1
|
Hamoen EC, van Blankenstein FM, de Jong PGM, Ray A, Reinders MEJ. Development of a Clinical Teaching Unit in Internal Medicine to Promote Interprofessional and Multidisciplinary Learning: A Practical Intervention. TEACHING AND LEARNING IN MEDICINE 2021; 33:78-88. [PMID: 32917107 DOI: 10.1080/10401334.2020.1792309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Problem: Effective clinical workplace learning depends on interprofessional and multidisciplinary learning. However, traditional patient wards are centered around patient care and not so much around education. Other barriers such as time constraints also contribute to suboptimal interprofessional and multidisciplinary learning. Intervention: Six formal and informal learning activities that aimed at stimulation of interprofessional and multidisciplinary learning were designed and introduced in our patient ward to enable optimal integration of clinical practice and learning. Context: The study took place in an internal medicine inpatient ward where daily patient care is performed by specialized teams consisting of different healthcare professionals from the departments of Endocrinology, Nephrology, and Infectious Diseases. In the traditional ward setting, interprofessional and multidisciplinary learning mostly takes place during shared clinical activities. In this article, we describe the development and implementation of a Clinical Teaching Unit to support learning between different healthcare professionals. Impact: The intervention was evaluated with an online questionnaire among 108 nurses, student nurses, clerks, residents, supervising clinicians, and managers. Open-ended questions (response rate 65%) were used to determine the changes in the workplace experienced by the participants since the introduction of the Clinical Teaching Unit and what influenced their learning process and motivation to learn. Closed questions (response rate 46%) aimed to measure the effect of our intervention on collaboration, learning, and the quality of care and education. The results of the open-ended questions showed that participants experienced more interprofessional collaboration and learning. This took place in a less hierarchical, safer work climate which also resulted in perceptions of a better quality of patient care and education. The closed-ended questions showed that the intervention resulted in perceptions of improved collaboration, work culture, quality of care, education, and learning conditions. Lessons Learned: The findings imply that implementation of a Clinical Teaching Unit not only facilitates the integration of patient care and education but also the integration of different professions working together. From the intervention, we also learned that a successful Clinical Teaching Unit requires investment of time and staff, clear communication between healthcare professionals, and dedication of teachers within all professions.
Collapse
Affiliation(s)
- Esther C Hamoen
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris M van Blankenstein
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter G M de Jong
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Arghya Ray
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
2
|
Wilson N, Pope C, Roberts L, Crouch R. Limited pharmaceuticalisation: a qualitative case study of physiotherapist prescribing practices in an NHS Trust in England following the expansion of non-medical prescribing in the UK. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:643-659. [PMID: 31845366 DOI: 10.1111/1467-9566.13050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Over the last quarter century, non-medical prescribing in the UK has grown significantly; eight non-medical professional groups now have authority to prescribe a wide range of medicines, suggesting it could be a potent driver of pharmaceuticalisation. In this article, we present data from a case study of physiotherapists' prescribing practices. UK physiotherapists have had legal rights to prescribe medicines since 2005, but relatively little is known about the contribution they make to expanding patient access to medicines. We approached our study through a lens of governmentality to capture the mentalities and micro-practices governing physiotherapist non-medical prescribing. Ethnographic methods were used to gather data from an outpatient orthopaedic service in an NHS Trust in England employing physiotherapist prescribers. From the data, we identified a grid of intelligibility - an organising framework formulated by powerful discourses and technologies of government through which physiotherapist prescribing was acted into being. A primary effect of this grid was the constitution of new physiotherapist subjectivities, mostly as non-prescribers of medicines contrary to policy intentions, underpinned by a familiar and enduring template of medical professionalism.
Collapse
Affiliation(s)
- Nicky Wilson
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lisa Roberts
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Robert Crouch
- School of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
Hindi AMK, Seston EM, Bell D, Steinke D, Willis S, Schafheutle EI. Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e459-e470. [PMID: 30884013 DOI: 10.1111/hsc.12746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/29/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
Besides doctors and dentists, an increasing range of healthcare professionals, such as nurses, pharmacists and podiatrists, can become independent prescribers (IPs). As part of an evaluation for independent prescribing funded training, this study investigated views and experiences of IPs, their colleagues and patients about independent prescribing within primary care. Questionnaires capturing quantitative and qualitative data were developed for IPs, their colleagues and patients, informed by existing literature and validated instruments. IPs were identified following independent prescribing training funded by Health Education England Northwest in 2015-2017. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Twenty-four patients, 20 IPs and 26 colleagues responded to the questionnaires. Most patient respondents had a long-term medical condition (n = 17) and had regular medicines prescribed (n = 21). IPs were nurses (n = 14), pharmacists (n = 4), one podiatrist (n = 1) and one was unknown. Half of the IPs were current prescribers (n = 10), the other half were still training (to become) IPs (n = 10). Colleague respondents were doctors and nurses (n = 15) other healthcare professionals (n = 8) and practice managers (n = 3). Both current IPs (n = 9) and colleague respondents (n = 25) (strongly) agreed that independent prescribing improved the quality of care provided for patients. Nearly all colleagues were supportive of independent prescribing and believed that they worked well with IPs (n = 25). Patients' perceptions and experiences of their consultations with the IP were mostly positive with the vast majority of respondents (strongly) agreeing that they were very satisfied with their visit to the IP (n = 23). Key barriers and enablers to independent prescribing were centred on IPs' knowledge, competence and organisational factors such as workload, effective teamwork and support from their colleagues. Findings from this study were mainly positive but indicate a need for policy strategies to tackle longstanding barriers to independent prescribing. However, a larger sample size is needed to confirm findings.
Collapse
Affiliation(s)
- Ali M K Hindi
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Elizabeth M Seston
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Dianne Bell
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Douglas Steinke
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Sarah Willis
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Ellen I Schafheutle
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| |
Collapse
|
4
|
Connor R, McHugh Á. The experience of the non-medical prescriber in the emergency department in Ireland. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/jprp.2019.1.5.240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim: this study set out to evaluate the position of the non-medical prescriber in the emergency department in Ireland. It aims to explore how the role is developing and determine possible barriers to role expansion. Results: six main themes were identified: the process of role development, changes in professional relationships, nurses' awareness of non-medical prescribing, role progression, the future of the role of the non-medical prescriber, and nursing management's understanding of the role. Conclusion: the findings suggest that despite major leaps in the progression of the non-medical prescriber role, many barriers remain. There have been great improvements in professional support from medical and pharmacy colleagues, but nurses themselves were identified as impeding the progression of the role.
Collapse
Affiliation(s)
- Roger Connor
- Advanced Nurse Practitioner, Minor Injury Unit, Emergency Department, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Áine McHugh
- Lecturer, Department of Nursing, Midwifery and Early Years, Dundalk Institute of Technology, Dundalk, Ireland
| |
Collapse
|
5
|
Halle AD, Mroz TM, Fogelberg DJ, Leland NE. Occupational Therapy and Primary Care: Updates and Trends. Am J Occup Ther 2018; 72:7203090010p1-7203090010p6. [PMID: 29689169 PMCID: PMC5915228 DOI: 10.5014/ajot.2018.723001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
As our health care system continues to change, so do the opportunities for occupational therapy. This article provides an update to a 2012 Health Policy Perspectives on this topic. We identify new initiatives and opportunities in primary care, explore common challenges to integrating occupational therapy in primary care environments, and highlight international works that can support our efforts. We conclude by discussing next steps for occupational therapy practitioners in order to continue to progress our efforts in primary care.
Collapse
Affiliation(s)
- Ashley D Halle
- Ashley D. Halle, OTD, OTR/L, is Assistant Professor and Coordinator of Primary Care Residency & Services, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Tracy M Mroz
- Tracy M. Mroz, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Donald J Fogelberg
- Donald J. Fogelberg, PhD, OTR/L, is Associate Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Natalie E Leland
- Natalie E. Leland, PhD, OTR/L, BCG, FAOTA, is Associate Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
6
|
Graham-Clarke E, Rushton A, Noblet T, Marriott J. Facilitators and barriers to non-medical prescribing - A systematic review and thematic synthesis. PLoS One 2018; 13:e0196471. [PMID: 29709006 PMCID: PMC5927440 DOI: 10.1371/journal.pone.0196471] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/13/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Non-medical prescribing has the potential to deliver innovative healthcare within limited finances. However, uptake has been slow, and a proportion of non-medical prescribers do not use the qualification. This systematic review aimed to describe the facilitators and barriers to non-medical prescribing in the United Kingdom. Methods The systematic review and thematic analysis included qualitative and mixed methods papers reporting facilitators and barriers to independent non-medical prescribing in the United Kingdom. The following databases were searched to identify relevant papers: AMED, ASSIA, BNI, CINAHL, EMBASE, ERIC, MEDLINE, Open Grey, Open access theses and dissertations, and Web of Science. Papers published between 2006 and March 2017 were included. Studies were quality assessed using a validated tool (QATSDD), then underwent thematic analysis. The protocol was registered with PROSPERO (CRD42015019786). Results Of 3991 potentially relevant identified studies, 42 were eligible for inclusion. The studies were generally of moderate quality (83%), and most (71%) were published 2007–2012. The nursing profession dominated the studies (30/42). Thematic analysis identified three overarching themes: non-medical prescriber, human factors, and organisational aspects. Each theme consisted of several sub-themes; the four most highly mentioned were ‘medical professionals’, ‘area of competence’, ‘impact on time’ and ‘service’. Sub-themes were frequently interdependent on each other, having the potential to act as a barrier or facilitator depending on circumstances. Discussion Addressing the identified themes and subthemes enables strategies to be developed to support and optimise non-medical prescribing. Further research is required to identify if similar themes are encountered by other non-medical prescribing groups than nurses and pharmacists.
Collapse
Affiliation(s)
- Emma Graham-Clarke
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Timothy Noblet
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Marriott
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
7
|
Toye F, Seers K, Barker K. A meta-ethnography of health-care professionals’ experience of treating adults with chronic non-malignant pain to improve the experience and quality of health care. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundPeople with chronic pain do not always feel that they are being listened to or valued by health-care professionals (HCPs). We aimed to understand and improve this experience by finding out what HCPs feel about providing health care to people with chronic non-malignant pain. We did this by bringing together the published qualitative research.Objectives(1) To undertake a qualitative evidence synthesis (QES) to increase our understanding of what it is like for HCPs to provide health care to people with chronic non-malignant pain; (2) to make our findings easily available and accessible through a short film; and (3) to contribute to the development of methods for QESs.DesignWe used the methods of meta-ethnography, which involve identifying concepts and progressively abstracting these concepts into a line of argument.Data sourcesWe searched five electronic bibliographic databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Allied and Complementary Medicine Database) from inception to November 2016. We included studies that explored HCPs’ experiences of providing health care to people with chronic non-malignant pain. We utilised the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework to rate our confidence in the findings.ResultsWe screened 954 abstracts and 184 full texts and included 77 studies reporting the experiences of > 1551 HCPs. We identified six themes: (1) a sceptical cultural lens and the siren song of diagnosis; (2) navigating juxtaposed models of medicine; (3) navigating the patient–clinician borderland; (4) the challenge of dual advocacy; (5) personal costs; and (6) the craft of pain management. We produced a short film, ‘Struggling to support people to live a valued life with chronic pain’, which presents these themes (seeReport Supplementary Material 1; URL:www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419807/#/documentation; accessed 24 July 2017). We rated our confidence in the review findings using the GRADE-CERQual domains. We developed a conceptual model to explain the complexity of providing health care to people with chronic non-malignant pain. The innovation of this model is to propose a series of tensions that are integral to the experience: a dualistic biomedical model compared with an embodied psychosocial model; professional distance compared with proximity; professional expertise compared with patient empowerment; the need to make concessions to maintain therapeutic relationships compared with the need for evidence-based utility; and patient advocacy compared with health-care system advocacy.LimitationsThere are no agreed methods for determining confidence in QESs.ConclusionsWe highlight areas that help us to understand why the experience of health care can be difficult for patients and HCPs. Importantly, HCPs can find it challenging if they are unable to find a diagnosis and at times this can make them feel sceptical. The findings suggest that HCPs find it difficult to balance their dual role of maintaining a good relationship with the patient and representing the health-care system. The ability to support patients to live a valued life with pain is described as a craft learnt through experience. Finally, like their patients, HCPs can experience a sense of loss because they cannot solve the problem of pain.Future workFuture work to explore the usefulness of the conceptual model and film in clinical education would add value to this study. There is limited primary research that explores HCPs’ experiences with chronic non-malignant pain in diverse ethnic groups, in gender-specific contexts and in older people living in the community.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Fran Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| |
Collapse
|
8
|
Mertens F, de Groot E, Meijer L, Wens J, Gemma Cherry M, Deveugele M, Damoiseaux R, Stes A, Pype P. Workplace learning through collaboration in primary healthcare: A BEME realist review of what works, for whom and in what circumstances: BEME Guide No. 46. MEDICAL TEACHER 2018; 40:117-134. [PMID: 29094626 DOI: 10.1080/0142159x.2017.1390216] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Changes in healthcare practice toward more proactive clinical, organizational and interprofessional working require primary healthcare professionals to learn continuously from each other through collaboration. This systematic review uses realist methodology to consolidate knowledge on the characteristics of workplace learning (WPL) through collaboration by primary healthcare professionals. METHODS Following several scoping searches, five electronic bibliographic databases were searched from January 1990 to December 2015 for relevant gray and published literature written in English, French, German and Dutch. Reviewers worked in pairs to identify relevant articles. A set of statements, based on the findings of our scoping searches, was used as a coding tree to analyze the papers. Interpretation of the results was done in alternating pairs, discussed within the author group and triangulated with stakeholders' views. RESULTS Out of 6930 references, we included 42 publications that elucidated who, when, how and what primary healthcare professionals learn through collaboration. Papers were both qualitative and quantitative in design, and focused largely on WPL of collaborating general practitioners and nurses. No striking differences between different professionals within primary healthcare were noted. Professionals were often unaware of the learning that occurs through collaboration. WPL happened predominantly through informal discussions about patient cases and modeling for other professionals. Any professionals could both learn and facilitate others' learning. Outcomes were diverse, but contextualized knowledge seemed to be important. DISCUSSION/CONCLUSIONS Primary care professionals' WPL is multifaceted. Existing social constructivist and social cognitivist learning theories form a framework from which to interpret these findings. Primary care policy makers and managers should ensure that professionals have access to protected time, earmarked for learning. Time is required for reflection, to learn new ways of interaction and to develop new habits within clinical practice.
Collapse
Affiliation(s)
- Fien Mertens
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
| | - Esther de Groot
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Loes Meijer
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Johan Wens
- c Department of Primary and Interdisciplinary Care Antwerp , University of Antwerp , Antwerp , Belgium
| | - Mary Gemma Cherry
- d Psychology of Healthcare Research Group, Department of Psychological Sciences , Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK
| | - Myriam Deveugele
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
| | - Roger Damoiseaux
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Ann Stes
- e Antwerp School of Education, Centre for Excellence in Higher Education , University of Antwerp , Antwerp , Belgium
| | - Peter Pype
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
| |
Collapse
|
9
|
Nuttall D. Nurse prescribing in primary care: a metasynthesis of the literature. Prim Health Care Res Dev 2018; 19:7-22. [PMID: 28786368 PMCID: PMC6452973 DOI: 10.1017/s1463423617000500] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 11/08/2022] Open
Abstract
Aim The aim of this metasynthesis was to develop an understanding of the existing theoretical perspectives around nurse prescribing and to identify any gaps in knowledge, which would support further research into the lived experience of the nurse prescriber in the primary care setting. BACKGROUND Nurse prescribing has been the focus of many research studies since its introduction, with many benefits to the patient, the prescriber and service identified; however, there remains variation in the utilisation of the prescribing qualification, particularly in primary care settings. Although a range of quantitative and qualitative studies have been undertaken, which aimed to explore the influences on prescribing, few have used a research methodology that supports the in-depth exploration of the nurse prescriber's experience. METHODS An extensive literature search was undertaken in April 2015 (20-24), which included UK and non-UK studies since 1999. Inclusion and exclusion criteria were applied to search for studies in which participants included nurse prescribers who practiced in primary or community care settings. Studies that only used a quantitative methodology and those not available in English were excluded. The literature search yielded 124 papers, with 50 papers remaining after the initial screen of full papers against the inclusion/exclusion criteria. The papers were reviewed and graded for their quality, with a further 13 papers excluded. A three-step qualitative analysis technique of metasynthesis was applied to the remaining 37 papers. Identification of similarities and differences enabled first-order interpretations to be identified, which were grouped into broader themes (second-order interpretations) by identifying concepts that applied to two or more studies. Further interpretation through synthesis of translation enabled third-order interpretations to emerge. Findings From the metasynthesis of the 37 papers, nine themes emerged: patient-centred care; benefits to the service; the need for knowledge; professional accountability and boundary setting; safety consciousness; barriers to effective prescribing; role preservation; power-shifts and inter-professional relationships; and culture of prescribing.
Collapse
Affiliation(s)
- Dilyse Nuttall
- Principal Lecturer, School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancsashire, UK
| |
Collapse
|
10
|
Toye F, Seers K, Barker KL. Meta-ethnography to understand healthcare professionals' experience of treating adults with chronic non-malignant pain. BMJ Open 2017; 7:e018411. [PMID: 29273663 PMCID: PMC5778293 DOI: 10.1136/bmjopen-2017-018411] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We aimed to explore healthcare professionals' experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care. DESIGN Qualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals' experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings. RESULTS We screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high. CONCLUSIONS This is the first qualitative evidence synthesis of healthcare professionals' experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations.
Collapse
Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
Noblet T, Marriott J, Graham-Clarke E, Rushton A. Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review. J Physiother 2017; 63:221-234. [PMID: 28986140 DOI: 10.1016/j.jphys.2017.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 01/06/2023] Open
Abstract
QUESTION What are the factors that affect the implementation or utilisation of independent non-medical prescribing (iNMP)? DESIGN Mixed-methods systematic review. Two reviewers independently completed searches, eligibility and quality assessments. DATA SOURCES Pre-defined search terms were utilised to search electronic databases. Reference lists, key journals and grey literature were searched alongside consultation with authors/experts. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Qualitative and quantitative studies investigating independent prescribing by any non-medical professional group. Study participants included any stakeholders involved in actual or proposed iNMP. Measurements reported on data describing stakeholders' perceptions and experiences of the barriers to/facilitators of iNMP. RESULTS A total of 43 qualitative and seven quantitative studies from three countries (n=12, 117 participants) were included. Quality scores varied from 9 to 35 (Quality Assessment Tool for Studies with Diverse Designs, 0 to 48). Qualitative data were synthesised into four themes (and subthemes): systems (government and political, organisational, formulary); education and support (non-medical prescribing (NMP) courses/continuous professional development (CPD)); personal and professional (medical profession, NMP professions, service users); and financial factors. Quantitative data corroborated the qualitative themes. Integration of the qualitative themes and quantitative data enabled the development of a NMP implementation framework. CONCLUSION Barriers to and facilitators of the implementation and utilisation of iNMP are evident, demonstrating multifactorial and context-specific variables within four explicit themes. Professional bodies, politicians, policy and healthcare managers and clinicians could use the resulting NMP implementation framework to ensure the safe and successful implementation and utilisation of NMP. Clinical physiotherapists and other clinicians should consider whether these variables have been adequately addressed prior to adopting NMP into their clinical practice. REGISTRATION PROSPERO CRD42015017212. [Noblet T, Marriott J, Graham-Clarke E, Rushton A (2017) Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review. Journal of Physiotherapy 63: 221-234].
Collapse
Affiliation(s)
- Timothy Noblet
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Department of Health Professions, Macquarie University, Sydney, Australia
| | - John Marriott
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Emma Graham-Clarke
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
12
|
Hopia H, Karhunen A, Heikkilä J. Growth of nurse prescribing competence: facilitators and barriers during education. J Clin Nurs 2017; 26:3164-3173. [DOI: 10.1111/jocn.13665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Hanna Hopia
- School of Health and Social Studies; JAMK University of Applied Sciences; Jyvaskyla Finland
| | - Anne Karhunen
- Central Finland Health Care District; Jyvaskyla Finland
| | - Johanna Heikkilä
- School of Health and Social Studies; JAMK University of Applied Sciences; Jyvaskyla Finland
| |
Collapse
|
13
|
Farrell C, Walshe C, Molassiotis A. Are nurse-led chemotherapy clinics really nurse-led? An ethnographic study. Int J Nurs Stud 2017; 69:1-8. [DOI: 10.1016/j.ijnurstu.2017.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
|
14
|
Darvishpour A, Joolaee S, Cheraghi MA. Situational Analysis of Nurse Prescribing Context in Iran: A Qualitative Research. ACTA ACUST UNITED AC 2017. [DOI: 10.29252/ijn.29.104.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
15
|
Differences in the working pattern among wound, ostomy, and continence nurses with and without conducting the specified medical act: a multicenter time and motion study. BMC Nurs 2016; 15:69. [PMID: 27956892 PMCID: PMC5129614 DOI: 10.1186/s12912-016-0191-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/22/2016] [Indexed: 01/22/2023] Open
Abstract
Background To overcome the shortage of medical care delivery in the rapidly aging Japanese society, the Ministry of Health, Labour and Welfare in 2010 started to train the nurses to be able to conduct the specified medical acts. The Japanese Nursing Association conducted the educational program to train the wound, ostomy, and continence nurses for the specified medical act of wound care. However, the difference between wound, ostomy, and continence nurses who conducted the medical act and those who did not was not clear. The aim of this study was to determine how trained wound, ostomy, and continence nurses spend their time during their entire shift in an acute hospital setting. Methods In this prospective observational study, we selected those wound, ostomy, and continence nurses who received advanced training in the wound management program (T-WN) in 2011–2012. Wound, ostomy, and continence nurses who did not receive the training (N-WN) were also recruited as controls. We conducted a time and motion study during subject's day shifts for 1 week. We calculated the time spent on tasks based on a task classification code that was created to facilitate a two-group comparison. Results Six T-WNs and five N-WNs were our analysis subjects. T-WNs spent significantly more time on direct care than did N-WNs (p = 0.00). Moreover, in the sub-categories s of direct care, T-WN spent significantly more time on “treatment” than did N-WN (p = 0.01). T-WN spent significantly more time on treatment with (p = 0.03) or without (p = 0.01) physicians than did N-WN. In the treatment activities, T-WN performed significantly more time on foot care (p = 0.01), wound cleansing (p = 0.01) and conservative sharp wound debridement (p = 0.01) than did N-WN. Frequencies of direct care interventions for the patients was significantly different between T-WN and N-WN (p = 0.04). Conclusions T-WNs frequently engaged in direct care provided treatment for patients with chronic wounds.
Collapse
|
16
|
Small K, Sidebotham M, Gamble J, Fenwick J. Exploring midwifery prescribing in Australia. Women Birth 2016; 29:436-442. [DOI: 10.1016/j.wombi.2016.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/27/2016] [Accepted: 02/17/2016] [Indexed: 11/16/2022]
|
17
|
Kooienga S, Wilkinson J. RN Prescribing: An Expanded Role for Nursing. Nurs Forum 2016; 52:3-11. [PMID: 27102376 DOI: 10.1111/nuf.12159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/23/2015] [Accepted: 12/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE With the implementation of the Affordable Care Act, recommendations of the Future of Nursing Report, and recent regulatory changes by state boards of nursing, registered nurse (RN) roles are expanding. In this article, we advocate for RN prescribing as an expanded role in the United States. METHODS We reviewed the literature on RN prescribing, the background in both high- and low-resource countries, levels of prescribing, specialized settings for RN prescribing, both RN and patients views/perceptions of prescribing, and evaluation research. From this review, we developed a proposal for RN prescribing. FINDINGS Due to expansion of RNs into prescribing worldwide to meet unmet healthcare needs in both primary and specialty settings, we propose a role for RN prescribing within both primary care and outpatient specialty settings. The differences between RN and advanced practice RN prescribing are defined, and U.S.-based regulatory challenges are examined. CONCLUSION Considering unmet healthcare needs and patients' need for medication and medication education, we advocate for RN prescribing as expanded scope and role change for experienced RNs to practice to the highest level of their education.
Collapse
Affiliation(s)
- Sarah Kooienga
- Assistant Professor, Fay W. Whitney School of Nursing, University of Wyoming, Laramie, WY, and
| | - Jill Wilkinson
- Senior Lecturer, School of Nursing, Massey University, Wellington, NZ
| |
Collapse
|
18
|
Affiliation(s)
- Neil Kelly
- Senior lecturer, Faculty of Health and Life Sciences, Coventry University
| |
Collapse
|
19
|
Ness V, Malcolm W, McGivern G, Reilly J. Growth in nurse prescribing of antibiotics: the Scottish experience 2007-13. J Antimicrob Chemother 2015; 70:3384-9. [PMID: 26311841 DOI: 10.1093/jac/dkv255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/23/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this study was to retrospectively analyse patterns of primary care antibiotic prescribing by nurse prescribers in Scotland. METHODS Data on dispensed antibiotic prescriptions written by nurse prescribers in 2007-13 were obtained from the Prescribing Information System, a database of all NHS prescriptions dispensed in Scotland. RESULTS Since 2007, there has been a steady increase in the volume of antibiotic prescribing in primary care undertaken by nurse prescribers. There was considerable variability in the frequency of antibiotic prescribing among nurses and across NHS regions. Since 2007, an increasing proportion of antibiotics prescribed by nurses are those recommended for first-line empirical treatment of infection, with a reduction in the proportion of broader-spectrum agents. Other measures of prescribing quality (duration of treatment of adult females with urinary tract infection and use of recommended doses) have improved since 2007. CONCLUSIONS This paper is the first, to our knowledge, to present an analysis of data on antibiotic prescribing in primary care by nurse prescribers. Inappropriate prescribing is a problem and, given the impact that antibiotic prescribing has on antimicrobial resistance, it is important that the prescribing behaviour of nurses is explored. This is especially significant as this is a growing body of prescribers who predominately work in the community, where the majority of antibiotics are prescribed. This analysis showed that practice varies across NHS regions and between prescribers and although more information is needed to establish whether nurse prescribers are prescribing appropriately, some quality indicators may suggest that they are following best practice.
Collapse
Affiliation(s)
- Valerie Ness
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, Scotland, UK
| | - William Malcolm
- Health Protection Scotland, NHS National Services Scotland, 4th Floor, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, Scotland, UK
| | - Guy McGivern
- Information Services Division (ISD) Scotland, NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK
| | - Jacqui Reilly
- Health Protection Scotland, NHS National Services Scotland, 4th Floor, Meridian Court, 5 Cadogan Street, Glasgow G2 6QE, Scotland, UK Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, Scotland, UK
| |
Collapse
|
20
|
Ziegler L, Bennett M, Blenkinsopp A, Coppock S. Non-medical prescribing in palliative care: a regional survey. Palliat Med 2015; 29:177-81. [PMID: 25501312 DOI: 10.1177/0269216314557346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The United Kingdom is considered to be the world leader in nurse prescribing, no other country having the same extended non-medical prescribing rights. Arguably, this growth has outpaced research to evaluate the benefits, particularly in areas of clinical practice where patients have complex co-morbid conditions such as palliative care. This is the first study of non-medical prescribing in palliative care in almost a decade. AIM To explore the current position of nurse prescribing in palliative care and establish the impact on practice of the 2012 legislative changes. DESIGN An online survey circulated during May and June 2013. PARTICIPANTS Nurse members (n = 37) of a regional cancer network palliative care group (61% response rate). RESULTS While this survey found non-medical prescribers have embraced the 2012 legislative changes and prescribe a wide range of drugs for cancer pain, we also identified scope to improve the transition from qualified to active non-medical prescriber by reducing the time interval between the two. CONCLUSION To maximise the economic and clinical benefit of non-medical prescribing, the delay between qualifying as a prescriber and becoming an active prescriber needs to be reduced. Nurses who may be considering training to be a non-medical prescriber may be encouraged by the provision of adequate study leave and support to cover clinical work. Further research should explore the patients' perspective of non-medical prescribing.
Collapse
Affiliation(s)
- Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Mike Bennett
- University of Leeds, Leeds, UK St Gemma's Hospice, Leeds, UK
| | | | | |
Collapse
|
21
|
Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Finding a way forward: a literature review on the current debates around clinical supervision. Contemp Nurse 2014; 45:22-32. [PMID: 24099223 DOI: 10.5172/conu.2013.45.1.22] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nursing research increasingly calls for clinical supervision to support nurses and improve nursing practice. Despite this, clinical supervision is not well established in healthcare organisations. This paper employs a critical interpretive approach to review the clinical supervision literature. The review discusses the current debates and challenges exploring possible ways of moving beyond the current criticisms and limitations in the literature. The review concludes that despite some confusion about the quantifiable outcomes, clinical supervision presents a professionally enriching activity that provides a forum for sharing of knowledge and generation of shared understandings of health care. Through this shared experience it is possible that innovative and creative approaches to health care will be born.
Collapse
Affiliation(s)
- Sophie Dilworth
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | | | | | | | | |
Collapse
|
22
|
Mitchell R, Paliadelis P, McNeil K, Parker V, Giles M, Higgins I, Parmenter G, Ahrens Y. Effective interprofessional collaboration in rural contexts: a research protocol. J Adv Nurs 2013; 69:2317-26. [DOI: 10.1111/jan.12083] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Karen McNeil
- Newcastle Business School; University of Newcastle; Australia
| | - Vicki Parker
- School of Health; University of Newcastle; Australia
| | - Michelle Giles
- Centre for Practice; Development and Opportunity; University of Newcastle; Australia
| | | | | | - Yvonne Ahrens
- Department of Health; University of New England; Armidale; New South Wales Australia
| |
Collapse
|
23
|
Courtenay M. Interprofessional education between nurse prescribing and medical students: a qualitative study. J Interprof Care 2012; 27:93-5. [PMID: 23025499 DOI: 10.3109/13561820.2012.724126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prescriptive authority has been extended in the UK to include non-medical healthcare professionals. However, uptake and use of prescribing by these professionals are inconsistent. Collaborative practice is key for its successful implementation, and such practice is a benefit of interprofessional education (IPE). This study explored the feasibility of IPE between nurse prescribers at Anglia Ruskin University and 3rd year medical students at the University of Cambridge. Three focus groups and three individual interviews were undertaken with nurse and medical prescribing students, following shared learning sessions on drug interactions, prescription writing and legal issues and accountability. Benefits included the opportunity for mutual understanding of prescribing training and role. Medical students valued the opportunity to be able to gain an insight into nurses' views about prescribing. The level and breadth of pharmacology knowledge of medical and nursing students differed. Location of sessions, scheduling of classes and balancing of students acted as barriers to learning.
Collapse
Affiliation(s)
- Molly Courtenay
- Faculty of Health and Medical Sciences, School of Health and Social Care, University of Surrey, Guildford, UK.
| |
Collapse
|
24
|
Stenner K, Carey N, Courtenay M. Prescribing for pain - how do nurses contribute? A national questionnaire survey. J Clin Nurs 2012; 21:3335-45. [DOI: 10.1111/j.1365-2702.2012.04136.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
Lim RHM, Courtenay M, Fleming G. Roles of the non-medical prescribing leads within organisations across a Strategic Health Authority: perceived functions and factors supporting the role. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 21:82-91. [PMID: 23419239 DOI: 10.1111/j.2042-7174.2012.00224.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 05/19/2012] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
Extending the roles of nurses, pharmacists and allied health professionals to include prescribing has been identified as one way of improving service provision. In the UK, over 50 000 non-medical healthcare professionals are now qualified to prescribe. Implementation of non-medical prescribing ( NMP) is crucial to realise the potential return on investment. The UK Department of Health recommends a NMP lead to be responsible for the implementation of NMP within organisations. The aim of this study was to explore the role of NMP leads in organisations across one Strategic Health Authority (SHA) and to inform future planning with regards to the criteria for those adopting this role, the scope of the role and factors enabling the successful execution of the role.
Methods
Thirty-nine NMP leads across one SHA were approached. Semi-structured telephone interviews were conducted. Issues explored included the perceived role of the NMP lead, safety and clinical governance procedures and facilitators to the role. Transcribed audiotapes were coded and analysed using thematic analytical techniques.
Key findings
In total, 27/39 (69.2%) NMP leads were interviewed. The findings highlight the key role that the NMP lead plays with regards to the support and development of NMP within National Health Service trusts. Processes used to appoint NMP leads lacked clarity and varied between trusts. Only two NMP leads had designated or protected time for their role. Strategic influence, operational management and clinical governance were identified as key functions. Factors that supported the role included organisational support, level of influence and dedicated time.
Conclusion
The NMP lead plays a significant role in the development and implementation of NMP. Clear national guidance is needed with regards to the functions of this role, the necessary attributes for individuals recruited into this post and the time that should be designated to it. This is important as prescribing is extended to include other groups of non-medical healthcare professionals.
Collapse
Affiliation(s)
- Rosemary Hwee Mei Lim
- NIHR King's Patient Safety and Service Quality Research Centre, King's College London, London, UK
| | - Molly Courtenay
- Division of Health and Social Care, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Gail Fleming
- NHS Postgraduate Deanery for Kent, Surrey and Sussex, Princess Royal Hospital, West Sussex, UK
| |
Collapse
|
26
|
Webb WA, Gibson V. Evaluating the impact of nurse independent prescribing in a weekend clinical nurse specialist service. Int J Palliat Nurs 2012; 17:537-43. [PMID: 22240631 DOI: 10.12968/ijpn.2011.17.11.537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nurse independent prescribing (NIP) is having a significant positive impact on patient care, yet little is written about NIP initiatives in the out-of-hours (OOH) period, which is a critical time for those with palliative care needs who wish to remain at home. This paper evaluates the impact of an NIP initiative in one weekend clinical nurse specialist (CNS) service in the UK. A 6-month audit of prescribing activity data is presented along with the results of a survey of local GPs. The paper concludes that NIP offers an effective way for the CNS working in the OOH period to offer timely and appropriate symptom control in a single, seamless consultation. Discussion surrounds the factors that affect the success of NIP initiatives and practical recommendations for other providers developing such a service.
Collapse
|
27
|
Abstract
Osteoarthritis (OA) is now considered one of the ten most disabling diseases in developed countries and it is estimated that worldwide, 18% of women and 9.6% of men aged over 60, suffer from OA. It is, therefore, vital to take into consideration the demographics of this disorder, including the health needs of this age group and associated problems, such as reduced mobility or immobility and the inability to perform everyday tasks associated with chronic pain. Older patients, however, are sometimes able to accept their condition and adopt a positive outlook towards their OA as a coping strategy. This association with and acceptance of pain by the patient as a normal part of the ageing process may compromise the patient's ability to undertake activities of daily living and impact their psychological wellbeing.
Collapse
Affiliation(s)
- Rena Creedon
- School of Nusing and Midwifery, University College Cork, Ireland.
| | | |
Collapse
|
28
|
Stenner KL, Courtenay M, Cannons K. Nurse prescribing for inpatient pain in the United Kingdom: A national questionnaire survey. Int J Nurs Stud 2011; 48:847-55. [DOI: 10.1016/j.ijnurstu.2011.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 01/14/2011] [Accepted: 01/16/2011] [Indexed: 11/29/2022]
|
29
|
Kroezen M, van Dijk L, Groenewegen PP, Francke AL. Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature. BMC Health Serv Res 2011; 11:127. [PMID: 21619565 PMCID: PMC3141384 DOI: 10.1186/1472-6963-11-127] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 05/27/2011] [Indexed: 11/22/2022] Open
Abstract
Background A growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor. Methods A comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods. Results One hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians. Conclusions Differences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some countries, nurses share (full) jurisdiction with the medical profession, whereas in other countries nurses prescribe in a subordinate position. In most countries the jurisdiction over prescribing remains predominantly with the medical profession. There seems to be a mechanism linking the jurisdictional settlements between professions with the forces that led to the introduction of nurse prescribing. Forces focussing on efficiency appear to lead to more extensive prescribing rights.
Collapse
Affiliation(s)
- Marieke Kroezen
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
30
|
Jones K, Edwards M, While A. Nurse prescribing roles in acute care: an evaluative case study. J Adv Nurs 2010; 67:117-26. [DOI: 10.1111/j.1365-2648.2010.05490.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
31
|
Affiliation(s)
- Rena Creedon
- School of Nursing and Midwifery, University College Cork, Ireland; and
| | | |
Collapse
|
32
|
Carey N, Stenner K, Courtenay M. How nurse prescribing is being used in diabetes services: views of nurses and team members. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1752-9824.2010.01043.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
33
|
Kaasalainen S, Martin-Misener R, Carter N, DiCenso A, Donald F, Baxter P. The nurse practitioner role in pain management in long-term care. J Adv Nurs 2010; 66:542-51. [DOI: 10.1111/j.1365-2648.2009.05206.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
34
|
Creedon R, O’Connell E, McCarthy G, Lehane B. An evaluation of nurse prescribing. Part 2: a literature review. ACTA ACUST UNITED AC 2009; 18:1398-402. [DOI: 10.12968/bjon.2009.18.22.45570] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Brenda Lehane
- School of Nursing and Midwifery, University College Cork, Ireland
| |
Collapse
|
35
|
McFall P, Abernethy K. Introduction to an integrated competence framework for health-care support workers and nurses working in menopause. MENOPAUSE INTERNATIONAL 2009; 15:157-159. [PMID: 19933467 DOI: 10.1258/mi.2009.009037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The evolving role of the menopause nurse is essential to the provision of expert clinical care, and for the education of both patients and health-care professionals. The new Royal College of Nursing integrated competence framework for health-care support workers and nurses working in menopause has been developed to provide specialist guidance and can be used to ensure practice is safe, effective and accountable. It supports acknowledgement for knowledge, skills and competence in their daily roles whilst caring for women at the time of menopause. It aims to ensure consistent standards across all settings whilst increasing the effectiveness of menopause service provision. Using the competences will help nursing staff identify their own level of practice, career plan in a more structured way and pinpoint education and development needs. The framework is a dynamic document that will continuously evolve in light of changes in menopausal healthcare.
Collapse
Affiliation(s)
- Philomena McFall
- Menopause Clinic, Royal Hospitals, Grosvenor Road, Belfast BT12 6BB, N. Ireland.
| | | |
Collapse
|
36
|
Courtenay M, Gordon J. A survey of therapy areas in which nurses prescribe and CPD needs. ACTA ACUST UNITED AC 2009. [DOI: 10.12968/npre.2009.7.6.255] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Molly Courtenay
- Professor of Prescribing and Medicines, University of Reading, Bulmershe Court, Earley, RG6 1HY
| | - John Gordon
- Non-medical Prescribers Customer Development Manager, Pfizer
| |
Collapse
|
37
|
Stenner K, Carey N, Courtenay M. Nurse prescribing in dermatology: doctors’ and non-prescribing nurses’ views. J Adv Nurs 2009; 65:851-9. [DOI: 10.1111/j.1365-2648.2008.04944.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
38
|
Goswell N, Siefers R. Experiences of ward-based nurse prescribers in an acute ward setting. ACTA ACUST UNITED AC 2009; 18:34-7. [DOI: 10.12968/bjon.2009.18.1.32087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
39
|
Abstract
There are now over 30,000 nurses across the UK who are qualified to prescribe from the Nurse Prescribing Formulary (NPF) for community practitioners. Training to prescribe from this formulary is now available to community staff nurses. Increasing numbers of community nurses are extending their prescribing skills by adopting independent and supplementary prescribing. Over 14,000 nurses across the UK are qualified to prescribe using these modes of prescribing. The benefits of nurse prescribing exceed those anticipated by the Government. However, there is some misunderstanding by doctors about the prescribing role. Doctors have concerns about nurses encroaching on medical territory, nurses' clinical skill base, and the possibility that nurses will prescribe outside of their area of competence. If doctors have an established relationship with a nurse prior to the adoption of prescribing, and have experienced some of the tangible benefits of this role, this helps to readdress these concerns. The increasing numbers of community nurses adopting and extending their role in the prescription of medicines is an indication that healthcare reforms, shifting care into the community, means that nurses are frequently the first point of contact from whom patients access their medicines. If the benefits of nurse prescribing are to be maximized and nurses are to feel supported in this role, there is a need to educate doctors about the professional limitations of nurse prescribing.
Collapse
|