Models of prescribing, scope of practice, and medicines prescribed, a survey of nurse practitioners

Scopes of practice for advanced practice nursing and advanced practice midwifery in Kenya: A gap analysis

BACKGROUND

There is increasing global evidence on the impact of advanced nursing and midwifery practitioners, and Kenya's healthcare system has an excellent opportunity to develop scopes of practice and other regulatory frameworks for the integration of these roles.

OBJECTIVE

The primary purpose of this gap analysis was to explore the existing evidence on opportunities and threats toward the integration of the advanced practice nursing (APN) and advanced practice midwifery (APM) roles in Kenya's healthcare system.

METHODS

The study team conducted a structured electronic database search of PubMed, CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrieve articles and credible websites for reports highlighting the opportunities and threats toward the integration of the APN and APM roles in Kenya's healthcare systems. The retrieved articles were screened for relevance and synthesized for reporting using the traditional literature review approach.

RESULTS

The Kenya Health Policy Framework 2014-2030, growing population needs, and implementation of universal health coverage provide an opportunity to harness and leverage advanced practice roles in nursing and midwifery. There is also momentum to develop advanced practice because of strategic alliances and global evidence showing the contributions and quality of services offered by advanced practice nurses and advanced practice midwives. However, lack of financial support, structural challenges, and lack of national policies, regulations, and legislation continue to obstruct progress.

CONCLUSION AND IMPLICATIONS FOR NURSING POLICY

Developing scopes of practice for APN and APM in Kenya will benefit the professions, the country's healthcare delivery system, and the population. Achieving universal health coverage depends on a health workforce trained and practicing at optimal levels in tandem with education and training to deliver quality care.

Nurse practitioners' use of diagnostic imaging: A scoping review

AIM

To explore the nature and extent of peer-reviewed literature related to the use of diagnostic imaging by nurse practitioners (NPs) to inform future practice and research.

BACKGROUND

Nurse practitioners undertake advanced assessment, diagnosis, and management of patients, including requesting and interpretation of diagnostic imaging. It is unclear what evidence exists related to the quality use of radiological investigations by NPs in recent years.

DESIGN

A scoping review based on the steps suggested by the Joanna Briggs Institute.

METHODS

A structured review of the databases Medline, CINAHL and Embase was undertaken using the keywords and MESH terms 'nurse practitioner', 'medical imaging', 'diagnostic imaging', 'scan' and 'radiography'. Only English language articles were included, and no date limit was applied. Database review was completed on 30 May 2021.

RESULTS

Eight themes were identified-country and clinical context, requesting diagnostic imaging, performing diagnostic imaging, image-guided interventions, interpreting diagnostic imaging, training education and knowledge, impact on resource usage and comparison with medical practitioners. There were more studies across a greater breadth of clinical specialties and imaging modalities in the United States than in other countries. Nurse practitioner practice is frequently benchmarked against that of medical colleagues. There is a paucity of studies focusing on educational preparation and the lack of relevant university curricula for NPs around diagnostic imaging.

CONCLUSION

There are significant gaps in the evidence outside of the United States across several of the identified themes. Further studies are needed to explore NP access to and use of diagnostic imaging and to understand the barriers and facilitators to this.

RELEVANCE TO CLINICAL PRACTICE

Studies from four countries were included in this review. The evidence suggests that, where studied, nurse practitioners (NPs) can safely and appropriately request and interpret plain x-rays in the emergency and minor injuries setting. Further research is needed to evaluate the educational needs of NPs in relation to diagnostic imaging and their use of advanced imaging techniques, particularly outside of the United States.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Advanced practice nurse capabilities: A mixed methods systematic review

BACKGROUND

Global health challenges demand the optimal use of nurses' professional competence and capability. Competencies related to the roles of advanced practice nurses have been developed, but research on these nurses' capabilities remains limited.

AIM

To summarise and compare the literature on the capabilities of advanced practice nurses and the dimensions of these capabilities.

METHODS

We carried out a mixed methods systematic review, using CINAHL, PubMed, and Scopus to search literature published between 1998 and 2021. The quality of the selected articles was evaluated with the JBI Critical Appraisal Tools. We employed abductive content analysis, including deductive and inductive analysis. The reporting was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement.

RESULTS

Eleven articles out of 357 met the inclusion criteria. We identified all five dimensions of Hase and Davis's (1999) capability framework: can apply competencies in familiar as well as unfamiliar situations, is creative, has a high degree of self-efficacy, knows how to learn, and works well in teams. Additionally, we found a new dimension of capability: identifies factors affecting the scope of practice.

LIMITATIONS

This mixed methods systematic review was conducted about a little-studied topic. Because country-specific differences exist and consensus on advanced practice nursing roles is lacking, the concept of advanced practice nurse capabilities cannot be directly generalised.

CONCLUSIONS

Capability is a requirement and a necessity in the performance of advanced practice nurses. Identifying and defining the dimensions of advanced practice nurses' capabilities will lead the way in developing the roles, education, and capability assessments of advanced practice nurses. Identification of advanced practice nurses' capability will facilitate role understanding, visibility, and implementation in health care services. This can improve the quality and accessibility of care and improve the cost-effectiveness of the use of health care professionals.

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.

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.

The development of nurse prescribing in mental health services: Outcomes from five national surveys 2004-2019

AIM

This study aimed to explore data from national surveys of nurse prescribing in England's National Health Service mental health services.

BACKGROUND

Nurse prescribing is increasing worldwide. Reports describing long-term developments after implementation are rare.

METHODS

Five surveys were distributed to all mental health organisations between 2004 and 2019.

RESULTS

Response rates increased from 54% (n = 45/83) in 2004 to 79% (n = 42/53) in 2019. The estimated proportion of mental health nurses who were prescribers increased to 4.3% by 2019. Distribution between clinical practice areas did not change significantly over time, with the largest numbers in community mental health teams. The proportion of nurse prescribers actively prescribing increased from 76.4% in 2014 to 87.8% in 2019. Independent prescribing became the predominant approach, with supplementary prescribing rarely used as the sole model within organisations. The scale of implementation varied markedly between organisations.

CONCLUSIONS

Although nurse prescribing in mental health services has grown over time, growth has slowed and is variable at local level.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisations considering the introduction or growth of nurse prescribing should note the evidenced preference for an independent prescribing model to date and consider how to avoid unwarranted variation in nurse prescriber role distribution.

Australian podiatrists scheduled medicine prescribing practices and barriers and facilitators to endorsement: a cross-sectional survey

Background

Non-medical prescribing is one healthcare reform strategy that has the potential to create health system savings and offer equitable and timely access to scheduled medicines. Podiatrists are well positioned to create health system efficiencies through prescribing, however, only a small proportion of Australian podiatrists are endorsed to prescribe scheduled medicines. Since scheduled medicines prescribed by Australian podiatrists are not subsidised by the Government, there is a lack of data available on the prescribing practices of Australian podiatrists. The aim of this research was to investigate the prescribing practices among Australian podiatrists and to explore barriers and facilitators that influence participation in endorsement.

Methods

Participants in this quantitative, cross-sectional study were registered and practicing Australian podiatrists who were recruited through a combination of professional networks, social media, and personal contacts. Respondents were invited to complete a customised self-reported online survey, developed using previously published research, research team’s expertise, and was piloted with podiatrists. The survey contained three sections: demographic data including clinical experience, questions pertaining to prescribing practices, and barriers and facilitators of the endorsement pathway.

Results

Respondents (n = 225) were predominantly female, aged 25–45, working in the private sector. Approximately one quarter were endorsed (15%) or in training to become endorsed (11%). Of the 168 non-endorsed respondents, 66% reported that they would like to undertake training to become an endorsed prescriber.

The most common indications reported for prescribing or recommending medications include nail surgery (71%), foot infections 474 (88%), post-operative pain (67%), and mycosis (95%). The most recommended Schedule 2 medications were ibuprofen, paracetamol, and topical terbinafine. The most prescribed Schedule 4 medicines among endorsed podiatrists included lignocaine (84%), cephalexin (68%), flucloxacillin (68%), and amoxicillin with clavulanic acid (61%).

Conclusion

Podiatrists predominantly prescribe scheduled medicines to assist pain, inflammatory, or infectious conditions. Only a small proportion of scheduled medicines available for prescription by podiatrists with endorsed status were reportedly prescribed. Many barriers exist in the current endorsement for podiatrists, particularly related to training processes, including mentor access and supervised practice opportunities. Suggestions to address these barriers require targeted enabling strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-022-00515-w.