Nurse supplementary prescribing for patients with diabetes: a national questionnaire survey

Aims and objectives. To examine the prescribing practices of nurse supplementary prescribing in diabetes. Background. Nurses in several roles are involved in the management of medicines for patients with diabetes. Nurse prescribing should help optimise these roles. Nurses in the UK have virtually the same independent prescribing rights as doctors. There is little or no evidence on the extent to which nurse supplementary prescribing is used, or the impact and activity of nurse supplementary prescribing for patients with diabetes. Design. Survey. Method. A random sample of 214 nurse supplementary prescribers self‐completed a written questionnaire. Results. The majority of nurses held an academic qualification at degree level or higher, had a wealth of clinical experience, worked full‐time, were based in primary care and worked in general practice. The majority of nurses prescribed between one and five items a week. Oral anti‐diabetic drugs, hypertension and lipid‐regulating drugs and insulins were the products most often prescribed. Over 85% had undertaken specialist training in diabetes prior to undertaking the prescribing programme. Conclusion. Supplementary prescribing provides a practical and useful framework within which to prescribe medicines for patients with diabetes and its associated complications. Specialist diabetes training is a necessary prerequisite for nurses prescribing in this area. It is evident that there is still a place for supplementary prescribing. Implications for clinical practice. ? Recent legislative changes mean that nurses can now independently prescribe practically any drug. ? Nurses in general practice appear to prescribe most frequently as a nurse supplementary prescriber for patients with diabetes. ? Nurse supplementary prescribers are likely to use this mode of prescribing to deliver medicines to patients with diabetes. ? Over two‐thirds prescribe for common but serious complications of diabetes, e.g. hypertension, hyperlipidaemia and cardiovascular disease     

Supplementary nurse prescribing for patients with skin conditions: a national questionnaire survey

Aim. To examine the prescribing practices of supplementary nurse prescribers (working in both primary and secondary care) who prescribe medicines for patients with skin conditions and the factors that facilitate or inhibit this mode of prescribing. Background. Nurses work in a variety of roles, with varying levels of expertise, are involved in the treatment management of a broad range of skin diseases. Skin conditions are those for which independent nurse prescribers prescribe most frequently. The role of the nurse, limitations of the formulary and inter‐professional relationships influence the prescribing practices of these nurses. There is no evidence currently available examining the impact and activity of supplementary nurse prescribing for patients with skin conditions. Methods. A convenient sample of 580 nurses who prescribed for skin conditions and were qualified supplementary nurse prescriber, self‐completed a written questionnaire. Results. Five hundred and twenty (89·7%) nurses were based in primary care and worked in general practice. Four hundred and thirty‐six (75%) held a degree level qualification or higher, 41 (7%) had specialist dermatology training and 512 (88·3%) had more than 10 years postregistration nursing experience. Supplementary prescribing was used by a minority of nurses. Nurses who had specialist dermatology training used this mode of prescribing most frequently. Doctor and pharmacists lack of understanding of supplementary prescribing, lack of peer support and clinical management plans prevented the implementation of this mode of prescribing. Conclusions. Supplementary prescribing is used by a minority of nurses to treat skin conditions. A number of factors prevent nurses from using this mode of prescribing including lack of specialist training and lack of support in practice. Relevance to clinical practice. Specialist dermatology training, an understanding of supplementary prescribing by the members of the healthcare team, and support in practice are required if supplementary prescribing is to be implemented effectively for the treatment of skin conditions.     

Nurse independent prescribing and nurse supplementary prescribing practice: national survey

Title. Nurse independent prescribing and nurse supplementary prescribing practice: national survey Aim. This paper is a report of a survey to provide an overview of nurse independent prescribing and nurse supplementary prescribing across the United Kingdom. Background. Evidence examining the frequency of prescribing by nurses is conflicting, and it is evident that several factors hamper prescribing practice. As of May 2006, legislative changes gave appropriately qualified nurses virtually the same independent prescribing right as doctors. However, there is currently no evidence available about the prescribing practices of these nurses. Method. A random sample of 1992 qualified Nurse Independent/Nurse Supplementary Prescribers registered with the Nursing and Midwifery Council was sent a postal questionnaire in 2006. A total of 1400 (70%) questionnaires were returned, of which 1377 were completed. Findings. Eight hundred and ninety‐one (65%) respondents worked in primary care, and 333 (24·3%) worked in secondary care. Three quarters of the sample had more than 5‐year clinical experience in the area in which they prescribed prior to entering the prescribing programme. One thousand one hundred and seven (87%) participants had used nurse independent prescribing and 568 (44·6%) nurse supplementary prescribing. Restriction of local arrangements, implementation of the Clinical Management Plan and access to doctors hampered or prevented prescribing. Conclusion. The adoption of prescribing by nurses in the United Kingdom has increased patient choice with regard to access to medicines. A number of factors which hamper or prevent prescribing require further exploration.     

Independent extended nurse prescribing for patients with skin conditions: a national questionnaire survey

Aim. To examine the prescribing practices of independent extended nurse prescribers for patients with skin conditions. Background. Nurse‐led services are one means of improving healthcare provision for dermatology patients. The advent of nurse prescribing should optimize the role of the nurse in these situations. Medicines for skin conditions constitute a significant category within the Nurse Prescribers Extended Formulary. The impact and activity of independent extended nurse prescribing for patients with skin disease has yet to be evaluated. Methods. A convenience sample of 638 qualified independent extended nurse prescribers self completed a written questionnaire. spss and splus were used for data entry and analysis. Results. The majority of nurses (89·7%) were based in primary care and worked in general practice. Four hundred and seventy‐six (75%) participants held a degree level qualification or higher. Forty‐four (6·9%) held a diploma, degree or master's level module/s in dermatology, 433 (67·9%) had undertaken study day/s in dermatology. Five hundred and sixty (87·8%) had more than 10 years postregistration nursing experience. A significantly broader range of skin conditions, and more items for these conditions, were prescribed by nurses with higher academic qualifications, nurses with specialist dermatology training (i.e. a diploma, degree or master's level module in dermatology or dermatology study days), nurses over 45 years and nurses in general practice. A small number of nurses felt unconfident in their prescribing practice. Conclusion. The majority of nurses treating skin conditions work in general practice, are highly qualified, and have a wealth of clinical experience. Nurses’ dermatology training is inconsistent A small number of nurses feel unconfident in their prescribing practice. Relevance to clinical practice. Nurses prescribing for skin conditions must be provided with appropriate dermatological training in order to treat the enormous numbers of patients with skin conditions treated in primary care.     

Perception of nurse prescribing among nurses and psychiatrists in a developing country: A cross‐sectional survey

Nurse prescribing has the potential to improve patients’ access to, and experiences of, treatment. The aim of the present study was to examine nurse and psychiatrist attitudes about this extended role in a developing country. We conducted a cross‐sectional survey using a previously‐used, 65‐item, seven subscale measure of attitudes to nurse prescribing in mental health. We achieved a 79% response rate. The majority of participants had trained in developing countries where nurse prescribing has yet to be implemented. Across five subscales (general beliefs, impact, uses, training, and supervision), both groups reported positive attitudes about nurse prescribing. Both groups scored the training subscale particularly highly. Compared with psychiatrists, nurses were more confident about the range of clinical settings where nurse prescribing could be applied (e.g. acute inpatient and substance use). Although both groups had less favourable attitudes on the two subscales relating to clinical and legal responsibility, compared to nurses, psychiatrists were more undesirable. Although, overall, clinician attitudes do not seem to represent a barrier towards the potential implementation of nurse prescribing in the study setting, clarity about clinical and legal responsibility needs to be addressed.     

Mental health nurse prescribing: issues for the UK

Supplementary nurse prescribing holds the key to rapid developments in psychiatric nursing and the care received by patients. In this paper, the origins, context and research data on nurse prescribing are reviewed, as a backdrop to a discussion on potential application of supplementary prescribing in a number of mental health settings. We describe a number of practice settings where nurse prescribing could be implemented, and argue that given service changes and informative educational preparation, access to care and user experience of that care will be enhanced. We conclude the paper by reviewing a number of clinical, organizational and research factors important for the success of nurse prescribing.     

The effectiveness of a diabetes nurse clinic in treating older patients with type 2 diabetes for their glycaemic control

Aims. The aim of this study is to determine the effectiveness of a diabetes nurse clinic intervention in controlling the poor glycaemia of older patients with type 2 diabetes. Research method. This is a quasi‐experimental design with pre‐ and follow‐up tests. The study was conducted in a regional acute hospital in Hong Kong. A total of 150 (75 controls, 75 cases) poor glycaemic control older patients with diabetes were recruited in the study. Outcome measures. Biomedical and psychological data were collected at pre‐ and follow‐up period and compared between groups. Results. The study results show an effective intervention of diabetes nurse clinic in giving consultation and education to the type 2 diabetic patients. Subjects in the nurse follow‐up group showed an improvement in the HbA1c, and systolic blood pressure and reduction on healthcare utilization. Conclusion. The study provided evidence to support the diabetes nurse clinic in treating the older patients with diabetes. This study has provided confidence to the diabetes nurse to treat the unstable older patients with diabetes. Relevance to clinical practice. Diabetes mellitus is a serious health concern that most commonly affects older people. As indicated by the results of this study, this educational programme can act as an effective nursing intervention to the type 2 diabetic patients.     

Nurses and Internet health information: a questionnaire survey

AIM: This paper is a report of a study to identify the extent of postgraduate nursing students' information literacy skills in relation to electronic media and health information and barriers to accessing this information. BACKGROUND: The Internet is a key source of information for a significant group of patients. However, there is evidence of quality issues with some Internet health information sites. Nurses need to be aware of the range and quality of online health information so as to assist patients and families to locate and evaluate relevant and current information. METHOD: A questionnaire designed to collect quantitative and qualitative data was posted to a convenience sample of all students enrolled in a postgraduate nursing programme in December 2005. The response rate was 55.1% or 123 responses. RESULTS: Most respondents had Internet access at home and work and believed that access to online health information resources had improved their practice. However, some had difficulties in accessing computers at work and insufficient time to search for online health information. Concern was expressed about the quality of online information, but the majority of respondents did not assess patient use. Frequent users of online resources were more likely to assess patient use. CONCLUSION: The development of nursing competencies in accessing and using online resources is a key precursor to supporting patients and families' use of the medium. Access to Internet resources at work, along with training and time for searching, is necessary for the development of skills enabling effective use of information technology.