Attitudes towards, and information needs in relation to, nurse prescribing
Berry, D.C., Courtenay, M., Bersellini, E. (2004). Attitudes towards, and information needs in relation to, nurse prescribing. Submitted Journal of Clinical Nursing.

Email: Molly Courtenay

Independent and supplementary prescribing is pivotal to modernising the NHS. By rethinking roles and responsibilities, breaking down the barriers between professions, and making better use of the skills of nurses and pharmacists, patients should gain easier access to medicines and the quality of care they receive should be improved. ‘Best use’ of doctor time should also be made. It is therefore essential to rigorously evaluate the safety and effectiveness of the development of these new initiatives to date, and to provide evidence to inform future policy and practice in both independent and supplementary prescribing by nurses, pharmacists and other professionals allied to health. Research currently in progress at Reading University (Berry, Courtenay, & Bersellini submitted) aims to assess whether:

• There is positive support by members of the general public for nurses to adopt the role of prescriber
• People have confidence that the nurse would prescribe the best medicine for them, and if they would be willing to take it
• Concerns about taking the medicine relate to the nurse’s status and if people would have the same need for an explanation if the medicine were prescribed by a doctor
• Patients have a strong desire for medicines information, and the type of information people most want in an explanation.
  
   

Evaluating the impact of supplementary prescribing on healthcare delivery in the West Midlands

Eleanor Bradley and Peter Nolan, Staffordshire University

E-mail: e.j.bradley@staffs.ac.uk

This three-year project sets out to address questions about the role and effectiveness of supplementary nurse prescribing throughout the West Midlands, looking in particular at the impact on clinical practice, medicines management and patient care. It will assess the impact of supplementary prescribing on the prescribers and the service users, before looking at perceptions of supplementary prescribing held by staff in the wider healthcare team. The project will focus in particular on nurse prescribers based in primary care who are working with service users diagnosed with chronic diseases. Stakeholders are the Shropshire and Staffordshire NHS Workforce Development Confederation, South Staffordshire Healthcare NHS Trust, Staffordshire University and Pfizer Ltd.
 

An evaluation of independent extended nurse prescribing

Latter, S.^*, Courtenay, M.^†, Maben, J.^*, Myall, M.^* - *University of Southampton, ^†Reading University

Email: Molly Courtenay

The aim of this DH funded research is to provide an evaluation of independent extended nurse prescribing to inform future developments for prescribing in nursing and other health professions. The project is of 15 months duration and commenced in May 2003.
 

A national evaluation of nurse prescribing for patients with dermatological conditions

This research is in two phases and commenced in September 2004. Phase 1 involves a national survey of extended/supplementary nurse prescribers who have completed the prescribing programme, and are prescribing in the area of skin care.

The survey will collect data from nurses on:

• Professional and personal characteristics
• Satisfaction with the taught content and mentoring process provided during the extended independent/supplementary prescribing programme
• Experiences of prescribing post training.

The focus of Phase 2 is case studies of different practice settings, using multiple methods to capture the perspectives of a range of stakeholders in each case. A case will comprise a practice setting in which one or more nurses are prescribing for patients with skin-related conditions.

Within each case study site, the following methods will be used:

• Videotaped observations of the nurse prescriber in single consultation sessions to assess competence.
• Semi-structured interviews with all extended/supplementary prescribers and independent prescribers i.e. doctors working in partnership with these prescribers
• Self administered questionnaires to patients at case study site
• Telephone interviews with a sample of the patients completing questionnaires
  
   

Identifying the barriers to nurse prescribing in secondary care

Jacqui Pirmohamed, Honorary Research Associate, Liverpool University Prescribing Research Group, Liverpool University

E-mail: J.A.Pirmohamed@liv.ac.uk

The first phase (focus groups) of this project, which is undertaken on a part-time basis, is now complete. The second phase of the project (undertaking one-to-one interviews) is now underway. Jacqui would like to hear from any nurses, doctors and pharmacists working in secondary care about their experiences or views on nurse prescribing. This study has full ethical approval, is anonymous, and interviews can be conducted face to face or over the telephone. If you would like further information please contact Jacqui at the address above.

Continuing professional development needs of nurse prescribers

Stephen Coopey, North Hampshire PCT

Qualified nurse prescribers need more formal structures for support and professional updating according to the results of this small study of nurse prescribers in Hampshire. Informal peer support was perceived as more useful.

The study used a questionnaire, sent to 65 nurse prescribers (mostly health visitors and district nurses) after piloting, with 25 being returned. Six people also attended a focus group discussion.

The questionnaire respondents identified the following sources of continuing professional development:

• journals, 19 (76%)
• peer support, 16 (64%)
• community pharmacist, 10 (40%)
• pharmacy representative, 6 (24%)
• study day, clinical supervision and support group, 4 (all 16%)
• internet, 2 (8%).

The respondents also identified areas where CPD was needed, and ways of delivering it:

• refresher courses on prescribable products, 5 (20%)
• support group, 5 (20%)
• skin care, 3 (12%)
• mentorship, 2 (8%)
• study days, 2 (8%)

The focus group identified a range of CPD sources, including the above. They could be divided into formal methods (courses and study days) and informal or personal methods (reading, experience, reflective practice, learning from each other). Factors restricting CPD opportunities were identified as: personal (motivation, attitude), workload (time, priorities, need to put patients first), environment (place to do it) and managerial support.

In general, CPD was not seen as meeting their needs as prescribers. Personal CPD did take place through reading, but journal articles were seen as more concerned with the development of the nurse prescribing process itself than providing clinical knowledge for prescribers. It was agreed that the act of prescribing itself helped develop confidence and competence. Support from community pharmacists who could provide “news about new products”, and other colleagues, was beneficial. Although information sharing was important, perceived isolation was raised as an issue.

After the nurse prescribing course, the only formal support offered was the support group, and the group felt a more structured approach was needed. Suggestions included: annual updates (consider mandatory statutory training?); regular dissemination of prescribing information; PACT data (feedback on prescribing habits); system for replacing BNFs and Drug Tariffs; improved access to internet (websites); discussion /integration with GP support networks; clinical supervision using the new competency framework.

The North Hampshire PCT has held its first nurse prescribing study day using the results of this study as a basis for the content of the day, and it is hoped this will become an annual event and part of the ongoing continual professional development for prescribers.
 

Nurse prescribing implementation

Judy Wayman, University of East Anglia School of Nursing and Midwifery
E-mail: j.wayman@uea.ac.uk

Undertaking a PhD in policy development and implementation of nurse prescribing in the UK.
 

The implications of nurse prescribing for child health nurses: a case study approach

Sue Jones, Practice Development Nurse, United Bristol Healthcare NHS Trust, UK
E-mail: Sue.Jones@ubht.swest.nhs.uk

This project is now complete and should be published in the near future. The results of a focus group of current nurse prescribers (district nurses and health visitors) were used to develop a questionnaire for child heath nurses in a regional children’s hospital. The research sought to answer the following questions:

• What opportunities do child health nurses identify as being appropriate for nurse prescribing?
• Can child health nurses identify the benefits of PGDs and the different levels of nurse prescribing?
• What preparation do children’s nurses need for nurse prescribing?

The work aimed to develop strategies for the roll-out of nurse prescribing in one regional children’s hospital with outreach specialist community nurses.
 

Nurse prescribing in mental health

Steve Hemingway, University of Sheffield
E-mail: S.J.Hemingway@sheffield.ac.uk

Undertaking a PhD on nurse prescribing in mental health, is involved in a project investigating the attitudes of community mental health nurses towards prescriptive authority, and in training initiatives for prescribing for mental health nurses.
 

Depression in primary care: treatment and medication management

Peter Nolan and Frances Badger*
Professor of Mental Health Nursing, Staffordshire University and School of Health Sciences, University of Birmingham*
E-mail: P.W.Nolan@staffs.ac.uk and f.j.badger@bham.ac.uk

Research on the treatment and medication management of depression in primary care. Aims to contribute to:

The prescribing course: the best treatment for nurses?

"Whatever the nature of the proposed extension to nurse prescribing, everyone agrees that training is central. But what do students think of the training available at present and what effect does it have on them? Here, Lesley Harris describes the results of a group interview among qualified prescribers." The views and experiences of 18 qualified prescribers, who had undertaken the prescribing programme at one institution, were explored using a focus group interview. The participants said the programme had affected them both personally and professionally.

The personal impact

All respondents said they had felt anxious during the course. Reasons given for this anxiety included the newness of the prescribing role, the physical act of writing a prescription and the examination at the end of the programme. Several of the respondents commented upon the extreme fatigue they had felt during the course. Some had suffered headaches, and one experienced an eczema flare-up. The negative impact of the course on family life and relationships was highlighted by a number of respondents.

The professional impact

Respondents felt strongly that they had been put under pressure to take the programme, without being given the autonomy to choose their own professional development path. More positively, Health Visitors and District Nurses thought that they had benefited by undertaking the course together and sharing experiences. The professional relationships formed during the programme had continued since completion of the course.

Respondents felt strongly that they had to prove themselves as practitioners in something they had been doing for years. The fear of failure during the programme, and how colleagues might judge them, was constant, although a few said they had experienced a sense of achievement after they had successfully completed the course.

A number of respondents found fulfilling the role of a student and what was expected of them worrying. The changes in teaching and learning strategies since some had last been in a classroom combined for one with the intimidating environment of the university generated strong concern.

Conclusion

Further research would be interesting to see how widely the experiences and views of nurses from one institution interviewed in one focus group are shared. However, the negative feelings expressed by some of these nurses do raise some important issues for those involved in the development of future prescribing programmes.