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Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. PATIENT EDUCATION AND COUNSELING 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
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Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
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Black A, Gage H, Norton C, Franklin BD, Murrells T, Courtenay M. Patient satisfaction with medication consultations and medicines information provided by nurses working autonomously in sexual health services: A questionnaire study. J Adv Nurs 2021; 78:523-531. [PMID: 34730841 DOI: 10.1111/jan.15087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/05/2021] [Accepted: 10/16/2021] [Indexed: 01/11/2023]
Abstract
AIM To compare the satisfaction of patients managed by independent nurse prescribers with that of patients managed by nurses using PGDs with respect to experience of the consultation and information received about the medication. DESIGN Survey. METHODS Patients receiving medications from nurses in five urban sexual health services in the United Kingdom completed validated questionnaires immediately after the consultation, September 2015-August 2016. Scores of independent nurse prescribers and nurses using patient group directions were compared about consultation experience (5 items) Satisfaction with Information about Medicines (SIMS 16 items scale). RESULTS Of 808 patients receiving medications, 393 (48.6%) received questionnaires and 380 were returned (independent nurse prescribers 180 of 198, 90.9%; patient group directions 173 of 195, 88.7%). Patients in both groups reported high levels of satisfaction. About the consultation experience, patients found nurses friendly/ approachable (>99%), instilling confidence and trust (>99%) and explaining reasons for medications clearly (97%). Satisfaction with medication information: Of 348 (92%) respondents completing SIMS, the overall mean score was 13.4 of maximum 16 (no difference between groups, t-test, p = .63). CONCLUSIONS Patients were highly satisfied with nurse consultations and information around medications regardless of whether they were managed by independent nurse prescribers or nurses using patient group directions. IMPACT Findings provide evidence in support of autonomous provision of medications by nurses in sexual health clinics.
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Spillane D, Courtenay M, Chater A, Family H, Whitaker A, Acton JH. Factors influencing the prescribing behaviour of independent prescriber optometrists: a qualitative study using the Theoretical Domains Framework. Ophthalmic Physiol Opt 2021; 41:301-315. [PMID: 33608897 DOI: 10.1111/opo.12782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Whilst the number of independent prescriber (IP) optometrists in the United Kingdom is increasing, there is limited evidence describing the experiences of these individuals. The Theoretical Domains Framework (TDF) provides an evidence-based approach to understand determinants of behaviour. This conceptual framework can enable mapping to the COM-B behaviour change model and the wider Behaviour Change Wheel to develop interventions to optimise behaviour-change and healthcare processes more systematically. The study aimed to use the TDF to identify the factors that influence independent prescribing behaviour, and to map these findings to the COM-B system to elucidate the relevant intervention functions, in order to identify the support required by optometrist prescribers. METHODS Using a qualitative design, semi-structured interviews based on the TDF were undertaken with independent prescriber optometrists. Thematic analysis was used to identify themes inductively, which were then deductively mapped to the TDF and linked to the COM-B. RESULTS Sixteen participants (9 male, 7 female; median age 45 years, range 28-65 years), based in community (n = 10) and hospital (n = 6) settings, were interviewed. Eleven of the TDF domains were found to influence prescribing behaviour. Findings highlighted the need for good communication with patients (TDF domain: Skills, COM-B: Capability); confidence (TDF domain: Beliefs about capabilities, COM-B: Motivation); good networks and relationships with other healthcare professionals, e.g., general practitioners (TDF domain: Social influences, COM-B: Opportunity; TDF domain: Social/professional role and identity, COM-B: Motivation); the need for appropriate structure for remuneration (TDF domain: Reinforcement, COM-B: Motivation; TDF domain: Social/professional role and identity, COM-B: Motivation) and the provision of professional guidelines (TDF domain: Knowledge, COM-B: Capability; TDF domain: Environmental context and resources, COM-B Opportunity). CONCLUSIONS Having identified theory-derived influencers on prescribing decisions by optometrists, the findings can be used to develop a structured intervention, such as a support package to help optimise prescribing by optometrists, with the ultimate goal of eye care quality improvement.
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Affiliation(s)
- Daniel Spillane
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Angel Chater
- Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, UK.,Centre for Behavioural Medicine, University College London School of Pharmacy, London, UK
| | - Hannah Family
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Angela Whitaker
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Jennifer H Acton
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
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Carey N, Edwards J, Otter S, Gage H, Williams P, Courtenay M, Moore A, Stenner K. A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists. BMC Health Serv Res 2020; 20:1074. [PMID: 33234141 PMCID: PMC7687831 DOI: 10.1186/s12913-020-05918-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists. AIM to compare outcomes of physiotherapist and podiatrist Independent Prescriber (PP- IP) patients with those of physiotherapist and podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications. DESIGN a mixed method comparative case study. METHODS Using mixed methods of data collection, outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). RESULTS 489 patients were recruited: n = 243 IP sites, and n = 246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p > 0.05) and patient satisfaction (p ≤ 0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than PP-NP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 min). CONCLUSION This study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.
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Affiliation(s)
- Nicola Carey
- School of Health Sciences, University of Surrey, Kate Granger Building, Guildford, GU2 7YH UK
| | - Judith Edwards
- School of Health Sciences, University of Surrey, Kate Granger Building, Guildford, GU2 7YH UK
| | - Simon Otter
- School of Health Science, University of Brighton, Brighton, UK
| | - Heather Gage
- Department of Clinical and Experimental Medicine, Surrey Health Economics, University of Surrey, Guildford, UK
| | - Peter Williams
- Department of Mathematics, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ann Moore
- School of Health Science, University of Brighton, Brighton, UK
| | - Karen Stenner
- School of Health Sciences, University of Surrey, Kate Granger Building, Guildford, GU2 7YH UK
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Black A, Gage H, Norton C, Franklin BD, Murrells T, Courtenay M. A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: A mixed methods study. Int J Nurs Stud 2020; 107:103590. [PMID: 32446018 DOI: 10.1016/j.ijnurstu.2020.103590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/23/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND United Kingdom legislation allows nurses to autonomously provide medications as independent nurse prescribers or using patient group directions. Evidence of medication safety and appropriateness is limited. We compared nurse prescribers and patient group direction users in terms of prevalence, types and severity of medication provision errors. METHODS Objectives: Compare safety and appropriateness of medication provision between nurse prescribers and patient group direction users. DESIGN MIXED METHODS: clinical notes review and nurse-patient consultation observations. SETTING Five United Kingdom sexual health services. SELECTION CRITERIA 'Clinical notes review' included a random selection of nurse-patient consultations July-December 2015, 743 consultations managed by nurse prescribers and 939 consultations by patient group direction users. 'Observation study' involved 15 nurse prescriber and 15 patient group direction user nurse-patient medication consultations. Patients aged under 16 or non-English speaking were excluded. MEASUREMENTS Medication safety/appropriateness was compared between nurse prescribers and patient group direction users. Medication provision errors were categorised and assigned severity ratings. The Medication Appropriateness Index and the Prescribing Framework were used to assess medication provision. RESULTS Of 1682 clinical notes (nurse prescribers=743, 44%; patient group directions=939, 56%), 879 involved the provision of 1357 medications (nurse prescribers=399, 54%; patient group directions=480, 51%). The overall error rate was 8.5% (1844 errors from a potential 21,738 errors), predominantly related to documentation omissions. Nurse prescribers were more likely to make an error compared to patient group directions users (error rates 9% versus 8%, respectively; p=0.001); most were 'minor' (nurse prescribers=489, 56%; patient group directions=602, 62%). Both nurse prescribers and patient group direction users made safe medication decisions (n=1640 of 1682 patient care episodes, 98%); however, patient group directions users worked outside patient group directions restrictions in 39 (8%) of consultations. In 101 consultations, medication was indicated but not documented as offered/provided. From 30 observed consultations assessed against the Prescribing Framework, nurse prescribers' and patient group directions users' clinical practice were comparable (maximum score 46: nurse prescribers=44.7; patient group direction=45.4, p=0.41). CONCLUSION Sexual health nurse prescribers and patient group direction users provided safe and therapeutically appropriate medication. Improvements in clinical documentation are recommended. Moreover, patient group directions users should be encouraged to adhere to patient group directions' governance restrictions, such as through regular training, audits and staff updates.
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Affiliation(s)
| | | | | | | | | | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
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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.
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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
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Kozlowski D, Hutchinson M, Hurley J, Rowley J, Sutherland J. The role of emotion in clinical decision making: an integrative literature review. BMC MEDICAL EDUCATION 2017; 17:255. [PMID: 29246213 PMCID: PMC5732402 DOI: 10.1186/s12909-017-1089-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/29/2017] [Indexed: 05/18/2023]
Abstract
BACKGROUND Traditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM. METHODS A systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations. Search terms were focused to identify studies reporting clinician emotion OR clinician emotional intelligence OR emotional competence AND clinical decision making OR clinical reasoning. RESULTS Twenty three papers were retained for synthesis. These represented empirical work from qualitative, quantitative, and mixed-methods approaches and comprised work with a focus on experienced emotion and on skills associated with emotional intelligence. The studies examined nurses (10), physicians (7), occupational therapists (1), physiotherapists (1), mixed clinician samples (3), and unspecified infectious disease experts (1). We identified two main themes in the context of clinical decision making: the subjective experience of emotion; and, the application of emotion and cognition in CDM. Sub-themes under the subjective experience of emotion were: emotional response to contextual pressures; emotional responses to others; and, intentional exclusion of emotion from CDM. Under the application of emotion and cognition in CDM, sub-themes were: compassionate emotional labour - responsiveness to patient emotion within CDM; interdisciplinary tension regarding the significance and meaning of emotion in CDM; and, emotion and moral judgement. CONCLUSIONS Clinicians' experienced emotions can and do affect clinical decision making, although acknowledgement of that is far from universal. Importantly, this occurs in the in the absence of a clear theoretical framework and educational preparation may not reflect the importance of emotional competence to effective CDM.
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Affiliation(s)
- Desirée Kozlowski
- Discipline of Psychology, School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
| | - Marie Hutchinson
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
| | - John Hurley
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
| | - Joanne Rowley
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
| | - Joanna Sutherland
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
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Innamaa A, Tidy JA, Nunns D, Palmer JE. A national audit of standards of care for women with vulval conditions and survey of attitudes to nurse practitioners in vulval services in the UK. J OBSTET GYNAECOL 2015; 36:380-5. [PMID: 26648096 DOI: 10.3109/01443615.2015.1072810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This national audit assessed whether UK specialist vulval clinics adhere to the British Society of Vulval Diseases (BSSVD) document 'Standards of care for women with vulval conditions' published in 2013 and benchmarked clinician attitudes towards nurse practitioners in vulval services. Audit standards were based on the BSSVD guidance. All BSSVD and British Society for Colposcopy and Cervical Pathology or BSCCP members were surveyed via two electronic questionnaires. Results demonstrate that the majority of specialist vulval clinics in the UK are non-compliant with the standards set out for specialist vulval services. The majority of clinicians would support the introduction of clinical nurse specialists to vulval services, but there is need for development of a national training programme. In conclusion, significant improvements are required in provision of patient information, guidelines, access to multidisciplinary services, multidisciplinary team or MDT processes and data recording in UK specialist vulval services.
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Affiliation(s)
- A Innamaa
- a Department of Obstetrics and Gynaecology , Poole Hospital NHS Foundation Trust , Poole , UK
| | - J A Tidy
- b Department of Gynaecological Oncology , Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK
| | - D Nunns
- c Department of Gynaecological Oncology , Nottingham University Hospitals Trust , Nottingham , UK
| | - J E Palmer
- b Department of Gynaecological Oncology , Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK
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Courtenay M, Carey N, Gage H, Stenner K, Williams P. A comparison of prescribing and non-prescribing nurses in the management of people with diabetes. J Adv Nurs 2015; 71:2950-64. [DOI: 10.1111/jan.12757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 01/29/2023]
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Smith M. Interview: Monica Smith. Br J Community Nurs 2014; 19:38-42. [PMID: 24704753 DOI: 10.12968/bjcn.2014.19.sup4.s38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Monica Smith
- Lymphoedema Clinical Nurse Specialist, Birmingham Community Health Care Trust
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Weiss MC, Platt J, Riley R, Taylor G, Horrocks S, Taylor A. Solicitations in GP, nurse and pharmacist prescriber consultations: an observational study. Fam Pract 2013; 30:712-8. [PMID: 23934144 DOI: 10.1093/fampra/cmt042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The opening solicitation is a key element of the primary care consultation as it enables patients to express their ideas, concerns and expectations that can lead to improved patient outcomes. However, in practice, this may not always occur. With nurses and pharmacists now able to prescribe, this research explored the opening solicitation in a multi-professional context. OBJECTIVE To compare the nature, frequency and response to opening solicitations used in consultations with nurse prescribers (NPs), pharmacist prescribers (PPs) and GPs. METHODS An observational study using audio-recordings of NP, PP and GP patient consultations in 36 primary care practices in southern England. Between 7-13 prescriber-patient consultations were recorded per prescriber. A standardized pro forma based upon previous research was used to assess recordings. RESULTS Five hundred and thirty-three patient consultations (213 GPs, 209 NPs, 111 PPs) were audio-recorded with 51 prescribers. Across the prescribing groups, pharmacists asked fewer opening solicitations, while GPs used more open questions than NPs and PPs. The mean number of patient agenda items was 1.3 with more items in GP consultations. Patients completed their opening agenda in 20% of consultations, which was unaffected by professional seen. Redirection of the patient's agenda occurred at 24 seconds (mean). CONCLUSION All prescribers should be encouraged to use more open questions and ask multiple solicitations throughout the consultation. This is likely to result in greater expression of patients' concerns and improved patient outcomes.
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Affiliation(s)
- Marjorie C Weiss
- Department of Pharmacy and Pharmacology, University of Bath, Bath
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Carey N, Courtenay M, Stenner K. The prescribing practices of nurses who care for patients with skin conditions: a questionnaire survey. J Clin Nurs 2013; 22:2064-76. [DOI: 10.1111/jocn.12271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Nicola Carey
- School of Health and Social Care; University of Surrey; Guilford UK
| | - Molly Courtenay
- Prescribing and Medicines Management; School of Health and Social Care; University of Surrey; Guilford UK
| | - Karen Stenner
- School of Health and Social Care; University of Surrey; Guilford UK
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Coull A, Murray I, Turner-Halliday F, Watterson A. The expansion of nurse prescribing in Scotland: an evaluation. Br J Community Nurs 2013; 18:234-242. [PMID: 23772448 DOI: 10.12968/bjcn.2013.18.5.234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Medicine prescribing by community nurses commenced in the UK in 1996. By 2001, nurse prescribing was extended to include more nurses and to cover a wider formulary. This research project provides an evaluation of the extension of prescribing powers to nurses in Scotland, following the introduction of legislation in 2001. It aimed to evaluate the impact of nurse prescribing powers on patients, nurses, prescribers, and other stakeholders. A range of methods were used, including two public surveys, stakeholder interviews, postal questionnaires and case studies. The benefits of extended nurse prescribing include: improved patient access to treatment; enhanced patient care; enabled more effective use of medical staff time and greater professional satisfaction for nurses who used nursing skills; and built inter-professional working. Some obstacles existed, including organisational, institutional and resource factors that restricted the overall success of the extension of nurse prescribing. There are high levels of agreement between patients, the public, nurse prescribers, physicians and other health professionals about the benefits of nurse prescribing to patients. The extension of nurse prescribing has been largely successful, with some organisational and procedural areas that could be addressed.
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Affiliation(s)
- Alison Coull
- School of Nursing, Midwifery and Health, University of Stirling.
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Romero-Collado A, Homs-Romero E, Zabaleta-del-Olmo E. Knowledge about medications and products to prevent and treat pressure ulcers: a cross-sectional survey of nurses and physicians in a primary health care setting. J Clin Nurs 2013; 22:2562-71. [PMID: 23551561 DOI: 10.1111/jocn.12175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To report on a study of what primary care nurses and physicians know about medications and healthcare products to prevent and treat pressure ulcers. BACKGROUND The prevention and treatment of pressure ulcers has generally become the responsibility of the nursing staff; this has resulted in studies of nurses' knowledge of this task, although few studies include physicians in their analysis. DESIGN Cross-sectional survey conducted in North Girona (Province) Primary Care Services from February to April 2010. METHODS The study questionnaire had three sections: sociodemographic data, questions about division of responsibility for the care of patients with pressure ulcers or at risk of developing them, and 36 statements based on the recommendations in clinical practice guidelines provided by well-recognised national and international institutions. RESULTS Eighty-one nurses (64·8%) and 46 physicians (36·8%) responded to this study. Nurses had greater responsibility for the care of pressure ulcers, made greater use of medical prescriptions to obtain supplies if not available in the primary care centre, were more familiar with the site's clinical practice guidelines on the topic and showed better adherence to their recommendations. Nurses also had better knowledge than the participating physicians of the use of medications and healthcare products to heal or to prevent pressure ulcers. CONCLUSIONS Nurses had sufficient knowledge and more appropriate skills than the participating physicians for the prescription of medications and healthcare products for the prevention and treatment of pressure ulcers. RELEVANCE TO CLINICAL PRACTICE The data demonstrated that nurses have sufficient knowledge and skill to provide wound care and could safely write these prescriptions, although Spanish law permitting nurse prescription is not fully implemented.
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Boreham N, Coull AF, Murray ID, Turner-Halliday F, Watterson AE. Education programmes preparing independent prescribers in Scotland: an evaluation. NURSE EDUCATION TODAY 2013; 33:321-326. [PMID: 23434190 DOI: 10.1016/j.nedt.2013.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 11/27/2012] [Accepted: 01/23/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND Nurse prescribing (NP) is part of the modernisation of the health care workforce and contributes to patient care by improving access to quality services and medication, through utilisation of advanced professional skills. Nurses and midwives need to complete additional education in order to prescribe. This paper explores pedagogical issues relevant to professional training programmes. OBJECTIVES To assess if programmes of education for nurse prescribing in Scotland were fit for purpose, from both the student and educator perspective with recommendations for future educational delivery. DESIGN Data were collected using several methods: a questionnaire to all course members on prescribing programmes followed by focus-groups; and interviews with programme providers. RESULTS Nurses and midwives training as prescribers work in a wide range of healthcare settings, in different geographic environments. They tended to be experienced, educated to degree level and most are over forty years of age. Most undertook the course to develop professionally and to improve patient care. Existing provision of education for prescribing is deemed appropriate and fit for purpose. The NP programme greatly enhances pharmacological knowledge building on existing clinical experience. The nature of these programmes works well and should be retained. However, whilst the educational programmes were centrally funded, less than half of students were provided with any allocated study time from their employers preventing nurses from maximising the gain from the educational preparation for prescribing. CONCLUSIONS Nurse and midwife generic preparation for independent nurse prescribing in Scotland greatly increases professional expertise and is appropriate and fit for purpose. As other countries beyond Scotland and the UK seek to further progress nursing roles, learning from this controlled and structured development of prescribing underpinned by evidence could be of significant benefit.
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Affiliation(s)
- Nick Boreham
- School of Education, University of Glasgow, Glasgow G12 8QQ, United Kingdom
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Naughton C, Drennan J, Hyde A, Allen D, O'Boyle K, Felle P, Butler M. An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland. J Adv Nurs 2012; 69:1478-88. [DOI: 10.1111/jan.12004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Corina Naughton
- School of Nursing, Midwifery and Health Systems; University College Dublin (UCD); Belfield Dublin Ireland
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems; University College Dublin (UCD); Belfield Dublin Ireland
| | - Abbey Hyde
- School of Nursing, Midwifery and Health Systems; University College Dublin (UCD); Belfield Dublin Ireland
| | - Deirdre Allen
- School of Nursing, Midwifery and Health Systems; University College Dublin (UCD); Belfield Dublin Ireland
| | - Kathleen O'Boyle
- School of Biomolecular and Biomedical Science; University College Dublin (UCD); Belfield Dublin Ireland
| | - Patrick Felle
- School of Medicine and Medical Science; University College Dublin (UCD); Belfield Dublin Ireland
| | - Michelle Butler
- School of Nursing, Midwifery and Health Systems; University College Dublin (UCD); Belfield Dublin Ireland
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Courtenay M, Carey N, Stenner K. An overiew of non medical prescribing across one strategic health authority: a questionnaire survey. BMC Health Serv Res 2012; 12:138. [PMID: 22657272 PMCID: PMC3420322 DOI: 10.1186/1472-6963-12-138] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 05/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA. METHODS NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7%) participants responded. Data was collected between November 2010 and February 2011. RESULTS The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6%) compared to community practitioner prescribers (198 or 22.4%), pharmacist independent supplementary prescribers (35 or 4%), and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%). Nearly all (over 90%) of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p < 0.001). CONCLUSION NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and allied health professional prescribers. This workforce is contributing to medicines management activities in a range of care settings. If non-medical prescibers are to maximise their contribution, robust governance and support from healthcare organisations is essential. The continued use of supplementary prescribing is questionable if maximum efficiency is sought. These are important points that need to be considered by those responsible for developing non-medical prescribing in the United Kingdom and other countries around the world.
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Affiliation(s)
- Molly Courtenay
- Division of Health and Social Care, University of Surrey, Guildford, Surrey, UK
| | - Nicola Carey
- Division of Health and Social Care, University of Surrey, Guildford, Surrey, UK
| | - Karen Stenner
- Division of Health and Social Care, University of Surrey, Guildford, Surrey, UK
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Patients’ level of satisfaction and self-reports of intention to comply following consultation with nurses and midwives with prescriptive authority: A cross-sectional survey. Int J Nurs Stud 2011; 48:808-17. [DOI: 10.1016/j.ijnurstu.2011.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 11/03/2010] [Accepted: 01/02/2011] [Indexed: 11/22/2022]
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Courtenay M, Carey N, Stenner K. Non medical prescribing leads views on their role and the implementation of non medical prescribing from a multi-organisational perspective. BMC Health Serv Res 2011; 11:142. [PMID: 21635744 PMCID: PMC3120647 DOI: 10.1186/1472-6963-11-142] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 06/02/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In the United Kingdom, non-medical prescribing (NMP) has been identified as one way to improve healthcare quality and efficiency. Healthcare organisations are charged with overseeing the clinical governance of NMP and guidance recommends the identification of a lead director to be responsible for its implementation. While over twelve million items are prescribed each year by the 50,000 qualified NMPs its uptake is inconsistent. Several studies have explored the barriers to NMP at a practice level, however little is known about the role the NMP lead and the implementation of NMP from an organisational perspective. The aim of this research was to explore the role of the organisational NMP lead across a range of practice settings within one Strategic Health Authority (SHA) and consider the development of NMP from a multi-organisational perspective. METHODS Semi-structured telephone interviews with 28 NMP leads across one SHA were undertaken by a trained qualitative researcher. Interviews addressed the purpose of the role and difficulties encountered; audiotapes were transcribed, coded and themes were identified. RESULTS The NMP lead role comprised of four main functions; communication, coordinating, clinical governance and support. Factors hampering progress in overseeing the safe development of NMP included lack of clarity about the NMP lead role and responsibilities, strategic support and a lack of protected time. The extent to which clinical governance systems were in place across organisations was inconsistent. Where a strategic approach to its development was adopted, fewer barriers were encountered and NMP was more likely to become embedded within organisations. CONCLUSIONS The significant contribution that NMP leads play in embedding NMP within organisations should be acknowledged by clearer national guidance for this role and its responsibilities. Greater standardisation and consistency is required of clinical governance systems if quality and safety is to be ensured given the expanding development of NMP. The extent to which NMP is in place worldwide differs. However, our findings will be of interest to policymakers in other countries involved in the development and implementation of this role.
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Affiliation(s)
- Molly Courtenay
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Nicola Carey
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Karen Stenner
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
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Courtenay M, Carey N, Stenner K, Lawton S, Peters J. Patients’ views of nurse prescribing: effects on care, concordance and medicine taking. Br J Dermatol 2011; 164:396-401. [DOI: 10.1111/j.1365-2133.2010.10119.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stenner KL, Courtenay M, Carey N. Consultations between nurse prescribers and patients with diabetes in primary care: A qualitative study of patient views. Int J Nurs Stud 2011; 48:37-46. [DOI: 10.1016/j.ijnurstu.2010.06.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/09/2010] [Accepted: 06/10/2010] [Indexed: 12/21/2022]
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Abstract
AIMS To explore the views of patients with diabetes about nurse prescribing and the perceived advantages and disadvantages. METHODS Patients were recruited from the case-loads of seven nurse prescribers in six National Health Service sites in England. Sites reflected the key settings in which nurses typically prescribe for patients with diabetes within primary care. Forty-one interviews were undertaken by trained qualitative researchers. Interviews addressed opinions and experiences of nurse prescribing; audiotapes were transcribed, coded, and themes identified. RESULTS Patients were confident in nurse prescribing. Distinctions were made between the role of the nurse and that of the doctor, and views varied with regard to the extent patients felt nurses should work autonomously. Confidence in nurse prescribing was inspired by nurses' specialist knowledge and experience, a mutual trusting relationship, a thorough consultation, and experience of the benefits of nurse prescribing. Communication between nurses and doctors about patient care, awareness by nurses of their area of competence, training and experience, specialist diabetes knowledge and access to training updates were considered important for safe prescribing. Patterns of attendance had changed in some cases, with patients tending to see doctors less often. Access to medicines was improved for patients during non-routine/emergency situations. CONCLUSIONS Nurse prescribing is acceptable to patients and can increase the efficiency of diabetes service in primary care. Workforce planners need to include the services of nurse prescribers alongside those of doctors.
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Affiliation(s)
- M Courtenay
- Division of Health and Social Care, University of Surrey, Guildford, UK.
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Gardner G, Gardner A, Middleton S, Della P, Kain V, Doubrovsky A. The work of nurse practitioners. J Adv Nurs 2010; 66:2160-9. [DOI: 10.1111/j.1365-2648.2010.05379.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Norman IJ, Coster S, McCrone P, Sibley A, Whittlesea C. A comparison of the clinical effectiveness and costs of mental health nurse supplementary prescribing and independent medical prescribing: a post-test control group study. BMC Health Serv Res 2010; 10:4. [PMID: 20051131 PMCID: PMC2820038 DOI: 10.1186/1472-6963-10-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 01/05/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supplementary prescribing for mental health nurses was first introduced in the UK in 2003. Since then, a number of studies have reported stakeholders' perceptions of the success of the initiative. However, there has been little experimental research conducted into its effectiveness. This paper reports findings from the first known study to compare the cost and clinical impact of mental health nurse supplementary prescribing to independent medical prescribing. METHODS A post-test control group experimental design was used to compare the treatment costs, clinical outcomes and satisfaction of patients in receipt of mental health nurse supplementary prescribing with a matched group of patients in receipt of independent prescribing from consultant psychiatrists. The sample comprised 45 patients in receipt of mental health nurse supplementary prescribing for a minimum of six months and a matched group (by age, gender, diagnosis, and chronicity) of patients prescribed for by psychiatrists. RESULTS There were no significant differences between patients in the nurse supplementary prescribers' group and the independent prescribers' group in terms of medication adherence, health status, side effects, and satisfaction with overall care. Total costs per patient for service use were 803 pounds higher for the nurse prescribers' group but this difference was not significant (95% confidence interval--1341 pounds to 3020 pounds). CONCLUSIONS No significant differences were found between the health and social outcomes of patients in the mental health nurse supplementary prescribers' group, and those prescribed for by the independent medical prescribers. The cost appraisal also showed that there was no significant difference in the costs of the two types of prescribing, although the pattern of resources used differed between patients in the two prescriber groups. The results suggest that mental health nurse supplementary prescribers can deliver similar health benefits to patients as consultant psychiatrists without any significant difference in patients' service utilisation costs.
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Affiliation(s)
- Ian J Norman
- King's College London, Division of Health and Social Care Research, London SE1 8WA, UK.
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Courtenay M, Stenner K, Carey N. An exploration of the practices of nurse prescribers who care for people with diabetes: a case study. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1752-9824.2009.01034.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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