Potential of nurse prescribing in dermatology
February 3, 2011 by admin
This commentary on a recent article (see here) argues that nurse prescribing has an important contribution to make to the development of dermatology services given its scale and its potential to improve treatment outcomes and access to care. As ways of improving treatment effectiveness develop and are evaluated, it is important that they take account of nursing activity.
Ersser SJ. Nurse prescribing, concordance and the therapeutic consultation. BJD 2011; 164(2): 236-237.
Dermatology and nurse prescribing: patients’ views
December 16, 2010 by admin
Nurse prescribing in dermatology services can increase both their efficiency and patients’ involvement in treatment, according to the views reported here of patients with acne, psoriasis or eczema treated by seven specialist dermatology nurse prescribers.
The patients reported improved access as a result of greater efficiency, more appointments, telephone access to nurse prescribers (particularly noted) and the provision of local services. They also said they were involved in treatment decisions and care planning and, in contrast to some previous work, that they were happy with the information about the medicines provided. They rated the continuity of care provided, and the consultation style of the nurse prescribers, highly - and levels of trust and confidence were also high.
The authors comment that, given the financial constraints the NHS will be operating under, these results could have important implications for using resources to their maximum and improving access to, and quality of, dermatology specialist services.
Courtenay M, Carey N, Stenner K, Lawton S and Peters J. Patients’ views of nurse prescribing: effects on care, concordance and medicine taking. Br J Dermatology, in press.
http://dx.doi.org/10.1111/j.1365-2133.2010.10119.x.
Nurse prescribers: what do dermatology patients think?
July 30, 2009 by admin
Dermatology patients were found to be very satisfied with the care they were given by nurse independent prescribers and nurse supplementary prescribers, in this study in which 165 (82%) patients treated by nurse prescribers from different convenience samples returned questionnaires.
The questionnaires asked patients about access and waiting times, continuity of care, communication during the consultation, outcomes of the consultation and satisfaction with the care received.
Continuity of care was seen as good and rated highly, suggesting that relationship continuity is an important aspect of the nurse-patient relationship: in particular, patients of the specialist nurses rated continuity highly - these patients are more likely to have long-term conditions.
All aspects of communication during the consultation were rated highly by patients, with slightly lower ratings being given to the amount of information patients received about their medicines. Patients of specialist nurses rated this aspect higher than those of GP nurses.
Overall, the authors conclude that the relationship nurse prescribers have with their dermatology patients and the length of the consultations are important features in this type of consultation. More research is needed on the information needs of dermatology patients, and on the effect of the nurse prescriber/patient relationship on medicines concordance and clinical outcomes.
Courtenay M, Carey N and Stenner K. Dermatology patients’ views on nurse prescribers. Dermatological Nursing 2009; 8(2): 38-44.
Prescribing works well for specialist dermatology nurses
May 26, 2009 by admin
Nurse prescribing enhances the care of patients with dermatological conditions, with the benefits being most pronounced for patients of dermatology specialist nurses rather than general practice nurses, according to this case study of consultations between nurse prescribers and patients. The authors also highlight the need for nurses to give patients more information about their medicines if they are to be more involved in the decision-making process.
Interviews, questionnaires and videotaping were used in 10 practice settings across England where nurses prescribe for patients with dermatological conditions. The nurses believed that their prescribing decisions were improved by their holistic assessment approach and better prescribing knowledge. Patients rated their listening and treatment explanation skills, and the assessors who watched the tapes also rated the nurses’ ability to listen and deal sensitively with emotions.
The authors conclude that prescribing allows specialist dermatology nurses to contribute more effectively to dermatology services and that more research is needed to establish whether this is the case for other specialist areas.
Courtenay M, Carey N and Stenner K. Nurse prescriber-patient consultations: a case study in dermatology. J Adv Nursing 2009; 65(6): 1207-1217.
Nurse prescribing: what do other professionals think?
April 10, 2009 by admin
What are the views of other healthcare professionals - doctors and non-prescribing nurses - on nurse prescribing? This is an important question because, if nurse prescribing is to reach its potential, the support and cooperation of other professionals is crucial. Two recent studies have sought to address this and related issues.
In one [1], 12 doctors (seven dermatology specialists and five GPs) and six non-prescribing nurses, all of whom worked with nurses prescribing for patients with dermatological conditions, were interviewed about their views on nurse prescribing in the light of this experience. They were positive about the prescribing practice of the nurses with whom they themselves worked and about the benefits, but they continued to have reservations about nurse prescribing in general and particularly about the importance of extensive experience before nurses start prescribing and about prescribing within limits of competence.
The authors point out that the parameters within which nurses prescribe are not always understood and some of the participants expected negative opinions about nurse prescribing to shift as more healthcare professionals gain direct experience of how it works in practice. The authors then recommend that the standards for nurse prescribing are promoted widely and adhered to.
In the other study [2], a questionnaire survey of all 200 qualified psychiatrists working in two UK mental health trusts, the results from the 149 that were returned suggested that senior doctors had fewer concerns about new nursing roles than their junior colleagues.
Although just over half the consultants felt that mental health nurses should be able to prescribe independently, 80% of junior doctors thought that they should not, although many thought they had a role in out-of-hours prescribing. The junior doctors suggested consistent supervision and limited access to mental health drugs. The senior doctors also had strong ideas about which drugs nurses should be prescribing.
The authors discuss these interesting results in terms of role change and implications for the future. It is possible that the consultants know the senior nurses who are prescribing better than their junior colleagues do, and therefore have had more chance to gain confidence in their abilities. It is also possible that the junior doctors are concerned about their roles in future. The concerns of junior doctors about nurse prescribing need addressing, to avoid conflict and to safeguard the quality of care that patients receive; more research is also needed in this area. Links between nurse prescribers and pharmacists could be a valuable means of support and development, given the importance participants attached to regular practice review for nurse prescribers, but the authors point out that there are few specialised mental health pharmacists in England and that not all mental health trusts have dedicated pharmacy support.
[1] Stenner K, Carey N and Courtenay M. Nurse prescribing in dermatology: doctors’ and non-prescribing nurses’ views. J Adv Nursing 2009; 65(4): 851-859.
http://dx.doi.org/10.1111/j.1365-2648.2008.04944.x
[2] Rana T, Bradley E and Nolan P. Survey of psychiatrists’ views of nurse prescribing. J Psychiatr Men Health Nursing 2009; 16(257-262).
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