Journals Watch 2002

This section features a regularly updated list of recently published articles relevant to nurse prescribing.

Abstracts of the papers are included and users are encouraged to submit their views about published papers through the feedback section.

Please note: In this section of the website we aim to cover articles on areas where nurses do prescribe. However, not all the treatments or appliances mentioned are prescribable by nurses. For that reason, nurses should check the up-to-date versions of the Nurse Prescribers’ Formulary for District Nurses and Health Visitors (NPF) and the Nurse Prescribers’ Extended Formulary (NPEF) and Drug tariff if they are in any doubt. Alternatively contact your Regional Nurse Prescribing Lead for clarification.

Click here to visit the 2001 archive of Lifestyle and Smoking

Health Promotion

Click on the article titles below to read the summaries.

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  • Vaccines: tetanus and diphtheria

Steimle D et al. Tetanus and diphtheria. Nursing Standard 2002; 16(22): 33-35.

This article highlights the importance of mass immunization programmes in controlling diphtheria and tetanus in much of the world. It looks at the symptoms, treatment and outcomes of the diseases and their epidemiology.

Tetanus is now rare in industrialized countries: fewer than 15 cases a year in Germany, mostly in older people, and an average of six a year in the UK. Adolescents and adults who have not kept their boosters up to date, adults who have never been vaccinated and those with uncertain vaccination histories are all at risk. The authors recommend that reviews of vaccination history should be routine in all healthcare settings.

There have been recent outbreaks of diphtheria in some parts of Europe and North Africa, highlighting the importance of booster doses in maintaining immunity. In the UK, recent work has indicated that 38% of the population is susceptible to diphtheria.

Website: Nursing Standard

 

  • Helping smokers stop

Wilson E. How to quit? Practice Nurse 2002; 23(3): 37-40.

This article looks at how practice nurses can encourage patients to stop smoking. According to the smoking cessation guidelines from the British Thoracic Society, health professionals should ask about smoking at every opportunity and urge people to stop. Smokers should be helped to stop with NRT and given follow-up and support.
The author discusses what happens in the various stages of behaviour change and how health professionals can support people through them. There is evidence that NRT can double the chance of successfully stopping and the different forms and methods of administration are outlined. With support, the sustained quit rate can increase to 25%.
Given that one smoking-related disease, chronic obstructive pulmonary disease, is the third most common cause of death in the UK, the imperative for health professionals is clear.

Visit the links section of Nurse Prescriber.

  • Nurse prescribing in family planning

Tyler C and Hicks C. The occupational profile and associated training needs of the nurse prescriber: an emperical study of family planning nurses. Journal of Advanced Nursing 2001; 35(5): 644-653.

This study used a psychometric questionnaire to try to define the role of the family planning nurse prescriber and to identify the skills that need developing for this position.

There was a 34% response rate (388 out of 1142 family planning nurses) and of these, 81% indicated a reasonable degree of interest in becoming a nurse prescriber.

Prescribing tasks were, unsurprisingly, considered the most important of the 15 top-rated skills for a family planning nurse prescriber. Safety concerns were of primary importance, and advocacy and informed consent issues were also seen as very relevant. The role definition that emerges may indicate that the respondents were aware of the extent of the nurse prescribers’ responsibilities, perhaps helping to allay any safety concerns. The nurse prescriber role was not seen exclusively in terms of prescribing, however, with advanced professional issues, communication/teamwork and business/administration also featuring.

No research activities were included in the priority listing, an interesting and perhaps worrying omission. When the training needs of family planning nurse prescribers were examined, however, seven of the top 15 related to research, with advanced clinical practice tasks, applied pharmacology, administration and technical activities also listed. [back]

 

  • Support for stopping smoking

Haw S. Providing support to quit smoking. Professional Nurse 2002; 17(8): 458-460

Much more can be achieved in helping smokers quit, according to the conclusions of this article. More than two-thirds of the 13 million UK smokers would like to give up but less than 3% of smokers a year succeed without help from health professionals.

The author describes the stepped care approach to supporting smokers who wish to stop, recommended in primary care in Scotland. This means that the support patients receive is matched to their level of nicotine addiction and their motivation to quit.

If patients express any interest in stopping, they should be offered advice and a plan should be drawn up with them. They should be encouraged to seek support from others and potential problems should be identified and discussed, with the emphasis on practical support.

NRT and Zyban are central to the stepped care approach. For NRT combined with intensive support, quit rates of 35% at one year have been reported. Reported quit rates for bupropion are similar although there are some serious adverse side effects. Practitioners should consider any possible contraindications to both therapies carefully before prescribing. [back]

  • Immunisation advice for parents

Steimle D et al. Immunisation information for parents. Nursing Standard 2002; 16(29): 40-44

Vaccination can become a victim of its own success, argue the authors of this article about the benefits of childhood immunisation and how to present them to parents. Within a few years of an immunisation programme starting, the disease often becomes so rare that parents have no experience of it and public alarm can then be fuelled by scare stories about the vaccine, leading to a fall in uptake levels.

If a vaccine has 90% efficacy, this still means that 1 in 10 vaccinated children can be at risk of a disease. If uptake falls, infectious diseases can spread to epidemic proportions. The authors, one of whom is from the European Vaccine Manufacturers group in Brussels, discuss the scares associated with the whooping cough vaccine in the 1970s and the MMR vaccine in the UK recently.

Immunity, the effects of immunisation, how parents can help their children, how records should be kept and European vaccination schedules are all discussed. Perhaps the most useful section is a table showing answers to frequently asked questions about many of the diseases included in the childhood immunisation programme (symptoms, transmission, possible complications and so on).

Website: www.nursing-standard.co.uk

 

  • NRT and bupropion in smoking cessation

Percival J and Milner D. Pharmacological management of smoking cessation. Br J Community Nursing 2002; 7(4): 202-205

Smoking costs the average English health authority £14 million a year and smoking cessation services are demonstrably cost-effective, argue these authors. The interventions of community nurses to help smokers stop may be their single most important action in improving the health and life expectancy of these patients.

The article examines the role of health professionals in helping smokers stop and describes the stages smokers may go through and the range of withdrawal symptoms they may experience.

Since the article was written NICE has recommended the use of NRT products, which are on the NPF, and bupropion (see news item). The RCP’s view is that NRT products, “are an essential and economic option for core NHS expenditure” and that if tobacco dependence is being treated as a medical condition, NRT should be prescribed as part of the treatment.

Although NRT is not a complete replacement for cigarettes, it does help reduce withdrawal symptoms, does not contain tar and carbon monoxide, and very few people become addicted to it. Different NRT products have similar success rates so the choice comes down to a personal and practical one: the various factors are discussed here. Nurse prescribers should refer pregnant women to their GP or discuss treatment options with the GP themselves.

  • Training needs of family planning nurse prescribers

Hicks C and Tyler C. Assessing the skills for family planning nurse prescribing: development of a psychometrically sound training needs analysis instrument. J Advanced Nursing 2002; 37(6): 518-531

The role of the family planning nurse prescriber has a conceptually distinct structure and is organized differently from that of the family planning nurse, according to the conclusions of this study. Developing family planning nurses for prescriber status would not simply involve the addition of prescribing training, but rather a reconfiguring of the role.
An existing psychometric training needs analysis instrument was adapted and used here among the 1142 members of the National Association of Nurses for Contraception and Sexual Health, with 388 being returned (34% response rate;  see previous article). The results suggested that the training needs analysis instrument remained valid and reliable after adaptation.

The factor analysis for the family planning nurse prescriber role identified nine factors: research and practice development; prescribing and professional accountability; management/leadership; clinical decision-making and risk assessment; advanced health assessment; critical appraisal; referral processes; core nursing skills; and dispensing of drugs. These factors could be used as the basis for a curriculum and assessment strategy.

 

Hainsworth T. Travel vaccines: a guide to appropriate use. Nursing Times 2002; 98(25): 40-42

Selecting the appropriate vaccines for someone travelling to a particular country can involve a complex risk assessment, with different experts reaching conflicting conclusions. Scheduling the vaccinations is not always straightforward, either. A methodical approach and good knowledge is therefore needed.

This article provides information about nine diseases: hepatitis A, typhoid, yellow fever, hepatitis B, tick-borne encephalitis, rabies, meningococcal meningitis, Japanese encephalitis, and cholera (although the cholera vaccine has been discontinued in Britain).

Website: www.nursingtimes.net

 

  • Nicotine lozenge safe and effective?

Shiffman et al. Efficacy of a nicotine lozenge for smoking cessation. Arch Intern Med 2002; 162:1267-1276

Nicotine lozenges that dissolve in the mouth are a safe and effective tool for stopping smoking, according to the results of a study of nearly 2000 smokers supported by GSK.

The low-dependency smokers received a 2 mg lozenge and the high-dependency smokers received a 4 mg lozenge in the placebo-controlled trial. Compared with 2 and 4 mg nicotine gum, the lozenges deliver more nicotine.

Using a primary efficacy measure of four weeks’ continuous abstinence at six weeks, the researchers report that the odds of being abstinent were 2.1 (for the 2 mg lozenge) and 3.69 (for the 4 mg lozenge) times greater for active lozenge than placebo. After one year, the odds of abstinence were doubled in the active lozenge groups. After the week 2 visit, participants who had smoked were not retained in the study and were not followed up.

 

Baker A. Flu vaccination audit. Practice Nurse 2002; 24(4): 28-32

Reactions to flu vaccinations were reported by 16% of patients returning a questionnaire in this flu audit in Devon. The audit was carried out in response to concerns about the quality of service given the high demands on flu programmes. A total of 239 questionnaires was returned, a response rate of 89%.

Of the reactions, 42% were local and 58% systemic: only two patients saw a doctor or nurse about them. As only a small percentage of patients were not aware of the possibility of a reaction, these results may reflect high standard of information given to patients by nurses. Patients were asked whether they were satisfied with the service for flu vaccination offered by their practice and 99.5% said they were.

 

  • Travel health advice: typhoid and hepatitis A

Hall S. Typhoid, hepatitis A. Practice Nurse 2002; 24(4): 45-51

Nurses giving travel health advice should have an understanding both of the illnesses for which vaccines may be recommended and of the other measures that can affect the health of an individual traveller, according to the conclusions of this article.

Hepatitis A and typhoid are often discussed together because they share water-borne and food-borne routes of transmission but they are unrelated. The author discusses risk assessment for individual travellers and explains how these diseases are transmitted, their course and their prevention.

Threat to funding for smoking cessation

Direct funding for smoking cessation services is expected to end in March 2003 and they will then have to compete for funds with other priority areas. The next two articles highlight the success of these services and discuss their future.

Andrews H. Smoking cessation and NHS performance indicators. Primary Health Care 2002; 12(8): 22-23

Tobacco dependence is responsible for one in five deaths across the UK. It must be taken seriously. That effective smoking cessation services feel threatened by the change in funding may suggest that there is an outdated attitude towards smokers in the NHS. The author argues that the sometimes-criticized performance indicators can be used to highlight the success of these services and build a case for their survival.

In the year ending April 2002, the Suffolk Stop Smoking Service had successfully supported 1632 people to four-weeks’ quit (the performance indicator for smoking cessation). This was 363% of its target of 450. The author identifies several factors as contributing to this success, among them: the fact that smokers are pleased to have their health needs taken seriously; comprehensive evidence-based guidance is available and all evidence-based treatments are available on prescription; the specialist services have developed expertise and knowledge bases that have helped flexible local services to be developed locally.

In the Suffolk smoking cessation service, training is offered to professionals regardless of discipline. Practice nurses are now supporting more smokers than the specialist service, with similar quit rates. Specialist services that are responsible for training, data collection, service delivery and that provide advice to professionals, must be maintained. Treatment services must be outdated and flexible.

Website: www.primaryhealthcare.net

 

Carlisle D. The affliction of addiction. Nursing Times 2002; 98(40); 23-25

This article traces the development of government policy on smoking and highlights the threat posed to smoking cessation services if, as expected, ringfencing ends in March next year. In the year ending March 2002, about 227 300 people set a quit date using the service and 119 800 had been successful at follow-up.
Nurses need training to offer even brief opportunistic advice about smoking and those professionals who are focussing specifically on offering smoking cessation advice need more.

Website: Nursing Times

 

Percival J. Strategies for smoking cessation. Nursing Times 2002; 98(40): 66-67

For smokers using professional help and NRT or bupropion, the quit rate may rise to 20-30%, from 2-3% for those attempting to stop without help. Nurses can support their patients through an attempt to stop smoking and this article looks at how they can do that and at the appropriate use of NRT and bupropion. NICE has recommended the use of these therapies (read news article).

Possible withdrawal symptoms and how NRT or bupropion can help with them, should be discussed with smokers. As the success rates of the current NRT products are similar, the choice should be a personal and practical one. Non-patch formulations give more control over the dose and speed of absorption although they are not as easy to use. Nurse should encourage smokers to use the full daily amount and continue the course for 10-12 weeks. For people who are pregnant or have coronary disease, using NRT may be safer than continued smoking but they will need to be assessed by a doctor.

Bupropion hydrochloride is a non-nicotine treatment in tablet form. It lasts for two months and smokers stop during the second week. It is not suitable for everyone and is not available over-the-counter, unlike NRT.

Without preparation, smokers are unlikely to succeed, and nurses may need to check smokers’ motivation before offering NRT.

Website: Nursing Times

 

  • Advising patients on contraceptive choice

Elliman A. Choosing a contraceptive. Practice Nurse 2002; 24(2):61-64.

Many factors will influence choice of contraceptive. Nurses should be aware of these and able to provide accurate and up-to-date advice on all choices. This article examines general and particular factors that nurses should be aware of and then looks at each method of contraception.

 

Mills P. Learning to support practice: smoking cessation. Practice Nurse Plus 2002; 24(7): 63-74.

This article reviews smoking behaviour and dependence, the pathophysiology of smoking and its epidemiology, and the targets and recommendations about smoking cessation. The benefits of giving up smoking are listed and possible approaches to cessation discussed.

 

  • Health professionals must offer help

Roberts J. Kicking the habit. Primary Health Care 2002; 12(9): 27-32.

This article examines the change in attitudes to smoking since its risks were first identified and highlights the addictive nature of nicotine. As there are specific medical therapies available for this addiction, health professionals are failing patients if they do not offer them help to stop.

The ‘30-second approach’ to identify motivated patients is described and the forms of therapy and their adverse effects discussed. Nurses should discuss NRT and bupropion in detail, warning patients what to expect, as they may otherwise believe that the symptoms of nicotine withdrawal are caused by the therapy.