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Zhu R, Zhang J, Zhang Q, Dong W, Meng Y, Wang Y, Wang X, Han S. Content of medicine prescription and clinical practice training for haematology advanced practice nurses in China: A modified Delphi study. Nurse Educ Pract 2024; 77:103974. [PMID: 38728791 DOI: 10.1016/j.nepr.2024.103974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/23/2024] [Accepted: 04/14/2024] [Indexed: 05/12/2024]
Abstract
AIM To explore the scope and form of prescriptions for blood and hematopoietic drugs that future advanced practice nurses (APNs) in the Department of Haematology and to establish a medicine prescription training content in China. BACKGROUND Because the increasing number of doctors cannot meet the increasing demand for medical care with the population growth, many countries have begun to explore the medical team structure and practice areas, among which nurse prescribing rights have been the most effective. However, China's higher nursing education system still lacks education and training on nurse prescription. DESIGN On the basis of literature research and semi-structured interviews, a set of nursing prescription content, education, training and practice system suitable for Chinese nurses was jointly created. METHODS Two rounds of expert consultation between 23 haematology nursing experts and clinical experts determined the training content of blood system drugs and medicine prescriptions. Additionally, on the basis of the 23 experts,13 experts engaged in clinical and education, teaching and training experts were involved. Two rounds of expert consultation with 36 experts identified a general clinical practice training program for advanced practice nurses in China. RESULTS Regarding contents and forms of hematopoietic drugs, the study concluded that advanced practice nurses in haematology department can prescribe anti-anemia drugs, anti-coagulant drugs and anti-thrombotic drugs in 2 categories and 16 drugs. Of these, four kinds of drugs should be prescribed in the form of protocol prescription. One kind of drug should be prescribed in the form of extended prescription and 11 drugs should be prescribed in the form of independent/extended or agreed/extended prescription. Regarding training content, the study obtained the training content of nurses' medicine prescriptions in eight clinical circumstances and the medicine prescription training content for common diseases of the blood system. The required specifications and the medicine prescription decision skills of nurses were sorted out according to different prescription types. CONCLUSIONS The degrees of expert authority were both higher in consultations. Moreover, the results after consultation were reliable. It was recommended that haematology APNs could prescribe anti-anaemic drugs and anti-coagulation and anti-thrombotic drugs. Furthermore, most drugs should be prescribed in the form of independent/extended or agreed/extended prescriptions. The establishment of a medicine prescription training content for haematology APNs is expected to provide a reference for clinical practice education and training for drug prescriptive authority applicants for blood and hematopoietic system nurses in China.
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Affiliation(s)
- Ruifang Zhu
- Editorial Office, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China; School of Nursing, Shanxi Medical University, Taiyuan, Shanxi 030001, China.
| | - Jun Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi 030001, China.
| | - Qian Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi 030001, China.
| | - Wenjing Dong
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi 030001, China.
| | - Yifei Meng
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi 030001, China.
| | - Yaping Wang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi 030001, China.
| | - Xiujuan Wang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi 030001, China.
| | - Shifan Han
- Editorial Office, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China; School of Nursing, Shanxi Medical University, Taiyuan, Shanxi 030001, China.
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Esteban-Sepúlveda S, Gallego-Cortes MC, Giró-Formatger D, Fernandez-Canto S, Salguero-Grau S, Lacueva-Pérez L. Nurse prescription start-up in a Spanish health organization: Nurses' preparedness and 6-month results. NURSE EDUCATION TODAY 2023; 120:105653. [PMID: 36436268 DOI: 10.1016/j.nedt.2022.105653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Nurse prescribing is well consolidated in many countries. In Spain, recent legislation has allowed nurse to prescribe under specific conditions, but the implementation process is complex. OBJECTIVES First, to describe nurses' knowledge and expectations of nurse prescribing in a health institution in Spain. Second, to report the nurses' prescriptions in a pilot group at 6 months. METHODS A descriptive, online survey design was used to identify nurses' knowledge and expectations of prescribing. The results were compared according to the nurses' professional position and training. We analyzed the number and type of prescriptions issued in the first 6 months. RESULTS Training needs (overall score = 4.2/5) and lack of knowledge of the law (4.25/5) were scored lower by nurses with postgraduate training. Subjective assessment of preparedness among nurses was high (>4/5), and the highest-scoring expected impact was improvement in patients' experience (4.25/5). Years of nursing experience were negatively correlated with preparedness and the expectation of an increase in patient management errors. A total of 212 prescriptions were issued (2 drugs and 200 health devices). CONCLUSIONS Nurses perceived good preparedness but also the need for more training in medicines and prescribing law. Expectations of prescribing were favourable. Most prescriptions were for health devices.
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Affiliation(s)
- Silvia Esteban-Sepúlveda
- Consorci Parc de Salut MAR de Barcelona, Methodology and Quality in Nursing Care, Barcelona, Spain; Hospital del Mar Institute of Medical Research (IMIM), Research group in nursing care (GRECI), Barcelona, Spain; Departament d'Infermeria Fonamental i Medicoquirúrgica, Escola d'Infermeria, Universitat de Barcelona (UB), Feixa Llarga, s/n, 08907 l´Hospitalet de Llobregat, Spain.
| | | | - Dolors Giró-Formatger
- Consorci Parc de Salut MAR de Barcelona, Methodology and Quality in Nursing Care, Barcelona, Spain.
| | - Sara Fernandez-Canto
- Consorci Parc de Salut MAR de Barcelona, Human Resources Department, Barcelona, Spain
| | - Sara Salguero-Grau
- Consorci Parc de Salut MAR de Barcelona, Human Resources Department, Barcelona, Spain.
| | - Laia Lacueva-Pérez
- Consorci Parc de Salut MAR de Barcelona, Methodology and Quality in Nursing Care, Barcelona, Spain.
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Brimblecombe N, Dobel‐Ober D. The development of nurse prescribing in mental health services: outcomes from five national surveys 2004‐19. J Nurs Manag 2022; 30:1018-1026. [PMID: 35278007 PMCID: PMC9314713 DOI: 10.1111/jonm.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Neil Brimblecombe
- Professor of Mental Health, Institute of Health and Social Care London South Bank University
| | - David Dobel‐Ober
- Evaluation Lead, Research and Innovations, Midlands Partnership NHS Foundation Trust
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Santos-Willshere J, Pizarro N. Introducing nurse prescribing in Gibraltar: the impact on palliative care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:162-168. [PMID: 35152752 DOI: 10.12968/bjon.2022.31.3.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article critically explores the impact of the introduction of nurse prescribing on palliative care in Gibraltar. A preliminary audit review of the prescriptions issued by the two palliative independent nurse prescribers over their first full calendar year of prescribing (2020) revealed two primary areas of impact: facilitating end-of-life care at home and improving anticipatory prescribing for end-of-life symptom management. These initial findings will be discussed in the context of the challenges and facilitators encountered during the first year of prescribing practice. Challenges were primarily related to the introduction of an advanced nursing role into an existing medical paradigm. Identified facilitators included comprehensive record keeping, collaborative working and the development of local guidelines, as well as the support of management and peers. The article concludes with a recommendation for further audits of prescribing data as a way to measure the impact of the new role and to inform future palliative service development.
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Affiliation(s)
| | - Nicole Pizarro
- Specialist Palliative Nurse, Gibraltar Health Authority, Gibraltar
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Snell H, Budge C, Courtenay M. A survey of nurses prescribing in diabetes care: Practices, barriers and facilitators in New Zealand and the United Kingdom. J Clin Nurs 2021; 31:2331-2343. [PMID: 34542207 DOI: 10.1111/jocn.16052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To compare diabetes-related prescribing practices, barriers and facilitators amongst nurse prescribers in New Zealand and the United Kingdom. BACKGROUND Nurses have been prescribing in the United Kingdom for many years but nurse prescribing in New Zealand is relatively recent. It is unknown whether similar system factors act to facilitate or limit prescribing. DESIGN A survey of 250 nurses prescribing in diabetes care in New Zealand (n = 111) and the United Kingdom (n = 139). METHODS A SurveyMonkey questionnaire was used to survey nurses about the extent of their prescribing practices, and barriers and facilitators experienced. Quantitative data were explored descriptively, and qualitative responses were grouped according to content, with quotes provided to exemplify thematic content. This study is reported following STROBE guidelines. RESULTS Insulin, metformin and sulphonylureas are the drugs most frequently prescribed in both countries. Considerably more New Zealand than United Kingdom nurses reported prescribing for cardiovascular and renal disease. In both countries, direct prescribing to the patient was most common, followed by remote prescribing in New Zealand and via recommendation to other prescribers in the United Kingdom. Most common barriers were lack of time and inadequate mentoring. Most common facilitators were as follows: good supervision; collegial relationships with specialists, pharmacists and peers; and ongoing education. CONCLUSIONS These New Zealand and United Kingdom nurses are prescribing a broad range of diabetes-related medications. Similar barriers and facilitators were identified in both countries. Adequate supervision, support from multidisciplinary team colleagues and prescribing education and guidelines are paramount. RELEVANCE TO CLINICAL PRACTICE Important insights on barriers and facilitators to implementation of nurse prescribing in two countries are highlighted and, despite a considerable difference in the longevity of prescribing practice, similar issues were identified.
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Affiliation(s)
- Helen Snell
- BlueHorizons NZ Ltd, Palmerston North, New Zealand
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Goldman J, Kuper A, Whitehead C, Baker GR, Bulmer B, Coffey M, Shea C, Jeffs L, Shojania K, Wong B. Interprofessional and multiprofessional approaches in quality improvement education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:615-636. [PMID: 33113055 DOI: 10.1007/s10459-020-10004-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
The imperative for all healthcare professionals to partake in quality improvement (QI) has resulted in the development of QI education programs with participants from different professional backgrounds. However, there is limited empirical and theoretical examination as to why, when and how interprofessional and multiprofessional education occurs in QI and the outcomes of these approaches. This paper reports on a qualitative collective case study of interprofessional and multiprofessional education in three longitudinal QI education programs. We conducted 58 interviews with learners, QI project coaches, program directors and institutional leads and 135 h of observations of in-class education sessions, and collected relevant documents such as course syllabi and handouts. We used an interpretive thematic analysis using a conventional and directed content analysis approach. In the directed content approach, we used sociology of professions theory with particular attention to professional socialization, hierarchies and boundaries in QI, to understand the ways in which individuals' professional backgrounds informed the planning and experiences of the QI education programs. Findings demonstrated that both interprofessional and multiprofessional education approaches were being used to achieve different education objectives. While each approach demonstrated positive learning and practice outcomes, tensions related to the different ways in which professional groups are engaging in QI, power dynamics between professional groups, and disconnects between curricula and practice existed. Further conceptual clarity is essential for a more informed discussion about interprofessional and multiprofessional education approaches in QI and explicit attention is needed to professional processes and tensions, to optimize the impact of education on practice.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada.
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Wilson Centre for Research in Education, University of Toronto, Toronto, Canada.
| | - Ayelet Kuper
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Wilson Centre for Research in Education, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Cynthia Whitehead
- Wilson Centre for Research in Education, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Beverly Bulmer
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maitreya Coffey
- Department of Paediatrics, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
- Children's Hospitals Solutions for Patient Safety, Cincinnati, OH, USA
| | - Christine Shea
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kaveh Shojania
- Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Brian Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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Blackwell CW, Faraci N. Conflict resolution between physicians and nurse practitioners. J Am Assoc Nurse Pract 2020; 33:931-937. [PMID: 32890051 DOI: 10.1097/jxx.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United States health care system, nurse practitioners (NPs) and physicians work very closely in the delivery of high-quality patient care across lifespans and acuities. In fact, advanced practice nurses work closer with physicians in their day-to-day care delivery than with any other group of professionals. This remains true even in states with independent practice for NPs. Because of the significant relationships between physicians and NPs, assessment of how these professionals resolve conflict is essential. PURPOSE The purpose of this study was to determine the style of conflict resolution employed by NPs and physicians. METHODS Nurse practitioners (n = 57) and physicians (n = 58) were randomly sampled from the Florida Department of Health-Health Care Practitioner Data Portal (N = 115). Participants completed a demographic questionnaire assessing experience in conflict resolution training and the Rahim Organizational Conflict Inventory-II, Form C, which defined the style of conflict resolution they most used and preferred. RESULTS Results showed that 29.8% of physicians and 40.4% of NPs received formal conflict resolution/management education/training (p = .24). The dominant style of conflict resolution used for 78% of physicians and 74% of NPs was the integrating style, with no statistical difference between the two professions (p = .87). IMPLICATIONS FOR PRACTICE Physicians and NPs lack formal education on conflict resolution in their graduate studies. In addition, both professionals tend to use similar styles of conflict resolution among one another in clinical practice, which affects their collaboration and ultimately how optimal care is delivered to patients.
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Affiliation(s)
- Christopher W Blackwell
- Adult-Gerontology Acute Care Nurse Practitioner Programs, College of Nursing, University of Central Florida, Orlando, Florida
| | - Nicholas Faraci
- College of Medicine, University of Central Florida, Orlando, Florida
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Pearson M, Papps E, Walker RC. Experiences of registered nurse prescribers; a qualitative study. Contemp Nurse 2020; 56:388-399. [PMID: 32814514 DOI: 10.1080/10376178.2020.1813044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aims: This study aimed to investigate the experiences of registered prescribers and their perceptions of the enablers and barriers to registered prescribing and the value of this fledgling role. Background: The role of prescribing has been extended to registered nurses in New Zealand. By adding the designated prescribing role to a nurse's role, their scope of practice expands and nurses are able to provide patients with holistic care while achieving greater independence and role satisfaction. Yet new nurse prescribers can experience anxiety and fear when confronted with the reality of the responsibility of prescribing. Methods: Sixteen semi-structured interviews were conducted with registered nurse prescribers across New Zealand. Data were analysed using a general inductive approach and thematic analysis utilised to identify themes and sub-themes. Results: Sixteen registered nurse prescribers participated in the study. Three main themes emerged with sub-themes: ability to expand practice, improving access to care, and importance of working in a collaborative team. Participants explained how they enjoyed the challenge and responsibility of the new prescribing role yet were frustrated with the realities of the restrictions of what they could actually prescribe and in some cases lack of role recognition. Registered nurse prescribing also improved access to care as nurses felt they provided more comprehensive care, resulting in reduced wait times, better continuity of care and a reduction in patient costs. The participants highlighted the importance of working in a collaborative team and believed their ability to prescribe maximised clinician time, however cautioned the need for on-going clinical mentorship and a prepared and supportive work environment. Conclusions: The addition of registered nurse prescribing provides a number of advantages to individual nurses in terms of career development and job satisfaction, and to patients and the health care system. The benefits to health care consumers and the health care system align directly to health care priorities of improving equity and access to care. Impact statement: Registered nurse prescribers perceive a number of advantages to the addition of prescribing to their own practice and benefits to patients and the health care system by enabling more accessible and cost-effective care.
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Affiliation(s)
- Maria Pearson
- Eastern Institute of Technology, Napier, New Zealand
| | - Elaine Papps
- Eastern Institute of Technology, Napier, New Zealand
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Fong J, Cashin A, Buckley T. Models of prescribing, scope of practice, and medicines prescribed, a survey of nurse practitioners. J Adv Nurs 2020; 76:2311-2322. [PMID: 32511776 DOI: 10.1111/jan.14444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/20/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore current Australian Nurse Practitioners (NPs) models of prescribing used and medicines prescribed within their scopes of practice. DESIGN Descriptive online electronic national survey. METHODS An online survey of Australian NPs was conducted in 2017. A total of 252 NP participants reported on their current prescribing practices. RESULTS Participants reported prescribing via three prescribing models with autonomous prescribing the most frequently used, followed by prescribing under supervision and prescribing under a structured arrangement. Participants reported prescribing 298 separate medications, representative of all major drug classifications from the Australian Medicines Handbook. CONCLUSIONS NPs appear to engage in several modes of prescribing as relevant to their context of practice with most NPs prescribing using all models of prescribing at different times. Findings also highlight the diversity of and breath of the medicines that NP prescribes and highlight the need for NPs to have broad capability in relation to the quality use of medicines, irrespective of specialty or location of practice. IMPACT Findings of this research add to the international literature on NP prescribing and through identification of models of prescribing and medicines prescribed inform future NP education and policy.
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Affiliation(s)
- Jacqueline Fong
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew Cashin
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Barriers and enablers for midwives using endorsement for scheduled medicines: A literature review. Women Birth 2020; 33:3-14. [DOI: 10.1016/j.wombi.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/11/2018] [Accepted: 11/16/2018] [Indexed: 11/22/2022]
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