[Nurse prescribing rights, the UK experience]. / Droit de prescription des infirmières, l'expérience du Royaume-Uni.

The United Kingdom has gradually introduced nurse prescribing. This authorisation is granted upon completion of a theoretical and practical training course. This evolution has been deemed to have had a positive impact twenty years after its implementation.

Use and evaluation of a mentoring scheme to promote integration of non-medical prescribing in a clinical context.

BACKGROUND: Growing numbers of non-medical health professionals are attaining prescribing rights through post-registration non-medical prescribing (NMP) courses in the UK. However, not all implement prescribing post-qualification. This study evaluated the uptake and perceived usefulness of a mentoring scheme for two cohorts of NMP students at the University of Nottingham. The scheme paired students with qualified mentors with whom they had an opportunity to discuss the integration of prescribing theory into practice. METHODS: Mentors were allocated on days 2-5 of the course. Surveys were distributed to students who completed the NMP course [n = 63] and their mentors. Likert-scale and open-ended questions addressed: use, perceived usefulness, and positive and negative aspects of the mentoring scheme. Semi-structured interviews were conducted with both students (n = 6) and mentors (n = 3) to explore their experience of the mentoring scheme in more detail. Students were purposively selected for interview depending on their level of use of the mentoring system. Interviews were analysed using thematic analysis. RESULTS: The response rates were 65.1% (n = 41) and 56.3% (n = 36) for students and mentors respectively. Just over half of students (57.1%) accessed their mentor. Having a sufficient support network was the key reason for not using the scheme. Students found mentors helpful for: moral support (68.2%); contextualising prescribing (71.4%); and helping them to think about implementing prescribing in practice (72.7%). Fewer mentors felt they helped in relation to contextualising (57.9%) or implementing prescribing (31.6%). Less than half the students and mentors surveyed agreed that they received/provided assistance related to the integration of prescribing theory into practice (38.1% and 42.2% respectively) and assistance with assignments (36.3% and 45.5% respectively).Interviews suggested that students found it difficult to focus on implementing prescribing because of the academic demands of their course, which impacted on uptake and use of the mentoring scheme. Students emphasised the importance of being paired with a prescriber who was successfully prescribing. Mentors benefited from sharing and refreshing their academic knowledge. CONCLUSIONS: Students and mentors derived benefits from participation in this scheme. This intervention may be better as a post-qualification support resource when students are ready to consider their future prescribing practice.

How do nurse prescribers integrate prescribing in practice: case studies in primary and secondary care.

AIMS AND OBJECTIVES: To report a study investigating how nurse prescribers integrate prescribing in clinical practice. Factors that influence integration are explored and how nurses approach integration is defined. BACKGROUND: There are expectations that nurse prescribers will prescribe for patients. Nurse prescribers share jurisdiction of prescribing with doctors in the workplace and new divisions of labour must be agreed to enable the nurse to begin prescribing. Little is known about how nurses integrate prescribing in practice but these agreements are potentially important to the organisation of professional work and the delivery of healthcare. DESIGN: Case study. METHODS: Twenty six nurse prescribers were interviewed in case studies of primary and secondary care prescribing. Case data were collected by semi-structured interview and combined with field notes and socio-demographic data in case summaries. Data were organised in vivo (QSR International Pty Ltd, Doncaster, Victoria, Australia) and subject to manual analysis at single and cross-case level. RESULTS: Twenty-one of the 26 cases were prescribing. Trust between doctor and nurse and nurse and employer was shown to be necessary for effective integration. There were differences in how prescribing agreements were reached in primary and secondary care. Restrictions were imposed in secondary care. In primary care, nurses made decisions themselves about the medicines they prescribe but frequently asked doctors to check their decisions. Nurses described three approaches to prescribing: as opportunity presents, for specific conditions and for individuals. CONCLUSIONS: Nurse prescribers described three approaches to prescribing and in two approaches the nurse self-restricted prescribing activity. Secondary care prescribers had more employer restrictions than their primary care counterparts. Trust between doctor nurse and nurse employer was shown to be necessary for integration; without trust, the nurse will not prescribe. RELEVANCE TO PRACTICE: Trust in prescribing relationships is necessary for effective integration of nurse prescribing in practice.

Medicines non-adherence: adult literacy and implications for practice.

Functional health literacy is defined as the level at which individuals can obtain, process and understand basic health information (Martin et al, 2009). Government statistics suggest low functional health literacy is an under-recognised and growing problem in UK health care. It is associated with high hospitalisation (Baker et al, 1998) and increased medicines non-adherence (Kalichman et al, 1999). Health professionals are poor at assessing and identifying those at risk because they have yet to acknowledge the prevalence of the problem. Initiatives attempting to address medicines non-adherence promote patient involvement in treatment decisions but remain ineffective if patients cannot read or understand written instructions. To help patients with low functional health literacy practitioners should speak slowly, repeat information, use plain, non-medical language and adopt teach-back techniques. These actions take extra time but are relatively easy to adopt and with a little thought become part of everyday practice.

Safety first on medicines.

Aspects of medicines management are increasingly being taken on by healthcare assistants.

Pharmacology podcasts: a qualitative study of non-medical prescribing students' use, perceptions and impact on learning.

BACKGROUND: There is growing research on student use of podcasts in academic settings. However, there is little in-depth research focusing on student experience of podcasts, in particular in terms of barriers to, and facilitators of, podcast use and students' perceptions of the usefulness of podcasts as learning tools. This study aimed to explore the experiences of non-medical prescribing students who had access to podcasts of key pharmacology lectures as supplementary learning tools to their existing course materials. METHODS: Semi-structured interviews were carried out with seven non-medical prescribing students (average age = 43 years), all of whom were nurses, who had access to seven podcasts of key pharmacology lectures. These podcasts took the form of downloadable audio lecture recordings available through the virtual learning environment WebCT. Low, medium and high users of the podcasts took part in the interviews in order to access a variety of student experiences. Interview data was analysed using thematic template analysis to identify key themes surrounding student experience of podcast availability, particularly in relation to barriers to and facilitators of podcast use, and students' experiences of podcasts as a learning tool. RESULTS: Students used podcasts for a variety of reasons such as revisiting lectures, preparing for exams, to clarify or revise specific topics and, to a lesser extent, to catch up on a missed lecture. Barriers to podcast use centred mainly around technological issues. Lack of experience of the technology required to access podcasts proved a barrier for some students. A lack of access to suitable technology was also a reported barrier. Family assistance and I.T. assistance from the university helped facilitate students' use of the podcasts. Students found that using podcasts allowed them to have greater control over their learning and to gauge their learning needs, as well as helping them build their understanding of a complex topic. CONCLUSIONS: Students used podcasts for a variety of reasons. Barriers to podcasts use were generally related to technological issues. Students often found that once assistance had been gained regarding these technological issues, they accessed the podcasts more easily. Students felt that access to podcasts added value to their learning materials by allowing them to better manage their learning and build their understanding. Podcasts represent a valuable additional learning tool for this specific group of older students.

Pharmacology as a foreign language: a preliminary evaluation of podcasting as a supplementary learning tool for non-medical prescribing students.

BACKGROUND: Nurses and other health professionals in the U.K. can gain similar prescribing rights to doctors by undertaking a non-medical prescribing course. Non-medical prescribing students must have a thorough understanding of the pharmacology of prescribing to ensure safe practice. Pharmacology education at this level is complicated by the variation in students' prior subject knowledge of, and anxiety about, the subject. The recent advances in technology, particularly the potential for mobile learning, provide increased opportunities for students to familiarise themselves with lecture materials and hence promote understanding. The objective of this study was therefore to evaluate both the subjective (student perception) and objective (student use and exam results) usefulness of podcasts of pharmacology lectures which were provided as an extra learning tool to two cohorts (n = 69) of non-medical prescribing students. METHODS: The podcasts were made available to students through the virtual learning environment WebCT. Use of podcasts by two successive cohorts of nurse prescribing students (n = 69) was tracked through WebCT. Survey data, which was collected from 44 of these students, investigated patterns of/reasons for podcast use and perceived usefulness of podcasts as a learning tool. Of these 69 students, 64 completed the pharmacology exam. In order to examine any impact of podcasts on student knowledge, their exam results were compared with those of two historical cohorts who did not have access to podcasts (n = 70). RESULTS: WebCT tracking showed that 91% of students accessed at least one podcast. 93% of students used the podcasts to revisit a lecture, 85% used podcasts for revision, and 61% used the podcasts when they had a specific question. Only 22% used the podcasts because they had missed a pharmacology session. Most students (81%) generally listened to the entire podcast rather than specific sections and most (73%) used them while referring to their lecture handouts. The majority of students found the podcasts helpful as a learning tool, as a revision aid and in promoting their understanding of the subject. Evaluation of the range of marks obtained, mode mark and mean mark suggested improved knowledge in students with access to podcasts compared to historical cohorts of students who did not have access to pharmacology podcasts. CONCLUSIONS: The results of this study suggest that non-medical prescribing students utilised podcasts of pharmacology lectures, and have found the availability of these podcasts helpful for their learning. Exam results indicate that the availability of podcasts was also associated with improved exam performance.