196,166 research outputs found
Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study
No full textMentorship in contemporary practice: the experiences of nursing students and practice mentors
No full textAim: 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 student
Experiences of extended formulary independent nurse prescribers (EFINPs): Findings from a national survey in England
No full textMyall Creek and the psychology of mass murder
No full textThe Myall Creek massacre of 1838 is one of the most emotive symbols of European-Aboriginal relations in Australian colonial history. It symbolizes the conflict of the actions of those on the frontier with the ideals espoused by humanitarians and colonial authority. The massacre also raises issues which are not so much symbolic as symptomatic of racial attitudes and indeed human violence. Historians, it seems to me, have adequately explained the nature of racist attitudes, but are still struggling with precisely why and how a mass murder took place. How did the Myall Creek murders come to be capable of committing inhuman acts
Evaluating nurse prescribers’ education and continuing professional development for independent prescribing practice: Findings from a national survey in England
No full textBackground:The number of nurses able to independently prescribe medicines in England has risen steadily in recent years.Aim:To evaluate the adequacy of nurses’ educational preparation for independent prescribing and to describe nurses’ experiences of their continuing professional development as prescribers in practice.Design and method:Postal questionnaire survey.Participants:Random sample of 246 nurses registered as nurse independent prescribers with the Nursing and Midwifery Council.Results:The majority of nurses considered that the initial taught course element of their education programme met their needs, either to some extent (61% 151/246), or completely (22% 54/246). Most nurses (77% 190/246) received the specified 12 days support from their supervising medical practitioner and most were satisfied and positive about this experience. Nearly all of the nurses (>95%) reported that they were able to maintain a range of specified prescribing competencies in practice. Two thirds (62% 152/246) of the sample reported that they were receiving support/supervision for prescribing. Ninety five per cent (233/246) of the sample also reported that they engaged in self-directed informal continuing professional development, but only half of the sample had experience of formally provided professional development opportunities. Approximately half (52% 127/246) of the sample identified needs for continuing professional development.Conclusion:This first national survey of the education and professional development experiences of nurse independent prescribers in England provides evidence which highlights areas in which national policy is working well, and also points up issues which may need addressing as the roll out of nurse prescribing continues. The study also highlights characteristics and issues that health care policy makers and nurse educationalists internationally may wish to consider in developing and refining their own nurse prescriber education programmes
Evaluating prescribing competencies and standards used in nurse independent prescribers’ prescribing consultations: An observation study of practice in England
No full textBackground: Independent prescribing of medicines by nurses is widely considered to be part of advanced nursing practice, and occurs within an episode of patient care that can be completed independently by a nurse. Nurse prescribers therefore require the competencies necessary to manage a consultation—such as history taking and diagnostic skills—and subsequently need to decide on any appropriate medicine to be prescribed. Safe prescribing should also involve an accurate, legible and comprehensive written prescription and documentation of the consultation in the patient’s records. However, the extent to which nurse independent prescribers use prescribing competencies and standards in practice had not been researched prior to this study. Aim: To describe the frequency with which nurses use a range of prescribing competencies in their prescribing consultations, in order to provide a measure of the quality and safety of nurses’ independent prescribing practices. Design and methods: Across 10 case study sites, 118 nurse independent prescribers’ prescribing consultations were analysed using non-participant observation and a structured checklist of prescribing competencies. Documentary analysis was also undertaken of a) prescriptions written (n =132) by nurses and b) the record of the prescribing episode in patient records (n =118). Sample and setting: 118 prescribing consultations of 14 purposively selected nurse independent prescribers working in primary and secondary care trust case study sites in England. Findings: Nurse independent prescribers were issuing a prescription every 2.82 consultations; nurses used a range of assessment and diagnosis competencies in prescribing consultations, but some were employed more consistently than others; nurses almost universally wrote full and accurate prescription scripts for their patients; nurses recorded each of their prescribing consultations, but some details of the consultation and the prescription issued were not always consistently recorded in the patient records. Conclusion: The findings from this observation study provide evidence about the quality and safety of nurses’ prescribing consultations in England
Ethnographic study of ICT-supported collaborative work routines in general practice
No full textAbstract Background Health informatics research has traditionally been dominated by experimental and quasi-experimental designs. An emerging area of study in organisational sociology is routinisation (how collaborative work practices become business-as-usual). There is growing interest in the use of ethnography and other in-depth qualitative approaches to explore how collaborative work routines are enacted and develop over time, and how electronic patient records (EPRs) are used to support collaborative work practices within organisations. Methods/design Following Feldman and Pentland, we will use 'the organisational routine' as our unit of analysis. In a sample of four UK general practices, we will collect narratives, ethnographic observations, multi-modal (video and screen capture) data, documents and other artefacts, and analyse these to map and compare the different understandings and enactments of three common routines (repeat prescribing, coding and summarising, and chronic disease surveillance) which span clinical and administrative spaces and which, though 'mundane', have an important bearing on quality and safety of care. In a detailed qualitative analysis informed by sociological theory, we aim to generate insights about how complex collaborative work is achieved through the process of routinisation in healthcare organisations. Discussion Our study offers the potential not only to identify potential quality failures (poor performance, errors, failures of coordination) in collaborative work routines but also to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in EPR technologies and via which "automated" safety features have an impact in practice.</p
Perceptions and practice of concordance in nurses’ prescribing consultations: findings from a national questionnaire survey and case studies of practice in England
No full textBackground:The number of nurses able to independently prescribe medicines in England is increasing. Patient adherence to prescribed medicines remains a significant problem [Department of Health, 2000. Pharmacy in the Future: Implementing the NHS Plan. A Programme for Pharmacy in the NHS. Stationary Office, London]. Concordance—a partnership approach to medicine consultations—is advocated as an effective solution [Medicines Partnership, 2003. Project Evaluation Toolkit. Medicines Partnership, London].Objectives:To investigate whether nurses were practising the principles of concordance within their prescribing interactions.Design:Phase (i) postal questionnaire survey. Phase (ii): case studies of practice.Settings:Phase (i) primary and secondary care trusts throughout England in which nurse prescribers were practicing. Phase (ii) six general practice settings; one community midwifery service; one specialist community palliative care service; one secondary care ophthalmology unit; one NHS walk-in centre.Participants:Phase (i) a random sample of 246 nurses registered as independent nurse prescribers with the Nursing and Midwifery Council in 2002/2003. Phase (ii) purposively selected sample of 14 nurse prescribers who participated in Phase (i) of the study; a total of 208 purposively selected patients completed self-administered questionnaires.Methods:Phase (i) postal questionnaires. Phase (ii) structured non-participant observation of 118 nurse prescribing consultations; 115 post-consultation patient questionnaires; 93-patient postal questionnaires.Results:99% of the nurses in the national survey stated they were practising the principles of concordance. The majority of patients surveyed also reported experiencing concordance in practice. Observation of practice revealed that although some principles of concordance were regularly integrated into nurses’ practice, other principles were less often in evidence. Some evidence from both observation of practice and patient questionnaires suggested that a professionally determined ‘compliance’ agenda may still be partially operating in practice.Conclusions:Most nurses believe they are practicing concordance in their prescribing consultations. The majority of patients also reported that they had experienced some of the principles of concordance in practice. Observation of practice highlighted that the shift from a professionally determined compliance agenda to the integration of concordance into nurses’ prescribing consultations had not yet taken place
Measuring clinical appropriateness of nurse prescribing: Methodological issues arising from a national evaluation of practice
No full textWhat do service users and health professions think about nurse prescribing? Exploring patients, doctors and pharmacists’ perceptions of extended formulating independent nurse prescribing in England
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