Mental health nurse prescribing: A qualitative, systematic review

Content of medicine prescription and clinical practice training for haematology advanced practice nurses in China: A modified Delphi study

AIM

To explore the scope and form of prescriptions for blood and hematopoietic drugs that future advanced practice nurses (APNs) in the Department of Haematology and to establish a medicine prescription training content in China.

BACKGROUND

Because the increasing number of doctors cannot meet the increasing demand for medical care with the population growth, many countries have begun to explore the medical team structure and practice areas, among which nurse prescribing rights have been the most effective. However, China's higher nursing education system still lacks education and training on nurse prescription.

DESIGN

On the basis of literature research and semi-structured interviews, a set of nursing prescription content, education, training and practice system suitable for Chinese nurses was jointly created.

METHODS

Two rounds of expert consultation between 23 haematology nursing experts and clinical experts determined the training content of blood system drugs and medicine prescriptions. Additionally, on the basis of the 23 experts，13 experts engaged in clinical and education, teaching and training experts were involved. Two rounds of expert consultation with 36 experts identified a general clinical practice training program for advanced practice nurses in China.

RESULTS

Regarding contents and forms of hematopoietic drugs, the study concluded that advanced practice nurses in haematology department can prescribe anti-anemia drugs, anti-coagulant drugs and anti-thrombotic drugs in 2 categories and 16 drugs. Of these, four kinds of drugs should be prescribed in the form of protocol prescription. One kind of drug should be prescribed in the form of extended prescription and 11 drugs should be prescribed in the form of independent/extended or agreed/extended prescription. Regarding training content, the study obtained the training content of nurses' medicine prescriptions in eight clinical circumstances and the medicine prescription training content for common diseases of the blood system. The required specifications and the medicine prescription decision skills of nurses were sorted out according to different prescription types.

CONCLUSIONS

The degrees of expert authority were both higher in consultations. Moreover, the results after consultation were reliable. It was recommended that haematology APNs could prescribe anti-anaemic drugs and anti-coagulation and anti-thrombotic drugs. Furthermore, most drugs should be prescribed in the form of independent/extended or agreed/extended prescriptions. The establishment of a medicine prescription training content for haematology APNs is expected to provide a reference for clinical practice education and training for drug prescriptive authority applicants for blood and hematopoietic system nurses in China.

Nurse prescription start-up in a Spanish health organization: Nurses' preparedness and 6-month results

INTRODUCTION

Nurse prescribing is well consolidated in many countries. In Spain, recent legislation has allowed nurse to prescribe under specific conditions, but the implementation process is complex.

OBJECTIVES

First, to describe nurses' knowledge and expectations of nurse prescribing in a health institution in Spain. Second, to report the nurses' prescriptions in a pilot group at 6 months.

METHODS

A descriptive, online survey design was used to identify nurses' knowledge and expectations of prescribing. The results were compared according to the nurses' professional position and training. We analyzed the number and type of prescriptions issued in the first 6 months.

RESULTS

Training needs (overall score = 4.2/5) and lack of knowledge of the law (4.25/5) were scored lower by nurses with postgraduate training. Subjective assessment of preparedness among nurses was high (>4/5), and the highest-scoring expected impact was improvement in patients' experience (4.25/5). Years of nursing experience were negatively correlated with preparedness and the expectation of an increase in patient management errors. A total of 212 prescriptions were issued (2 drugs and 200 health devices).

CONCLUSIONS

Nurses perceived good preparedness but also the need for more training in medicines and prescribing law. Expectations of prescribing were favourable. Most prescriptions were for health devices.

Evidence-informed implementation of nurse prescribing under supervision: An integrative review

AIM

To explore evidence reporting facilitators and barriers to implementation of nurse prescribing and provide practical recommendations for evidence-informed implementation and adoption of nurse prescribing under a supervision model.

BACKGROUND

As demand for access to quality health care services increases, health professional roles are expanding to meet population needs. Nurse prescribing has been effective in some countries and is being considered globally to address growing health care demand. Successful implementation of health service models requires careful planning and consideration. No existing reviews have examined implementation factors in the literature.

DESIGN

Integrative review.

DATA SOURCES

CINAHL, MEDLINE, PubMed and EMBASE databases were searched from inception to 15 April 2020.

REVIEW METHODS

This integrative review is guided by Whittemore and Knafl and adheres to PRISMA reporting guidelines. The sustainability of innovation framework was used to synthesize data concerning implementation and sustainability factors (i.e. innovation, organizational, political, workforce and financial) for nurse prescribing.

RESULTS

A total of 39 articles were reviewed with literature predominantly reporting findings related to non-medical and nurse prescribing under various models. Variable evidence was found to inform nurse prescribing across five implementation and sustainability factors identifying several areas that require in-depth consideration. Very little evidence is available on nurse prescribing under supervision.

CONCLUSION

Introduction of service reform is often costly. This review highlights gaps in the literature and raises areas for consideration prior to implementation of this new service delivery model. The introduction of nurse prescribing must be planned and informed by available evidence to support effective adoption, practice and patient outcomes.

IMPACT

There are significant gaps in evidence related to nurse prescribing under a supervision model. Based on the evidence synthesized in this review, this paper provides practical recommendations for health service providers, managers, clinicians, educators and researchers to support implementation and adoption of nurse prescribing.

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.

'Not Left in Limbo': Service User Experiences of Mental Health Nurse Prescribing in Home Care Settings

Prescribing in mental health nursing in the Republic of Ireland is still an unusual occurrence and despite an uptake in prescriber training, this does not often translate to practice. Recent Irish research, however, has identified that nurse prescribing when offered, is perceived to enhance care and offer better delivery of services. Since the legislation was introduced in the Republic of Ireland to enable nurses and midwives to prescribe in May 2007, there are now 1,123 nurses registered to prescribe medication. Mental health nurses, however, do not tend to be a priority when it comes to training in prescribing; in the UK it took two years after nurse prescribing was rolled out to extend the scheme to mental health nursing. Although nurse and other professional perspectives explored this topic, there is limited research specifically detailing the experience of service users in long term care who are prescribed by mental health nurse practitioners in a home care setting. This research follows a qualitative exploratory research design using thematic analysis to explore service user (n = 12) experiences of mental health nurse prescribing. The following four themes emerged from the analysis: 'empowerment and trust'; 'person-centered care'; 'time and flexibility' and 'collaborative approach'. Results indicate a positive and rich experience of nurse prescribing, which facilitate a more trusting, holistic and autonomous therapeutic relationship. Future research looking at other issues relating to medication including reduction and support for coming off where appropriate is recommended.

Positioning Psychiatric and Mental Health Nursing as a Transformative Force in Health Care

From the perspective of psychiatric and mental health nurses in Sweden, this discussion paper aims to position psychiatric and mental health nursing as a transformative force contributing to enforcing person-centered values and practices in health care. We argue the potential impact of psychiatric and mental health nursing on service user health and recovery, nursing student education and values, and the organization and management of health care. Psychiatric and mental health nursing is discussed as a caring, reflective, and therapeutic practice that promotes recovery and health. Implications for nursing education, research, management, and practice are outlined.

The need for and value of nurse and midwife prescribing: Findings from an Irish research investigation

AIM

The aim of this study is to determine the need for and value of nurse and midwife prescribing in Ireland as identified by these prescribers-the people most able to provide relevant insights and information.

BACKGROUND

Since 2007, nurses and midwives in Ireland who have passed an additional educational program can prescribe medicinal products relative to their clinical practice areas. Research evidence of efficacy is needed now for prescribing sustainability in Ireland and to encourage, if successful, the adoption or expansion of frontline nurse/midwife prescribing rights in other countries.

DESIGN

A qualitative study was undertaken.

METHODS

Interviews with registered nurse and midwife prescribers were conducted in 2017 until data saturation. Constant-comparative coding and categorization of data revealed themes and categories, with explanatory quotes for research trustworthiness and credibility purposes.

RESULTS

Six data themes emerged: (a) more than just writing prescriptions; (b) highly individualized evidence-based specialist care; (c) assured, timely and rapid accessibility to needed care; (d) health system and healthcare efficiency gains; (e) satisfaction with nurse/midwife prescriber services and (f) quality care improvements.

CONCLUSION

Nurse/midwife prescribing in Ireland was identified as needed, safe, effective and cost-effective. Prescribing permitted accessible, thorough and proactive holistic health promotive care to be provided in nurse- or midwife-led outpatient clinics.