Nurses' decision-making related to administering as needed psychotropic medication to persons with dementia: an empty systematic review

Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

Background and objectives: Highly widespread use of pro re nata (PRN) medicines in various healthcare settings is a potential area for improper medication prescription and administration leading to patient harm. This study aimed to summarize and integrate the findings of all relevant individual studies regarding the practical considerations of PRN medicines management including strategies and interventions by healthcare professionals for safe prescription, dispensing, administration, monitoring, and deprescription of PRN medicines in healthcare settings. Methods: An integrative systematic review on international databases were performed. Electronic databases including Web of Knowledge, Scopus, PubMed (including MEDLINE), and Cinahl were searched to retrieve articles published until end of May 2021. Original qualitative, quantitative, and mixed methods studies written in English were included with a focus on PRN medicines management in healthcare settings. Research synthesis using the narrative method was performed to summarise the results of included studies. Results: Thirty-one studies on PRN medicines in healthcare settings by different healthcare providers were included after the screening of the databases based on eligibility criteria. They were published from 1987 to 2021. The majority of studies were from Australia, the United States, Canada, and the United Kingdom and were conducted in psychiatric settings. Given variations in their purposes, methods, and outcomes, the research synthesis was conducted narratively based on diversities and similarities in findings. Eight categories were developed by the authors as follows: "PRN indications and precautionary measures," "requirements of PRN prescription," "interventions for PRN administration," "monitoring and follow up interventions," "deprescription strategies," "healthcare professionals' role," "participation of patients and families," and "multidisciplinary collaboration." Each category consists of several items and describes what factors should be considered by healthcare professionals for PRN medicines management. Conclusion: The review findings provide insights on the practical considerations of PRN medicines management in clinical practice. The suggested list of considerations in our review can be used by healthcare professionals for optimal PRN medicines management and safeguarding patient care.

Challenging Behaviors as a Relational Phenomenon: Findings From a Qualitative Study in a Nursing Home in Norway

Challenging behaviors are common in nursing homes. Drawing on rich qualitative data from fieldwork and in-depth interviews with staff in a nursing home in Norway, we will explore (a) how challenging behaviors unfolded, and (b) how such incidents were handled and talked about among staff. Our data is presented firstly through Anna's story as an introduction to discussing: (1) the problem of contrasting approaches to avoid challenging behaviors and (2) the importance of knowing the resident. Christopher's story then works as an introduction to discuss (3) the importance of understanding how to prioritize, (4) the importance of caring with connection and concern, and (5) the importance of sharing success stories among staff. In conclusion we argue that we should develop a more flexible organizational culture and a staffing practice in which care workers are empowered to use their discretion and thus to care for the residents with more connection and sensitivity than is currently the case.