Interest in the role of the nurse practitioner in primary care, as first point of contact for patients with acute illnesses, is well established. Recent studies in the UK have examined the role in the context of a variety of acute presentations and have addressed issues of competence, safety and patient satisfaction. The management of acute presentations involves responsibility for making a diagnosis and, frequently, for recommending medication either on prescription or to be purchased from the pharmacy. As the nurse practitioner role develops in primary care there is a need for evidence of the effective management of specific acute presentations. Protocols have been advocated as a key to the successful introduction of the nurse practitioner role but the legality of their use, particularly in relation to prescribing, remains unclear. The aim of this study was to compare, in one general practice, the management of acute urinary symptoms by nurse practitioners with that of GPs in the context of a protocol. The study was undertaken in two parts: a retrospective analysis of a sample of the records of female patients followed by a patient satisfaction survey. The retrospective analysis examined the use of the protocol in guiding the decision-making of both groups of practitioners and evaluated the outcome for the patient. The outcome indicator used in this part of the study was the need for a repeat consultation within 14 days due to non-resolution of symptoms. The retrospective analysis of records was supplemented by a patient satisfaction survey. In comparison with the GPs, the nurse practitioners' records were more complete, the prescribing rate was lower, the use of laboratory resources was similar and there was no difference in the number of patients who needed to be seen again. In the patient satisfaction study higher levels of patient satisfaction were achieved by the nurse practitioners.

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

The increased emphasis on evidence-based practice within healthcare has compelled nurses to obtain up to date research information to assist them in clinical decision-making. Electronic databases are a crucial resource for finding this information, but a successful search strategy is vital if relevant information is not to be missed. This article highlights the key steps in the searching process with examples from three databases on the OVID and Dialog Datastar platforms.

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.

Summary This article sets out to review recent research studies pertaining to the drug treatment of oropharyngeal candidiasis in infants. The main aims of treatment programmes are to resolve signs and symptoms of the infection; and minimise drug induced resistance, with minimal adverse side effects. A search for clinical evidence using Medline, Nursing Index and Embase between 1995 and 2003, produces no systemic reviews, no placebo controlled trials only three random control trials for the treatment of oropharyngeal candidiasis in infants. Three independent randomised control trials with samples of infants with oropharyngeal candidiasis (who were not immuno-compromised), compare the three main drug treatments of choice for infants, i.e. miconazole gel, clotrimazole (nystatin) suspension, and fluconazole suspension. The randomised trial of these infants found that miconazole gel had a significantly higher cure rate compared with nystatin suspension. At day 12 of the trial there was a 99% cure rate with the use of miconazole gel (25 mg QDS) compared to only a cure rate of 54% with nystatin suspension (100 000 IU QDS) (P> < 0.0001). The evidence from these studies suggest that miconazole gel (25 mg QDS) is the drug of choice for health visitors treating infants with oropharangeal candidiasis, as it is a safe and effective and cost effective treatment regime from birth.

Summary

The extended independent and supplementary nurse prescribing programme implemented in 2003 is anticipated to have the potential to improve patient care by enabling faster access to medicine for people with chronic conditions such as Diabetes. Diabetes mellitus is a progressive, life–long, chronic condition which affects an estimated 1.4 million people in the UK and inevitably requires medication to control symptoms and prevent complications associated with the disease.

The supplementary prescribing option of nurse prescribing is an opportunity for Diabetes Specialist Nurses (DSN) to provide timely and appropriate clinical management for patients with diabetes within an agreed management plan. The clinical management plan (CMP) is a patient specific document and can only be implemented to enable supplementary nurse prescribing upon agreement by the individual patient, the independent prescriber (doctor or dentist and supplementary prescriber (nurse or pharmacist). The CMP allows the DSN to manage the treatment of the patient by modifying diabetes therapies tailored to the needs of the individual to achieve treatment goals. The use of a patient specific CMP compliments the National service Framework for diabetes requirement that all patients have a care plan. Involving the patient by seeking agreement to implement the CMP may improve concordance and compliance with therapies and treatment decisions.

Monitoring diabetes control is essential from diagnosis as the information received provides valuable feedback as to the effectiveness of therapies. Comprehensive diabetes education should be tailored to empower the patient with knowledge and skills to manage this chronic condition regardless of treatment regimes.

Consideration should always be given to the type of diabetes, the potential effects on lifestyle and treatment options available today.