Included in

Nursing Commons