Nurses' responsibilities and tasks in pharmaceutical care: A scoping review

Trust in nurses and its association with medication adherence of cardiovascular patients: A descriptive correlational study

Background

Medication adherence plays an important role in managing cardiovascular diseases. Trust in nurses may be effective in enhancing medication adherence in patients with cardiovascular diseases.

Aim

This study aimed to investigate the correlation between trust in nurses among cardiac patients and their medication adherence and explore the predictors of medication adherence.

Methods

This descriptive correlational design was conducted among "302″ cardiac patients hospitalized at Amir Al-momenin Teaching Hospital affiliated with Maragheh University of Medical Sciences. Data was gathered using a demographic characteristics questionnaire, Medication Adherence Scale, and Trust in Nurses' Scale. Data was analyzed using descriptive (frequency, percentage, mean, standard deviation, median, and descriptive tables) and inferential (Kruskal-Wallis, Mann-Whitney, Spearman correlation coefficient, and quartile regression) statistics. Data was gathered from October 2023 to January 2024. The data was analyzed using SPSS software ver.21.

Findings

The mean and standard deviation of medication adherence and trust in nurses were 91.6 ± 6.9 and 10.5 ± 3.9, respectively. A significant positive correlation was found between trust in nurses and medication adherence(r = 0.61). There was a significant difference in medication adherence based on the type of disease. So that, the median medication adherence was the highest for coronary artery patients and the lowest for hypertensive patients. The results of quartile regression analysis showed that trust in nurses and type of disease are the main predictors of medication adherence (R2 =20 %.).

Discussion and conclusions

The results indicated that medication adherence among cardiovascular patients was moderate and patients' trust in nurses was less than average. Considering the type of disease as an unmodifiable variable, trust in nurses was the main modifiable factor that plays an important role in increasing medication adherence of cardiovascular patients. Therefore, appropriate strategies such as teaching communication skills to nurses, and training and attracting interested individuals with high communication skills should be taken to enhance patients' trust in nurses.

Educational needs for medication safety competence among nurses by clinical ladder stage

The objective of this study is to identify the educational needs of nurses in regard to medication safety competence at different career levels. The identification of these needs is grounded in nurse clinical career ladder theoretical frameworks. In April of 2022, focus group interviews were conducted with twenty participants currently engaged in patient care work. These participants were categorized into four groups based on their clinical experience levels: novice (entry to 1 year), advanced novice (from 13 months to 47 months), competent (48 months to 83 months), and proficient (from 84 months). Key educational needs included: self-reflective attitude toward medication safety, effective interaction skills, medication practice knowledge, ability to manage safety risk situations, and establishment of a continuous education system for medication safety. These findings will contribute to the development of medication safety education programs based on a clinical ladder system including attitudes, knowledge, and skills related to self-reflection, self-improvement, and collaboration.

Medication adherence in the curricula of future European physicians, pharmacists and nurses - a cross-sectional survey

AIM

Many patients are not taking their medicines. It has substantial negative medical and economic consequences for patients and healthcare systems but there is limited knowledge on how medication adherence is integrated in medical education. This study seeks to investigate to what extent students in medicine, pharmacy and nursing in Europe are taught about medication adherence.

METHODS

A cross-sectional online survey was distributed to 731 persons teaching relevant courses across 142 European universities between February and June 2024. The survey addressed definitions of adherence and The ABC Taxonomy; methods to support adherence, methods to identify and monitor non-adherence; consequences and outcomes of non-adherence, and methods applied in teaching. They were also asked to provide links to their curricula. Responses from quantitative questions were analyzed descriptively. Word frequency and qualitative thematic analysis was used for the curricula inventory and analysis of free-text answers, respectively.

RESULTS

In total, 212 participants from 114 universities in 34 countries completed the survey. Respondents agreed to similar level on the need to enhance medication adherence teaching, with 72% in pharmacy, 71% medical, and 59% agreement in nursing education. The most taught topic across educations was the clinical impact of non-adherence, according to 89% in pharmacy, 84% medical, and 76% in nursing education. The ABC Taxonomy was taught in more than half of all pharmacy (73%), nursing (60%) and medical education (52%). In the qualitative analysis of free text-answers respondents emphasized the value of early, mixed method teaching. They reported a lack of guidance in teaching medication adherence, causing inconsistency in the educational quality and depth. Time constraints were highlighted as a significant challenge, while interprofessional collaboration and use of medication adherence technologies were seen as opportunities, though not widely implemented in teaching. The curricula inventory showed a substantial variance in how medication adherence content was described.

CONCLUSION

There is a lack of consistent teaching on medication adherence in Europe, underlining the necessity to establish a unified curriculum incorporating the ABC taxonomy, and to include a more patient-centred approach to support medication adherence.

EQUANU: Equality in Societal and Professional Recognition of Nurses-A Cross-Sectional Study on Societal and Professional Recognition of European Nurses

Background: Despite trends towards greater professionalisation of the nursing profession and an improved public image in certain countries, studies also show that large proportions of the public still do not fully appreciate nurses' competencies. Mapping differences in the societal and professional recognition of nurses allows for benchmarking among countries. Aim: To investigate the level of societal recognition of the nursing profession in nine European countries, and the level of professional recognition perceived by European nurses themselves; to compare levels of recognition between countries; and to identify influencing factors. Methods: A cross-sectional study was conducted. Through an online survey, the study surveyed both the general public and nurses from various healthcare settings across nine countries between December 2022 and June 2023. The instrument used was a combination of self-developed questions on societal and professional recognition, the Work Motivation Scale and an adapted version of the Multidimensional Work Motivation Scale. Data were analysed using SPSS v.29.0, with socioeconomic prestige scores for the public and work environment/work motivation scores for nurses calculated accordingly. Results: A total of 1618 adult citizens and 2335 nurses participated. The public predominantly characterised nurses with attributes such as friendliness, warmth, empathy and compassion. The mean socioeconomic prestige score assigned to nurses was 7.2/10 (SD 1.9), with Portugal having the highest score (M 7.5/10, SD 2.0) and Norway the lowest (M 5.8/10, SD 1.4; p < 0.001). Professional recognition experienced by nurses was generally low (54% indicated rather low, 17% very low). Slovenia, the Netherlands and Belgium had slightly higher mean scores (all M 1.4/3) compared to other countries (p < 0.001). High professional recognition could be predicted for 33% by work environment score (OR = 1.21; 95% CI [1.19-1.24]), work motivation score (OR = 1.02; 95%CI[1.01-1.02]), expertise outside the hospital (OR = 1.57; 95% CI [1.25-1.97]) and work experience (OR = 1.01; 95% CI [1.00-1.02]) corrected for country. Conclusion: The study highlights the need for targeted interventions to improve the professional and public image of the nursing profession while addressing disparities in professional recognition between countries. Longitudinal studies are recommended to monitor changes in public perception and professional recognition among nurses.

Navigating transitions: a qualitative study of nursing teams' experiences of educational and cultural transitions in Germany

BACKGROUND

The global migration of health professionals in general and nurses in particular, has led to nursing shortages and socioeconomic impacts on health systems in both source and destination countries. Adding to the complexity of the situation is the fact that the nursing profession itself is evolving from a vocational to an academic one. Although nursing migration and academization have been studied from either an institutional or an individual perspective, there is a gap in the literature regarding how nursing teams experience these transitions. This study aims to explore how nursing teams navigate through the transitions of academization and internationalization of the current dynamic nursing landscape in Germany.

METHODS

Based on social constructivism epistemology this qualitative study involved face-to-face focus group discussions conducted at several hospital sites in Germany from September 2021 to May 2023. The focus group discussions were audio-recorded, transcribed, and analysed using content analysis; the four dimensions of transition theory according to Schlossberg's Four S (4 S) framework (self, situation, support, and strategy) were used as a priori items to construct the coding framework.

RESULTS

Nine focus group discussions were conducted with a total of 40 nurses from different educational and migrant backgrounds. The analysis showed that the transition experiences of the nursing teams were heterogeneous, with educational and national backgrounds playing an important role in how realistic their expectations of their professional roles and identities were. The dynamic situation characterized by a shortage of qualified nursing staff, increases the pressure on nursing teams and underscores the importance of employer-provided and peer support. Onboarding and communication are key strategies used depending on the duration of the employee turnover.

CONCLUSION

This study provides insights into the challenges and coping strategies of nursing teams in the current dynamic scene of migration, academicization and professional socialisation in Germany. Extending the Schlossberg 4 S framework from the individual to the team perspective provides a comprehensive view of the transitional experiences of nursing teams. Within each domain of the framework, the experiences of nursing teams are remarkably diverse. Educational background (vocational or academic) and origin (German or foreign trained) play an important role in shaping the transitional experiences of nursing teams.

Nurses' responses to patients' medication self-management problems in hospital and the use of recommendations

This study aimed to describe the use of recommendations as a guide for healthcare providers to support patients experiencing medication self-management problems and to evaluate their feasibility, user-friendliness and usefulness. Between March and August 2023, 58 hospitalized patients completed a self-assessment on medication self-management problems. The problems addressed in this self-assessment were based on a list of frequently encountered medication self-management problems from previous research. Consequently, 18 nurses responded to the reported problems using the recommendations. Nurses evaluated the feasibility, user-friendliness and usefulness of these recommendations through a survey. A total of 217 medication self-management problems were reported by 58 patients. Nurses intervened in 52% of the problems using the recommendations. According to nurses, the recommendations were user-friendly and feasible but required a substantial time investment. Considering these pilot-based results, the recommendations have the potential to be a valuable resource for nurses in practice, though this potential requires further exploration.

The effect of the case-based learning approach on the level of satisfactions and learning of nursing students in Iran: A randomized controlled trial

Introduction

Nurses must have sufficient knowledge and skills in the field of medications and medication management. This study was designed to investigate the effect of the case-based learning (CBL) approach on the level of satisfaction and learning of nursing students.

Materials and methods

This study was conducted using a randomized controlled trial on 70 Iranian third-semester nursing students during a pharmacology internship in 2023. After considering the inclusion criteria, the samples were entered into the study by census method and then they were placed in either the control (35 people) or intervention (35 people) groups by simple random method. Pharmacology training was done in the control group by the usual method (lectures by the instructor and conferences with students) and in the intervention group by the Kaddoura case-based learning method. Data collection tools included a demographic questionnaire, satisfaction of educational approach questionnaire, and exam scores before and after the internship. SPSS version 26 software was used for statistical analysis.

Results

There was no statistically significant difference (P = 0.88) in the mean scores of the pharmacology pre-test in the control (10.54 ± 2.74) and intervention groups (10.6 ± 3.49) before the intervention. Also, there was no statistically significant difference (P = 0.19) between the pharmacology post-test scores in the control (17.7 ± 1.15) and intervention groups (18.07 ± 0.91). A comparison of pre-test and post-test scores in both control and intervention groups showed that the post-test scores in both groups increased significantly (P < 0.001). The results showed that the intervention group was significantly (P = 0.008) more satisfied with the learning method.

Conclusion

The case-based educational approach resulted in improved satisfaction among students in the pharmacology course. It is recommended to incorporate this learning method alongside traditional teaching methods, in nursing education, particularly in pharmacology instruction.

Intranasal Delivery of Medications for the Treatment of Neurologic Conditions: A Pharmacology Update

ABSTRACT

INTRODUCTION: Nurses have a central role in educating patients and families about treatment options and how to integrate them into action plans for neurologic conditions. In recent years, a growing number of intranasal formulations have become available as rescue therapy for neurologic conditions or symptoms including migraine, opioid overdose, and seizures. Rescue therapies do not replace maintenance medications or emergency care but are designed to enable rapid treatment of urgent or disabling conditions in community settings. Yet, discussion of rescue therapies for neurologic conditions remains limited in nursing literature. CONTENT: Intranasal formulations are specifically formulated for delivery and absorption in the nose and have several characteristics that are well suited as rescue therapies for neurologic conditions. Intranasal formulations include triptans for migraine, naloxone and nalmefene for opioid overdose, and benzodiazepines for seizure clusters in patients with epilepsy. Therapeutic attributes discussed here include ease of use in community settings by nonmedical professionals, relatively rapid onset of action, and favorable safety profile and patient experience. This information is critical for nurses to make informed decisions about rescue therapy options, incorporate these into plans of care, and educate patients, care partners, and other healthcare providers. CONCLUSION: Rescue therapies are increasingly important in the care of people with neurologic conditions. Various formulations are available and continue to evolve, offering easy and quick ways for nurses, patients, and nonmedical care partners to administer critical rescue medications. For nurses overseeing medication management, the attributes of intranasal rescue therapies should be considered in the context of providing patients with the right care at the right time.

Pharmaceutical Care in Primary Healthcare-A Study of Nurses', Pharmacists', and Physicians' Experiences of Interprofessional Collaboration

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.

Nursing Interventions to Prevent Secondary Injury in Critically Ill Patients with Traumatic Brain Injury: A Scoping Review

Background: Traumatic brain injury is a prevalent health issue with significant social and economic impacts. Nursing interventions are crucial in preventing secondary injury and improving patient prognosis. This scoping seeks to map and analyze the existing scientific evidence on nursing interventions aimed at preventing secondary injuries in critically ill patients with traumatic brain injury. Methods: The review was conducted according to Arksey and O'Malley's methodological framework. The electronic databases Pubmed, MEDLINE Complete, CINAHL Complete, Nursing & Allied Health Collection: Comprehensive, Cochrane Central Register of Controlled Trials, and Cochrane Clinical Answers were consulted in May 2023. We included articles published in English and Portuguese between 2010 and 2023. Results: From the initial search, 277 articles were identified, with 15 meeting the inclusion criteria for the review. Nursing interventions for TBI patients include neuromonitoring, therapeutics, analytical surveillance, professional training, and family support. Nurses play a crucial role in detecting neurological changes, administering treatments, monitoring metabolic markers, training staff, and involving families. These interventions aim to prevent secondary injury and improve patient outcomes. Conclusions: By prioritizing evidence-based practice and utilizing innovative technologies, nurses enhance TBI patient care and contribute to overall well-being.

Nursing-sensitive quality indicators for quality improvement in Norwegian nursing homes - a modified Delphi study

BACKGROUND

Use of nursing-sensitive quality indicators (QIs) is one way to monitor the quality of care in nursing homes (NHs). The aim of this study was to develop a consensus list of nursing-sensitive QIs for Norwegian NHs.

METHODS

A narrative literature review followed by a non-in-person, two-round, six-step modified Delphi survey was conducted. A five-member project group was established to draw up a list of nursing-sensitive QIs from a preliminary list of 24 QIs selected from Minimum Data Set (2.0) (MDS) and the international Resident Assessment Instrument for Long-Term Care Facilities (interRAI LTCF). We included scientific experts (researchers), clinical experts (healthcare professionals in NHs), and experts of experience (next-of-kin of NH residents). The experts rated nursing-sensitive QIs in two rounds on a seven-point Likert scale. Consensus was based on median value and level of dispersion. Analyses were conducted for four groups: 1) all experts, 2) scientific experts, 3) clinical experts, and 4) experts of experience.

RESULTS

The project group drew up a list of 20 nursing-sensitive QIs. Nineteen QIs were selected from MDS/interRAI LTCF and one ('systematic medication review') from the Norwegian quality assessment system IPLOS ('Statistics linked to individual needs of care'). In the first and second Delphi round, 44 experts (13 researchers, 17 healthcare professionals, 14 next-of-kin) and 28 experts (8 researchers, 10 healthcare professionals, 10 next-of-kin) participated, respectively. The final consensus list consisted of 16 nursing-sensitive QIs, which were ranked in this order by the 'all expert group': 1) systematic medication review, 2) pressure ulcers, 3) behavioral symptoms, 4) pain, 5) dehydration, 6) oral/dental health problems, 7) urinary tract infection, 8) fecal impaction, 9) depression, 10) use of aids that inhibit freedom of movement, 11) participation in activities of interest, 12) participation in social activities, 13) decline in activities of daily living, 14) weight loss, 15) falls, and 16) hearing loss without the use of hearing aids.

CONCLUSIONS

Multidisciplinary experts were able to reach consensus on 16 nursing-sensitive QIs. The results from this study can be used to implement QIs in Norwegian NHs, which can improve the quality of care.

The Evolving Role of Haematology Nursing Practice: A Cross-Sectional Survey

Background And Objectives

The scope of haematology nursing practice is dynamic and must respond to advances in treatment, patients' needs and service requirements. Little is known, however, about the different roles of haematology nurses across the European setting. The purpose of this study was to identify the professional practices of haematology nurses.

Method

A cross-sectional online survey design was used to investigate practice elements undertaken by haematology nurses. Frequencies and descriptive statistics were calculated for demographic variables and chi-square tests to examine relationships between practice elements, nursing role and country.

Results

Data is reported from 233 nurses across 19 countries, working as Staff Nurses (52.4%), senior nurses (12.9%) and Advanced Practice Nurses (APNs) (34.8%). Most frequently reported activities included medication administration - oral/ intravenous (90.0%), monoclonal antibodies (83.8%), chemotherapy (80.6%), and blood components (81.4%). APNs were more commonly involved in nurse-led clinics and prescribing activities (p < .001, p = .001, respectively); however, other nursing groups also reported performing extended practice activities. Patient and carer education was a significant part of all nurses' roles; however, senior nurses and APNs were more often involved with the multidisciplinary team (p < .001) and managerial responsibilities (p < .001). Nurses' involvement in research was limited (36.3%) and frequently reported as an out-of-work hours activity.

Conclusions

This study describes haematology nursing care activities performed in various contexts and within different nursing roles. It provides further evidence of nursing activity and may contribute to a core skills framework for haematology nurses.

Recognising older people's individual resources and home‐care‐specific tasks in home care in Finland: A document analysis of care and service plans

BACKGROUND AND RATIONALE

Comprehensive care and service planning in home care is tailored to older people's individual needs and resources in order to support them living at home. However, little is known about how these individual resources and home-care-specific tasks are recognised in older people's care and service plans.

AIMS

To describe the content of care and service plans in older people's home care with special attention to their individual resources and home-care-specific tasks.

DESIGN

This was a document-based cross-sectional study with mixed-methods analysis, carried out in Eastern Finland during Spring 2018.

METHODS

A document analysis using the deductive Finnish Care Classification (FinCC), and an inductively developed framework of older people's care and service plans (n = 71). The data were analysed with descriptive statistical methods.

RESULTS

Altogether, 1718 notes were relevant to the FinCC main categories: 707 (41%) focused on older people's needs and 1011 (59%) on nursing interventions. We identified 1104 notes based on the 26 inductively developed main categories: the majority (n = 628, 57%) focused on individual resources and the remainder (n = 476, 43%) on home-care-specific tasks. Increasing age resulted in fewer notes on safety and sensory functions. There were fewer notes on resources related to sleeping and wakefulness after longer care and service periods. An increased number of home visits resulted in more documentation on tasks related to pharmaceutical issues, including repeat prescriptions.

DISCUSSION

Individual resources for older people were documented, to some extent, in their care and service plans. It is necessary to review these alongside home-care-specific tasks that support older people's independence and safety at home.

CONCLUSION

Individual resources need to be recognised in order to enable home-care professionals to provide tailored, high-quality home care services. Home-care-specific tasks should be supported by documentation with updated, sensitive home care classifications.

Beliefs about medication after hospital discharge in geriatric patients with polypharmacy

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.

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.