[Nurse prescription: A concept analysis]. / Prescripción enfermera: análisis de concepto.

OBJECTIVE: To critically analyse the concept of nursing prescription through the study of its background and a review of the scientific literature, in order to develop an accurate conception of this nursing activity and to identify the essential elements surrounding this concept. METHOD: Application of the concept analysis method described by Wilson, and adapted by Avant. RESULTS: The concept of nurse prescription implies prescribing, by the nurse, the best therapeutic regimen for a health problem. This prescription will be guided by the assessment of the health problem, by the criterion of the good clinical practice of the nurse, and will be focused to satisfy the health needs of the patient and the population. CONCLUSIONS: The results clarify the meaning of the study's concept to help professionals understand and address this nursing activity in all its dimensions, and promote social recognition of the nursing profession.

[Implementation of nurse demand managment in primary health care service providers in Catalonia]. / Implantación de la gestión enfermera de la demanda en las entidades proveedoras de servicios de Atención Primaria de Salud de Cataluña.

OBJECTIVE: To describe and analyse the implementaction of nurse demand managment (NDM) among health care providers in Catalonia from 2005 to 2014. DESIGN: Cross sectional survey. Participants All service providers in Catalonia (n=37). Main measurements Interviews with nurse manager of each health care provides about ht barriers and facilitators concerning NDM. Facilitators and barriers were classified into 3 types: (i)health professional (competence, attitudes, motivation for change and individual characteristics); (ii)social context (patients and companions), and (iii)system related factors (organization and structure, economic incentives). RESULTS: Of the 37 providers, 26 (70.3%) have implemented the Demand Management Nurse (NDM). The main barriers identified are the nurse prescriptin regulation, lack of knowledge and skills of nurses, and the lack of protocols at the start of implantation. Among the facilitators are the specific training of professionals, a higher ratio of nurses to doctors, consensus circuits with all professionals and linking the implementation of NDM to economic incentives. DISCUSSION: NDM is consolidated in Catalonia. However, the NDM should be included in the curricula of nursing degree and continuing education programs in primary care teams.

[Evaluation of Nurse Demand Management in Primary Care]. / Evaluación de la gestión enfermera de la demanda en atención primaria.

OBJECTIVE: to evaluate the health outcomes of nurse demand management on unscheduled patients in a Primary Care Centre, following a clinical guide designed by the whole primary care team. DESIGN: Cross-sectional study. SETTING: A primary care team from Castelldefels. Barcelona, Spain. PARTICIPANTS: A random sample of 558 patients requesting a consultation for the same day in a Primary Care setting, attended between May 1st, 2011 and January 31st, 2012. INTERVENTION: The guide includes 23 health problems that can be dealt by a nurse autonomously, 18 of them possibly requiring an emergency intervention, and shared decision with the physician. Each health problem is divided into three sections: a) a brief definition of the problem; b) an intervention algorithm; and c) nursing diagnoses of North American Nursing Diagnosis Association for each health problem and a description of the possible nursing interventions. RESULTS: We studied 558 patients with a mean age of 42.5 years old (SD 17.7). The most commonly consulted problems were upper respiratory tract symptoms (19.4%), followed by nausea/vomiting (16.5%), and burns/wounds (12.5%). 73.3% of the problems were resolved autonomously by a nurse. 65,8% of the patients attended received health advice. DISCUSSION: Nurse demand management has shown to be highly effective at handling the conditions attended, while it provides a high percentage of health advice and education during consultations.

Opinion on the benefits of nurse prescribing in Catalonia. Consensus of health professionals and managers.

OBJECTIVE: To study the level of agreement among health professionals and managers in Catalonia on the benefits of nurse prescribing (NP). METHOD: An online Real Time Delphi was conducted to collect the level of agreement of health professionals and managers. Participants voted in a 6-point scale (1 low benefit and 6 high benefit) for 12 items describing benefits of NP. A total of 1332 professionals participated. The level of consensus was calculated applying interquartile ranges of scores and standardized mean differences among subgroups using effect sizes (ES) and their corresponding 95% confidence intervals. RESULTS: The scores indicate a general agreement on the perceived benefits of NP among participants. Standardized differences among scores on the perceived benefits among professionals were small to high (ES range between 0.2 and 1.2) between nurses and medical doctors and high between nurses and pharmacists (ES range: 1.2 and 2.4). Differences between scores of nurses and those of managers or other professionals in the present study were smaller for most voted benefits. CONCLUSIONS: The study shows an agreement on the benefits of NP. Nevertheless, when standardized scores are taken into consideration, differences among professionals' perceptions emerged, and aligned with documented barriers identified in the literature such as corporative aspects, cultural limitations, institutional and organisational inertia, beliefs and unawareness of what NP implies.

[An approach to acute diseases using a nursing practice guide]. / Abordaje de la demanda de visitas espontáneas de un equipo de atención primaria mediante una guía de intervenciones de enfermería.

OBJECTIVE: To evaluate the health results of patients who make spontaneous visits when attended by nurses in a primary health care team and by applying a nursing practice guide. DESIGN: Cross-sectional, descriptive study. SETTING: Primary health care team from the Barcelona metropolitan area, Spain. PARTICIPANTS: Patients who request a spontaneous visit for the same day in the primary health care centre (PHC). INTERVENTION: A nursing practice guide was prepared in which health problems were classified into 3 groups according to seriousness and possibility of being resolved by the nursing staff: a) group 1, problems where the protocols allowed that the nurse could finalise the process; b) group 2, problems that might require emergency action; and c) group 3, problems that required an assessment of the level of seriousness. When the patient arrived at the PHC requesting an urgent visit, and the problem fell into group 1 it was dealt with by a nurse. RESULTS: There were 202 patients with health problems included in group 1.The mean age was 36.3 years (SD, 18.6 years).The most consulted health problems were musculo-skeletal (32.7%), followed by skin (22.3%), and the digestive system (22.3%). Of those, 63.9% of the problems were completely resolved and only 5.9% required visits by the out of hours doctor. DISCUSSION: The nursing practice guide meant that the nurse became the entrance door to the primary care system, with a high possibility of resolving health problems.