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Independent extended and supplementary nurse prescribing practice in the UK: a national questionnaire survey.

BACKGROUND: Nurses are able to prescribe independently from a list of nearly 250 prescription only medicines for a range of over 100 medical conditions or, from the whole British National Formulary as a supplementary prescriber. There is some evidence available on the prescribing practices of district nurses and health visitors and early independent extended prescribers. Little or no attention has focussed on supplementary nurse prescribing. OBJECTIVE: To provide an overview of the prescribing practices of independent extended/supplementary nurse prescribers and the factors that facilitate or inhibit prescribing. DESIGN OF STUDY: National questionnaire survey. SETTING: United Kingdom. PARTICIPANTS AND METHOD: A convenience sample of 868 qualified independent extended/supplementary nurse prescribers self-completed a written questionnaire. RESULTS: A total of 756 (87%) used independent extended prescribing; 304 (35%) used supplementary prescribing to treat a range of chronic conditions (including asthma, diabetes and hypertension); 710 (82%) nurses worked in primary care. Nurses in general practice reported the largest number of reasons preventing prescribing. Reasons included the inability to computer generate prescriptions and to implement the Clinical Management Plan. Nurses in primary care reported more continuing professional development needs. These needs included update on prescribing policy and the treatment management of conditions. A total of 277 (32%) nurses were unable to access continuing professional development. CONCLUSION: Independent extended/supplementary nurse prescribers work predominantly in primary care and do prescribe medicines. These nurses are highly qualified and have many years clinical experience. Supplementary prescribing is used by a minority of nurses. Implementing the Clinical Management Plan is a barrier preventing the use of this mode of prescribing. The continuing professional development needs of independent extended/supplementary nurse prescribers are frequently unmet. It will become increasingly important that these needs are met once nurses are able to prescribe the full range of medicines included in the British National Formulary, limited only by their area of competence.

Adult↗

IDEA: an index of dental educational activity.

This paper reports on the construction of an index of dental educational activities (IDEA) developed as part of an exploration of continuing professional development activities among a sample of general dental practitioners (GDPs) in the Yorkshire Region in Britain. To assist in the interpretation of the index scores an analogy is drawn to an academic examination. Only 50% of the GDPs passed, 31% achieving scores of 40% or less and 9% distinctions. Higher IDEAS were achieved by practitioners who spent a lot on their dental education, those who intended to attend continuing education events next year practice principals, those who worked in larger practices and men GDPs. Little difference in the scores was observed by the age of the practitioner, experience of working in hospital or distance from the central continuing education centre. Discussion centres on the utility of the index as a summary of updating practices and its potential as a comparative measure across health professions. High levels of continuing professional development and thus high IDEAs must be encouraged, but they need to be accompanied by high quality care and effective job performance.

Education, Dental, Continuing↗

A training programme for healthcare support workers.

Healthcare support workers (HCSWs) are at the front line of patient care delivery. It is essential that they are appropriately trained and competent in the skills required to deliver the fundamentals of care. There is also a need for HCSWs to have access to continuing professional development that offers a career pathway. The University Hospitals Coventry and Warwickshire NHS Trust has developed a framework for career progression that incorporates three phases of continuing professional development. These are organised and co-ordinated by a dedicated support worker training team comprising four registered nurses plus senior support workers in the role of peripatetic NVQ Care assessors.

Clinical Competence↗

Child care responsibilities and participation in continuing education and training: issues relating to motivation, funding and domestic roles.

Changes in the organization and funding of health services and in the education and training of NHS staff have placed increased influence in the hands of employers and individual students as users of continuing professional development. Against this policy context an interview study was carried out with students participating in a range of continuing professional development activities. The sample included 89 participants attending a range of courses. Approximately half of the sample had children. Many of the participants were attending courses in their own rather than in their employers' time and several were self-funding. The influence of domestic responsibilities on motivations, along with the impact of course participation on home and family life, were examined. Results revealed that those with children were less likely to perceive continuing education in a positive light compared to those without. The impact of course participation on home and family life was invariably negative and for some the consequences were serious. The policy implications of findings are discussed.

Adult↗

Improving quality measures in the emergency services.

A large and continuing increase in medical emergency admissions has coincided with a reduction in hospital beds, putting the acute medical services under great pressure. Increasing specialization among physicians creates a conflict between the need to cover acute unselected medical emergencies and the pressure to offer specialist care. The shortage of trained nursing staff and changes in the training of junior doctors and the fall in their working hours contribute to the changing role of the consultant physician. The organization of the acute medical service is of paramount importance and requires multi-disciplinary teamwork on an admissions unit with full support services. Excellent bed management is essential. There must be guidelines for all the common medical emergencies and all units must undertake specific audits of the acute medical service. Continuing professional development (CPD) and continuing medical education (CME) should reflect the workload of the physician; that is, it must include time specifically focused on acute medicine and general (internal) medicine, as well as the specialty interest.

Emergency Service, Hospital↗

Independent extended supplementary nurse prescribers, their prescribing practice and confidence to educate and assess prescribing students.

BACKGROUND: No other country in the world has such extended prescribing rights for nurses as the United Kingdom. Concerns surround the move of nursing towards a medical model of care, and the level of medical practice support required by trainee prescribers. AIM: To provide an overview of the nurses adopting the role of independent extended supplementary prescriber, their prescribing practice and confidence to educate and assess prescribing students. METHODS: A convenience sample of 1187 independent extended supplementary nurse prescribers were sent a questionnaire. Eight hundred and sixty eight completed questionnaires were returned. RESULTS: The majority (82%) of nurses worked in primary care. Eighty seven percent used independent extended prescribing and 35% supplementary prescribing. Most were qualified to degree level or higher and had over 10 years nursing experience. Seventy four percent felt confident to act as a mentor during the prescribing programme. More highly qualified nurses and those who had undertaken, or had access to continuing professional development, were statistically more likely to feel confident to adopt this role. CONCLUSION: Appropriately qualified nurse prescribers might be best placed to support trainee prescribers. Exploration of the low uptake of supplementary prescribing and access to continuing professional development is required.

Adult↗

A national survey of dental technicians: career development, professional status and job satisfaction.

OBJECTIVE: To investigate the career development, perception of status within the dental team, and level of job satisfaction of dental technicians in the United Kingdom. DESIGN: Cross-sectional postal questionnaire survey of 1,650 dental technicians registered with the Dental Technicians Association. Replies were received from 996 (60%). RESULTS: Eighty two per cent respondents had a qualification in dental technology and 21% also had an advanced level qualification. Almost two thirds of the respondents had undertaken no verifiable continuing professional development in the previous year. Only 27% of respondents expected to develop their career over the next five years. Less than 50% of the respondents felt adequately valued as individuals and as a professional group in the dental team. Job satisfaction was significantly related to age, attendance at one or more courses in the last year, working shorter hours, feeling valued in the dental team, and future career plans. CONCLUSIONS: Plans for the registration and role expansion of dental technicians provide opportunities for career development which have yet to be realised. The low levels of continuing professional development currently undertaken indicate the need for a review of the provision and funding of training at a strategic level. Whilst levels of job satisfaction are satisfactory, many dental technicians feel insufficiently valued in the dental team.

Attitude of Health Personnel↗

GP selection of postgraduate education courses has implications for colleagues: messages for course providers and for those writing practice professional development plans.

BACKGROUND: The Department of Health's review of continuing professional development in general practice advocates setting team and individual goals. AIM: To explore how general practitioners (GPs) share learning experiences with colleagues, focusing on how GPs choose courses as one factor influencing sharing. METHOD: Interviews were conducted with 21 GPs using grounded theory methodology. The responses were coded by six researchers from psychology, education, and general practice. RESULTS: Much sharing with colleagues took place, though not always immediately following a course. GP explanations revealed four reasons for course selection that influenced the degree of sharing: 1. Attendance to meet group needs encouraged rapid sharing and could involve course attendance with colleagues. 2. Attendance to enhance 'special interests' could either encourage or inhibit sharing. 3. Attendance in pursuit of 'personal interests' peripheral to general practice did not result in sharing within the primary care team. 4. Attendance to meet personal learning needs did not involve sharing when needs were not currently shared with colleagues. CONCLUSION: Course selection and subsequent sharing have implications for course providers and those writing personal and practice professional development plans.

Curriculum↗

Understanding the internet-based distance learning preferences of European respiratory specialists.

We studied the learning preferences of 160 respiratory specialists from four European countries who participated in ten internet-based learning modules and answered linked survey questions. Specialists were enthusiastic for internet learning amongst all national groups and particularly wanted to access material for teaching others. The value of social interactive learning was acknowledged but British and German subjects appeared more reluctant to participate. Internet delivered distance learning is well perceived amongst respiratory specialists. There is potential for both individual and group learning that could be realized by developing Europe-wide continuing professional development communities.

Choice Behavior↗

Leading interprofessional practice: a conceptual framework to support practitioners in the field of learning disability.

One of the key challenges for practitioners in present day health and social care has been responding effectively in the interprofessional teamwork setting, where collaboration is at the centre of professional activity. For whilst practitioners are expected to work interprofessionally there often remains limited attention to the actual process of interprofessional practice itself, within organizational strategy, local workforce development planning and individual continuing professional development. These concerns were a driver for this research with practitioners in the field of learning disability which resulted in the development of a conceptual framework for interprofessional practice. This paper sets out the process of conceptual framework development, underpinned by the concepts of knowledge of learning disabilities, contextual socialisation, empowerment, conflict management, transforming capability and interprofessional reflection on action. The researcher suggests that the framework may offer clinical leaders in learning disabilities and a range of other practice settings a tool to facilitate individual practitioner development, enabling as it does, the identification of a range of critical factors which impact on the outcomes of interprofessional practice intervention.

Attitude of Health Personnel↗

Whole-system evaluation research of a scheme to support inner city recruitment and retention of GPs.

BACKGROUND: The GP Assistant/Research Associate scheme developed in the Guy's, King's and St Thomas' School of Medicine, London, aims to attract and recruit young GPs (GP Assistants) and develop their commitment to work in local inner city practices. Continuing professional development for both young and established GPs is a key feature of the scheme. OBJECTIVES: The objectives of the whole-system evaluation research were to explore the perspectives of 34 stakeholders in the academic department, the practices and the PCGs, and to investigate the experiences of 19 GP Assistants who have participated in the scheme. METHODS: Qualitative methods included semi-structured interviews, non-participant observations in the practices, audio-taped meetings and personal journals. Data collection also included reviewing documentation of the scheme, i.e. the previous quantitative evaluation report, publications and e-mails. The multi-method approach enabled individual, group and team perspectives of the scheme and triangulation of the data through comparing dialogue with observations and documentary evidence. Thematic analysis was undertaken to elicit the complex experiences of the GP Assistants. RESULTS: Wide-ranging findings included enthusiastic support for the continuation of the scheme. The GP Assistants' personal and professional development was clearly evident from the themes 'eye opener', new knowledge, managing multiple roles, feeling vulnerable, time constraints and empowering processes. Seven of the GP Assistants have become partners and ten chose to remain working in local practices. Significant challenges for managing and leading the scheme were apparent. Greater co-operation and collaborative working between the academic department and the practices is required. CONCLUSION: The scheme provides a highly valued visible means of support for GPs and could act as a model for a career pathway aimed at enhancing recruitment and retention of GPs. The scheme is also at the forefront of national initiatives aimed at supporting single-handed practices and helping GPs with their continuing professional development. An integrated approach to change, education, research and development is advocated to enable recruitment and retention of GPs, their academic development, and to underpin the evolution of PCTs as learning organizations.

Adult↗

The utility of CPD for older adult mental health nurses.

AIM: To investigate how mental health nurses working with older adults perceive the benefits and realities of developing the outcomes of current continuing professional development training into actual clinical practice. METHOD: A structured questionnaire was used with a convenience sample of nursing staff. Qualitative analysis was performed using a grounded theory approach in order to identify emergent themes, concepts and categories of data. Four randomly selected nurses were subjected to a voluntary semistructured interview using the questionnaire as a basis for information gathering. RESULTS: The main reason for attending courses was developing skills. Of those attending courses, 42 per cent of qualified and 35 per cent of unqualified staff had a personal development plan (PDP) or individual performance review (IPR). Significantly, all unqualified staff who had not been on a course had no PDP or IPR. Learning was described as applicable to practice by 85 per cent of unqualified and 70 per cent of qualified staff. However, 28 per cent of unqualified staff and 20 per cent of qualified staff felt their practice had not changed as a result of their learning. CONCLUSION: CPD can be a positive experience, providing nurses with the opportunity to direct their professional development.

Aged↗

Exploring staff nurses' views on professional development.

AIM: The aim of this study is to explore senior staff nurses' experiences of continuing professional development. METHOD: A hermeneutic phenomenological methodology was used with a purposive sample of five participants. RESULTS: Four key themes were identified: the experience is about being opportunistic; the experience is about keeping up to date with ongoing advances in nursing practice; the experience is about experiential learning and meeting the demands of the informant's current role. CONCLUSION: CPD enabled the nurses who took part in this study to keep up to date with nursing practice. It also illustrates that engaging with this system of skills enhancement helps to reduce work-related stress among nurses, thereby providing further opportunities to enhance confidence and competence as well as developing a workforce that is 'fit for practice' and 'fit for purpose'.

Attitude of Health Personnel↗