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Helgesen AK, Nome CM, Stenbjerg JK, Arnesen MH, Aardalen TR, Dilles T, Grøndahl VA. Pharmaceutical Care in Primary Healthcare-A Study of Nurses', Pharmacists', and Physicians' Experiences of Interprofessional Collaboration. Healthcare (Basel) 2024; 12:1100. [PMID: 38891175 PMCID: PMC11171861 DOI: 10.3390/healthcare12111100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Implementation of pharmaceutical care for the benefit of patients and health services has been highlighted worldwide. Interprofessional collaboration between nurses, pharmacists, and physicians may contribute to raising awareness of pharmacological challenges, increasing quality, and minimising errors in pharmaceutical care. This study aimed to investigate how nurses, pharmacists, and physicians experience interprofessional collaboration in pharmaceutical care within community healthcare in Norway. The study had an explorative and descriptive design with a qualitative approach. Individual interviews were conducted with 12 healthcare personnel with key roles in pharmaceutical care within community healthcare services. The data were analysed using systematic text condensation. The results revealed three categories and four subcategories: The category "Professional challenges" contained the subcategories "Blurred responsibilities" and "The importance of trust and continuity". The category "Organisational barriers" contained the subcategories "Lack of information exchange and suitable communications channels" and "Lack of time and meeting places". The third category was "Nurses-the important link". This study reveals challenges to and factors of success in increasing high-quality and safe pharmaceutical care, knowledge that can be used in quality work in the community health services and as input in curriculum development for the three professions.
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Affiliation(s)
- Ann Karin Helgesen
- Faculty of Health, Welfare, and Organisation, Østfold University College, P.O. Box 700, NO-1757 Halden, Østfold, Norway;
| | - Carina Marie Nome
- Haugvoll Nursing Home, Sarpsborg Kommune, Myrvollveien 25, NO-1743 Klavestadhaugen, Sarpsborg, Norway
| | - Julie Kjølhede Stenbjerg
- Emergency Room, Fredrikstad Kommune, Jens Wilhelmsens Gate 1, NO-1671 Kråkerøy, Fredrikstad, Norway
| | - Marie Helen Arnesen
- Home Nursing Care Centre, Fredrikstad Kommune, Faunsvei 3-6, NO-1654 Sellebakk, Fredrikstad, Norway
| | | | - Tinne Dilles
- Centre for Research and Innovation in Care, Nurse and Pharmaceutical Care, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium;
| | - Vigdis Abrahamsen Grøndahl
- Faculty of Health, Welfare, and Organisation, Østfold University College, P.O. Box 700, NO-1757 Halden, Østfold, Norway;
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Cucolo DF, de Campos Oliveira JL, Rossit RAS, Mininel VA, Perroca MG, Silva JAMD. Effects of interprofessional practice on nursing workload in hospitals: A systematic review. Int J Health Plann Manage 2024; 39:824-843. [PMID: 38353613 DOI: 10.1002/hpm.3779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE To synthesise scientific evidence on interprofessional practice in hospital care and the effects on nursing workload. METHODS Systematic mixed method review, registered in PROSPERO (CRD42021225627) and conducted in the following databases: CINAHL, Medline, Web of Science and Scopus, with no restrictions on the publication period of the studies. Primary studies were recruited on nurses' interprofessional practice (actions and interactions with other professional categories) in hospitals and the effects on one or more dimensions of nursing workload (quantitative, qualitative, physical, cognitive, emotional, time and variation). Scientific articles available in open access, in English, Spanish or Portuguese, were included. The searches were carried out in January 2021. The studies were evaluated by pairs of independent researchers to verify methodological quality, through the Mixed Method Appraisal Tool, and data extraction. To summarise the studies, thematic analysis was adopted. RESULTS A total of 1774 publications were assessed for eligibility and 17 studies were included. Of these, two were mixed methods, four were qualitative, and 11 were quantitative, published between 2011 and 2020. The main scenarios investigated were Intensive Care Units and/or Inpatient Units. During data analysis, three thematic categories emerged: Interprofessional practice in coping with emotional overload; Time dedicated by nurses to professional communication; and Working conditions and patient care. The third category consisted of three subthemes: Conflict and flexibility in the context of practice; Working conditions and interprofessional practice; and Effects on patient care. CONCLUSIONS The evidence points to the emotional overload of nurses in the face of uncooperative practices. Interprofessional actions, especially communicative ones, demand nurses' time and impact the care provided. The results contribute to political decisions and health work management.
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Affiliation(s)
- Danielle Fabiana Cucolo
- Postgraduate Program, Multiprofessional Residency in Health at the Pontifícia Universidade Católica de Campinas, Campinas, Brazil
- Postgraduate Program, Masters Course in Nursing at the Medical School of São José do Rio Preto, São José do Rio Preto, Brazil
| | - João Lucas de Campos Oliveira
- Nursing School of the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Postgraduate Program in Nursing at the UFRGS and Clinical Nursing Service at Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Vivian Aline Mininel
- Postgraduate Nursing Program at the Federal University of São Carlos (UFSCar), Sao Carlos, Brazil
- Nursing Department at the UFSCar, Sao Carlos, Brazil
- Center de Recherche sur le Travail et le Développement, Conservatoire National des Arts et Métiers (CRDT-Cnam), Paris, France
| | - Marcia Galan Perroca
- Postgraduate Program, Masters Course in Nursing at the Medical School of São José do Rio Preto, São José do Rio Preto, Brazil
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Crunenberg R, Charles C, Lallemand A, Buret L, Philippe G, Ethgen O. Interpretative phenomenological analysis of the collaboration among healthcare professionals in the nursing home setting. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100424. [PMID: 38516547 PMCID: PMC10955404 DOI: 10.1016/j.rcsop.2024.100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Background The theory of planned behavior (TPB) postulates that behavioral performance is guided by the intention to perform that behavior, influenced by attitudes, subjective norms, and perceived behavioral control. This framework can be applied to studying interprofessional collaboration among healthcare professionals to enhance patient safety and public health within nursing homes. Objectives This study aimed to explore the roles of physicians, pharmacists, and nurses in the interprofessional collaboration process while identifying facilitators and barriers to effective collaboration among healthcare professionals. Methods A qualitative interpretative phenomenological analysis (IPA) was carried out. Individual semi-structured interviews were conducted with 19 healthcare professionals. Qualitative data were then integrated and analyzed through the lens of the TPB. Findings The IPA revealed the ten following themes, considered as both facilitators and barriers to interprofessional collaboration among healthcare professionals in the nursing home setting: communication, roles and responsibilities, willingness and recognition of collaboration's importance, mutual knowledge, trust, confidence, support from decision-makers, protocols, and technology were considered as facilitators while distance was considered as a barrier. Conclusion Enhancing pharmacist-physician collaboration and refining pharmacist-nurse collaboration were essential goals. Intention for collaboration was influenced by attitudes (such as communication and mutual understanding), subjective norms (including support from decision-makers), and perceived behavioral control (such as confidence and adherence to protocols and technology). Addressing these factors could improve collaboration, enhancing residents' quality of life and professionals' sense of achievement.
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Affiliation(s)
- Robin Crunenberg
- Faculty of Medicine, Department of Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium
- Faculty of Medicine, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium, Liège, Belgium
| | - Camille Charles
- Faculty of Medicine, Department of Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium
| | - Alice Lallemand
- Faculty of Medicine, Department of Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium
| | - Laetitia Buret
- Faculty of Medicine, Department of General Medicine, University of Liège, Liège, Belgium
| | - Geneviève Philippe
- Faculty of Medicine, Department of Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium
| | - Olivier Ethgen
- Faculty of Medicine, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium, Liège, Belgium
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De Baetselier E, Dijkstra NE, Batalha LM, Carvalho Ferreira PA, Filov I, Grøndahl VA, Heczkova J, Helgesen AK, Jordan S, Karnjuš I, Kolovos P, Langer G, Lillo-Crespo M, Malara A, Padyšaková H, Prosen M, Pusztai D, Raposa B, Riquelme-Galindo J, Rottková J, Sino CGM, Talarico F, Tingle N, Tziaferi S, Van Rompaey B, Dilles T. Cross-sectional evaluation of pharmaceutical care competences in nurse education: how well do curricula prepare students of different educational levels? BMC Nurs 2024; 23:96. [PMID: 38321491 PMCID: PMC10845807 DOI: 10.1186/s12912-023-01646-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/09/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Nurses play an important role in interprofessional pharmaceutical care. Curricula related to pharmaceutical care, however, vary a lot. Mapping the presence of pharmaceutical care related domains and competences in nurse educational programs can lead to a better understanding of the extent to which curricula fit expectations of the labour market. The aim of this study was to describe 1) the presence of pharmaceutical care oriented content in nursing curricula at different educational levels and 2) nursing students' perceived readiness to provide nurse pharmaceutical care in practice. METHODS A quantitative cross-sectional survey design was used. Nursing schools in 14 European countries offering educational programs for levels 4-7 students were approached between January and April 2021. Through an online survey final year students had to indicate to what extent pharmaceutical care topics were present in their curriculum. RESULTS A total of 1807 students participated, of whom 8% had level 4-5, 80% level 6, 12% level 7. Up to 84% of the students indicated that pharmaceutical care content was insufficiently addressed in their curriculum. On average 14% [range 0-30] felt sufficiently prepared to achieve the required pharmaceutical care competences in practice. In level 5 curricula more pharmaceutical care domains were absent compared with other levels. CONCLUSIONS Although several pharmaceutical care related courses are present in current curricula of level 4-7 nurses, its embedding should be extended. Too many students perceive an insufficient preparation to achieve pharmaceutical care competences required in practice. Existing gaps in pharmaceutical care should be addressed to offer more thoroughly prepared nurses to the labour market.
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Affiliation(s)
- Elyne De Baetselier
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Nienke E Dijkstra
- University of Applied Sciences Utrecht, Research Group Care for the Chronically Ill, Utrecht, Netherlands
| | - Luis M Batalha
- Higher School of Nursing of Coimbra, Health Sciences Research Unit: Nursing, Coimbra, Portugal
| | | | - Izabela Filov
- University "St.Kliment Ohridski", Bitola, Republic of North Macedonia
| | - Vigdis A Grøndahl
- Østfold University College, Faculty of Health and Welfare, Halden, Norway
| | - Jana Heczkova
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ann K Helgesen
- Østfold University College, Faculty of Health and Welfare, Halden, Norway
| | - Sue Jordan
- Department of Nursing, Swansea University, Swansea, Wales, UK
| | - Igor Karnjuš
- Department of Nursing, Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Petros Kolovos
- Department of Nursing, Laboratory of Integrated Health Care, University of Peloponnese, Tripolis, Greece
| | - Gero Langer
- Medical Faculty, Institute of Health and Nursing Sciences, Martin-Luther-Universitat Halle-Wittenberg, Halle (Saale), Germany
| | | | | | - Hana Padyšaková
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Mirko Prosen
- Department of Nursing, Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Dorina Pusztai
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, University of Pecs Faculty of Health Sciences, Pecs, Hungary
| | - Bence Raposa
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, University of Pecs Faculty of Health Sciences, Pecs, Hungary
| | | | - Jana Rottková
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Carolien G M Sino
- University of Applied Sciences Utrecht, Research Group Care for the Chronically Ill, Utrecht, Netherlands
| | | | - Nicola Tingle
- Department of Nursing, Swansea University, Swansea, Wales, UK
| | - Styliani Tziaferi
- Department of Nursing, Laboratory of Integrated Health Care, University of Peloponnese, Tripolis, Greece
| | - Bart Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tinne Dilles
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Bos M, Schouten J, De Bot C, Vermeulen H, Hulscher M. A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses' activities in daily practice regarding antibiotic use. JAC Antimicrob Resist 2023; 5:dlad123. [PMID: 38021036 PMCID: PMC10667038 DOI: 10.1093/jacamr/dlad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use. Objectives To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements. Methods We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool. Results A total of 118 studies were included. The majority of the proposed nurses' activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses' activities. Conclusions Nurses' activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.
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Affiliation(s)
- Maria Bos
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cindy De Bot
- School of Social Work and Health, Avans University of Applied Sciences, ’s Hertogenbosch, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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Dopelt K, Asna N, Amoyal M, Bashkin O. Nurses and Physicians' Perceptions Regarding the Role of Oncology Clinical Nurse Specialists in an Exploratory Qualitative Study. Healthcare (Basel) 2023; 11:1831. [PMID: 37444665 DOI: 10.3390/healthcare11131831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The purpose of the study was to examine the attitudes of nursing and medical teams about the role of oncology clinical nurse specialists in the healthcare system in Israel, where, unlike many countries in the world, such a role has not yet been developed or professionally defined. We conducted 24 interviews with physicians and nurses between August and October 2021. The interviews were transcribed and analyzed using a thematic analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study. Five main themes emerged from the interviews: (1) contribution to the healthcare system, (2) contribution to the patient, (3) drawing professional boundaries, (4) additional responsibilities and authority for oncology clinical nurse specialists, and (5) the field's readiness for a new position of oncology clinical nurse specialists. The findings provide evidence about the need to develop the role of clinical nurse specialists in the oncology field due to its potential benefits for nurses, physicians, patients, family members, and the healthcare system. At the same time, an in-depth exploration of the boundaries of the role and its implementation, in full cooperation with the oncologists and relevant professional unions, is needed to prevent unnecessary conflicts in the oncology field. Professional development training programs in nursing must create a platform for open dialogue between key stakeholders, nurses, and physicians, in order to help all involved parties, place the benefits to the patients above any personal or status considerations.
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Affiliation(s)
- Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Noam Asna
- Oncology Institute, Shaare Zedek Medical Center, Jerusalem 91031, Israel
| | - Mazal Amoyal
- Palliative Care Unit, Barzilai Medical Center, Ashkelon 78306, Israel
| | - Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel
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Gomis-Jimeno FJ, Lillo-Crespo M. Identifying the Enablers and Barriers to Advance Nurse Prescribing of Medication in Spain According to Experts' Views: A Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4681. [PMID: 36981590 PMCID: PMC10048874 DOI: 10.3390/ijerph20064681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Nurses play an important role in pharmaceutical care worldwide in detecting clinical changes, communicating and discussing pharmacotherapy with patients, their families, and other healthcare professionals, proposing and implementing drug-related interventions, and ensuring the monitoring of patients and their medication regimens, among others. However, there is no global consensus across countries regarding the prescribing of medication by nurses. In Spain, for example, this topic is currently in transition since the approval of the Royal Decree 1302/2018 of October 22nd, which regulates the indication, use, and authorization for dispensing human-use medication by nurses. Our study aims to identify the enablers and barriers to advancing the nurse prescribing of medication in Spain through the views of experts in the field and according to the latest Royal Decree approved and the steps taken by the different Spanish autonomous communities. A modified qualitative Delphi study with three iterations was performed online through the perspectives of experts from the field of healthcare education, research, practice, management, and policy. Data extracted from the literature review were used to formulate the open-ended questions utilized in the three rounds. The experts involved (n = 15) belonged to different Spanish regions where the Royal Decree is being implemented with different speeds, and had distinct backgrounds and experiences. Our results highlight the importance of prospectively developing additional protocols based on chronic diseases as well as scaling up towards independent nursing prescription, the inclusion of a joint multidisciplinary pharmaceutical care model, the controversial role played by national nursing councils and boards, the variability in the speed of implementation among the autonomous communities, and the lack of nursing training in the field of medication prescription.
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Affiliation(s)
- Francisco Javier Gomis-Jimeno
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain
- HLA Vistahermosa Hospital, 03015 Alicante, Spain
| | - Manuel Lillo-Crespo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain
- HLA Vistahermosa Hospital, 03015 Alicante, Spain
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Klatt T, Baltes M, Friedrichs J, Langer G. [The role of nurses in pharmaceutical care in Germany: A qualitative analysis]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 176:31-41. [PMID: 36642623 DOI: 10.1016/j.zefq.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/17/2022] [Accepted: 10/25/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND In 13 European countries, laws have been passed that allow nurses to prescribe medicines, but mostly within a limited framework and with a doctor involved. Germany is not among these countries. Only the prescription of medical aids has already been included into the development of extended nursing competencies. We investigated the views of the health care professions involved (doctors, pharmacists and nurses) regarding the role of nurses in pharmaceutical care. METHOD We conducted 22 semi-structured interviews with 23 members of the three professional groups involved in the European research project DeMoPhaC. These data collected in Germany were analysed using qualitative content analysis. Five main categories were developed. RESULTS Pharmaceutical care by nurses can be described within the following main categories: 1. Knowledge and competences, 2. Patient care, 3. Communication, 4. Multi-professional team and 5. System. The communication between the professional groups involved and with patients and caregivers is of particular importance. Interaction in the multi-professional team is just as crucial. Pharmaceutical care takes place within the health system which sets the framework and often boundaries as well. The current and ideally conceived roles of nurses are seen differently in the respondents' respective contexts. Between the professional groups there is both agreement and dissent on the topics addressed. However, the development of nursing roles requires collaborative and transparent processes in teams and organisations. Particularly in the hospital setting, the participants saw a great need for change in order to achieve cooperation at eye level. DISCUSSION The results show that nurses play their role in the complex field of pharmaceutical care under very heterogeneous circumstances. The empowerment of nurses, which was called for by some participants, cannot be achieved from within the professional group alone. Cooperation from all the players involved is needed. The development of nursing roles in the medication process with simultaneous expansion of qualifications and competences can contribute to making the nursing role more attractive. Clear role models promote the transparency of processes for all involved. If all players know what they can expect of nurses, tasks can be redistributed in the multiprofessional team. CONCLUSION The above-mentioned diversity of perspectives can be a resource for development and individual solutions. However, it can also be interpreted negatively as a sign of uncertainty and less standardised ways of working. In view of the data evaluated here, the prescription of medicines by non-medical professionals remains a distant goal for developments in the German health care system. First of all, structures and processes are required that permanently guarantee safe pharmaceutical care with equal participation of all relevant stakeholders.
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Affiliation(s)
- Thomas Klatt
- Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale), Deutschland.
| | - Marion Baltes
- Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale), Deutschland; Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Juliane Friedrichs
- Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale), Deutschland; Klinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Gero Langer
- Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale), Deutschland
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Dumitrescu I, Casteels M, De Vliegher K, Mortelmans L, Dilles T. Home care nurses’ management of high-risk medications: a cross-sectional study. J Pharm Policy Pract 2022; 15:88. [PMID: 36414977 PMCID: PMC9682630 DOI: 10.1186/s40545-022-00476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background High-risk medications use at home entails an increased risk of significant harm to the patient. While interventions and strategies to improve medications care have been implemented in hospitals, it remains unclear how this type of medications care is provided in the home care setting. The objective was to describe home care nurses’ management of high-risk medications. Methods A cross-sectional, descriptive design was set up in home care nurses in Flanders, Belgium. Participants were recruited through convenience sampling and could be included in the study if they provided medications care and worked as a home care nurses. Participants completed an online structured questionnaire. Questions were asked about demographic information, work experience, nurses’ general attitude regarding high-risk medications, contact with high-risk medications and the assessment of risk and severity of harm, specific initiatives undertaken to improve high-risk medications care and the use of additional measures when dealing with high-risk medications. Descriptive statistics were used. Results A total of 2283 home care nurses participated in this study. In our study, 98% of the nurses reported dealing high-risk medications. Home care nurses dealt the most with anticoagulants (96%), insulin (94%) and hypnotics and sedatives (87%). Most nurses took additional measures with high-risk medications in less than 25% of the cases, with the individual double check being the most performed measure for all high-risk medications except lithium. Nurses employed by an organization received support mostly in the form of a procedure while self-employed nurses mostly look for support through external organizations and information sources.
Conclusions The study shows several gaps regarding high-risk medications care, which can imply safety risks. Implementation and evaluation of more standardized high-risk medications care, developing and implementing procedures or guidelines and providing continuous training for home care nurses are advised. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00476-2.
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Lillo-Crespo M, Riquelme-Galindo J, De Baetselier E, Van Rompaey B, Dilles T. Understanding pharmaceutical care and nurse prescribing in Spain: A grounded theory approach through healthcare professionals' views and expectations. PLoS One 2022; 17:e0260445. [PMID: 35073326 PMCID: PMC8786147 DOI: 10.1371/journal.pone.0260445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pharmaceutical care has been implemented and regulated differently across Europe with no consensus among countries in relation with professional competencies and especially on nurse prescribing. Demophac Project funded by the European Commission aims to develop a Pan-European Pharmaceutical Care Model with collaboration of 14 partner teams across Europe including Spain where nurse prescribing is starting its implementation at regional level. The aim of the study was to increase understanding of the role of nurses in Pharmaceutical care in Spain after the Nurse Prescribing Regulation approved in 2018 throughout exploring the views and expectations of health professionals involved in the representative settings. METHODS AND FINDINGS In depth interviews were conducted in a structure previously agreed by the European Demophac partnership around four topics associated with the Nursing ideal role in pharmaceutical care and the ideal interaction with other healthcare professionals. A grounded-theory approach based on Corbin & Strauss was conducted to interpret collected data from the Spanish most representative settings (primary care, specialized care and residential care for older population). Participants were health professionals involved in pharmaceutical care that accepted to participate (nurses (n = 7), physicians (n = 8) and pharmacists (n = 9)). A pharmaceutical care comprehensive model for the Spanish context considering the recently approved Nurse Prescribing role and the interprofessional collaboration and communication was developed towards facilitating the understanding in such context and the contribution to the unified European Demophac Framework. CONCLUSIONS Nurses are primarily responsible for population's Pharmaceutical Care while other professionals pivot on them to provide quality healthcare on a multidisciplinary level. Nurse prescribing may contribute efficiently to the Spanish Health System though more consensus in terms of nurses' training nationwide and enhancement in communication among different professionals within healthcare organizations is required to achieve adequate integrated care into practice.
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Affiliation(s)
- Manuel Lillo-Crespo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Jorge Riquelme-Galindo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Elyne De Baetselier
- Department of Nursing and Pharmaceutical Care, University of Antwerp, Antwerp, Belgium
| | - Bart Van Rompaey
- Department of Nursing and Pharmaceutical Care, University of Antwerp, Antwerp, Belgium
| | - Tinne Dilles
- Department of Nursing and Pharmaceutical Care, University of Antwerp, Antwerp, Belgium
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11
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Mortelmans L, Goossens E, Dilles T. Beliefs about medication after hospital discharge in geriatric patients with polypharmacy. Geriatr Nurs 2021; 43:280-287. [PMID: 34963073 DOI: 10.1016/j.gerinurse.2021.12.007] [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: 10/04/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To describe beliefs about medication in geriatric patients with polypharmacy post-discharge and to evaluate the impact of discharge management on patients' medication beliefs. METHODS A cross-sectional study was conducted between November 2019 and March 2020 in twelve general hospitals in Belgium. Four hundred geriatric patients with polypharmacy were surveyed at hospital discharge and two to five days post-discharge using the Beliefs about Medicines Questionnaire and self-developed questionnaires. RESULTS According to participants, the benefits of medication outweighed the disadvantages as the mean necessity score (19.4/25) outweighed the mean concern score (11.9/25). Patients receiving help with medication management post-discharge had stronger necessity-, concern- and overuse-related beliefs. No patient- or discharge management-related factors were significant predictors of medication beliefs. CONCLUSIONS Assessing patients' medication beliefs and identifying and addressing patients' concerns, can be an opportunity to improve medication use, to prevent non-adherence and to enhance safe medication practices at home.
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Affiliation(s)
- Laura Mortelmans
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
| | - Eva Goossens
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium; Research Foundation Flanders (FWO), Egmontstraat 5, 1000 Brussels, Belgium; Department of Patient Care, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Tinne Dilles
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
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12
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De Baetselier E, Van Rompaey B, Dijkstra NE, Sino CG, Akerman K, Batalha LM, Fernandez MID, Filov I, Grøndahl VA, Heczkova J, Helgesen AK, Keeley S, Kolovos P, Langer G, Ličen S, Lillo-Crespo M, Malara A, Padyšáková H, Prosen M, Pusztai D, Raposa B, Riquelme-Galindo J, Rottková J, Talarico F, Tziaferi S, Dilles T. The NUPHAC-EU Framework for Nurses' Role in Interprofessional Pharmaceutical Care: Cross-Sectional Evaluation in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157862. [PMID: 34360162 PMCID: PMC8345454 DOI: 10.3390/ijerph18157862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Elyne De Baetselier
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (B.V.R.); (T.D.)
- Correspondence:
| | - Bart Van Rompaey
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (B.V.R.); (T.D.)
| | - Nienke E. Dijkstra
- Research Group Care for the Chronically III, University of Applied Sciences Utrecht, 3584 CH Utrecht, The Netherlands; (N.E.D.); (C.G.S.)
| | - Carolien G. Sino
- Research Group Care for the Chronically III, University of Applied Sciences Utrecht, 3584 CH Utrecht, The Netherlands; (N.E.D.); (C.G.S.)
| | - Kevin Akerman
- Department of Nursing, Swansea University, Swansea SA2 8PP, UK;
| | - Luis M. Batalha
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046851 Coimbra, Portugal; (L.M.B.); (M.I.D.F.)
| | - Maria I. D. Fernandez
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3046851 Coimbra, Portugal; (L.M.B.); (M.I.D.F.)
| | - Izabela Filov
- Higer Medical School, University “St. Kliment Ohridski”, 7000 Bitola, North Macedonia;
| | - Vigdis A. Grøndahl
- Faculty of Health and Welfare, Østfold University College, 1757 Halden, Norway; (V.A.G.); (A.K.H.)
| | - Jana Heczkova
- First Faculty of Medicine, Institute of Nursing Theory and Practice, Charles University, 11000 Prague, Czech Republic;
| | - Ann Karin Helgesen
- Faculty of Health and Welfare, Østfold University College, 1757 Halden, Norway; (V.A.G.); (A.K.H.)
| | - Sarah Keeley
- Department of Nursing and Clinical Science, Bournemouth University, Bournemouth BH12 5BB, UK;
| | - Petros Kolovos
- Department of Nursing, University of Peloponnese, 22100 Tripolis, Greece; (P.K.); (S.T.)
| | - Gero Langer
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, 06108 Halle/Saale, Germany;
| | - Sabina Ličen
- Department of Nursing, Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (S.L.); (M.P.)
| | - Manuel Lillo-Crespo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain; (M.L.-C.); (J.R.-G.)
| | - Alba Malara
- ANASTE-Humanitas Foundation, 00192 Rome, Italy; (A.M.); (F.T.)
| | - Hana Padyšáková
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, 83101 Bratislava, Slovakia; (H.P.); (J.R.)
| | - Mirko Prosen
- Department of Nursing, Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia; (S.L.); (M.P.)
| | - Dorina Pusztai
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (D.P.); (B.R.)
| | - Bence Raposa
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (D.P.); (B.R.)
| | - Jorge Riquelme-Galindo
- Department of Nursing, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain; (M.L.-C.); (J.R.-G.)
| | - Jana Rottková
- Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, 83101 Bratislava, Slovakia; (H.P.); (J.R.)
| | | | - Styliani Tziaferi
- Department of Nursing, University of Peloponnese, 22100 Tripolis, Greece; (P.K.); (S.T.)
| | - Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium; (B.V.R.); (T.D.)
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13
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Dilles T, Heczkova J, Tziaferi S, Helgesen AK, Grøndahl VA, Van Rompaey B, Sino CG, Jordan S. Nurses and Pharmaceutical Care: Interprofessional, Evidence-Based Working to Improve Patient Care and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5973. [PMID: 34199519 PMCID: PMC8199654 DOI: 10.3390/ijerph18115973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 12/13/2022]
Abstract
Pharmaceutical care necessitates significant efforts from patients, informal caregivers, the interprofessional team of health care professionals and health care system administrators. Collaboration, mutual respect and agreement amongst all stakeholders regarding responsibilities throughout the complex process of pharmaceutical care is needed before patients can take full advantage of modern medicine. Based on the literature and policy documents, in this position paper, we reflect on opportunities for integrated evidence-based pharmaceutical care to improve care quality and patient outcomes from a nursing perspective. Despite the consensus that interprofessional collaboration is essential, in clinical practice, research, education and policy-making challenges are often not addressed interprofessionally. This paper concludes with specific advises to move towards the implementation of more interprofessional, evidence-based pharmaceutical care.
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Affiliation(s)
- Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium;
| | - Jana Heczkova
- First Faculty of Medicine, Institute of Nursing Theory and Practice, Charles University, 11000 Prague, Czech Republic;
| | - Styliani Tziaferi
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, 22100 Tripolis, Greece;
| | - Ann Karin Helgesen
- Faculty of Health and Welfare, Østfold University College, 1757 Halden, Norway; (A.K.H.); (V.A.G.)
| | | | - Bart Van Rompaey
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing and Midwifery Science, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium;
| | - Carolien G. Sino
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, 3584 CH Utrecht, The Netherlands;
| | - Sue Jordan
- Department of Nursing, Swansea University, Swansea SA2 8PP, Wales, UK;
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