Non-medical prescribing: audit, practice and views

Non-medical prescribing is increasingly utilized in clinical care and UK Standards have been produced for this. This study was undertaken to investigate compliance with these standards which were adopted by one mental health service and to review whether any changes were necessary to existing arrangements monitoring this compliance. A questionnaire was distributed to all 24 non-medical prescribers from one UK Mental Health Trust. Participants were asked to respond to questions about demographic data and prescribing practices. We also asked them to rate their experience on a 5-point scale. In all, 83% of non-medical prescribers responded. The UK Standards were met even though there was a shortfall in the uptake of training and supervision. Non-medical prescribers from the Community Drug Team and Older People's Service prescribed a narrow range of speciality drugs than any other category of drugs, but prescribed more often. UK Standards were met by the majority of non-medical prescribers. However, concerns were noted about a shortfall in training, supervision and experience of some non-medical prescribers. Conflict with psychiatrists was reported but their availability for support when necessary was valued. Non-medical prescribers believed that their input with non-medical prescribing had benefited patients.     

Nurse prescribing in specialist mental health (part 1): the views and experiences of practising and non-practising nurse prescribers and service users

Non-medical prescribing is a relatively new competency that appears to benefit both service users and health professionals alike. However, little is known about its use in mental health settings. This single case study in one UK National Health Service (NHS) Trust aimed to look at these views and consider how the role can be developed further in light of this. Six service users and two nurses trained in nurse prescribing were individually interviewed. One trained nurse had been prescribing for the last 3 years; the other was trained but had never practised. Service users reported that nurse prescribing was more convenient and less anxiety provoking, an issue of particular importance for optimizing mental health services. Offering choice was deemed important; however, for some service users, information about why medication may be beneficial was highlighted as an unmet need in the prescribing process. The practising nurse prescriber described her experiences and credited a good structure of supervision and support from the team. Reasons why trained nurse prescribers may not be practising are discussed, with suggestions for future developments and guidance. This competence appears to work well in a mental health setting when conducted in a supported and structured way.     

Spiritual care: implications for nurses' professional responsibility

Aim. This paper aimed to gain insight into the spiritual aspects of nursing care within the context of health care in the Netherlands and to provide recommendations for the development of care in this area and the promotion of the professional expertise of nurses. Background. International nursing literature suggests that caregivers are expected to pay attention to spiritual aspects of patient care. In Dutch nursing literature, the spiritual dimension is increasingly becoming a focus of attention. Despite this, there is a lack of empirical data from professional practice in the Netherlands. Method. Data were collected by means of focus group interviews. The sample was made up of the specialist fields of cardiology, oncology and neurology and divided into groups of patients, nurses and hospital chaplains. The interviews took place between May and December 2004. Data were qualitatively analysed using the computer programme Kwalitan. Results. Different spiritual themes emerged from the interviews. There were different expectations of the nurse's role with regard to spiritual aspects. The main themes derived from this research can be recognized as aspects of nursing competencies that are reported in the literature. However, the attention to spiritual aspects in the nursing process is not clear cut. It seems to be highly dependent on personal expression and personal commitment. Conclusions. The study raises questions about the nurse's professional role in spiritual care. The study shows that different factors (personal, cultural and educational) play a role in the fact that spiritual care is not structurally embedded in nursing care. Further research on the impact of that variable is recommended. Relevance to clinical practice. Nursing care implies care for the spiritual needs of patients. To provide this care, nurses need to be knowledgeable regarding the content of spiritual care and the personal, professional, cultural and political factors influencing it. They also need to be able to participate in policy and decision‐making discussions of spiritual care in clinical nursing practice.     

The challenges of caring in a technological environment: critical care nurses' experiences

Purpose. This paper presents and discusses the findings from a phenomenological study which illuminated the lived experiences of experienced critical care nurses caring within a technological environment. Background. While nursing practice is interwoven with technology, much of the literature in this area is speculative. Moreover, there is a debate as to whether and how ‘high tech’ and ‘high touch’ are reconcilable; this orientation is referred to as the optimism vs. pessimism debate. On a personal level, the motivation for this study came from the author's 13 years’ experience in the critical care area. Method. Following ethical approval, 10 experienced nurses from two cardiothoracic critical care units in Ireland participated in the study. A Heideggerian phenomenological methodology was used. Data collection consisted of unstructured interviews. A method of data analysis described by Walters was used. Findings. The findings provide research‐based evidence to illuminate further the optimistic/pessimistic debate on technology in nursing. While the study demonstrates that the debate is far from resolved, it reveals a new finding: life‐saving technology that supports the lives of critically ill patients can bring experienced nurses very close to their patients/families. The three main themes that emerged: ‘alien environment’, ‘pulling together’ and ‘sharing the journey’ were linked by a common thread of caring. Conclusion. Experienced critical care nurses are able to transcend the obtrusive nature of technology to deliver expert caring to their patients. However, the journey to proficiency in technology is very demanding and novice nurses have difficulty in caring with technology. Relevance to clinical practice. It is recommended that more emphasis be placed on supporting, assisting and educating inexperienced nurses in the critical care area and that the use of technology in nursing be given serious consideration.     

Exploring community nurses' perceptions of life review in palliative care

Aims and objectives. This exploratory study aimed to identify community nurses’ understanding of life review as a therapeutic intervention for younger people requiring palliative care. The objectives set out to: (i) Describe the participants’ understanding of reminiscence and life review (ii) Detail their current ideas regarding a structured approach to using life review in the community setting. (iii) Outline their understanding of the possible advantages and limitations of life review in relation to palliative care. (iv) Identify future training requirements. Background. The literature review illustrated how the eighth developmental stage of Erikson's theory, ego‐integrity vs. despair, is a ‘crisis’ often faced by older people entering the final stage of life. Life review is considered a useful therapeutic intervention in the resolution of this crisis. Younger terminally ill people in the palliative stage of an illness may face the same final crises due to their reduced lifespan. Therefore, this study explored the benefits and limitations of life review as an intervention in palliative care. Method. The study used a purposive sample of community nurses responsible for delivering generic and specialist palliative care. A qualitative method of data collection in the form of three focus group interviews was used. Subsequent data were manually analysed, categorized and coded with associations between the themes identified. Results. The findings suggested that community nurses have limited knowledge pertaining to the use of life review and tend to confuse the intervention with reminiscence. Furthermore, they believed that life review could potentially cause harm to practitioners engaged in listening to another person's life story. However, the participants concur that with appropriate training they would find life review a useful intervention to use in palliative care. Conclusions. The results led to the identification of a number of key recommendations: Community nurses require specific education in the technicalities of life review and additional interpersonal skills training. The need for formalized support through clinical supervision is also recognized and discussed. Finally, suggestions are offered regarding the need to generate wider evidence and how, possibly, to integrate life review into existing palliative care services. Relevance to clinical practice. This study has demonstrated that community nurses are keen to extend the support offered to younger terminally ill people who are in the palliative stage of their illness. Despite having limited knowledge of life the main components and underpinning theory pertaining to life review participants could appreciate the potential of life review as a therapeutic intervention in palliative care and were keen to learn more about its use and gain the necessary knowledge and skills.     

Community mental health nurses' perspectives of recovery-oriented practice

Recovery-oriented practice, an approach aligned towards the service user perspective, has dominated the mental health care arena. Numerous studies have explored service users' accounts of the purpose, meaning and importance of 'recovery'; however, far less is known about healthcare staff confidence in its application to care delivery. A self-efficacy questionnaire and content analysis of nursing course documents were used to investigate a cohort of community mental health nurses' recovery-oriented practice and to determine the extent to which the current continuing professional development curriculum met their educational needs in this regard. Twenty-three community mental health nurses completed a self-efficacy questionnaire and 28 course documents were analysed. The findings revealed high levels of nurses' confidence in their understanding and ability to apply the recovery model and low levels of confidence were found in areas of social inclusion. The content analysis found only one course document that used the whole term 'recovery model'. The findings suggest a gap in the nurses' perceived ability and confidence in recovery-oriented practice with what is taught academically. Hence, nursing education needs to be more explicitly focused on the recovery model and its application to care delivery.     

Mentorship in contemporary practice: the experiences of nursing students and practice mentors

Aim. This paper explores the role of the mentor in contemporary nursing practice in the UK. It presents findings from a recent study which investigated the impact of a locality‐based nursing education initiative on students, practice mentors and academic staff and draws on another study, conducted in the same setting and two Australian sites, to examine the perceptions of nursing students and mentors. Background. Within nursing, mentorship is integral to students’ clinical placement experiences and has attracted increasing interest among researchers. Despite a plethora of studies focussing on mentoring and its nature and application within the practice setting, limited attention has been paid to the extent to which guidelines provided by regulatory bodies for nursing inform and influence the practice of mentoring in contemporary health‐care settings. Design. The study used a two‐phased design with data on mentorship being focussed on the second phase. Method. Data were collected using an online survey questionnaire of pre‐qualifying students and a postal questionnaire for practice mentors. Findings. The findings highlight the importance of mentorship for prequalifying students and emphasise the need to provide mentors with adequate preparation and support. They confirm previous research, but also highlight improvements in bridging the gap between rhetoric and reality for mentorship. Results are further strengthened when compared with those of the second study. Conclusions. Findings provide new evidence of a narrowing of the gap between the theory and practice of mentoring and for the continuing implementation of national standards to clarify the roles and responsibilities of the mentor. They also suggest the benefits of developing such standards in countries with similar systems of support for nursing students. Relevance to clinical practice. Mentorship is pivotal to students’ clinical experiences and is instrumental in preparing them for their role as confident and competent practitioners.     

Exploring views on Swedish district nurses' prescribing--a focus group study in primary health care

Since 1994 district nurses (DNs) in Sweden have been permitted to prescribe drugs from a limited list. This reform has met severe resistance from doctors and the opinions of general practitioners (GPs) and DNs have differed in many aspects. The aim of this study was to gain deeper understanding of the different opinions about DNs' prescribing and to explore the impact of the reform on primary care. Six focus group interviews were conducted, four with DNs and two with GPs. Data analysis revealed six categories, which were condensed into two dimensions. The dimensions were individual prerequisites, with the categories responsibility and knowledge, and organizational prerequisites, with the categories distribution of work, climate of co-operation, resistance and economic considerations. District nurses were very positive towards prescribing and had gained new knowledge through the compulsory training course and via discussions with pharmacists. Because of the responsibility required for prescribing, some nurses had introduced systems for self-monitoring. Prescribing was seen as a natural part of the nursing process. All interviewees could describe periods of resistance against the reform, and the head of the health centre was a key person for attitudes at the workplace. The DNs found the nurse prescribing reform very positive. They experienced a strengthening of professionalism and also thought that the reform was a natural development. Negative attitudes and opinions offset the positive feelings. The resistance that had appeared in the beginning had now turned into silent acceptance.     

Oral care in cancer nursing: nurses' knowledge and education

AIM: This paper reports a study of nurses' knowledge and education in relation to oral care and oral health assessment for patients undergoing cancer treatment. BACKGROUND: Studies suggest that ritualistic practice of oral care occurs and that nurses dislike providing this type of care. Inadequate knowledge and education of oral care among nurses have also been revealed, as well as a lack of involvement of dentists in this aspect of nurse education. METHOD: In 2003, an oral care questionnaire was administered to a non-random sample of 100 general and cancer nurses employed in an oncology centre, with a response rate of 72%. Information was collected on knowledge and education in relation to oral care, management of oral care, and influences on nurses' knowledge of oral care and performance of oral care. The questionnaire was tested for content validity by a panel of experts and modified accordingly. Reliability of the questionnaire subscales varied from a Cronbach's alpha of 0.56-0.82. Internal consistency for the total knowledge of oral care scale obtained an alpha of 0.93. FINDINGS: Data indicated that respondents had not had substantial oral care education during preregistration education, and their knowledge of oral health status, signs and symptoms of abnormalities was inadequate. Nurses placed a high degree of priority on oral care for patients with cancer. Respondents had also received insufficient support from hospital dentists for patients undergoing cancer treatment. CONCLUSION: Nurses require more education if they are to manage the oral care of patients with cancer effectively, and further research is needed into the actual practice of oral care for patients with cancer.