1
|
Seck F, Masot O, Carey N, Roca J, Botigué T, Paraíso Pueyo E, Lavedán Santamaría A. Nurses' perceived barriers and facilitators to the implementation of nurse prescribing: Delphi study and focus group. J Adv Nurs 2024; 80:2106-2120. [PMID: 37909547 DOI: 10.1111/jan.15936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/11/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
AIM To obtain consensus on barriers and facilitators to nurse prescribing following its recent introduction in Spain. DESIGN A three round online Delphi survey and focus group. METHODS An exploratory method was used with three consecutive rounds of questionnaires based on anonymity and feedback, and a focus group. The study was carried out with primary care, specialized care, socio-health care and manager nurses. RESULTS On the basis of the Delphi study that was conducted, a list of 15 barriers and 18 facilitators of nurse prescribing was obtained. However, no general consensus was found with respect to the prioritization of these barriers/facilitators. The analysis of the results of the focus group confirmed the information obtained from the Delphi study. The main barriers highlighted were dependence on the figure of the physician, insufficient training in pharmacology, a lack of institutional support and the limited list of products that could be prescribed. The key facilitators were academic knowledge and ongoing training and education, independence in the functions and responsibilities of the nursing profession, adaptation to new roles and autonomy in the case of chronic care processes. CONCLUSION Nurses were generally positive about the introduction of nurse prescribing. The commitment of nurses to training and their accreditation as prescribers (internal forces) and health policy and nursing management (external forces) play a fundamental role in supporting the basis of nurse prescribing and ensuring that it is developed with the identified support resources, such as staff training and the provision of the materials necessary for its proper implementation, all with the aim of guaranteeing quality healthcare. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Strong models of nurse prescribing are being considered globally to address population needs. The results can help the future implementation of non-medical independent prescribing and provide guidance to the government and society on the interventions that can be used to consolidate it. IMPACT What problem did the study address? By 2027, the world's population will receive more than 4.5 trillion doses of medicine each year. However, the WHO estimates a projected shortfall of 10 million health workers by 2030. Inadequacies with traditional physician-led care systems mean that new approaches are imperative to maintain patient access to prescription medicines, with NP being a key element in this regard. In Catalonia (Spain), the accreditation process for nurses as prescribers was implemented in 2021. It is therefore of vital importance to question and consult the nurses themselves, the main promoters of the process, to find out their perceptions and thus be able to take them into consideration in the implementation process. What were the main findings? A total of 15 barriers and 17 facilitators were identified. The main perceived barriers are dependence on the figure of the physician, insufficient training in pharmacology during undergraduate studies and a lack of institutional support. The main perceived facilitators are academic knowledge and ongoing education and training, independence in nursing functions and responsibilities, and adaptation to new roles and tasks. Where and on whom will the research have an impact? These results can contribute to improving NP implementation in Spain and serve as a reference for other countries, especially where NP education and training have only recently been instigated or are in the planning process. REPORTING METHOD Standards for reporting qualitative research: a synthesis of recommendations. SRQR. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Faty Seck
- Internal Medicine Service, Santa Maria University Hospital, Lleida, Spain
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Department of Pulmonology, Biomedical Research Institute, Lleida, Spain
| | - Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
| | - Nicola Carey
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| | - Judith Roca
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
| | - Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
| | - Elena Paraíso Pueyo
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
| | - Ana Lavedán Santamaría
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group (GREISI), University of Lleida, Lleida, Spain
| |
Collapse
|
2
|
Pearson M, Sibson T, Carter T. A qualitative study of service users' experiences of mental health nurses' knowledge and skills in relation to medication. J Psychiatr Ment Health Nurs 2021; 28:682-691. [PMID: 33274534 DOI: 10.1111/jpm.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/12/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The role of the mental health nurse in relation to medications remains complex. Despite an increasing focus on pharmacology within pre-registration nurse education, there is limited research exploring how mental health service users experience mental health nurses' knowledge and skills in relation to medication. AIM To explore the experiences of service users working with mental health nurses, in relation to the nurses' knowledge and skills associated with medicines management. METHOD The research prioritized the principles of co-production and was undertaken collaboratively with a researcher with lived experience. Data were collected via semi-structured interviews with individuals who have accessed UK mental health services. Interviews were audio-recorded, transcribed verbatim and subjected to thematic analysis. RESULTS Three themes were generated from the data: inconsistencies in knowledge and practice, holistic therapeutic engagement and dialogical approach to medicines. DISCUSSION Service users may have a sense of uncertainty around the role of the nurse, potentially resulting in frustration and anxiety. However, mental health nurses also possess unique skills in relation to medicines management. IMPLICATIONS FOR PRACTICE The findings emphasize that service users value not only pharmacological knowledge but also unique skills in facilitating dialogue, prioritising shared decision-making and practical support in medicines optimization.
Collapse
Affiliation(s)
- Mark Pearson
- School of health Sciences, The University of Nottingham, South Block Link, Queen's Medical Centre, Nottingham, UK
| | - Tara Sibson
- School of health Sciences, The University of Nottingham, South Block Link, Queen's Medical Centre, Nottingham, UK
| | - Timothy Carter
- Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
3
|
Frain S, Chambers L, Higgins A, Donohue G. 'Not Left in Limbo': Service User Experiences of Mental Health Nurse Prescribing in Home Care Settings. Issues Ment Health Nurs 2021; 42:660-666. [PMID: 32990116 DOI: 10.1080/01612840.2020.1820120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Prescribing in mental health nursing in the Republic of Ireland is still an unusual occurrence and despite an uptake in prescriber training, this does not often translate to practice. Recent Irish research, however, has identified that nurse prescribing when offered, is perceived to enhance care and offer better delivery of services. Since the legislation was introduced in the Republic of Ireland to enable nurses and midwives to prescribe in May 2007, there are now 1,123 nurses registered to prescribe medication. Mental health nurses, however, do not tend to be a priority when it comes to training in prescribing; in the UK it took two years after nurse prescribing was rolled out to extend the scheme to mental health nursing. Although nurse and other professional perspectives explored this topic, there is limited research specifically detailing the experience of service users in long term care who are prescribed by mental health nurse practitioners in a home care setting. This research follows a qualitative exploratory research design using thematic analysis to explore service user (n = 12) experiences of mental health nurse prescribing. The following four themes emerged from the analysis: 'empowerment and trust'; 'person-centered care'; 'time and flexibility' and 'collaborative approach'. Results indicate a positive and rich experience of nurse prescribing, which facilitate a more trusting, holistic and autonomous therapeutic relationship. Future research looking at other issues relating to medication including reduction and support for coming off where appropriate is recommended.
Collapse
Affiliation(s)
- Sinead Frain
- Home Based Treatment Team, Ballyfermot/Lucan Community Mental Health Service Primary, Care Centre, Ballyfermot, Dublin, Ireland
| | - Liah Chambers
- Home Based Treatment Team, Tallaght Mental Health Service, Dublin, Ireland
| | - Agnes Higgins
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College, University of Dublin, Dublin, Ireland
| | - Gráinne Donohue
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College, University of Dublin, Dublin, Ireland
| |
Collapse
|
4
|
Emrich-Mills L, Collier P, West J. The role of nurse prescribers in memory services and their continuing professional development: A review of the literature. J Clin Nurs 2019; 28:1422-1432. [PMID: 30667577 DOI: 10.1111/jocn.14796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nurse prescribers (NPs) in memory services have a potentially important role in alleviating the burden of dementia on health care, but they require continuing professional development (CPD) specific to their scope of practice. AIMS To inform development of CPD workshops for mental health NPs working in memory services, a review of the literature was undertaken regarding role and CPD issues of this professional group. DESIGN AND METHODS Healthcare databases were searched using defined search terms alongside lateral searches. Study characteristics were extracted systematically, with results grouped thematically in the style of a narrative review. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, adapted for current methods (see Supporting Information File S1). RESULTS AND DISCUSSION Nine articles specifically addressing nurse prescribing in memory services were found. Studies from broader areas were drawn upon. Considerable variation was found for how the role of memory service NPs might be defined, due in part to variation in characteristics of memory services. NPs, other clinical staff and patients have provided positive feedback to the introduction of the role in memory services and elsewhere. However, concerns around prescribing cautiousness of NPs were apparent. Little clinical or economic outcome data were found to compare opinions and experiences to, with none for NPs in memory services. Literature addressing CPD issues for NPs in memory services was nonexistent. Studies from surrounding areas suggest a problem with availability of CPD opportunities for nurse prescribers. CONCLUSION This review highlights the paucity of literature for this area of inquiry, particularly for clinical, economic and other patient outcome data. RELEVANCE TO CLINICAL PRACTICE Variation in the little existing evidence suggests development of CPD opportunities should spend time understanding issues at the local level. The gap in the literature in this area may impact policy decisions in the UK and elsewhere.
Collapse
Affiliation(s)
- Luke Emrich-Mills
- Research Development Programme, Older People's Services, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Paul Collier
- Chatterton House, Older People's Services, Norfolk and Suffolk NHS Foundation Trust, Kings Lynn, UK
| | - Juniper West
- Research Development Programme, Older People's Services, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| |
Collapse
|
5
|
Cleary M, Kornhaber R, Sayers J, Gray R. Mental health nurse prescribing: A qualitative, systematic review. Int J Ment Health Nurs 2017; 26:541-553. [PMID: 28771922 DOI: 10.1111/inm.12372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 11/27/2022]
Abstract
The aim of the present qualitative, systematic review was to identify and summarize qualitative research that focussed on mental health nurse prescribing, synthesize findings, and outline key themes discerned. In November 2016, a systematic search was conducted for primary studies of the electronic databases PubMed, Excerpta Medica, (Embase), Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO. Of the 101 papers identified through the search strategy, 12 qualitative studies met the review inclusion criteria. These studies included perspectives from nurses, doctors, and patients/clients regarding their attitudes about, and experiences of, nurse prescribing. Three themes emerged from the review: (i) patient-centred care; (ii) professional role; and (iii) professional support. Nurse prescribers embrace a patient-centred approach, providing timely and effective medication management. Adequate education and continuing professional development inclusive of clinical supervision enable competency development in nurse prescribing, supportive professional relationships, and patient safety. Further research is necessary to establish safety and demonstrate enhanced clinical outcomes from mental health nurse prescribing.
Collapse
Affiliation(s)
- Michelle Cleary
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Rachel Kornhaber
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Jan Sayers
- School of Health Sciences, University of Tasmania, Sydney, New South Wales, Australia
| | - Richard Gray
- College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Snowden A, Young J. A screening tool for predicting gatekeeping behaviour. Nurs Open 2017; 4:187-199. [PMID: 29085645 PMCID: PMC5653390 DOI: 10.1002/nop2.83] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/28/2017] [Indexed: 11/30/2022] Open
Abstract
AIM To develop a typology and screening tool for gatekeeping behaviours by nurses responsible for recruitment in palliative care research. DESIGN Concurrent analysis. METHOD Two focus groups were conducted in 2015 with nine qualified hospice community nurses involved in recruitment to a trial in palliative care. The literature was searched for research into gatekeeping from 2000-2016. All narrative examples of gatekeeping activity were coded using gerunds. Common codes were then grouped and interpreted as a social process. RESULTS Gatekeeping is normal and should be expected. A continuum typology emerged, ranging from unintentional to active disengagement. Justification ranged from forgetting to deliberately not mentioning the study for fear of burdening patients. Viewing gatekeeping as a continuum allowed for the creation of a screening tool designed to collaboratively discuss and hence mitigate specific types of gatekeeping behaviour before they occur. This is a unique international contribution to this persistent issue.
Collapse
Affiliation(s)
| | - Jenny Young
- Edinburgh Napier UniversityEdinburghEH11 4BNUK
| |
Collapse
|
7
|
Fernández-Ortega P, Cabrera-Jaime S, Estrada-Masllorens JM. The Oncology Nurse Prescribing: A Catalonian Survey. Asia Pac J Oncol Nurs 2016; 3:108-114. [PMID: 27981146 PMCID: PMC5123529 DOI: 10.4103/2347-5625.177395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: This study identifies the capability, knowledge, and satisfaction of oncology nurses in Spain after approval of the nurse prescribing law in 2006. Methods: A descriptive cross-sectional study was conducted among 140 nurses in three cancer centers in Catalonia, Spain, by using convenience sampling method. The principal variables of this study were nurse satisfaction, knowledge about what products nurses are allowed to prescribe, the nurses’ perception of their own prescribing ability, and their opinion on education and training needs with regard to the new approved law. The secondary variables included years of professional experience, place of work, and sociodemographic variables. Data were collected during a 3 months period by using a piloted 29-item self-assessment questionnaire. Results: Analyses of univariate and bivariate data showed that 82.2% of the nurses were aware of the approved law, but 94.2% indicated that they lack information about it. The mean satisfaction with the approval of the law was 6.64 ± 1.76 (numerical scale 0-10). In addition, 68.1% and 55.1% of the nurses were prepared to prescribe medical devices and drugs, respectively. To date, 61.1% of the nurses prescribe medical devices and 66% prescribe pharmacological products daily. Conclusions: Nurses expressed general satisfaction with the approval of the Law 29/2006. Nurses currently provide prescriptions, but widespread knowledge of the allowed prescriptions is lacking.
Collapse
Affiliation(s)
- Paz Fernández-Ortega
- Department of Nursing Research, Catalan Institute of Oncology, Hospital Duran i Reynals, Badalona, Spain; Department of Public and Mental Health, Medical and Surgical Nursing Science, Faculty of Nursing, University of Barcelona, Barcelona, Spain
| | - Sandra Cabrera-Jaime
- Department of Nursing Research, Catalan Institute of Oncology, Hospital Duran i Reynals, Badalona, Spain; Department of Fundamental, Medical and Surgical Nursing Science, Faculty of Nursing, University of Barcelona, Barcelona, Spain
| | - Joan María Estrada-Masllorens
- Department of Fundamental, Medical and Surgical Nursing Science, Faculty of Nursing, University of Barcelona, Barcelona, Spain
| |
Collapse
|
8
|
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
| |
Collapse
|
9
|
Abstract
Some mental health nurses have now been prescribing for their clients for several years. When suitably qualified they can prescribe the same range of medication as medical staff. Concern was expressed that nurse prescribers might become more like doctors and as a result would sacrifice their nursing skills. The views of those who have their medication prescribed by mental health nurses as well as views of nurse prescribers, pharmacist prescribers, nurse managers and doctors were explored by using interviews and focus groups. Most participants saw the inclusion of prescribing in the nursing role as a benefit to clients. Rather than detracting from the nurse patient relationship, results from this study suggest that the nurse patient relationship was improved and more holistic care was provided. Nurse prescribing is well received by those who have experienced it. As nurse prescribing effects a change of power dynamics this could result in the need for less involvement of the medical profession in clients' care. As clients found nurses easier to talk to about their medication than doctors, medication concordance could be increased. Medication reconciliation could also be increased as medications no longer required by clients were more likely to be reduced or stopped by nurse prescribers. Discontinuing medication may indicate a new culture around mental health nurse prescribing. It may be that this trend has an impact on future service provision to clients. Results suggest that clients prefer to have their medication prescribed by nurses. Mental health nurse prescribing has been established in some areas in the UK for quite some time. Other than speculation that nurse prescribing would have a detrimental effect on the nurse-patient relationship, little has been written about the impact of nurse prescribing to date. Bradley and Nolan found that prescribing allowed nurses to overcome difficulties in the health-care system which would have previously delayed clients' access to medicines. Prescribing was believed to compliment many aspects of nursing and integrated previously diffuse aspects of the nursing role. Latter and Courtenay found that clients were generally satisfied with nurse prescribing. The aim of this study was to explore the impact mental health nurse prescribing has had on those involved. The views of clients, nurse prescribers, pharmacist prescribers, nurse managers and doctors were investigated. Questionnaires were used to gather demographic data and basic qualitative data. Focus groups and interviews were undertaken with 57 participants. The study was undertaken within one National Health Service Foundation Trust in England. Data analysis was guided by a framework approach. The majority of participants believed that the inclusion of prescribing in mental health nurses' roles improved the nurse-patient relationship, and five themes including the relationship, concordance, power, treatment approach and 'unprescribing' emerged. Trust was highly valued, and clients found nurses easier to talk to about their medication than doctors. Rather than detracting from the nurse-patient relationship, results from this study suggest that nurse prescribing enables mental health nurse prescribers to provide more holistic care than previously.
Collapse
Affiliation(s)
- J D Ross
- University of Aberdeen, Aberdeen, UK
| |
Collapse
|
10
|
Drennan VM, Grant RL, Harris R. Trends over time in prescribing by English primary care nurses: a secondary analysis of a national prescription database. BMC Health Serv Res 2014; 14:54. [PMID: 24499423 PMCID: PMC3922985 DOI: 10.1186/1472-6963-14-54] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 01/31/2014] [Indexed: 11/16/2022] Open
Abstract
Background A growing number of countries legislate for nurses to have medication prescribing authority although it is a contested issue. The UK is one of these countries, giving authority to nurses with additional qualifications since 1992 and incrementally widened the scope of nurse prescribing, most recently in 2006. The policy intention for primary care was to improve efficiency in service delivery through flexibility between medical and nursing roles. The extent to which this has occurred is uncertain. This study investigated nurses prescribing activities, over time, in English primary care settings. Methods A secondary data analysis of a national primary care prescription database 2006-2010 and National Health Service workforce database 2010 was undertaken. Results The numbers of nurses issuing more than one prescription annually in primary care rose from 13,391 in 2006 to 15,841 in 2010. This represented forty three percent of those with prescribing qualifications and authorisation from their employers. The number of items prescribed by nurses rose from 1.1% to 1.5% of total items prescribed in primary care. The greatest volume of items prescribed by independent nurse prescribers was in the category of penicillins, followed by dressings. However, the category where independent nurse prescribers contributed the largest proportion of all primary care prescriptions was emergency contraception (9.1%). In contrast, community practitioner nurse prescribers’ greatest volume and contribution was in the category of gel and colloid dressings (27%), medicated stockings (14.5%) and incontinence appliances (4.2%). There were slightly higher rates of nurse prescribing in areas with higher levels of socio-economic deprivation and fewer physicians per capita, but the correlations were weak and warrant further investigation. Conclusions The percentage of prescriptions written by nurses in primary care in England is very small in comparison to physicians. Our findings suggest that nurse prescribing is used where it is seen to have relative advantage by all stakeholders, in particular when it supports efficiency in nursing practice and also health promotion activities by nurses in general practice. It is in these areas that there appears to be flexibility in the prescribing role between nurses and general practitioners.
Collapse
Affiliation(s)
- Vari M Drennan
- Faculty of Health, Social Care & Education, Kingston University & St George's, University of London, London, UK.
| | | | | |
Collapse
|
11
|
Ross JD, Clarke A, Kettles AM. Mental health nurse prescribing: using a constructivist approach to investigate the nurse-patient relationship. J Psychiatr Ment Health Nurs 2014; 21:1-10. [PMID: 23413877 DOI: 10.1111/jpm.12039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/27/2022]
Abstract
Nurse prescribing has been embraced in many areas of nursing, but less so in mental health. Relatively few studies have been published in this field with even fewer asking clients who have their medication prescribed by a mental health nurse about their views. This paper reports findings concerning the mental health nurse prescriber-patient relationship. It draws on data from a qualitative study, which was undertaken in one mental health National Health Service Foundation Trust in England to ascertain the views of clients and other stakeholders (nurse prescribers, pharmacist prescribers, nurse managers and doctors) about nurse prescribing. Data were collected by interview (either face to face or telephone) or focus group. Following Framework analysis, findings revealed that clients liked to have their nurse prescribe for them as they valued the pre-established relationship. They also valued the consistency of seeing the same person and the relative ease of access to appointments. Doctors and nurse managers were aware of positive feedback from clients. Nurse prescribers believed that nurse prescribing provided an enhanced service to clients.
Collapse
Affiliation(s)
- J D Ross
- Honorary Lecturer in Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | | |
Collapse
|
12
|
Ross JD, Kettles AM. Mental health nurse independent prescribing: what are nurse prescribers' views of the barriers to implementation? J Psychiatr Ment Health Nurs 2012; 19:916-32. [PMID: 22295995 DOI: 10.1111/j.1365-2850.2011.01872.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This paper reports a pilot study exploring mental health nurse prescribers' perceptions of barriers to prescribing independently but also includes perceptions of barriers to supplementary prescribing. Current prescribing practice as experienced by mental health nurses suggests a need to identify and highlight these barriers. A mixed methodology explanatory sequential study was carried out over 3 months in Scotland in 2008 as part of a Master's degree. A questionnaire was completed by 33 mental health nurse prescribers. A focus group was conducted with 12 mental health nurse prescribers. Participants' views exposed a number of barriers to prescribing previously unidentified in a review of the relevant literature, and concurred with some previously documented barriers. Sixty per cent of mental health nurse prescribers in the study were not prescribing. Barriers identified in the study included concern about how prescribing impacts on the therapeutic relationship, role conflict, lack of support, inappropriateness of prescriber training, remuneration, qualifying to prescribing time, supervision, prescribing policies, clinical governance and nurse management. Nurse prescribing involves increased accountability and responsibility which is not currently recognized in job status or pay banding. Mental health nurse prescribing has the potential to enhance service provision, but until barriers to prescribing have been identified and addressed as part of the process of organizational change, nurse prescribing cannot achieve its maximum potential.
Collapse
Affiliation(s)
- J D Ross
- Centre for Advanced Studies in Nursing, Division of Applied Health Sciences, University of Aberdeen, UK.
| | | |
Collapse
|
13
|
Bowskill D, Timmons S, James V. How do nurse prescribers integrate prescribing in practice: case studies in primary and secondary care. J Clin Nurs 2012. [DOI: 10.1111/j.1365-2702.2012.04338.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dianne Bowskill
- School of Nursing Midwifery and Physiotherapy; Queens Medical Centre; University of Nottingham; Nottingham; UK
| | - Stephen Timmons
- Faculty of Medicine & Health Sciences; Queens Medical Centre; University of Nottingham; Nottingham; UK
| | - Veronica James
- School of Health and Life Sciences; Glasgow Caledonian University; Glasgow; UK
| |
Collapse
|
14
|
Hollins Martin CJ, Snowden A, Martin CR. Concurrent analysis: validation of the domains within the Birth Satisfaction Scale. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.710833] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Caroline J. Hollins Martin
- a School of Nursing, Midwifery and Social Work, College of Health and Social Care , University of Salford , Salford, Greater Manchester, UK
| | - Austyn Snowden
- b School of Health Nursing and Midwifery , University of the West of Scotland , Ayr , UK
| | - Colin R. Martin
- b School of Health Nursing and Midwifery , University of the West of Scotland , Ayr , UK
| |
Collapse
|
15
|
|
16
|
Snowden A, Martin C, Jomeen J, Hollins Martin C. Concurrent analysis of choice and control in childbirth. BMC Pregnancy Childbirth 2011; 11:40. [PMID: 21631910 PMCID: PMC3123250 DOI: 10.1186/1471-2393-11-40] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 06/01/2011] [Indexed: 11/10/2022] Open
Abstract
Background This paper reports original research on choice and control in childbirth. Eight women were interviewed as part of a wider investigation into locus of control in women with pre-labour rupture of membranes at term (PROM) [1]. Methods The following study uses concurrent analysis to sample and analyse narrative aspects of relevant literature along with these interviews in order to synthesise a generalisable analysis of the pertinent issues. The original PROM study had found that women experienced a higher degree of control in hospital, a finding that appeared at odds with contemporary notions of choice. However, this paper contextualises this finding by presenting narratives that lucidly subscribe to the dominant discourse of hospital as the safest place to give birth, under the premise of assuring a live healthy baby irrespective of their management type. Results This complex narrative is composed of the following themes: 'perceiving risk', 'being prepared', 'reflecting on experience', maintaining control' and relinquishing control'. These themes are constructed within and around the medical, foetocentric, risk averse cultural context. Primary data are presented throughout to show the origins and interconnected nature of these themes. Conclusions Within this context it is clear that there is a highly valued role for competent health professionals that respect, understand and are capable of facilitating genuine choice for women.
Collapse
Affiliation(s)
- Austyn Snowden
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley Campus, Paisley, PA1 2BE, Scotland, UK
| | | | | | | |
Collapse
|
17
|
Earle EA, Taylor J, Peet M, Grant G. Nurse prescribing in specialist mental health (part 1): the views and experiences of practising and non-practising nurse prescribers and service users. J Psychiatr Ment Health Nurs 2011; 18:189-97. [PMID: 21395910 DOI: 10.1111/j.1365-2850.2010.01672.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Non-medical prescribing is a relatively new competency that appears to benefit both service users and health professionals alike. However, little is known about its use in mental health settings. This single case study in one UK National Health Service (NHS) Trust aimed to look at these views and consider how the role can be developed further in light of this. Six service users and two nurses trained in nurse prescribing were individually interviewed. One trained nurse had been prescribing for the last 3 years; the other was trained but had never practised. Service users reported that nurse prescribing was more convenient and less anxiety provoking, an issue of particular importance for optimizing mental health services. Offering choice was deemed important; however, for some service users, information about why medication may be beneficial was highlighted as an unmet need in the prescribing process. The practising nurse prescriber described her experiences and credited a good structure of supervision and support from the team. Reasons why trained nurse prescribers may not be practising are discussed, with suggestions for future developments and guidance. This competence appears to work well in a mental health setting when conducted in a supported and structured way.
Collapse
Affiliation(s)
- E A Earle
- Doncaster Early Intervention Team, Rotherham, Doncaster & South Humber Mental Health NHS Foundation Trust (RdaSH), Doncaster, UK.
| | | | | | | |
Collapse
|