Abstract

Mental health nurses are relative latecomers to nurse prescribing. This is primarily because nurse prescribing has been seen as more appropriate for general nurses, particularly those working in the community or primary care. Pharmacists and psychiatrists were concerned about the complexity of prescribing for clients with mental health problems and felt that the training of mental health nurses and their clinical experience did not fit them to take on a prescribing role. These, and other impressions, may have influenced which groups of nurses were first selected to become nurse prescribers. However, recent studies have indicated that mental health nurses add considerably to the effectiveness of assessments and care plans, and that they are in an ideal position to integrate drug treatments with a wide range of non-pharmacological therapies knowledgeably, safely, effectively and in a manner that is acceptable to the patient. They have also been found to have an important role to play in monitoring the side effects of drugs and in providing education about medication, and in maintaining a therapeutic alliance with clients on long-term drug treatment. Whatever the limitations, mental health nurses as prescribers may still be deemed to have by some professional groups, and even by themselves, at this stage in the evolution of nurse prescribing, it is now inevitable that they will play a significant part in the overall improvement of mental health services during this decade. They are likely to challenge the existing prescribing practices and help in identifying the conditions under which medication is most therapeutic.

Summary

The role of the Pharmaceutical Industry within healthcare has been a debate amongst our medical colleagues for the past decade. However, with the growing number of nurses who are now qualified to prescribe, this controversial aspect of professional practice is becoming an area of interest to nurses. This article reviews some of the literature on prescribing and the pharmaceutical Industry, in an attempt to raise nurses awareness. Nurses have skills that are central to their education of assessment and evaluation. It argues that nurses are well placed to utilise these skills to identify the influences of the Pharmaceutical Industry. The role of the Pharmaceutical Industry in professional development is debated, suggesting that nurses have the skills to analyse the potential impact of this form of education. Concepts of Ethics are discussed in relation to prescribing, patient care and professional education and practice.

Summary

Nurse Prescribing in mental health care is now a reality. As part of a long-term plan to introduce the prescribing role for mental health nurses in the local area, Doncaster and South Humber Health Care Trust and the School of Nursing and Midwifery at the University of Sheffield conducted a study tour of centres well established in the clinical practice and educational preparation for prescriptive authority for nurses. The findings from the visit are explored, for example: a) how is a competence in prescribing achieved by nurse, b) what is the educational delivery needed to prepare the potential prescriber? Insights are offered based on the provision of care by nurse prescribers in the states of Massachusetts and Connecticut that we visited. These are then discussed in the context of the future development of this role, which is now being introduced as an innovation aimed at meeting the mental health care needs of patients in the UK.

Abstract

This article discusses the challenging question of facilitating the educational requirements of students who enter the extended/supplementary prescribing programmes from diverse clinical backgrounds. Data emerging from a survey of mental health nurses (MHNs) by one of the authors (S.H.) and specifically what they perceive as the educational providers role in helping them develop as prescribers is presented. Secondly, the second author (J.D.) then discusses the implications of responding to student's expectations and importantly facilitating competence for the student for the differing contexts of where they will prescribe.

Summary

Prescribers face a range of ethical dilemmas in their everyday practice. In this article, the principles-based approach to biomedical ethics developed by Beauchamp and Childress is outlined, with a particular focus on ‘respect for autonomy’. It is argued that the purpose of ethical reflection is to deepen and enrich more general reflection about clinical practice, rather than to provide definitive answers to dilemmas in prescribing.

Abstract

This paper evaluates the benefit and value of supplementary prescribing for rheumatology patients, and the teams who manage their care. Problems and challenges are highlighted as the paper also reviews implementation into practice and discusses audit results in terms of patient and service outcomes.

Kraszewski S. Learning to support Practice 18b: Contraception and unwanted pregnancy (i). Practice Nurse 2004; 28(6): 75–83.

Summary

There are many responsibilities and challenges organisations need to address to ensure the selection of nurses for extended/supplementary prescribing occurs within an environment which guarantees success and fits the long-term objectives of the organisation in terms of role re-design and service delivery. As a local lead it is important to recognise the challenges influencing the development, implementation and effectiveness of nurse prescribing. This article considers some of those challenges and shares the experience of Coventry Teaching Primary Care Trust. The article provides some food for thought for nurses wanting to become prescribers, organisations and Higher Educational Institutes.

Summary

The discipline of evidence-based prescribing is relatively new to nurses and other non-medical prescribers. The introduction of clinical governance, which emphasises accountability, quality and efficiency, means that it is no longer acceptable to base clinical decisions on personal opinion. Prescribing itself is just one stage in making a rational treatment decision, which requires a fully structured approach. This article will highlight some of the considerations that the prescriber has to take into account, including: the efficacy and cost-effectiveness of treatment options, how to check the evidence, the benefits or harms of a treatment and, the patient's own involvement in the treatment plan.