The experiences of mental health professionals and patients in the use of pro re nata medication in acute adult mental health care settings: a systematic review of qualitative evidence

Abstract

The use of pro re nata (PRN) medication, a medication that is given when needed, as opposed to medication that is given at a regular time, is surrounded by claims of misuse and poor accountability within the mental health setting. Gaining insight and understanding into the experiences of health professionals and patients in the use of PRN medication will assist in contributing to improving education and safety around this common intervention. The objective was to synthesize the best available evidence of qualitative research that looked at the experiences of mental health professionals and patients in the use of PRN medication in acute adult mental health care settings. The review considered studies that included mental health professionals who were working in an acute adult mental health care setting as well as adults who were admitted into an acute adult mental health care setting. The phenomena of interest was the experience of the mental health professionals and patients in the use of PRN medication in acute adult mental health care settings. Studies that focused on qualitative data including, but was not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered. The databases searched included: CINAHL, PubMed, Embase, Scopus, PsycINFO and the search for unpublished studies included: Proquest Dissertation and Theses, Mednar and Google Scholar. Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Assessment Review Instrument (JBI-QARI). This involved the aggregation or synthesis of findings to generate a set of statements that represented that aggregation through assembling the findings rated according to their quality, and categorizing these findings on the basis of a similarity in meaning. Categories were then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Studies published in the English language were considered for inclusion. Literature from the last 30 years was searched to ensure currency and relevance of the research. Four studies were included in the systematic review. Two studies each from both groups’ perspective. These experiences were combined in one synthesis to look at the issues from mutual perspectives. A total of forty findings were extracted. The findings were grouped into ten categories and five synthesized findings were developed. The findings demonstrated that PRN medication use among mental health professionals and service users is subject to many variables such as individual decision making to organizational policies. The findings also showed there are many contributing factors to the prescribing and administering of PRN medications. Patients had views and opinions on their use of PRN medication describing that they found PRN medication to be useful in helping them to take control of their symptoms and that education around alternatives to PRN medication administration should be offered.