Keywords: community nurse prescribing
This essay analyses a recent (i. e. , not over the age of 5 years) development in community nursing practice for people. The article picks one section of the community nurses role and explores the impact of this role on patient care. The role which will be analysed is nurse prescribing. The article includes the key policy drivers behind the area of development and includes the analysis of factors such as inter-professional working and consumer involvement. The essay considers the request of the role, including obstacles to its success. The required skills included to ensure patient care and attention continues to improve are also talked about. Research that evaluates the effectiveness of the role is also explored.
This essay commences with a brief overview of nurse prescribing, and then talks about the possible barriers to the success of community nurse prescribing, including the important need to make correct assessments of the patients conditions, their record (i. e. , making enough notes regarding their symptoms and the remedies that is prescribed), the need for clear communication and assessment with all patients and the development of a working identification, based on the best information available at anybody particular time. Issues such as when to recommend, and when never to suggest, are also mentioned, as is the issue of possible treatment of the patients condition without medication, or through referral for even more treatment with other medical researchers. Other possible obstacles to the adequate implementation of nurse prescribing are also reviewed, including the marriage with the patient, for example. Patient partnership in conditions of taking drugs, including an awareness of, and awareness towards, social and ethnic needs, is also reviewed, as is the issue of concordance vs. compliance.
Nurse prescribing started out in earnest in 1994, and, since that time, the number and type of nurses who are expertly able, and legally allowed, to suggest medications has increased significantly, as set out in the Medicinal Products: Prescription by Nurses, Midwives and Health Site visitors Action 1992, which came up in to results in 1994 and, generally, under the individual Group Directions plan. Individual (or nurse) prescribing is where the prescriber requires full responsibility for the professional medical analysis of particular patients, from making the medical diagnosis, to implementing the necessary professional medical management, to taking responsibility for prescribing (see NMC, 2005).
When nurse prescribing was first created, in 1994, there have been two main categories of nurses who could suggest medication: independent and supplementary prescribers (including district - or community - nurses, health tourists, practice nurses and midwives). There were several requisites for nurse prescribing to be allowed: the nurses must have completed the NMC approved programme of planning for nurse prescribers, the nurses should have acquired their prescribing status entered to a register of nurse prescribers, the nurses should be employed by an NHS Trust, and they should be employed in a post selected for prescribing (see NMC, 2005). Nursing personnel were, at this time, when prescribing, expertly responsible, on an individual basis, for any instructions that were directed at patients (see the NMC Specifications for carry out, performance and ethics).
Independent nurse prescribing came, fully, directly into effect on 1st May 2006, however, with the designation of nurse impartial prescribers. Nurse 3rd party prescribers are allowed, for legal reasons, to suggest any licensed drugs for any condition that is at their competence to detect (see Section of Health, 2008). Nurse impartial prescribers are also lawfully able to suggest off-label or off-license (i. e. , for pediatric conditions), within the bounds with their full specialized medical and professional duties as laid down in guidelines from the Nursing and Midwifery Council and with the caveat that nurse independent practitioners are appropriately responsible for their own activities (Section of Health, 2008).
Essentially, prescribing by nurses ties in to the framework of evidence-based practice that happens to be in place within the NHS environment. In addition, prescribing by nurses is also governed by the construction for specialized medical governance, for the reason that nurse prescribers need to be aware of the current evidence base for a particular analysis or treatment plan, and they have to be fully versed in the relevant literature, in terms of understanding that what they are diagnosing, and prescribing based on that diagnosis, is the foremost current approach to dealing with the problem the individual is showing with and knowing that this treatment option has a high chance of success for each particular patient. Essentially, the evidence-based method of prescribing by community nurses, set up, as it is, within the professional medical governance platform, ensures best practice and the best treatment for patients, according to the guidelines of these professional body and current best practice as suggested by the research.
This part of the essay discusses how important it is ideal for an accurate assessment of the patients condition to be made, and exactly how important it is ideal for the patients history to be saved. The need for clear communication and consultation with patients is also talked about, as is the concept of a working identification based on the perfect information.
Community nurses, who often see patients on a regular basis, have the ability to build up a rapport with their patients, which means that, generally, a complete and concise medical history can be gained from the individual, that can be useful in deciding the medication, and other treatment routes, that are essential. Even though the community nurse creates this rapport with patients they see on a regular basis, not all of the patients they'll see during their working day are regular, long-term, patients, and so it is important that community nurses have good communication skills, in conditions of creating clear communication stations between themselves and their patients. This calls for not only communicating clearly, to the patient, what is required of these and what they will be doing with the individual, but also fostering clear communication from the patient, in terms of gaining an obvious medical history from the individual, in order to be able to make a identification of the patients condition.
This involves not only finding out the historical antecedents of the patients current condition but also learning the way the patient seems now, what medication has been taken, or has been taken, and finding out how any previous medication has transformed their condition, for better or worse, so that alternate medication can, perhaps, be approved. An accurate article of this communication with the individual needs to be left in place, following this patient-nurse dialogue, that ought to, ideally, include both opinion of the patient and the results of any diagnostic testing which may have been previously performed or that the community nurse has purchased. This is necessary so that another community nurse who might be called to treat the individual has a thorough record of the patients history, including the medication that is prescribed.
For a community nurse to have the ability to suggest a medication to an individual of theirs, they need, therefore, to talk to the patient to be able to arrive at a working identification of the patients condition. Normally, this is performed on the basis of the information the community nurse must hand i. e. , records made from prior relationships with other community nursing staff, the discussion with the individual and the observations that the community nurse made, within the consultation. Once all of this information has been collated and evaluated, a identification will be arrived at, and the nurse prescriber will then prescribe the correct medication predicated on this identification.
It is very important to the community nurse, who is able to prescribe, to realize that not absolutely all patients, or all conditions, will need a prescription: some diagnoses may be best cured through non-drug treatment or many need a referral for even more analysis or treatment, by an expert, for example. Your choice concerning when to prescribe medication, or not, is thus in the hands of the community nurse responsible for that patient, and can only be produced, as has been seen, when the nurse feels they have all the necessary information they need to make a full diagnosis, on the basis of that they feel positive about prescribing medication.
The community nurse thus gets the capacity, and capability, to detect patients, which is manufactured based on clear, two-way, communication with the individual. The community nurse also has a responsibility to the individual to treat the individual in the most appropriate manner. This could be through the prescribing of medication or could be through recommendation to another health professional. Nurse prescribing is thus part of an activity of discussion, and communication, with the patient, in conditions of determining, to the best of their capabilities, what is incorrect with the individual and then dealing with the patient to ensure that the best plan of action is taken, and fully integrated, in conditions of making certain the condition is get over and the individual gets better.
If a community nurse gets control the care of a patient from another community nurse or from a GP, for example, it is important to repeat the same process, i. e. , to make an diagnosis of the individual, in terms of looking over the patients previous notes, and communicating with the individual, in order to determine their problems and their views on their condition and then, using all of this information, to come up with an independent analysis regarding the most appropriate examination, and treatment options, with the patient. It isn't sufficient to cimply, blindly, continue wit the same treatment program as previously, without questioning this through appointment with the patient and without an assessment with their history. The community nurse may disagree with the previous diagnosis, or treatment plans being implemented, based on the consultation with the individual, and the reading of the patients record. In cases like this, the responsibility of the community nurse lies with the patient, and it would be necessary for the city nurse to make any necessary changes, as they see fit, to the patients treatment regime, through the ceasing of the prior medication regime and the initiation of a new treatment program. If, in this case, it is set that the best thing for the patient is to improve the treatment plan, this should be duly mentioned on the patients documents, including some aspect as to the reason why the procedure approach was modified.
This part of the essay discusses the relationship with the individual in terms of patient partnership in medicine taking, including awareness of cultural and cultural needs. Patients have the right to be involved in the procedure process, in terms of being communicated with, throughout the examination process, and having their thoughts and views paid attention to, within the medical diagnosis process. Patients should, ideally, be given all the necessary information they need to make informed options about their treatment, but, often, in community medical situations, this is not possible, with older people, for example, who can often present with bafflement, or with sound system of a dialect other than English who, if the translator is not present, can have problems understanding the information that is directed at them, making the whole process of identification difficult. Such barriers to effective nurse prescribing are commonplace and the professional community nurse needs to have actions in place to have the ability to overcome such obstacles, in terms of delivering equivalent quality of attention to all or any patients who might show them. In a few situations, however, it is a fact that concordance (not compliance) is usually the best that can be achieved with particular patients, scheduled to such problems, which, unfortunately, must be accepted.
As has been seen, for a community nurse to be able to suggest a medication to an individual of theirs, they need to communicate with the patient to be able to arrive at a working identification of the patients condition. Normally, this is performed based on the information the community nurse has to palm i. e. , notes made from prior connections with other community nursing personnel, the discussion with the patient and the observations that the community nurse made, within the consultation. Once all of this information has been collated and assessed, a analysis will be arrived at, and the nurse prescriber will prescribe the correct medication based on this medical diagnosis.
Thus, it's important for the community nurse to realize that, although they could seem to be treating the patient in isolation, the individual has, in simple fact, a history of connection with other nursing staff and medical researchers, and often, in addition, with other experts, such as interpersonal workers, for example, and this, as such, the community nurse has a job that can be played in inter-professional working. The various ways that mental health issues are treated in the community can, for example, often lead to inter-professional working, with the city nurse needing to be amply trained in how to work inter-professionally, in conditions of how to squeeze in to an inter-professional team, for example. The community nurse who's accountable for nurse prescribing thus not only needs to be able to connect effectively with the individual but with other experts who might be in charge of the care and attention of the patient.
As has been shown in the course of this article, there are numerous factors that need to be looked at whenever a community nurse prescribes medication, for example, the need for clear communication with the individual, which can be an essential element for the success of treatment regimes, and the necessity for clear, concise, record-keeping which is essential to guarantee the continuity of care for patients also to ensure that any necessary inter-professional working is prosperous.
This essay has, essentially, analysed a recent development in community nursing practice for adults, namely the issue of nurse prescribing by community nurses. The article has explored the impact of this development on patient care, including a presentation of the main element policy individuals behind the area of development and like the examination of factors such as inter-professional working and customer involvement. It was seen that prescribing by community nurses ties in to the current evidence-based framework of the NHS, within the construction of specialized medical governance, and this community nurses are also bound by their professional commitments when prescribing.
The essay also considered the request of the development of nurse prescribing, including barriers to its success. These obstacles were identified as much and various, including obstacles to effective communication, through having patients who find it hard to communicate, for just one reason or another, or through problems posed by inter-professional working within an inter-professional team, which can lead to disagreements as to the best suited treatment regime, for example.
The necessary skills involved to ensure patient care and attention continues to boost were also discussed, in conditions of the professional commitments of the community nurse and their ultimate responsibility to the individual, in conditions of making certain the principles of evidence-based practice are key to the day-to-day working of the city nurse. The necessity for effective communication, between patient and nurse and between the nurse and other users of any inter-professional team was also pressured, as was the need for effective record-keeping, to ensure continuity of care for the patient also to ensure that the nurse prescriber has an archive of each step of the identification and treatment steps, should anything go wrong, for example.
In summary, the essay started out with a brief history of nurse prescribing, demonstrating its development in the legislation, and then talked about the possible obstacles to the success of community nurse prescribing, like the fundamental need to make exact assessments of the patients conditions, their history (i. e. , making adequate notes regarding their symptoms and the medicine that is prescribed), the necessity for clear communication and appointment with all patients and the introduction of a working medical diagnosis, predicated on the best information offered by anybody particular time. If these programs of communication aren't left wide open, and provided with the opportinity for success, the role of the city nurse prescriber is made more difficult, with such obstacles and therefore success of the nurse-patient marriage will, probably, be jeopardized.
Issues such as when to suggest, and when not to prescribe, have also been discussed, as has the problem of the possible treatment of the patients condition without medication, or through referral for further treatment with other health professionals. The problem of halting medication that has recommended by other health professionals, which has been a controversial part of the development of nurse prescribing, in addition has reviewed. Other possible obstacles to the sufficient execution of nurse prescribing are also discussed, like the relationship with the individual, for example. Patient partnership in terms of taking drugs, including an awareness of, and awareness towards, cultural and cultural needs, in addition has discussed, as gets the issue of concordance vs. conformity.
In conclusion, therefore, nurse prescribing, a recently available development in community medical, has supposed many changes to the ways that community nurses work, but, given the relatively low levels of requisites for successful execution of this development (i. e. , effective communication and record-keeping), the development has been successful, overall, in conditions of releasing other experts from the responsibility of prescribing and presenting community nurses the liberty to manage their patients, from examination through to treatment. You will find, as has been seen, various obstacles to the success of community nurse prescribing, but these obstacles can, generally, be conquer with creative thinking. Thus, in conclusion, the development of nurse prescribing is a positive one, on the whole, for the city nursing career, allowing an unprecedented level of liberty for community nurses and providing a revolution in patient treatment locally setting.
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