Perceptions and practice of concordance in nurses’ prescribing consultations: Findings from a national questionnaire survey and case studies of practice in England
Section snippets
What is already known about the topic?
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The number of nurses independently prescribing medicines to patients in England is rising steadily.
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Many patients do not take medicines as the prescriber intended.
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Concordance—a partnership between the prescriber and the patient—is recommended as an effective approach to prescribing and medicine management.
What this study adds
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Evidence about the potential effectiveness of nurses’ prescribing consultations from (a) a national survey of prescribing nurses’ views on their use of concordance in practice and (b) a survey of patients’ experiences of concordance in nurse prescribing consultations.
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This is the first study in England to use observation to analyse the extent to which nurse prescribers are using concordance competencies in the reality of practice. The study therefore provides evidence from practice about the
Aims and objectives
The aim of the study was to provide a national evaluation of the expansion of independent nurse prescribing in England to inform future developments for prescribing in nursing and other health professions. (A summary of the full study is available in Latter et al., 2004.)
The study objectives included the following:
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to describe nurses’ independent prescribing patterns and practices;
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to evaluate patients’ views of independent nurse prescribing.
One key component of these broad study objectives was
Research design
The research was conducted in two phases: phase (i) comprised a national survey of independent nurse prescribers using a postal questionnaire; phase (ii) comprised case studies of independent nurse prescribing practice settings, using multiple methods of data collection.
Response rate
Phase (i): Of the 400 nurse questionnaires distributed, a total of 285 (71%) were returned. Of these, 39 (14%) respondents had qualified as nurse prescribers, but were not actively prescribing at the time of the survey, giving a total of 246 completed questionnaires available for analysis.
Sample characteristics
Over half of the sample (56%, ) were employed as nurse practitioners; most others were employed in relatively senior grade nurse positions, such as sister/team lead (7.5%, ), nurse specialist (6.5%,
Discussion
Nearly all of the nurses in this national sample of nurse prescribers believed that they were practising certain fundamental principles of concordance, were able to establish relationships with patients based on trust and mutual respect, and were working in partnership with patients. At face value, this finding is encouraging and suggests that concordance may be a feature of most prescribing nurses’ practice. It represents a departure from previous research into doctors’ and pharmacists’
Conclusions
This paper reports findings from the first large-scale evaluation of independent nurse prescribing in England. It provides evidence about the extent to which nurses are conducting their prescribing consultations within a framework of concordance, which is widely considered to enhance the effectiveness of prescribing consultations and medicines management. Findings from the study have relevance for both nurse prescribers and those responsible for the initial and continuing professional
Acknowledgements
This study was commissioned and funded by the Policy Research Programme at the Department of Health. We wish to thank all of the nurses and patients who participated in the study. We are also grateful to Dr. Molly Courtenay and Dr. Nick Dunn, project team members who contributed to the design of data collection tools and processes.
References (22)
- et al.
Nursing, medication education and the new policy agenda: the evidence base
International Journal of Nursing Studies
(2000) - et al.
Implementing health promoting nursing: the integration of interpersonal skills and health promotion
Journal of Advanced Nursing
(1998) - et al.
The patients’ view: the benefits and limitations of nurse prescribing
British Journal of Community Nursing
(2001) - et al.
A Question of Choice–Compliance in Medicine Taking
(2003) Pharmacy in the Future: Implementing the NHS Plan. A Programme for Pharmacy in the NHS
(2000)Supplementary Prescribing
(2002)Extending Independent Nurse Prescribing Within the NHS in England: A Guide for Implementation
(2002)Prescription Cost Analysis: England 2002
(2003)Reflective practice: a critique of the work of Argyris and Schon
Journal of Advanced Nursing
(1993)- et al.
Interventions for Helping Patients to Follow Prescriptions for Medications (Review). The Cochrane Collaboration
(2005)
Representations of medication and treatment: advances in theory and measurement
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Formerly School of Nursing & Midwifery, University of Southampton, Highfield, Southampton SO17 1BJ, UK.