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Tan W, Hu Q, Wang C, Li Y, Jiang Y. Outline of nurse prescribing education programs: A scoping review. NURSE EDUCATION TODAY 2023; 131:105941. [PMID: 37690439 DOI: 10.1016/j.nedt.2023.105941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The role of nurse prescribers is developing rapidly to meet rising health care demands worldwide. However, prescribing is a complex process that requires nurses to receive the proper education. OBJECTIVES To identify what is known in the research field on nurse prescribing education. DESIGN Arksey and O'Malley's five-stage methodological framework was used to guide this scoping review. DATA SOURCES PubMed, Web of Science, CINAHL, Embase, and the Cochrane Library. REVIEW METHODS Databases were searched from inception to December 31, 2022. Data were extracted from papers meeting the inclusion criteria using the data chart and synthesized using a narrative method. RESULTS Seventy-one studies were included in the scoping review. Five education content themes and four education modes were identified. In addition, positive effects of nurse prescribing education and the learning needs of nurses were also found. CONCLUSIONS There is considerable heterogeneity in nurse prescribing education content and mode. This scoping review highlights the benefits of implementing education programs to prepare nurses for prescribing. However, nurses still have some unmet needs for prescribing education. More longitudinal studies and evaluation tools are needed to determine long-term effects. Future nurse prescribing education programs could consider the dual mentorship system, interactive educational activities, and specialized courses to improve the motivation of nurses and the quality of education.
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Affiliation(s)
- Wei Tan
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qin Hu
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Cong Wang
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yijing Li
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.
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Martin SE, Graham K, Banwell HA, Johnson JL. Continuing professional development opportunities for Australian endorsed for scheduled medicines podiatrists-What's out there and is it accessible, relevant, and meaningful? A cross-sectional survey. PLoS One 2023; 18:e0289217. [PMID: 37733657 PMCID: PMC10513227 DOI: 10.1371/journal.pone.0289217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Non-medical prescribing is a valuable strategy to enable equitable access to medications in the context of the increasing demands on health services globally. Australian podiatrists have been able to seek endorsement for scheduled medicines (ESM) for over a decade. This project investigates the perceptions and habits of ESM podiatrists in meeting the extra continuing professional development (CPD) requirements associated with their ESM status. METHODS Australian ESM podiatrists completed an anonymous, online survey capturing demographics; CPD engagement; and self-reflections of CPD activities. RESULTS Twenty percent (n = 33) of Australian ESM registered podiatrists (N = 167) responded to the survey (18 female; median ESM status 2.5 years, (IQR 1.0, 9.0)). For the previous registration period, 88% (n = 29) completed the mandatory CPD hours, with only 35% (n = 11) completing a CPD learning goal plan. Over 80% identified their last ESM CPD activity as accessible, affordable, and could recommend to colleagues. Conversely, 50% or less agreed the activity increased confidence; changed their practice; improved communication skills; or enabled networking. Most respondents (81%, n = 27) indicated improvements should be made to the content, relevance, accessibility, and meaningfulness of CPD. These findings were supported by responses to the open-ended questions. CONCLUSIONS Our findings suggest ESM podiatrists engage in CPD that is accessible rather than learning goal driven. Concerningly, CPD activities resulted in low translation of learnings to practice. This brings in to question the value of mandatory CPD systems based on minimum hours, rather than meaningfulness.
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Affiliation(s)
- Saraid E. Martin
- Allied Health & Human Performance, The University of South Australia, Adelaide, South Australia, Australia
- Podiatry Department, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kristin Graham
- Allied Health & Human Performance, The University of South Australia, Adelaide, South Australia, Australia
| | - Helen A. Banwell
- Allied Health & Human Performance, The University of South Australia, Adelaide, South Australia, Australia
| | - Jacinta L. Johnson
- Clinical & Health Sciences, The University of South Australia, Adelaide, South Australia, Australia
- SA Pharmacy, Statewide Clinical Support Services, SA Health, Adelaide, South Australia, Australia
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Fresán A, González-Castro TB, Pool-García S, Tovilla-Zárate CA, Sánchez de la Cruz JP, López-Narváez ML, Castillo-Avila RG, Ramos-Méndez MÁ. Chronic Pain and Depression are Increased in Outpatient Adults with Somatic Symptoms from Secondary Health Care Services. Pain Manag Nurs 2023:S1524-9042(23)00032-2. [PMID: 36890094 DOI: 10.1016/j.pmn.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 12/13/2022] [Accepted: 02/11/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Somatic symptom disorder is described as excessive thoughts, feelings, or behaviors related to physical symptoms. The presence of somatic symptoms has been associated with depression, alexithymia, and the presence of chronic pain. Individuals with somatic symptom disorder are frequent attenders of primary health care services. AIM We focused on investigating if the presence of psychological symptoms, alexithymia, or pain could be risk factors for somatic symptoms in a secondary health care service. METHODS A cross-sectional and observational study. A total of 136 Mexican individuals who regularly attend a secondary health care service were recruited. The Visual Analogue Scale for Pain Assessment, the Symptom Checklist 90, and the Patient Health Questionnaire-15 were applied. RESULTS Of all the participants, 45.2% showed somatic symptoms. We observed that these individuals more frequently presented with complaints of pain (χ2 = 18.4, p < .001), as well as more severe (t = -4.6, p < .001), and prolonged (χ2 = 4.9, p = 0.02). They also exhibited higher severity in all psychological dimensions assessed (p < .001). Finally, cardiovascular disease (t = 2.52, p = .01), pain intensity (t = 2.94, p = .005), and SCL-90 depression (t = 7.58, p < .001) were associated with somatic symptoms. CONCLUSIONS In this study, we observed a high frequency of somatic symptoms in outpatients attending secondary health care services. They may be accompanied by comorbid cardiovascular conditions, higher pain intensity, and other mental health-related symptoms, which may aggravate the general clinical picture presented by the patient seeking health care. The presence and severity of somatization should be taken into consideration in the first and second level health care services for an early mental state evaluation and treatment of these outpatients to have a better clinical assessment and health outcome.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, México
| | - Thelma Beatriz González-Castro
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, México
| | - Sherezada Pool-García
- Hospital General de Comalcalco "Dr. Desiderio G. Rosado Carbajal", Secretaría de Salud, Comalcalco, Tabasco, México
| | - Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México.
| | - Juan Pablo Sánchez de la Cruz
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México
| | - María Lilia López-Narváez
- Hospital Chiapas Nos Une Dr. Gilberto Gómez Maza, Secretaría de Salud de Chiapas, Tuxtla Gutiérrez, Chiapas, México
| | - Rosa Giannina Castillo-Avila
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Miguel Ángel Ramos-Méndez
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
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Factors Influencing Nurses’ Opinions on the Implementation of Nursing Advice in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137764. [PMID: 35805426 PMCID: PMC9265661 DOI: 10.3390/ijerph19137764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
In the past five years, nursing practice has changed drastically in Poland. Nurses have received many new competencies in response to the need to provide services to patients. The purpose of the study was to analyze nurses’ opinions on the new rights to provide nursing advice and to identify factors that influence their opinions in this regard. A descriptive cross-sectional study was conducted among 798 nurses who work in various medical facilities. The influence of selected variables on nurses’ opinions on the provision of nursing advice to patients was evaluated using logistic regression. The nurses surveyed had a positive attitude towards new competencies and believed that they were able to independently provide the patient with advice within the scope provided by Polish legislation. Logistic regression showed that the factors that statistically significantly influenced nurses’ opinions on particular types of nursing advice were age (p = 0.038), education (p = 0.000), and the place of work of the respondents; that is, hospital (p = 0.016). More research is needed to demonstrate the effectiveness and quality of the implemented nursing advice and its impact on the functioning of the health system.
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Malhi H, Dera M, Fletcher J. Exploring the role of the nutrition nurse specialist in an intestinal failure tertiary referral centre. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S4-S12. [PMID: 35404659 DOI: 10.12968/bjon.2022.31.7.s4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The role of the nutrition nurse specialist (NNS) is diverse and is usually integral to a wider, multidisciplinary nutrition support team (NST). Practice frameworks have been developed to identify competencies within the NNS role. A mind-mapping technique was used with the NNS team and the wider NST to explore the role of the NNS in the authors' intestinal failure tertiary referral centre. The results of this were further compared with the published competency frameworks. The mind maps from the NNS team and NST demonstrated commonality. It was encouraging to see that colleagues seem to have a similar understanding of the NNS role and contribution to the wider service. Published competency frameworks did not entirely reflect the expanded scope of practice that is undertaken within this particular team. It is important for clinical nurse specialist teams to evaluate their role and service provision and to compare this against published competency frameworks.
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Affiliation(s)
- Hardip Malhi
- Nutrition Nurse, Queen Elizabeth Hospital Birmingham
| | | | - Jane Fletcher
- Nutrition Nurse, Queen Elizabeth Hospital Birmingham/School of Nursing, University of Birmingham
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Experiences and opinions of multi-professional non-medical oncology prescribers on post-qualification training: a qualitative study. Int J Clin Pharm 2022; 44:698-708. [PMID: 35378673 PMCID: PMC9200693 DOI: 10.1007/s11096-022-01396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/04/2022] [Indexed: 11/11/2022]
Abstract
Background: Within the UK, a non-medical prescriber is a non-medical healthcare professional who has undertaken post-registration training to gain prescribing rights. Lack of post-qualification NMP training has previously been identified as a barrier to the development of oncology non-medical prescribing practice. Aim: To explore the experiences and opinions of multi-professional non-medical oncology prescribers on post-qualification training. Method: Nine out of 30 oncology non-medical prescribers (three nurses, three pharmacists and three radiographers) from a single cancer centre in Wales, were selected from a study site NMP database using randomisation sampling within Microsoft® Excel. Participants were interviewed using a validated and piloted semi-structured interview design on the topic of post-qualification training for non-medical prescribers. Participants were invited via organisational email. Interviews were audio-recorded and transcribed verbatim. Anonymised data were thematically analysed aided by NVivo® software. Results: Main themes identified: experience related to training, competency, support and training methods. Competency assessment methods discussed were the annual non-medical prescriber appraisal, peer review and a line manager’s overarching appraisal. Support requirements identified included greater consultant input to help non-medical prescribers identify training and peer support opportunities. Organisational support was requested regarding regular study leave and governance around clinical judgement and errors. The need for regular structured in-house training related to non-medical prescriber’s level of experience was identified. Conclusion: Development of organisation-led governance strategies and in-house training programmes will support training equity for all non-medical prescribers within the organisation.
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Santos-Willshere J, Pizarro N. Introducing nurse prescribing in Gibraltar: the impact on palliative care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:162-168. [PMID: 35152752 DOI: 10.12968/bjon.2022.31.3.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article critically explores the impact of the introduction of nurse prescribing on palliative care in Gibraltar. A preliminary audit review of the prescriptions issued by the two palliative independent nurse prescribers over their first full calendar year of prescribing (2020) revealed two primary areas of impact: facilitating end-of-life care at home and improving anticipatory prescribing for end-of-life symptom management. These initial findings will be discussed in the context of the challenges and facilitators encountered during the first year of prescribing practice. Challenges were primarily related to the introduction of an advanced nursing role into an existing medical paradigm. Identified facilitators included comprehensive record keeping, collaborative working and the development of local guidelines, as well as the support of management and peers. The article concludes with a recommendation for further audits of prescribing data as a way to measure the impact of the new role and to inform future palliative service development.
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Affiliation(s)
| | - Nicole Pizarro
- Specialist Palliative Nurse, Gibraltar Health Authority, Gibraltar
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Snell H, Budge C, Courtenay M. A survey of nurses prescribing in diabetes care: Practices, barriers and facilitators in New Zealand and the United Kingdom. J Clin Nurs 2021; 31:2331-2343. [PMID: 34542207 DOI: 10.1111/jocn.16052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To compare diabetes-related prescribing practices, barriers and facilitators amongst nurse prescribers in New Zealand and the United Kingdom. BACKGROUND Nurses have been prescribing in the United Kingdom for many years but nurse prescribing in New Zealand is relatively recent. It is unknown whether similar system factors act to facilitate or limit prescribing. DESIGN A survey of 250 nurses prescribing in diabetes care in New Zealand (n = 111) and the United Kingdom (n = 139). METHODS A SurveyMonkey questionnaire was used to survey nurses about the extent of their prescribing practices, and barriers and facilitators experienced. Quantitative data were explored descriptively, and qualitative responses were grouped according to content, with quotes provided to exemplify thematic content. This study is reported following STROBE guidelines. RESULTS Insulin, metformin and sulphonylureas are the drugs most frequently prescribed in both countries. Considerably more New Zealand than United Kingdom nurses reported prescribing for cardiovascular and renal disease. In both countries, direct prescribing to the patient was most common, followed by remote prescribing in New Zealand and via recommendation to other prescribers in the United Kingdom. Most common barriers were lack of time and inadequate mentoring. Most common facilitators were as follows: good supervision; collegial relationships with specialists, pharmacists and peers; and ongoing education. CONCLUSIONS These New Zealand and United Kingdom nurses are prescribing a broad range of diabetes-related medications. Similar barriers and facilitators were identified in both countries. Adequate supervision, support from multidisciplinary team colleagues and prescribing education and guidelines are paramount. RELEVANCE TO CLINICAL PRACTICE Important insights on barriers and facilitators to implementation of nurse prescribing in two countries are highlighted and, despite a considerable difference in the longevity of prescribing practice, similar issues were identified.
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Affiliation(s)
- Helen Snell
- BlueHorizons NZ Ltd, Palmerston North, New Zealand
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Wilson DM, Fahy A, Nam MA, Murphy J. The need for and value of nurse and midwife prescribing: Findings from an Irish research investigation. Int J Nurs Pract 2020; 27:e12877. [PMID: 33155742 DOI: 10.1111/ijn.12877] [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: 03/06/2019] [Revised: 05/31/2020] [Accepted: 06/21/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to determine the need for and value of nurse and midwife prescribing in Ireland as identified by these prescribers-the people most able to provide relevant insights and information. BACKGROUND Since 2007, nurses and midwives in Ireland who have passed an additional educational program can prescribe medicinal products relative to their clinical practice areas. Research evidence of efficacy is needed now for prescribing sustainability in Ireland and to encourage, if successful, the adoption or expansion of frontline nurse/midwife prescribing rights in other countries. DESIGN A qualitative study was undertaken. METHODS Interviews with registered nurse and midwife prescribers were conducted in 2017 until data saturation. Constant-comparative coding and categorization of data revealed themes and categories, with explanatory quotes for research trustworthiness and credibility purposes. RESULTS Six data themes emerged: (a) more than just writing prescriptions; (b) highly individualized evidence-based specialist care; (c) assured, timely and rapid accessibility to needed care; (d) health system and healthcare efficiency gains; (e) satisfaction with nurse/midwife prescriber services and (f) quality care improvements. CONCLUSION Nurse/midwife prescribing in Ireland was identified as needed, safe, effective and cost-effective. Prescribing permitted accessible, thorough and proactive holistic health promotive care to be provided in nurse- or midwife-led outpatient clinics.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Department of Nursing and Midwifery, University of Limerick, Limerick, Republic of Ireland
| | - Anne Fahy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Republic of Ireland
| | - Mavis A Nam
- Nursing and Midwifery Training College, Mampong, Ghana
| | - Jill Murphy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Republic of Ireland
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Zimmermann A, Cieplikiewicz E, Wąż P, Gaworska-Krzemińska A, Olczyk P. The Implementation Process of Nurse Prescribing in Poland-A Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072417. [PMID: 32252355 PMCID: PMC7177755 DOI: 10.3390/ijerph17072417] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022]
Abstract
The study aimed to investigate the situation of nurse prescribing, introduced in Poland in 2016, by analyzing the opinions of nurses, expected to be influential on nurses' actual practices, in response to legislative change to enable nurses to prescribe and comparing this with actual nurse prescribing behaviours during the early years of the legislation. The paper fills a knowledge gap and provides baseline data analysis for subsequent research. Nurses' opinions were collected during the period they were preparing themselves for prescribing. That data was compared with data on the character and extent of nurses' actual prescribing practices over the first two years of implementation. The study showed the number of nurse prescriptions increased. Comparing the first and second years of nurse prescribing, the number of nurse independent prescriptions more than doubled. Over the same period, the number of nurse supplementary prescriptions increased almost six-fold. The implementation of nurse prescribing has increased the scope of nursing care, especially in the treatment of the infections, pain and chronic conditions in the elderly.
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Affiliation(s)
- Agnieszka Zimmermann
- Department of Medical and Pharmaceutical Law, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
- Correspondence:
| | - Ewa Cieplikiewicz
- Department of Medical and Pharmaceutical Law, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Piotr Wąż
- Department of Nuclear Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Aleksandra Gaworska-Krzemińska
- Department of Nursing Management, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Paweł Olczyk
- Department of Clinical Chemistry and Laboratory Diagnostics, School of Pharmacy and Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Katowice, Poland;
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McHugh Á, Hughes M, Higgins A, Buckley T, Cashin A, Casey M, Rohde D. Non-medical prescribers: prescribing within practice. ACTA ACUST UNITED AC 2020. [DOI: 10.12968/jprp.2020.2.2.68] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since its inception in Ireland in 2007, the Nurse Prescribing Programme has prepared registered nurses and midwives to prescribe from a limited formulary in their area of clinical speciality. However, registration numbers have declined in recent years, prompting changes to the registration processes. This article present the findings of a study conducted on the prescribing behaviours, practices and confidence of registered nurse/midwife prescribers following these changes, reporting the findings from the qualitative arm of a larger mixed-method study. Interviews with participants (n=6) explored their prescribing behaviours, practices and confidence. The findings suggest that organisational and professional factors influence prescribing. Scope of practice and expert decision-making is seen to influence engagement with treatment. Interprofessional cooperation continues to develop in making prescribing decisions. There is a clear need for interprofessional education to increase cooperation between health professionals in making prescribing decisions and including national competencies for all prescribers.
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Affiliation(s)
- Áine McHugh
- Lecturer in Mental Health Nursing, Department of Nursing, Midwifery and Early Years, Dundalk Institute of Technology, Dundalk, Ireland
| | - Mary Hughes
- Associate Professor in Children’s Nursing, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Tom Buckley
- Associate Professor Faculty of Nursing and Midwifery, Sydney Nursing Schoo, University of Sydney, NSW, Australia
| | - Andrew Cashin
- Professor of Autism and Intellectual Disability, School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Mary Casey
- Associate Professor in Nursing, UCD School of Nursing, Midwifery and Health Systems, University College Dublin
| | - Daniela Rohde
- Research Assistant, UCD School of Nursing, Midwifery and Health Systems University College Dublin
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An exploration of the perceptions of non-medical prescribers, regarding their self-efficacy when prescribing, and their willingness to take responsibility for prescribing decisions. Res Social Adm Pharm 2020; 16:249-256. [DOI: 10.1016/j.sapharm.2019.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 05/05/2019] [Accepted: 05/19/2019] [Indexed: 11/16/2022]
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Hall S, Thompson J, Phair T, Davies AN. Clinical nurse specialist prescribing in a cancer centre supportive and palliative care team. BMJ Support Palliat Care 2019; 10:111-113. [PMID: 31446392 DOI: 10.1136/bmjspcare-2019-001867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To provide insight into the prescribing practices of three independent nurse prescribers (INPs)/clinical nurse specialists (CNSs) working in a supportive and palliative care team (SPCT) in a district general hospital and a specialist tertiary cancer centre in the UK. METHODS A prospective review of all consultations and the prescribing activity arising from the consultations (and reasons for non-prescribing following a consultation) of 3 INPs/CNSs between 1 August 2018 and 31 October 2018. RESULTS Four hundred ninety-three consultations were undertaken on 186 individual patients. Two hundred forty-seven consultations representing 50% resulted in changes to a prescription, and 123 of those consultations representing 50% of prescriptions written resulted in the prescribing of an opioid for moderate-to-severe pain. CONCLUSIONS This service evaluation demonstrates the potential for INPs in SPCTs to provide comprehensive symptom control while enabling CNSs to practice with a greater degree of autonomy leading to enhanced job satisfaction. On the basis of our experience, we would encourage all palliative care CNSs to undergo training to become INPs (if available).
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Affiliation(s)
- Sally Hall
- Department of Supportive and Palliative Care, Royal Surrey County Hospital, NHS Foundation Trust, Guildford, UK
| | - Jo Thompson
- Department of Supportive and Palliative Care, Royal Surrey County Hospital, NHS Foundation Trust, Guildford, UK
| | - Toni Phair
- Department of Supportive and Palliative Care, Royal Surrey County Hospital, NHS Foundation Trust, Guildford, UK
| | - Andrew Neil Davies
- Department of Supportive and Palliative Care, Royal Surrey County Hospital, NHS Foundation Trust, Guildford, UK
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Courtenay M, Deslandes R, Harries-Huntley G, Hodson K, Morris G. Classic e-Delphi survey to provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services in Wales. BMJ Open 2018; 8:e024161. [PMID: 30232116 PMCID: PMC6150146 DOI: 10.1136/bmjopen-2018-024161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/09/2018] [Accepted: 08/18/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To provide national consensus and establish priorities with regards to the factors that promote the implementation and continued development of non-medical prescribing within health services. DESIGN Classic e-Delphi survey. SETTING National study in Wales. PARTICIPANTS Pharmacists, nurses and allied health professionals with the independent/supplementary prescribing qualification. RESULTS A total of 55 non-medical prescribers agreed to become members of the expert panel of whom 42 (76%) completed the round 1 questionnaire, 40/42 (95%) completed round 2 and 34/40 (85%) responded to round 3. Twenty-one statements were developed, and consensus was achieved on nine factors representing those necessary for the successful implementation of non-medical prescribing and five representing actions required for its continued development. Strategic fit between non-medical prescribing and existing service provision, organisation preparedness, visible benefits, good managerial and team support, and a clear differentiation of roles were each important influences. CONCLUSION Given the high degree of consensus, this list of factors and actions should provide guidance to managers and commissioners of services wishing to initiate or extend non-medical prescribing. This information should be considered internationally by other countries outside of the UK wishing to implement prescribing by non-medical healthcare professionals.
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Affiliation(s)
- Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rhian Deslandes
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Gail Harries-Huntley
- Workforce Education and Development Service, NHS Wales Shared Services Partnership, Cardiff, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Gary Morris
- School of Healthcare Sciences, Cardiff University & HywelDda University Health Board, Carmarthen, SA31, Cardiff University, Cardiff, UK
- Advanced Physiotherapy Practitioner, Hywel Dda University Health Board, Carmarthen, UK
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Ziegler L, Bennett MI, Mulvey M, Hamilton T, Blenkinsopp A. Characterising the growth in palliative care prescribing 2011-2015: Analysis of national medical and non-medical activity. Palliat Med 2018; 32:767-774. [PMID: 29130384 DOI: 10.1177/0269216317739805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role of non-medical prescribers working in palliative care has been expanding in recent years and prescribers report improvements in patient care, patient safety, better use of health professionals' skills and more flexible team working. Despite this, there is a lack of empirical evidence to demonstrate its clinical and economic impact, limiting our understanding of the future role of non-medical prescribers within a healthcare system serving an increasing number of people with palliative care needs. AIM We developed a unique methodology to establish the level of non-medical prescribers' activity in palliative care across England and consider the likely overall contribution these prescribers are making at a national level in this context in relation to medical prescribing. SETTING/PARTICIPANTS All prescriptions for 10 core palliative care drugs prescribed by general practitioners, nurses and pharmacists in England and dispensed in the community between April 2011 and April 2015 were extracted from the Prescribing Analysis Cost Tool system. DESIGN The data were broken down by prescriber and basic descriptive analysis of prescription frequencies by opioid, non-opioids and total prescriptions by year were undertaken. To evaluate the yearly growth of non-medical prescribers, the total number of prescriptions was compared by year for each prescribing group. RESULTS Non-medical prescribers issued prescriptions rose by 28% per year compared to 9% in those issued by medical prescribers. Despite this, the annual growth in non-medical prescribers prescriptions was less than 1% a year in relation to total community palliative care prescribing activity in England. Impact on medical prescribing is therefore minimal.
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Affiliation(s)
- Lucy Ziegler
- 1 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Michael I Bennett
- 1 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Matt Mulvey
- 1 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Tim Hamilton
- 1 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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16
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Ling DL, Lyu CM, Liu H, Xiao X, Yu HJ. The necessity and possibility of implementation of nurse prescribing in China: An international perspective. Int J Nurs Sci 2018; 5:72-80. [PMID: 31406805 PMCID: PMC6626201 DOI: 10.1016/j.ijnss.2017.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/07/2017] [Accepted: 12/28/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The number of countries where nurses are legally permitted to prescribe has grown rapidly due to a variety of external and internal forces. Despite its international popularity, nurse prescribing has not yet been implemented in China widely. OBJECTIVE The intent of this paper is to review the current international literature regarding nurse prescribing so as to explore the necessity and possibility of implementation of nurse prescribing in China and classify the research gap. METHODS Eight electronic databases including Embase, SpringerLink, EBSCO, CINAHL, Medline, Wiley, Science Direct, CochraneLibrary were electronically searched to identify related peer-review articles published in the English language only from 2007 to 2017. Relative references found from the identified studies were traced back to ensure that potentially eligible articles were included. RESULTS Thirty-three publications which met the inclusion criteria were included in this literature review. The literature shows that not only could nurse prescribing provide quicker service, improvements in quality, but also could make better utilization of the nurses' professional skills and increase nurses' autonomy. Moreover, the barriers of nurse prescribing are explored to identify the factors that may facilitate the success of its implementation. CONCLUSION The review advises that nurses' views towards nurse prescribing have played a significant role in the success of nurse prescribing. While no literature regarding Chinese nurses' attitudes towards nurse prescribing could be identified, it is imperative to examine their attitudes on it. This would help Chinese healthcare policymakers ascertain the necessity of the introduction of nurse prescribing and provide them with valuable information for service planning.
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Affiliation(s)
- Dong-Lan Ling
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chun-Mei Lyu
- The First People's Hospital of Foshan, Foshan, Guangdong Province, China
| | - Hui Liu
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Xiao Xiao
- Southern Medical University Affiliated Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Hong-Jing Yu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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17
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Lennon R, Fallon A. The experiences of being a registered nurse prescriber within an acute service setting. J Clin Nurs 2017; 27:e523-e534. [DOI: 10.1111/jocn.14087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anne Fallon
- National University of Ireland Galway Galway Ireland
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18
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Toso BRGDO, Filippon J, Giovanella L. Nurses' performance on primary care in the National Health Service in England. Rev Bras Enferm 2017; 69:169-77. [PMID: 26871232 DOI: 10.1590/0034-7167.2016690124i] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/28/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the expansion of nursing roles in primary care in the English National Health Service and the implications for professional practice. METHOD qualitative research in case study format, held in London, England, in six primary care units. Data were obtained through interviews with nine nurses. After the thematic data analysis, two units emerged: the nurses' performance characteristics and effects of the expansion of nursing roles. RESULTS expansion of nurses' roles: consultation, diagnosis and drug therapy, case management and monitoring of chronic conditions. Repercussions: for the user, there was improved access, communication and comprehensive care, increased duration of consultations, resulting in greater adherence; for nurses, there was the expansion of professional skills, knowledge and professional recognition; to the health care system, it resulted in cost savings. CONCLUSION benefits in expanding nursing roles, were visible, contributing to primary care quality.
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Affiliation(s)
| | - Jonathan Filippon
- Postgraduate Program in Primary Care and Public Health, Centre for Primary Care and Public Health, University of London, London, Ingland
| | - Ligia Giovanella
- Departamento de Atenção Primária a Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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19
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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].
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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
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20
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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
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21
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Abstract
Nonmedical prescribing has been allowed in the United Kingdom (UK) since 1992. Its development over the past 24 years has been marked by changes in legislation, enabling the progression towards independent prescribing for nurses, pharmacists and a range of allied health professionals. Although the UK has led the way regarding the introduction of nonmedical prescribing, it is now seen in a number of other Western-European and Anglophone countries although the models of application vary widely between countries. The programme of study to become a nonmedical prescriber (NMP) within the UK is rigorous, and involves a combination of taught curricula and practice-based learning. Prescribing is a complex skill that is high risk and error prone, with many influencing factors. Literature reports regarding the impact of nonmedical prescribing are sparse, with the majority of prescribing research tending to focus instead on prescribing by doctors. The impact of nonmedical prescribing however is important to evaluate, and can be carried out from several perspectives. This review takes a brief look back at the history of nonmedical prescribing, and compares this with the international situation. It also describes the processes required to qualify as a NMP in the UK, potential influences on nonmedical prescribing and the impact of nonmedical prescribing on patient opinions and outcomes and the opinions of doctors and other healthcare professionals.
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Affiliation(s)
- Louise C Cope
- Drug Usage and Pharmacy Practice Division, Prescribing and Patient Safety Research Room 132, 1st Floor, Stopford Building, Manchester Pharmacy School, Oxford Road, Manchester, M13 9PT, UK
| | | | - Mary P Tully
- University of Manchester Pharmacy School, Manchester, UK
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22
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Creedon R, Byrne S, Kennedy J, McCarthy S. The impact of nurse prescribing on the clinical setting. ACTA ACUST UNITED AC 2015; 24:878-85. [DOI: 10.12968/bjon.2015.24.17.878] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rena Creedon
- Nurse Lecturer and Programme Coordinator, Nurse Prescribing, School of Nursing and Midwifery, University College Cork, Ireland
| | - Stephen Byrne
- Head of School of Pharmacy, University College Cork, Ireland
| | - Julia Kennedy
- Head of School Pharmacy, University of Auckland, New Zealand
| | - Suzanne McCarthy
- Clinical Pharmacy Research Group, School of Pharmacy, University College Cork, Ireland and Research Pharmacist, Cork University Hospital, Ireland
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O' Halloran M, Sweeney J, Doody O. Exploring fathers' perceptions of parenting a child with Asperger syndrome. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2013; 17:198-213. [PMID: 23803646 DOI: 10.1177/1744629513494928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study explores Irish fathers' perceptions of parenting a child with Asperger syndrome (AS). Ethical approval was granted by the service provider, and Husserlian phenomenological approach facilitated the exploration. Data were collected through semi-structured interviews of nine fathers in the West region of Ireland. Data were transcribed and analysed using Colaizzi's (1978) method. The study highlighted that parenting a child with AS is an arduous task, but while there are difficulties, many positive aspects to their parenting experience were reported. Overall, the study highlights the importance of listening to parents and their initial concerns regarding their child's development.
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