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1.
Artigo em Inglês | MEDLINE | ID: mdl-31500266

RESUMO

Recent research has highlighted that the number of people impacted by a death by suicide is far greater than previously estimated and includes wider networks beyond close family members. It is important to understand the ways in which suicide impacts different groups within these wider networks so that safe and appropriate postvention support can be developed and delivered. A systematic review in the form of a qualitative research synthesis was undertaken with the aim of addressing the question 'what are the features of the experiences of workers in health, education or social care roles following the death by suicide of a client, patient, student or service user?' The analysis developed three categories of themes, 'Horror, shock and trauma', 'Scrutiny, judgement and blame', and 'Support, learning and living with'. The mechanisms of absolution and incrimination were perceived to impact upon practitioners' experiences within social and cultural contexts. Practitioners need to feel prepared for the potential impacts of a suicide and should be offered targeted postvention support to help them in processing their responses and in developing narratives that enable continued safe practice. Postvention responses need to be contextualised socially, culturally and organisationally so that they are sensitive to individual need.

2.
Immun Inflamm Dis ; 7(3): 214-228, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290265

RESUMO

BACKGROUND: Clinicians draw on instructional approaches when training patients with anaphylaxis to use adrenaline autoinjectors, but patient use is poor. Psychological barriers to these behaviours exist but are not considered routinely when training patients to use autoinjectors. Health Psychology principles suggest exploring these factors with patients could improve their autoinjector use. OBJECTIVE: To evaluate the impact of a 90-minute workshop training clinicians in strategies and techniques for exploring and responding to psychological barriers to autoinjector use with patients. Attendees' knowledge, confidence and likelihood of using the strategies were expected to improve. METHODS: Impact was evaluated using a longitudinal mixed-method design. Twenty-nine clinicians (general and specialist nurses, general practitioners, and pharmacists) supporting patients with anaphylaxis in UK hospitals and general practice attended. Self-rated knowledge, confidence, and likelihood of using the strategies taught were evaluated online 1 week before, 1 to 3, and 6 to 8 weeks after the workshop. Clinicians were invited for telephone interview after attending to explore qualitatively the workshop impact. RESULTS: χ2 analyses were significant in most cases (P < .05), with sustained (6-8 weeks) improvements in knowledge, confidence, and likelihood of using the strategies taught. Thematic analysis of interview data showed the workshop enhanced attendees' knowledge of the care pathway, understanding of patient's experience of anaphylaxis as psychological not purely physical, and altered their communication with this and other patient groups. However, interviewees perceived lack of time and organisational factors as barriers to using the strategies and techniques taught in clinical contexts. CONCLUSION: Training clinicians in psychologically informed strategies produce sustained improvements in their confidence and knowledge around patient autoinjector education, and their likelihood of using strategies in clinical practice. CLINICAL RELEVANCE: Exploring psychological barriers should be part of training patients with anaphylaxis in autoinjector use.

3.
J Contin Educ Health Prof ; 39(2): 130-135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31045987

RESUMO

Adrenaline autoinjectors (AAIs) improve outcomes and reduce fatalities in patients with anaphylaxis, but many patients neither carry them nor know how to use them. Practitioner training in evidence-based strategies designed to increase patient adherence could improve the likelihood of AAI adherence and increase confidence among practitioners to initiate discussions about practical and perceptual barriers to AAI adherence. This article reports the development of a new practitioner training intervention, grounded in health psychology theory and evidence designed for practitioners in contact with patients with anaphylaxis to encourage adherence to AAIs. Potential implications for the design, implementation, and evaluation of future practitioner training in strategies they can use to encourage anaphylaxis patients' AAI adherence are discussed. Although designed for those working with anaphylaxis patients, this step-by-step process to encouraging adherence could be adapted for practitioners working with patients living with other long-term conditions.

4.
J Psychiatr Ment Health Nurs ; 25(5-6): 327-337, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29753313

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: User involvement, when people who have accessed services become actively involved in aspects of mental health care, can sometimes be "tokenistic" and not well thought through. Users are often involved in their own care, and asked for feedback, but are less likely to be meaningfully involved in developing services and training staff. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To implement meaningful involvement, it is important to know why some users choose to devote time to such activities. User representatives in this study, involved in a UK mental health service, wanted to help people in a similar position and give something back to those that helped them. As people started involvement activities, such as interviewing staff, they gained confidence and felt part of something that was making a difference. After being supported by staff to explore opportunities, representatives become more independent and some moved to different, sometimes salaried, roles. Some representatives did not feel valued or supported. Staff often controlled opportunities, and many users missed out on being involved. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Staff need to understand and receive training on involvement. The definition of involvement should be agreed by users and staff together, and outcomes of involvement activities must be fed-back to users on a regular basis. There should be dedicated involvement workers in services, to support individuals and integrate involvement into the system. It is important to consider how to make involvement accessible to more mental health service users. ABSTRACT: Introduction Despite guidance promoting user involvement, meaningful involvement continues to be debated within services. To effectively implement involvement, it is important to acknowledge why users devote time to such activities. Aim This study explores user representatives' experiences of involvement, including motivations and personal benefits. Method Thirteen user representatives involved in activities such as staff training and interviews were recruited from a UK National Health Service mental health Trust during 2015. Themes within semi-structured interviews were developed using constructivist grounded theory analysis. Memo-writing, process and focused coding, and core categories supported development of the conceptual framework of being a user representative. Findings Being a user representative was inextricably linked to wellness, yet staff governed opportunities. Making a difference to others and giving back were initial motivating factors. Experiences depended on feeling valued, and the theme of transition captured shifts in identity. Discussion User representatives reported increased confidence and well-being when supported by staff. However, involvement triggered mental health difficulties and identified the need for regular monitoring and reflection of involvement activities and practice. Implications for practice Services should consider coproduction, where users and staff agree together on involvement definitions. Dedicated involvement workers are crucial to supporting individual well-being and monitoring involvement.

5.
Cochrane Database Syst Rev ; 4: CD004363, 2018 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-29669175

RESUMO

BACKGROUND: Depression is common in the postnatal period and can lead to adverse effects on the infant and wider family, in addition to the morbidity for the mother. It is not clear whether antidepressants are effective for the prevention of postnatal depression and little is known about possible adverse effects for the mother and infant, particularly during breastfeeding. This is an update of a Cochrane Review last published in 2005. OBJECTIVES: To assess the effectiveness of antidepressant medication for the prevention of postnatal depression, in comparison with any other treatment, placebo or standard care. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR ‒ both Studies and References), CENTRAL (Wiley), MEDLINE (OVID), Embase (OVID), PsycINFO (OVID), on 13 February 2018. We also searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov on 13 February 2018 to identify any additional unpublished or ongoing studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) of initiation of antidepressants (alone or in combination with another treatment), compared with any other treatment, placebo or standard care for the prevention of postnatal depression among women who were either pregnant or had given birth in the previous six weeks and were not currently depressed at baseline. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We requested missing information from investigators wherever possible and sought data to allow intention-to-treat analyses. MAIN RESULTS: Two trials including a total of 81 participants fulfilled the inclusion criteria for this review. All participants in both studies had a history of postnatal depression and were not taking antidepressant medication at baseline. Both trials were conducted by the same research group. Risk of bias was low or unclear in most domains for both studies. We were unable to perform a meta-analysis due to the small number of studies.One study compared nortriptyline with placebo and did not find any evidence that nortriptyline was effective in preventing postnatal depression. In this study, 23% (6/26) of women who took nortriptyline and 24% (6/25) of women who took placebo experienced postnatal depression (RR 0.96, 95% CI 0.36 to 2.59, very low quality evidence) in the first 17 weeks postpartum. One woman taking nortriptyline developed mania; and one side effect, constipation, was more common among women taking nortriptyline than those taking placebo.The second study compared sertraline with placebo. In this study, 7% (1/14) of women who took sertraline developed postnatal depression in the first 17 weeks postpartum compared with 50% (4/8) of women who took placebo. It is uncertain whether sertraline reduces the risk of postnatal depression (RR 0.14, 95% CI 0.02 to 1.07, very low quality evidence). One woman taking sertraline had a hypomanic episode. Two side effects (dizziness and drowsiness) were more common among women taking sertraline than women taking placebo.Conclusions are limited by the small number of studies, small sample sizes and incomplete outcome data due to study drop-out which may have led to bias in the results. We have assessed the certainty of the evidence as very low, based on the GRADE system. No data were available on secondary outcomes of interest including child development, the mother‒infant relationship, breastfeeding, maternal daily functioning, family relationships or maternal satisfaction. AUTHORS' CONCLUSIONS: Due to the limitations of the current evidence base, such as the low statistical power of the included studies, it is not possible to draw any clear conclusions about the effectiveness of antidepressants for the prevention of postnatal depression. It is striking that no new eligible trials have been completed in the period of over a decade since the last published version of this review. Larger trials are needed which include comparisons of antidepressant drugs with other prophylactic treatments (e.g. psychological interventions), and examine adverse effects for the fetus or infant. Future reviews in this area may benefit from broadening their focus to examine the effectiveness of antidepressants for the prevention of perinatal (i.e. antenatal or postnatal) depression, which could include studies comparing antidepressant discontinuation with continuation for the prevention of relapse of depression during pregnancy and the postnatal period.


Assuntos
Antidepressivos/uso terapêutico , Depressão Pós-Parto/prevenção & controle , Nortriptilina/uso terapêutico , Sertralina/uso terapêutico , Feminino , Humanos , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Health Expect ; 21(1): 192-200, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28779520

RESUMO

BACKGROUND: A diagnosis of serious mental illness can impact on the whole family. Families informally provide significant amounts of care but are disproportionately at risk of carer burden when compared to those supporting people with other long-term conditions. Shared decision making (SDM) is an ethical model of health communication associated with positive health outcomes; however, there has been little research to evaluate how routinely family is invited to participate in SDM, or what this looks like in practice. OBJECTIVE: This UK study aimed to better understand how the family caregivers of those diagnosed with SMI are currently involved in decision making, particularly decisions about treatment options including prescribed medication. Objectives were to Explore the extent to which family members wish to be involved in decisions about prescribed medication Determine how and when professionals engage family in these decisions Identify barriers and facilitators associated with the engagement of family in decisions about treatment. PARTICIPANTS: Open-ended questions were sent to professionals and family members to elicit written responses. Qualitative responses were analysed thematically. RESULTS: Themes included the definition of involvement and "rules of engagement." Staff members are gatekeepers for family involvement, and the process is not democratic. Family and staff ascribe practical, rather than recovery-oriented roles to family, with pre-occupation around notions of adherence. CONCLUSIONS: Staff members need support, training and education to apply SDM. Time to exchange information is vital but practically difficult. Negotiated teams, comprising of staff, service users, family, peers as applicable, with ascribed roles and responsibilities could support SDM.

7.
J Health Psychol ; 23(12): 1579-1589, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27553607

RESUMO

Anaphylaxis is a serious, rare condition increasing in prevalence. This study explored the psychological experience of adult-onset anaphylaxis from patient, family and staff perspectives. Semi-structured interviews were conducted with 12 participants. Two global themes emerged from thematic analysis: 'controllability' ('an unknown and distressing experience', 'the importance of control over triggers' and 'responsibility but no control: the impact on others') and 'conflict' ('rejecting illness identity', 'minimisation of risk', 'accessing specialist care: running in slow motion' and 'patient-centred versus service-centred care'). Findings highlight the importance of perceived control and emphasise the presence of conflict in the experience of this complex, episodic condition.

8.
Int J Clin Pharm ; 38(5): 1191-9, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27450504

RESUMO

Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user's lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.


Assuntos
Antipsicóticos/uso terapêutico , Atitude do Pessoal de Saúde , Tomada de Decisão Clínica/métodos , Transtornos Mentais/tratamento farmacológico , Saúde Mental , Farmacêuticos , Adulto , Tomada de Decisões , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Inquéritos e Questionários , Reino Unido/epidemiologia
9.
Maturitas ; 80(3): 265-72, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25616779

RESUMO

Ultraviolet radiation (UVR)-induced photoageing of the skin is associated with characteristic clinical features including a sallow complexion, deep, coarse wrinkles and a loss of elasticity. Remodelling of the dermal extracellular matrix (ECM) with changes to fibrillar collagens, elastic fibres and glycosaminoglycans is likely to be a major contributing factor to these particular clinical signs. Over-the-counter (OTC) topical formulations are one popular management strategy for preventing and/or repairing photoaged skin, most commonly targeting wrinkles as these are often the most concerning clinical feature. Due to the cosmetic nature of such formulations, evidence of their clinical efficacy and mechanism of action is often limited. However, these formulations usually contain putative active ingredients which individually have been subject to in vitro and in vivo investigation for efficacy as photoageing interventions. This review highlights commonly found ingredients within OTC formulations and assesses the evidence for: (i) their efficacy in clinically and histologically improving photoaged skin; (ii) the potential mechanisms of action; and (iii) their ability to act synergistically with complementary ingredients to enhance the clinical outcome.


Assuntos
Envelhecimento da Pele , Protetores Solares/administração & dosagem , Raios Ultravioleta/efeitos adversos , Administração Cutânea , Química Farmacêutica , Sinergismo Farmacológico , Humanos , Medicamentos sem Prescrição
10.
Health Expect ; 18(6): 2401-12, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24831061

RESUMO

BACKGROUND: Care for patients with multimorbidity represents a major challenge not only for patients and carers but to health-care systems. Hospital discharge transition is a critical point at which challenges for multimorbidity may amplify. OBJECTIVES: The main objective of the study was to explore the experiences of heart failure (HF) and chronic obstructive pulmonary disease (COPD) multimorbid patients and their carers on hospital discharge. Secondary objectives included identification of gaps in the health care of multimorbidity and optimal solutions from patients and carers' perspectives. DESIGN: Mixed methods were applied to collect data using patient self-completion questionnaire from an adapted version of the American Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and in-depth interviews. SETTING: Participants were recruited from two cardiology and respiratory wards at a large regional hospital in England, and all had a multimorbidity diagnosis of COPD and HF. RESULTS AND CONCLUSIONS: Findings revealed that patients experienced difficulties in their communication with health-care professionals and there were specific challenges with information about medication. Qualitative descriptions revealed that experiences fell into two main categories: (i) information transfer to patients with multimorbidity in terms of issues with medication and clarity of information on diagnosis and (ii) communication and continuity of care after discharge. Respondents highlighted gaps in the management of patients with multimorbidity of HF and COPD at the critical time of care transition. They suggested the need for a comprehensive, coordinated and integrated approach to incorporate patients, carers and staff preferences for treatment on discharge from hospital.


Assuntos
Cuidadores/psicologia , Insuficiência Cardíaca/terapia , Alta do Paciente , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Continuidade da Assistência ao Paciente , Inglaterra , Feminino , Insuficiência Cardíaca/complicações , Humanos , Disseminação de Informação , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Inquéritos e Questionários
11.
J Ment Health ; 22(5): 402-11, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24020849

RESUMO

BACKGROUND: Following the introduction of the No Secrets (Department of Helath, (2000). No Secrets: Guidance on Developing and Implementing Multi-agency Policies and Procedures to Protect Vulnerable Adults from Abuse. London: HMSO) guidance, the implementation and development of adult safeguarding practices and procedures across national services has become an ongoing endeavour. Despite existing research highlighting practice improvements in many services, NHS mental health services are persistently criticised for their lack of engagement with the national adult safeguarding agenda ( Department of Health (2009) . Safeguarding Adults: Report on the Consultation on the Review of 'No Secrets'. London: HMSO). AIM: To investigate the organisational structure, implementation and development of adult safeguarding in NHS mental health services. METHOD: A cross-sectional survey was distributed on-line to 79 (72 NHS Mental Health Trusts in England and seven Health Boards in Wales) NHS mental health services. Results Thirty-three completed surveys were returned, yielding a response rate of 41%. The results highlight adequate arrangements for adult safeguarding in many services; however, it appears implementation is in its initial stages. Responses suggest that staff attitudes and uptake of training are the greatest barrier to practice; however, barriers are also indicated at a strategic and operational level. CONCLUSION: The importance of adult safeguarding must be recognised at all levels and there is an immediate need for improvement to staff training and engagement to ensure future effective practice in this area.


Assuntos
Serviços de Saúde Mental/organização & administração , Programas Nacionais de Saúde , Adulto , Estudos Transversais , Inglaterra , Humanos , Populações Vulneráveis , País de Gales
12.
Nurs Stand ; 26(38): 50-6; quiz 58, 2012 May 23-29.
Artigo em Inglês | MEDLINE | ID: mdl-22787971

RESUMO

Practitioners' attitudes to self-injury vary widely. While some healthcare professionals are comfortable providing advice about safe self-injury in the inpatient setting, others believe they have a duty of care to protect patients from harming themselves, including removing all potentially sharp implements and increasing observation levels. This article describes work undertaken at South Staffordshire and Shropshire Healthcare NHS Foundation Trust to explore self-injurious behaviour in inpatient settings, including staff knowledge and perceptions and service users' experiences. Development of clinical guidelines for safe self-injury is also discussed.


Assuntos
Redução do Dano , Doença Aguda , Humanos , Capacitação em Serviço , Auditoria Administrativa , Comportamento Autodestrutivo
14.
Nurs Times ; 106(44): 20-2, 2010 Nov 9-15.
Artigo em Inglês | MEDLINE | ID: mdl-21155401

RESUMO

This article outlines the key challenges inherent in sharing and disseminating research findings within NHS organisations. Staff working in joint posts between universities and clinical settings are in a unique position to address these challenges. They should encourage article publication, presentations, and the implementation of recommendations that are locally relevant. An action research approach is key to boosting the likelihood of findings being implemented. Such steps would also enable clinical staff to become more research aware.


Assuntos
Disseminação de Informação/métodos , Pesquisa , Medicina Estatal/organização & administração , Universidades/organização & administração , Academias e Institutos/organização & administração , Difusão de Inovações , Docentes de Medicina/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Editoração , Pesquisa/educação , Pesquisa/organização & administração , Apoio à Pesquisa como Assunto/organização & administração , Pesquisa Médica Translacional , Reino Unido
15.
J Nurs Manag ; 16(4): 388-93, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18405254

RESUMO

AIMS: The aim of this paper was to undertake a brief critical appraisal of evidence-based practice (EBP) as it is currently perceived in health care settings. BACKGROUND: The past two decades have seen EBP become increasingly important in health care planning, clinical thinking, and choice of treatments. It is based on scientific rationalism and adherents claim that decisions based on EBP are superior to those based on other approaches to care. Concerns are now being expressed that positivistic approaches to health care fail to take into account people's preferences, their internal resources and their personal understandings of health and wellbeing. It has been argued that there may be multiple types of evidence, all of which have a part to play in the formulation and execution of health care. METHODS: After a literature search, this paper argues that whereas EBP may be useful in treating conditions that have a biological cause, it may be less helpful in understanding and treating conditions that have their origins in the social, psychological or spiritual domains. RESULTS: The nature, strengths and limitations of evidence-based practice is discussed in this paper. Nurses are encouraged to develop the critical skills of evaluating EBP in the lives and experiences of the people they care for. CONCLUSIONS: Evidence-based practice has a part to play in improving the treatment provided for patients. Nonetheless, nurses should be aware of other kinds of evidence, and appreciate that any single approach to determining care, no matter how popular, is likely to lead to a service that does not truly meet the complex individual needs of patients. Implications for nursing management In order for evidence-based practice to be safe, the nursing workforce must be able to evaluate the strength and relevance of research findings, and be able to understand that there are different kinds of evidence which should be called upon in order to respond sensitively and appropriately to the preferences of patients. A responsive workforce embraces multiple ways of thinking, respects different paradigms of care, and is able to respond to and respect the forms of care people value and seek.


Assuntos
Pesquisa em Enfermagem Clínica , Medicina Baseada em Evidências , Papel do Profissional de Enfermagem , Humanos , Modelos de Enfermagem
16.
Soc Sci Med ; 65(3): 599-609, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17482332

RESUMO

This qualitative study explores how recently qualified nurse prescribers describe, and rate, the safety of their prescribing. Internationally, the costs of drug errors are enormous and they can have serious implications for staff and patients. Nurses are now undertaking extended prescribing practice throughout the UK. Nurse prescribers work across different work settings and although safe prescribing is a priority in all of them, it is essential to ascertain the conditions that foster the highest levels of safety and how nurses can be supported in practice. Thirty-one nurses form the West Midlands area of England agreed to participate in an in-depth interview which sought to elicit their responses to various aspects of their prescribing work. They came from a variety of specialities and from hospital, community and general practice backgrounds. On completion of their training nurses were acutely aware of the responsibility that prescribing imposed on them. Although this awareness was thought to encourage caution and safety, it may also account for the fact that 26% of the nurses (n=8) had not prescribed since qualifying. Nurses felt that the multidisciplinary team had a vital role to play in supporting their prescribing practice as did collaborative working. It is concluded that those working in specialty areas that are less well-defined in terms of scope of practice (e.g. older adult nursing and learning disability) would benefit in particular from ongoing mentoring relationships with experienced prescribers and the development of individual formularies.


Assuntos
Prescrições de Medicamentos/enfermagem , Enfermeiras e Enfermeiros/psicologia , Segurança , Competência Clínica , Humanos , Erros de Medicação/enfermagem , Erros de Medicação/prevenção & controle , Papel do Profissional de Enfermagem/psicologia , Equipe de Assistência ao Paciente , Reino Unido
17.
J Adv Nurs ; 59(2): 120-8, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17524048

RESUMO

AIM: This paper is a report of an investigation of the impact of prescribing on a group of recently qualified nurse prescribers in the United Kingdom. BACKGROUND: The creation of advanced nursing roles, and specific skills such as nurse prescribing, has resulted in nurses taking on roles that have traditionally been associated with doctors. The non-doctor prescribing initiative is continually developing and many nurses are now able to prescribe independently from almost the same range of medicines as doctors. Despite the advantages that appear to stem from nurses prescribing, some nurse researchers have been cautious about the impact that prescribing may have on the nursing profession. METHOD: Interviews were conducted during 2005 and 2006 with 45 nurse prescribers. All nurses had successfully qualified and registered as prescribers. Interviews were analysed thematically in line with the principles of grounded theory. FINDINGS: Prescribing allows nurses to overcome difficulties in the healthcare system that previously delayed patients' access to medicines. Prescribing is viewed as more than an 'add on' to current roles, it complements many aspects of nursing and integrates previously diffuse aspects of the nursing role. This enables nurses to adopt a more holistic approach to patient care and prescribing. Prescribing has the potential to increase job satisfaction and autonomous working, with the result that nurses are more likely to involve patients in decision-making about their care. CONCLUSIONS: Prescribing enhances nurses' knowledge about medication and increases their confidence to engage in prescribing decisions across the healthcare team. Nurse prescribing has the potential to improve service-user care, enhance collaboration and widen discussions about medicines. However, team members need to be prepared for the impact nurse prescribing could have on the dynamics of the multidisciplinary team. Preparatory information about nurse prescribing should be provided to all team members by trainee nurse prescribers. Information could include details about the proposed scope of future prescribing roles, allowing team members to consider how their roles could develop.


Assuntos
Prescrições de Medicamentos/enfermagem , Profissionais de Enfermagem/normas , Papel do Profissional de Enfermagem/psicologia , Atitude do Pessoal de Saúde , Competência Clínica/normas , Humanos , Relações Interprofissionais , Relações Enfermeiro-Paciente , Pesquisa Metodológica em Enfermagem/métodos , Relações Médico-Enfermeiro , Autonomia Profissional
18.
J Clin Nurs ; 15(8): 989-97, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16879543

RESUMO

AIMS AND OBJECTIVES: To outline the development and content of a 'top-up' neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice. BACKGROUND: Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid-1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication. METHODS: Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles. RESULTS: The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they prescribe coupled with the information they provide to service users can be improved as a result of specific educational support. It would appear that adopting a prescribing dimension to one's role requires nurses to revisit a number of skills that are integral to the work of the mental health nurse, e.g. good communication, establishing empathy, listening to what clients say, responding to what is required and involving clients in their own care. CONCLUSIONS: Mental health nurses from one particular Trust in the West Midlands were provided with a 'top-up' course in neuropharmacology and, although they found this challenging, ultimately they found this to be helpful. As nurse prescribing is 'rolled out' to other nursing specialities it is important that local Trusts and Workforce Development Directorates maintain a dialogue about nurse prescriber training to ensure that nurse prescribers receive the appropriate time and support for their ongoing Continued Professional Development. As increasing numbers of nurses from different specialities qualify as nurse prescribers it is vital that they are supported by their employing organizations and given the opportunity to maintain their competency and confidence in their prescribing practice.


Assuntos
Prescrições de Medicamentos , Educação Continuada em Enfermagem/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Neurofarmacologia/educação , Autonomia Profissional , Enfermagem Psiquiátrica/educação , Atitude do Pessoal de Saúde , Competência Clínica/normas , Currículo , Interações de Medicamentos , Inglaterra , Humanos , Papel do Profissional de Enfermagem , Pesquisa em Educação de Enfermagem , Pesquisa Metodológica em Enfermagem , Recursos Humanos de Enfermagem/educação , Recursos Humanos de Enfermagem/psicologia , Educação de Pacientes como Assunto , Seleção de Pacientes , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Enfermagem Psiquiátrica/organização & administração , Autoeficácia , Inquéritos e Questionários
19.
Nurs Times ; 102(11): 36-9, 2006 Mar 14-20.
Artigo em Inglês | MEDLINE | ID: mdl-16566187

RESUMO

AIM: To identify the specialties from which trainee prescribers come and to determine their pre-training and post-training concerns about prescribing and how they are utilising their prescribing skills. METHOD: A self-report profile questionnaire including open and closed questions, some Likert-type scales and a 24-item, self-report follow-up questionnaire were used. RESULTS: Half of the nurses who took part in this study came from four disciplines--practice nursing, mental health nursing, district nursing and paediatric/neonatal nursing. Before the course they were concerned that they had insufficient pharmacological knowledge to prescribe. However, once they had qualified this changed to concerns regarding educational needs, formal support and the way their role would be perceived by colleagues. Most participants felt that nurse prescribing impacted positively on patient care. CONCLUSION: With the right support systems in place, nurse prescribers are utilising their prescribing skills in order to develop their role, increase their clinical autonomy and improve the care of patients.


Assuntos
Prescrições de Medicamentos , Educação em Enfermagem/normas , Humanos , Profissionais de Enfermagem , Inquéritos e Questionários
20.
Nurse Educ Today ; 26(7): 538-44, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16529849

RESUMO

In the UK, nurse prescribing training is delivered within a Higher Education Institution (HEI). Although prescribing courses are regularly evaluated by individual HEIs and associated commissioning bodies, there has been little focus on the perspective of the lecturers who provide the training. The aim of this paper is to explore nurse lecturers' experiences of delivering nurse prescribing courses and their views on how well they prepare nurses for the prescribing role. Eight members of lecturing staff (7 female and 1 male) from four HEIs across the West Midlands participated in one-to-one, semi-structured interviews to discuss their experiences of prescribing training. Key issues to emerge were the selection criteria for acceptance onto prescribing courses; the diverse skills, experience and background of the nurses accepted; the addition of supplementary prescribing to independent prescribing courses, and the problems of providing pharmacology input into courses. Feedback from students and lecturers is vital to ensure the quality of training. The study recommends that selection criteria for prescribing training courses should receive further attention. Providing more material for potential students prior to their embarking on training would help applicants understand better what is involved and ultimately improve implementation of nurse prescribing in practice.


Assuntos
Atitude do Pessoal de Saúde , Prescrições de Medicamentos , Educação Continuada em Enfermagem/organização & administração , Docentes de Enfermagem , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem/educação , Competência Clínica/normas , Inglaterra , Docentes de Enfermagem/organização & administração , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Capacitação em Serviço/organização & administração , Masculino , Papel do Profissional de Enfermagem/psicologia , Pesquisa em Educação de Enfermagem , Pesquisa Metodológica em Enfermagem , Recursos Humanos de Enfermagem/organização & administração , Recursos Humanos de Enfermagem/psicologia , Planejamento de Assistência ao Paciente/organização & administração , Seleção de Pessoal , Farmacologia/educação , Autonomia Profissional , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
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