An exploration of how nurse prescribing is being used for patients with respiratory conditions across the east of England

Evaluation of postoperative results after a presurgical optimisation programme

BACKGROUND

Presurgical optimisation programmes decrease the risk of postoperative complications, reduce hospital stays and speed up patient recovery. They usually involve a multidisciplinary team addressing physical, nutritional and psychosocial issues. The objective of this study was to assess the results of implementing a presurgical optimisation programme led by a liaison nurse in patients undergoing major surgery in a primary general hospital.

METHODS

An observational, retrospective, descriptive, cross-sectional, comparative study based on the revision of patients' health records undergoing major surgery between January 2019 and December 2022. Patients entering the presurgical optimisation programme (intervention group) were compared with patients receiving usual medical care (control group). The presurgical optimisation programme consisted of oral nutritional supplementation, physical exercise, strengthening of lung capacity and psychological and emotional support. Frequency (%) of surgery complications and use of healthcare resources (duration of hospitalisation, time spent in the intensive care unit (ICU), and readmission) at day 30 were recorded. Descriptive statistics were applied.

RESULTS

Two hundred eleven patients (58.5% men, mean age: 65.76 years (SD 11.5), 75.2%. non-smokers; mean body mass index (BMI): 28.32 (SD 5.38); mean Nutritional Risk Score (NRS) 3.71 (SD 1.35; oncology diagnosis: 88.6%) were included: 135 in the intervention group, and 76 in the control group. The average duration of the presurgical optimisation programme was 20 days (SD 5). Frequency of postoperative complications was 25% (n = 33) in the intervention group and 52.6% (n = 40) in the control group (p < 0.001) [odds ratio (OR) = 3.4; 95% confidence interval (CI) (1.8; 6.2)]. 14.5% (n = 19) of patients in the intervention group and 34.2% (n = 26) in the control group had remote postoperative complications [OR = 3.1; 95% CI (1.6; 6.2)]. Patients in the intervention group spent fewer days in the hospital [mean 8.34 (SD 6.70) vs 11.63 (SD 10.63)], and there were fewer readmissions at 30 days (7.6% vs 19.7%) compared with the control group.

CONCLUSIONS

A presurgical optimisation programme led by a liaison nurse decreases the rate of immediate and late surgical complications and reduces hospital stays and readmissions in patients undergoing major surgery.

Attitudes of the public and medical professionals toward nurse prescribing: A text-mining study based on social medias

Objectives

This study aimed to explore the public and medical professionals' concerns and attitudes toward nurse prescribing using text-mining method to analyze social media data.

Methods

Python was used to automatically mine data related to the keywords "nurse prescribing" and "prescription" that were posted on four Chinese internet platforms between January 1, 2017, and November 1, 2022. The four Chinese internet platforms included social media sites such as Zhihu and Weibo, as well as medical forums like Aiaiyi Medical Hotspot and Dingxiangyuan Medicine. We conducted personnel, topic, and sentiment analysis techniques using SnowNLP, Bayesian Latent Dirichlet Allocation (LDA), and BosonNLP. Finally, we conducted content analysis using Nvivo 11 based on the results of the topic and sentiment analysis to obtain comprehensive and insightful results.

Results

We acquired 2,823 comments totaling 92,859 words on the four Internet platforms to conduct analysis. The analyze result showed that many public and medical professionals held a negative attitude toward nurse prescribing, and few had a prudent positive attitude. The public is concerned about the impact of nurse prescribing on medical professionals and the competency requirements for nurses. Medical professionals are concerned about the current and future status of nurse prescribing in China and the difficulties in implementing nurse prescribing.

Conclusion

Nurses should gradually gain recognition for their expertise and win the acceptance of the public and medical professionals on their ability of nursing prescribing by striving to enhance their professional capacity and self-authorization capabilities. Nurse administrators and educators need to recognize the advantages of nurse prescribing and address the challenges and issues in its implementation through promoting legislation, education, and heightening public awareness of its benefits.

Outline of nurse prescribing education programs: A scoping review

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.

Nurses' readiness to prescribe under supervision in Saudi Arabia: A cross-sectional study

Aim

To explore nurses' readiness to prescribe medications under supervision and identify associations between prescribing practices under supervision and demographic characteristics in Saudi Arabia.

Design

A cross-sectional study.

Methods

Using convenience sampling, this study used a 32-item survey to collect data on nurses prescribing medications under supervision between December 2022 and March 2023.

Results

A total of 379 nurses were recruited from different regions in Saudi Arabia. Approximately 7% (n = 30) of the participants were prescribing medications independently, and 70% (n = 267) expressed their likelihood of becoming prescribers. The highest motivating factors to become prescribers were improvement of patient care (52.2%) and contribution to the multidisciplinary team (52.0%). Most participants (60%-81%) agreed that prescribing medications under supervision would improve potential outcomes at the system, nurse, and patient levels. Availability of appropriate mentors or supervisors (72.9%) was the highest rated facilitating factor, followed by support of nursing colleagues (72%). Based on demographic characteristics, findings revealed significant differences in the: a) likelihood and motivators of becoming prescribers; b) required minimum qualification, years of experience, and continuing professional education hours to become prescribers; and c) type of organizations delivering educational programs for nurse prescribing.

Conclusion

Majority of nurses in Saudi Arabia favored becoming prescribers, and motivating factors were mostly relevant to optimizing patient care outcomes. Having the proper supervision was rated as the most facilitating factor for nurse prescribing. Nurses' views on potential outcomes, facilitating factors, and possible motivators varied based on nurses' demographical characteristics.

Implications for the professional and/or patient care

Nurses favored prescribing under supervision to improve patient care outcomes, which is an opportunity to expand the benefits of health services, including easy access to healthcare.

Impact

Results revealed that nurses support the implementation of prescribing practice under supervision. Thus, the findings may inform practice change in Saudi Arabia to allow prescribing under supervision, which was perceived to have a positive impact on patient care outcomes.

Reporting Method

This study adhered to STROBE guidelines.

Experiences of Spanish nurses in the rollout of nurse prescribing: a qualitative study

Introduction

Nurse prescribing has legal recognition in Spain, after a long regulatory process, with confusing, changing legislation that does not fully coincide with the reality of nurses' practice. There is currently no research available on how nurses have experienced the rollout of nurse prescribing. The objective of this study is to describe the experiences of nurses in the rollout of nurse prescribing in the province of Barcelona, Spain.

Method

A descriptive qualitative study with intentional sampling was carried out between March 2021 and July 2022. The data were collected through semi-structured individual interviews and discussion groups. The participants were 24 nurses working in the province of Barcelona who were accredited in nurse prescribing or involved in the rollout of nurse prescribing. The data were analyzed using thematic analysis, following Braun and Clark. The COREQ checklist was used to report findings.

Results

We describe nurses' responses on the following themes: internal and external barriers; strategies to support nurse prescribing in the initial rollout and proposals for improvement; and factors linked to nurses' satisfaction.

Discussion

The regulatory process has provided a safety framework for nurse prescribing. Strategies are needed for its comprehensive development and its acceptance among the public. The findings give visibility to nurse prescribing internationally.

Dermatology nurse prescribing in China: a Delphi method

Objectives: To identify the dermatological system drugs that may be prescribed by Chinese dermatological nurses through expert consensus.

Methods: A 2-round study, consisting of 32 medical and nursing experts, was conducted using the Delphi method from September 2019 to June 2020. Microsoft Excel 2019 and IBM SPSS Ver. 22 were used to analyze the results of the consultations.

Results: A total of 63 drugs across 13 categories were identified as relevant to Chinese nurses working in dermatological departments. Among these drugs, 1 drug was generally prescribed independently, 17 drugs tended to be prescribed collaboratively, and 45 were prescribed either independently or in collaboration with others.

Conclusions: This expert consensus determines the prescription drugs that may be prescribed by dermatology nurses in China, which can be used as the key content of prescription drug training for dermatology nurses in future. The results of the study could provide a basis for the implementation of nurses’ prescription rights in China in future and provide a reference for the formulation of relevant legislation on nurses’ prescription rights.

Speech pathology prescribing in the outpatient setting: A review of requirements, considerations and barriers

BACKGROUND

As health systems face increasing demands, non-medical prescribing is a workforce redesign strategy adopted within some services. Despite successful implementation in other professional groups, non-medical prescribing within speech pathology (SP) has not yet been described.

AIMS

To provide a descriptive account of the development and planned implementation of two SP prescribing models.

METHODS & PROCEDURES

The evolution of two SP-led prescribing models, including relevant training and credentialing, for use of (1) nystatin oral drops (100,000 units/mL); and (2) lidocaine (lignocaine) and phenylephrine nasal spray (5 mg/500 μg/spray), in the outpatient setting is detailed. Challenges to implementation are outlined.

MAIN CONTRIBUTION

The development of relevant governance structures, a research evidenced-based project evaluation framework, and an overview of training pathways and credentialing was successfully completed. However, implementation of the models was unable to be achieved. A thorough review of the requirements and a discussion of contextual considerations that had a negative influence on the implementation of SP-led prescribing within this specific service context is provided.

CONCLUSIONS & IMPLICATIONS

The successful implementation of SP-led prescribing is complex and highly context dependent. This work offers a discussion and review of the complexities of introducing a non-medical prescribing model in an outpatient hospital setting.

WHAT THIS PAPER ADDS

What is already known on the subject Allied Health prescribing is an emerging practice area aiming to reduce current pressures on health services. SP-led prescribing has not been thoroughly investigated in the Australian context. What this study adds to existing knowledge This study describes the development of a SP-led prescribing process in the outpatient setting, and a thorough review and discussion of the drivers and barriers to the model's implementation. What are the potential or actual clinical implications of this work? The successful implementation of SP-led prescribing was identified to be complex from a legislative and operational perspective, as well as being highly context dependent. This study further highlights the importance of a thorough context evaluation and workflow mapping prior to full-scale implementation of SP prescribing trials.

Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review

OBJECTIVES

To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders' views on IP in primary care and identify barriers and facilitators influencing implementation.

SETTING

UK primary/community care.

PARTICIPANTS

Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data were extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors.

PRIMARY AND SECONDARY OUTCOME MEASURES

N/A.

RESULTS

Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: (1) 'Preparation', (2) 'Training', (3) 'Transition' and 4) 'Sustainment'. Enhancement, substitution and role-specific implementation models reflected three main ways that the IP role was used in primary care.

CONCLUSIONS

In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world.

PROSPERO REGISTRATION NUMBER

CRD42019124400.

Introducing nurse prescribing in Gibraltar: the impact on palliative care

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.

Effect of high quality nursing on alleviating negative emotions in patients with advanced lung cancer

OBJECTIVE

To analyze the risk factors of moderate and severe depression and to study the effect of high quality nursing on alleviating negative emotions and improving quality of life of patients with advanced lung cancer.

METHOD

A total of 100 patients with advanced lung cancer were collected from our hospital. According to the SDS score before the nursing, the patients with SDS score ≤62 and >52 were enrolled in the mild depression group, and those with SDS score >62 were enrolled in the moderate, severe depression group. The risk factors that make mild depression develop into moderate/severe depression were studied. The patients were randomly divided into a control group (n = 50) and an observation group (n = 50). The patients in both groups were given routine nursing, and those in the observation group received high quality nursing on the basis of routine nursing. The QOL-C30 was used to evaluate the changes in quality of life. The SDS (Self-Rating Depression Scale) and SAS (Self-rating Anxiety Scale) were used for assessing the degree of anxiety and depression. The incidence of complications and the nursing satisfaction of patients were observed.

RESULTS

The multi-factor Logistic regression results showed that gender (OR: 3.398, 95% CI: 1.020-11.324), course of disease (OR: 0.676, 95% CI: 0.562~0.814), educational level (OR: 2.073, 95% CI: 1.165-3.688), and family income (OR: 1.676, 95% CI: 9.020) were the influence factors of moderate and severe depression. The QOL-30 score in the observation group was higher than those in the control group after nursing, and the changes in the observation group were significantly greater than those in the control group (P<0.05). After nursing, the observation group had much lower SAS and SDS scores and significantly greater changes than the control group (P<0.5). The total incidence of complications in the control group was statistically greatly higher than that in the observation group (P<0.05). The nursing satisfaction in the control group was statistically much lower than that in the observation group (P<0.5).

CONCLUSIONS

Gender, course of disease, educational level, and family income are independent influencing factors of moderate and severe depression. High quality nursing can effectively improve the anxiety and depression, and quality of life of patients, which is worthy of being popularized clinically.

Iranian nurses' attitudes towards the necessity and barriers to developing nurse prescribing roles

Background

Prescribing medication by nurses as an approach to rational drug prescription has been proposed in many countries. Nursing prescribing is an effective measure in the management of critically ill patients admitted to intensive care units (ICU). This study investigated the attitude of ICU nurses towards the necessity and the barriers to developing nursing prescribing.

Materials and methods

In this cross-sectional study, 136 ICU nurses were included by stratified random sampling. The data collection tool was the researcher-made questionnaire. Cronbach’s alpha method was used to evaluate the reliability of the instrument. The validity of the instrument was also verified by the content validity method. To collect the data, the researcher referred to the nurses’ workplace and provided them with a questionnaire and collected it after completion.The collected data were analyzed by IBM SPSS 16 using descriptive and inferential statistics.

Results

It was revealed that 58.8 % of nurses were familiar with the term ‘nursing prescribing’; a majority (92.1 %) of whom considered it vital to develop this role in the ICU. Moreover, 86 % (n = 98) of the nurses assumed that it is possible to implement this role in ICU. The most potential barriers to its implementation were lack of legitimacy, disapproval of physicians, and the reluctance of nursing managers.

Conclusions

Most nurses maintained a positive attitude towards nursing prescribing; hence, its legitimacy seems vital in ICUs. For the development of the ‘nurse prescribing’ role, the Nursing System Organization may be helpful.

The NUPHAC-EU Framework for Nurses' Role in Interprofessional Pharmaceutical Care: Cross-Sectional Evaluation in Europe

Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses’ responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses’ level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86–97%), patient education (85–96%), medication safety (83–95%), monitoring adherence (82–97%), care coordination (82–95%), and drug monitoring (78–96%). The most prevalent level of responsibility was ‘with shared responsibility’. Prescription management tasks were considered to be nurses’ responsibility by 48–81% of the professionals. All contextual factors were indicated as being relevant for nurses’ role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks.

Time for change? A qualitative exploration of the educational preparation and subsequent continuing professional development needs of nurse and midwife prescribers

AIM/OBJECTIVE

The aim of this study was to explore nurse and midwife prescribers' perception of their educational preparation for the role and identify continuing professional development (CPD) requirements to generate practitioner-based knowledge with the potential to inform education and research, policy and practice.

BACKGROUND

Educational preparation for the nurse and midwife prescribing role has remained relatively unchanged since its introduction and follows a model whereby practitioners engage in theoretical learning and learning situated within the clinical environment, facilitated by a dedicated medical mentor. No significant examination of this preparation has been undertaken in Ireland since 2009.

DESIGN

This was a qualitative study, guided by elements associated with hermeneutic phenomenology.

METHODS

Following research ethics approval and informed consent, 16 participants from 2 maternity hospitals participated in one-to-one audio recorded semi-structured interviews.

RESULTS

Participants experience of the education programme varied with some acknowledging the importance of a broad pharmacological module whereas others believed it to be irrelevant given their prescribing scope was in many instances quiet narrow. The experience of being mentored by a medical doctor ranged from a positive learning experience to one which did not contribute to learning. Barriers to engaging with CPD were identified along with advancements in the practice arena which identify additional CPD requirements.

CONCLUSIONS

This study has generated practitioner-based knowledge which provides direction for future developments in the educational preparation of nurse and midwife prescribers, particularly around pharmacology and mentorship and outlines specific CPD requirements for practitioners.

Factors influencing the prescribing behaviour of independent prescriber optometrists: a qualitative study using the Theoretical Domains Framework

PURPOSE

Whilst the number of independent prescriber (IP) optometrists in the United Kingdom is increasing, there is limited evidence describing the experiences of these individuals. The Theoretical Domains Framework (TDF) provides an evidence-based approach to understand determinants of behaviour. This conceptual framework can enable mapping to the COM-B behaviour change model and the wider Behaviour Change Wheel to develop interventions to optimise behaviour-change and healthcare processes more systematically. The study aimed to use the TDF to identify the factors that influence independent prescribing behaviour, and to map these findings to the COM-B system to elucidate the relevant intervention functions, in order to identify the support required by optometrist prescribers.

METHODS

Using a qualitative design, semi-structured interviews based on the TDF were undertaken with independent prescriber optometrists. Thematic analysis was used to identify themes inductively, which were then deductively mapped to the TDF and linked to the COM-B.

RESULTS

Sixteen participants (9 male, 7 female; median age 45 years, range 28-65 years), based in community (n = 10) and hospital (n = 6) settings, were interviewed. Eleven of the TDF domains were found to influence prescribing behaviour. Findings highlighted the need for good communication with patients (TDF domain: Skills, COM-B: Capability); confidence (TDF domain: Beliefs about capabilities, COM-B: Motivation); good networks and relationships with other healthcare professionals, e.g., general practitioners (TDF domain: Social influences, COM-B: Opportunity; TDF domain: Social/professional role and identity, COM-B: Motivation); the need for appropriate structure for remuneration (TDF domain: Reinforcement, COM-B: Motivation; TDF domain: Social/professional role and identity, COM-B: Motivation) and the provision of professional guidelines (TDF domain: Knowledge, COM-B: Capability; TDF domain: Environmental context and resources, COM-B Opportunity).

CONCLUSIONS

Having identified theory-derived influencers on prescribing decisions by optometrists, the findings can be used to develop a structured intervention, such as a support package to help optimise prescribing by optometrists, with the ultimate goal of eye care quality improvement.

Prescription for care

Nursing and midwifery practice has evolved, with many nurses and midwives now holding prescriptive authority. This paper reports on findings in relation to care which formed part of a broader qualitative study which aimed to explore the experiences of nurse and midwife prescribers in the maternity setting in Ireland. Following research ethics approval, 16 nurse/midwife prescribers participated in one-to-one audio recorded semi-structured interviews. Prescriptive authority both enhances the caring role of the nurse/midwife and supports safer care. The ways in which this happened have been illuminated though barriers have also been identified. In order for the full potential of nurses/midwives with prescriptive authority to be realised, measures such as increasing the number of prescribers and the provision on non-interruption zones need to be considered.

Independent prescribing in primary care: A survey of patients', prescribers' and colleagues' perceptions and experiences

Besides doctors and dentists, an increasing range of healthcare professionals, such as nurses, pharmacists and podiatrists, can become independent prescribers (IPs). As part of an evaluation for independent prescribing funded training, this study investigated views and experiences of IPs, their colleagues and patients about independent prescribing within primary care. Questionnaires capturing quantitative and qualitative data were developed for IPs, their colleagues and patients, informed by existing literature and validated instruments. IPs were identified following independent prescribing training funded by Health Education England Northwest in 2015-2017. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically. Twenty-four patients, 20 IPs and 26 colleagues responded to the questionnaires. Most patient respondents had a long-term medical condition (n = 17) and had regular medicines prescribed (n = 21). IPs were nurses (n = 14), pharmacists (n = 4), one podiatrist (n = 1) and one was unknown. Half of the IPs were current prescribers (n = 10), the other half were still training (to become) IPs (n = 10). Colleague respondents were doctors and nurses (n = 15) other healthcare professionals (n = 8) and practice managers (n = 3). Both current IPs (n = 9) and colleague respondents (n = 25) (strongly) agreed that independent prescribing improved the quality of care provided for patients. Nearly all colleagues were supportive of independent prescribing and believed that they worked well with IPs (n = 25). Patients' perceptions and experiences of their consultations with the IP were mostly positive with the vast majority of respondents (strongly) agreeing that they were very satisfied with their visit to the IP (n = 23). Key barriers and enablers to independent prescribing were centred on IPs' knowledge, competence and organisational factors such as workload, effective teamwork and support from their colleagues. Findings from this study were mainly positive but indicate a need for policy strategies to tackle longstanding barriers to independent prescribing. However, a larger sample size is needed to confirm findings.

Facilitators and barriers to non-medical prescribing - A systematic review and thematic synthesis

Introduction

Non-medical prescribing has the potential to deliver innovative healthcare within limited finances. However, uptake has been slow, and a proportion of non-medical prescribers do not use the qualification. This systematic review aimed to describe the facilitators and barriers to non-medical prescribing in the United Kingdom.

Methods

The systematic review and thematic analysis included qualitative and mixed methods papers reporting facilitators and barriers to independent non-medical prescribing in the United Kingdom. The following databases were searched to identify relevant papers: AMED, ASSIA, BNI, CINAHL, EMBASE, ERIC, MEDLINE, Open Grey, Open access theses and dissertations, and Web of Science. Papers published between 2006 and March 2017 were included. Studies were quality assessed using a validated tool (QATSDD), then underwent thematic analysis. The protocol was registered with PROSPERO (CRD42015019786).

Results

Of 3991 potentially relevant identified studies, 42 were eligible for inclusion. The studies were generally of moderate quality (83%), and most (71%) were published 2007–2012. The nursing profession dominated the studies (30/42). Thematic analysis identified three overarching themes: non-medical prescriber, human factors, and organisational aspects. Each theme consisted of several sub-themes; the four most highly mentioned were ‘medical professionals’, ‘area of competence’, ‘impact on time’ and ‘service’. Sub-themes were frequently interdependent on each other, having the potential to act as a barrier or facilitator depending on circumstances.

Discussion

Addressing the identified themes and subthemes enables strategies to be developed to support and optimise non-medical prescribing. Further research is required to identify if similar themes are encountered by other non-medical prescribing groups than nurses and pharmacists.

Nurse prescribing in primary care: a metasynthesis of the literature

Aim The aim of this metasynthesis was to develop an understanding of the existing theoretical perspectives around nurse prescribing and to identify any gaps in knowledge, which would support further research into the lived experience of the nurse prescriber in the primary care setting.

BACKGROUND

Nurse prescribing has been the focus of many research studies since its introduction, with many benefits to the patient, the prescriber and service identified; however, there remains variation in the utilisation of the prescribing qualification, particularly in primary care settings. Although a range of quantitative and qualitative studies have been undertaken, which aimed to explore the influences on prescribing, few have used a research methodology that supports the in-depth exploration of the nurse prescriber's experience.

METHODS

An extensive literature search was undertaken in April 2015 (20-24), which included UK and non-UK studies since 1999. Inclusion and exclusion criteria were applied to search for studies in which participants included nurse prescribers who practiced in primary or community care settings. Studies that only used a quantitative methodology and those not available in English were excluded. The literature search yielded 124 papers, with 50 papers remaining after the initial screen of full papers against the inclusion/exclusion criteria. The papers were reviewed and graded for their quality, with a further 13 papers excluded. A three-step qualitative analysis technique of metasynthesis was applied to the remaining 37 papers. Identification of similarities and differences enabled first-order interpretations to be identified, which were grouped into broader themes (second-order interpretations) by identifying concepts that applied to two or more studies. Further interpretation through synthesis of translation enabled third-order interpretations to emerge. Findings From the metasynthesis of the 37 papers, nine themes emerged: patient-centred care; benefits to the service; the need for knowledge; professional accountability and boundary setting; safety consciousness; barriers to effective prescribing; role preservation; power-shifts and inter-professional relationships; and culture of prescribing.

Antibiotics for acute respiratory tract infections: a mixed-methods study of patient experiences of non-medical prescriber management

OBJECTIVE

To (1) explore patients' expectations and experiences of nurse and pharmacist non-medical prescriber-led management of respiratory tract infections (RTIs), (2) examine whether patient expectations for antibiotics affect the likelihood of receiving them and (3) understand factors influencing patient satisfaction with RTI consultations.

DESIGN

Mixed methods.

SETTING

Primary care.

PARTICIPANTS

Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers (NMPs).

RESULTS

Patients had multiple expectations of their consultation with 43% expecting to be prescribed an antibiotic. There was alignment between self-reported patient expectations and those perceived by NMPs. Patient expectations for non-antibiotic strategies, such as education to promote self-management, were associated with receipt of those strategies, whereas patient expectations for an antibiotic were not associated with receipt of these medications. 'Patient-centred' management strategies (including reassurance and providing information) were received by 86.7% of patients. Regardless of patients' expectations or the management strategy employed, high levels of satisfaction were reported for all aspects of the consultation. Taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions and lack of time restrictions were each reported to contribute to patient satisfaction.

CONCLUSIONS

NMPs demonstrate an understanding of patient expectations of RTI consultations and use a range of non-antibiotic management strategies, particularly those resembling a patient-centred approach. Overall, patients' expectations were met and prescribers were not unduly influenced by patient expectations for an antibiotic. Patients were satisfied with the consultation, indicating that strategies used by NMPs were acceptable. However, the lower levels of satisfaction among patients who expected but did not receive an antibiotic indicates that although NMPs appear to have strategies for managing RTI consultations, there is still scope for improvement and these prescribers are therefore an important group to involve in antimicrobial stewardship.

Deprescribing in older adults: a new concept for nurses in administering medicines and as prescribers of medicine

Deprescribing is a new and emerging theme in the care of older adults living with multimorbidities including frailty. Deprescribing requires a comprehensive review of risk and benefits of a medication in the context of the quality of remaining life and patient and family priorities and preferences. Nursing to date has not engaged with this issue, yet in their roles administering medicines and prescribing medicines they are a fundamental part of the pathway in deprescribing decisions and in supporting patients to make such decisions. In administering medicines, nurses are in a position to observe the degree of difficulty or burden experienced by patients due to polypharmacy or side effects of medicines. While as prescribers for adults with multimorbidities, active review of the risk and benefits of all medicines using evidence-based instruments is part of prescribing responsibility. This article is calling for a critical examination of nurses' roles in deprescribing and in supporting patients to make informed choices about their treatment. There is a need to articulate the role of nursing in this emerging area of medicines management and contribute to a multidisciplinary discourse on deprescribing. Equally professional standards and continuous professional development for nurses as prescribers and administrators of medicines needs to reflect the complexity of an older population. A deprescribing ethos challenges nurses to actively elicit patients' experiences of medicines burden, while nurse prescribers should recognise that appropriate deprescribing is as much a part of their role as appropriate prescribing.

RN Prescribing: An Expanded Role for Nursing

PURPOSE

With the implementation of the Affordable Care Act, recommendations of the Future of Nursing Report, and recent regulatory changes by state boards of nursing, registered nurse (RN) roles are expanding. In this article, we advocate for RN prescribing as an expanded role in the United States.

METHODS

We reviewed the literature on RN prescribing, the background in both high- and low-resource countries, levels of prescribing, specialized settings for RN prescribing, both RN and patients views/perceptions of prescribing, and evaluation research. From this review, we developed a proposal for RN prescribing.

FINDINGS

Due to expansion of RNs into prescribing worldwide to meet unmet healthcare needs in both primary and specialty settings, we propose a role for RN prescribing within both primary care and outpatient specialty settings. The differences between RN and advanced practice RN prescribing are defined, and U.S.-based regulatory challenges are examined.

CONCLUSION

Considering unmet healthcare needs and patients' need for medication and medication education, we advocate for RN prescribing as expanded scope and role change for experienced RNs to practice to the highest level of their education.