Date of Award

Fall 2021

Degree Type

Dissertation/Thesis

Degree Name

Doctor of Nursing Practice (DNP)

School

Leadership and Advanced Nursing Practice

Committee Chair

Dr. Carolyn Coleman

Committee Chair School

Leadership and Advanced Nursing Practice

Committee Member 2

Dr. LaWanda Baskin

Committee Member 2 School

Leadership and Advanced Nursing Practice

Abstract

The first phase in the management of mental illnesses requires an intimate understanding of the thorough side effects of the medications prescribed. The treatment of antipsychotics involves a unique approach. New technological shifts in the field of anti-psychotic medications have been revolutionized. While most anti-psychotic medications are capable of battling psychosis, the effects vary from medication to medication. The susceptibility of akathisia has significant consequences. Akathisia can be easily overlooked and passed off as irritability leading to misdiagnosis.

The purpose of the Doctor of Nursing Project (DNP) was to bring awareness to akathisia and the Barnes Akathisia Rating Scale (BARS). Patients taking anti-psychotics need an accurate tool to measure their baseline prior to starting anti-psychotics and an accurate to measure the side effects of anti-psychotics during treatment. The BARS scale is the solution to accurately measure akathisia symptoms.

The DNP project was conducted in an outpatient clinic in southern Mississippi. Four hundred thirty-six (436) patients were seen within a 30-day time frame. Of those 436 patients 27 patients presented with symptoms of akathisia. The healthcare providers at this clinic documented akathisia's symptoms using a narrative note or the Abnormal Involuntary Movement Scale (AIMS). This scale can mask akathisia symptoms because it does not distinguish between akathisia and tardive dyskinesia. The two side effects have very different treatments. It is important to rate the level of severity on abnormal movement-specific scales. The BARS Scale measures akathisia exclusively.

Participants in the DNP project were given a pre-test, education, and a post-test. The pre-test tested the knowledge of participants' awareness of akathisia, the BARS scale, and how they currently document akathisia. The pre-test revealed that 60% of

participants see akathisia on a weekly basis. Most participants documenting akathisia using a narrative note, while 20% used the AIMS scale to document akathisia. The education was given in a form of a PowerPoint®. The post-test was scenario-based patients and required the use of the BARS scale to rate the level of the severity of akathisia each patient presented with. Participants’ post-tests were compared. The post-test revealed 80% of the participants answered the scenario-based questions similarly. The post-test proves that the BARS scale validity to measure akathisia.

The findings from this DNP project indicate that there is a need for an akathisia scale in an outpatient clinical setting. Research revealed that patients taking anti-psychotics are distressed due to their akathisia. First episode akathisia patient’s experience thoughts of suicide (Salem, 2017). Patients usually stop taking their medications due to having thoughts of suicide induced by akathisia. The distress caused by the side effects of antipsychotics needs to be addressed. The BARS scale is easy to use tool to measure the baseline of akathisia symptoms and is a tool that can be used throughout the treatment of antipsychotic use. The BARS scale aids in the early detection and treatment of akathisia. Early treatment of akathisia lessens the patients’ feelings of distress and increases the chances of medication compliance.

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