Wednesday, 28 March 2018

Establishing priorities on the range of conditions managed by UK community practitioner nurse prescribers

In the United Kingdom (UK), around 35,000 community and public health nurses (including district nurses, community staff nurses, school nurses and health visitors) can independently prescribe from a limited list of medicines described in the Nurse Prescribers Formulary (NPF) for community practitioners. Although prescribing is viewed as a key role for these nurses, by both nurses themselves and healthcare policy, decreasing numbers of these nurses actively prescribe, and there have been reports that items included in the NPF no longer meet the needs of the patients these nurses manage.

Changing population profiles have led to international interest in the work of community and public health nurses. Although there is a huge diversity in community and public health nursing roles globally, the available international evidence suggests a shift in focus, over the last 20 years, in the typical activities of these nurses. Activities have moved away from longer term support and care, to the provision of a more ‘acutely’ focussed episodic care with increasing involvement in health promotion activities. 

As the items listed in the NPF have remained unchanged for two decades, it is highly likely, given the changing population profiles and changing patterns of client and service delivery, that these items no longer reflect the prescribing needs of these nurses. This study, a modified Delphi technique, was designed to provide national consensus on the range of conditions CPNPs manage, and for which it is considered important that they can prescribe. 

Panelists reached a consensus, with consistent high levels of agreement reached, on nineteen conditions (both chronic and more acutely focused) for which each group of CPNPs believed it to be important for them to be able to prescribe.

Strategies are required to address health service demands in low-, middle- and high-income countries. Strengthening nurses’ capacity by extending their scope of practice to include prescribing is one such strategy which improves nurse’s ability to reach more people with quality health services. Although it is recognised that the findings of this work originate from a UK perspective, and so leaves open the need for adaptation to other healthcare systems and consideration of other national and regional concerns, our findings provide some guidance for those countries in which prescribing by community and public health nurses is established, and for those countries wishing to establish prescribing by these nurses, with regards to the conditions they manage and so the medicines they will need to prescribe. Our findings can also be used to direct national education and training for the preparation of community and public health nurses.

by Molly Courtenay

Reference

Courtenay, M, Franklin, P, Griffiths, M, Hall, T, MacAngus, J, Myers, J, Penistone-Bird, F, Radley, K (2018). 'Establishing priorities on the range of conditions managed by UK community practitioner nurse prescribers': A modified Delphi consensus study. Journal of Advanced Nursing

What leads to missed care?

Roger Watson, Editor-in-Chief

The concept of 'missed care' has been very prominent in nursing in recent years and has been extensively reported over the years in JAN. A recent UK study titled: 'The association between nurse staffing and omissions in nursing care: a systematic review' and published in JAN presents some interesting findings.

The study is by Griffiths et al. (2018) on behalf of the Missed Care Study Group and aimed to: 'identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing.' Eighteen studies reporting missed care and meeting the criteria for the review were identified. 

The results are presented in detail in the article but, to summarise: 'Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care. Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy.'

The authors conclude: 'While reported missed care is associated with nurse staffing levels and such reports may indeed be indicators of inadequate nurse staffing, there is no research demonstrating associations with objective measures of care. The extent to which the relationships observed in these studies represent actual omissions of care and the consequences of such failures, remains largely uninvestigated. Future research should focus on objective measures of missed care to investigate the impact of missed care on patient outcomes.'

You can listen to this as a podcast.

Reference

Griffiths, P. , Recio‐Saucedo, A. , Dall'Ora, C. , Briggs, J. , Maruotti, A. , Meredith, P. , Smith, G. B., Ball, J. On behalf of the Missed Care Study Group (2018), The association between nurse staffing and omissions in nursing care: a systematic review. J Adv Nurs. doi:10.1111/jan.13564