5.7 Health Promotion, Care Coordination & Medication Adherence
Key Takeaways
- SBIRT (Screening, Brief Intervention, and Referral to Treatment) is the standard framework for substance use prevention.
- SBAR structures handoff communication to prevent errors at transitions of care.
- Medication reconciliation compares pre-admission and current medication lists at every transition of care to catch omissions and errors.
- Long-acting injectable antipsychotics address adherence barriers rooted in forgetfulness or inconsistent daily dosing.
The final Implementation section pulls together three TCO buckets — health promotion (III-S6), care coordination (III-S1), and medication management (III-S4) — that together determine whether gains made during acute treatment are sustained after discharge.
Health Promotion in Psychiatric-Mental Health Nursing
People with serious mental illness die on average years earlier than the general population, driven largely by preventable cardiometabolic disease — a fact that makes physical health promotion a core, not peripheral, psychiatric nursing responsibility.
- Self-care — sleep hygiene, nutrition, and regular physical activity are foundational and directly affect mood, anxiety, and cognitive symptoms.
- Tobacco cessation — smoking rates are markedly higher in psychiatric populations than the general public. Evidence-based cessation support includes nicotine replacement therapy, bupropion, and varenicline, combined with counseling; cessation should be offered even during acute admission, not deferred.
- Substance use prevention — SBIRT (Screening, Brief Intervention, and Referral to Treatment) is the standard framework: screen every patient, deliver a brief motivational intervention for risky use, and refer patients who screen positive for a substance use disorder to specialized treatment.
- Physical health integration — because many psychotropics (particularly second-generation antipsychotics) carry metabolic risk, health promotion includes reinforcing the metabolic monitoring schedule (weight, waist circumference, blood pressure, glucose, lipids) and coordinating with primary care.
Care Coordination
Handoff Communication
Standardized handoff communication prevents the errors and omissions that occur most often at transitions of care. SBAR is the standard structure:
| SBAR Element | Content |
|---|---|
| Situation | The current problem or reason for the handoff |
| Background | Relevant history, diagnoses, and context |
| Assessment | The nurse's clinical judgment of the current status |
| Recommendation | What the receiving clinician should do next |
Community Resource Identification
Discharge planning begins at admission and requires connecting the patient with the supports that will sustain recovery outside the hospital: outpatient psychiatric follow-up (scheduled before discharge whenever possible), case management, peer support/recovery groups, housing assistance, vocational or educational services, and crisis lines/mobile crisis teams for relapse prevention. Case management and social work partnership are essential, especially for patients with limited social support or unstable housing. A warm handoff — directly introducing or connecting the patient with the receiving outpatient provider or community resource, rather than simply providing a phone number — meaningfully increases the odds the patient actually follows through on referrals after leaving a structured setting.
Wellness and Self-Management
Health promotion also includes teaching patients structured self-management tools they can use independently after discharge. The Wellness Recovery Action Plan (WRAP), developed by Mary Ellen Copeland, is a widely used, patient-authored framework with several components:
- Wellness toolbox — a personal list of coping strategies that help maintain stability day to day.
- Daily maintenance plan — what the patient does routinely to stay well (sleep, medication, activity).
- Triggers and early warning signs — identifying stressors and the earliest personal signals that symptoms are building.
- Crisis plan — instructions, written while well, for how others should support the patient during a severe episode, including preferred providers and treatments.
- Post-crisis plan — steps for returning to routine and rebuilding stability after a crisis resolves.
Because WRAP is developed collaboratively and used by the patient rather than imposed by the clinician, it reinforces the recovery model's emphasis on self-direction and complements the relapse-prevention and safety-planning tools introduced elsewhere in this guide.
Medication Reconciliation and Adherence Support
Medication reconciliation — comparing the patient's pre-admission medication list against current orders at every transition of care (admission, transfer, discharge) — catches omissions, duplications, and dangerous interactions before they reach the patient. It is a formal patient-safety requirement at every transition point, not an optional courtesy.
Medication non-adherence is a leading cause of psychiatric relapse and readmission. Common barriers and matched nursing interventions:
- Side effects — proactively assess and address before the patient stops the medication independently; involve the prescriber for dose or agent adjustment.
- Limited insight/anosognosia — common in psychotic disorders; motivational interviewing rather than confrontation is more effective at building engagement.
- Cost and access — connect patients with manufacturer assistance programs, generics, or case management.
- Stigma — normalize psychotropic medication as treatment for a medical condition, similar to insulin or antihypertensives.
- Complex regimens — simplify dosing schedules and use pill organizers or reminder systems where possible.
- Long-acting injectable (LAI) antipsychotics — offered when adherence to oral regimens is a recurrent barrier; an LAI removes the need for daily self-administration and gives the treatment team an objective adherence signal (a missed injection is immediately apparent).
Family Psychoeducation and Relapse Warning Signs
Adherence and relapse prevention extend beyond the individual patient. Family psychoeducation teaches relatives about the diagnosis, treatment plan, and communication strategies (e.g., reducing expressed emotion — hostility, criticism, and over-involvement — which is associated with higher relapse rates in conditions like schizophrenia). Both the patient and involved family members should be taught the individual's early relapse warning signs — changes such as worsening sleep, social withdrawal, increased irritability, or the return of specific prodromal symptoms — so that treatment can be escalated proactively rather than only after a full crisis develops. This teaching is typically paired with a written relapse-prevention or safety plan the patient keeps after discharge.
Exam Application
When a stem describes a patient being discharged after an acute admission, the priority nursing actions are: confirm the outpatient follow-up appointment is scheduled, complete medication reconciliation, and provide adherence-focused education addressing the patient's specific stated barrier — not simply handing over a discharge instruction sheet. When a stem describes a patient who has stopped taking oral antipsychotics multiple times due to forgetfulness, an LAI formulation is the best long-term nursing recommendation to raise with the prescriber.
A patient is being discharged after an acute psychiatric admission. Which nursing action reflects the medication reconciliation requirement at this transition of care?
A patient has been readmitted twice in the past year after repeatedly stopping oral antipsychotic medication due to forgetfulness, despite denying any distressing side effects. Which recommendation should the nurse raise with the prescriber to best address this specific adherence barrier?