This paper is a report of a study to identify the content of, and participation in, medicine discussion between nurse prescribers and people with diabetes in England.
Diabetes affects 246 million people worldwide and effective management of medicines is an essential component of successful disease control. There are now over 20,000 nurse independent prescribers in the UK, many of whom frequently prescribe for people with diabetes. With this responsibility comes a challenge to effectively communicate with patients about medicines. National guidelines on medicines communication have recently been issued, but the extent to which nurse prescribers are facilitating effective medicine-taking in diabetes remains unknown.
A purposive sample of 20 nurse prescribers working with diabetes patients audio-recorded 59 of their routine consultations and a descriptive analysis was conducted using a validated coding tool: MEDICODE. Recordings were collected between January and July 2008. The unit of analysis was the medicine.
A total of 260 instances of medicine discussion identified in the audio-recordings were analysed. The most frequently raised themes were 'medication named' (raised in 88·8% of medicines), 'usage of medication' (65·4%) and 'instructions for taking medication' (48·5%). 'Reasons for medication' (8·5%) and 'concerns about medication' were infrequently discussed (2·7%). Measures of consultation participation suggest largely dyadic medicine discussion initiated by nurse prescribers.
MEDICODE discussion themes linked to principles of recent guidelines for effective medicine-taking were infrequently raised. Medicine discussion was characterized by a one statement-one response style of communication led by nurses. Professional development is required to support theoretically informed approaches to effective medicines management.
[Show abstract][Hide abstract] ABSTRACT: To describe what patients want to know about their medications and how they currently access information. To describe how physicians and pharmacists respond to patients' information needs. To use patients', physicians', and pharmacists' feedback to develop evidence-based treatment information sheets.
Qualitative study using focus groups and a grounded-theory approach.
Three regions of Canada (British Columbia, Nova Scotia, and Ontario).
Eighty-eight patients, 27 physicians, and 35 pharmacists each took part in one of 19 focus groups.
Purposeful and convenience sampling was used. A trained facilitator used a semistructured interview guide to conduct the focus groups. Analysis was completed by at least two research-team members.
Patients wanted both general and specific information when considering medication treatments. They wanted basic information about the medical condition being treated and specific information about side effects, duration of treatment, and range of available treatment options. Physicians and pharmacists questioned the amount of side-effect and safety information patients wanted and thought that too much information might deter patients from taking their medications. Patients, physicians, and pharmacists supported the use of evidence-based treatment information sheets.
Patients and clinicians each appear to have a different understanding of what and how much information patients should receive about medications. Feedback from patients can be used to develop patient-oriented treatment information.
Canadian family physician Médecin de famille canadien 02/2002; 48:104-10. · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this cross-sectional study was to quantify patients' personal beliefs about the necessity of their prescribed medication and their concerns about taking it and to assess relations between beliefs and reported adherence among 324 patients from four chronic illness groups (asthma, renal, cardiac, and oncology). The findings revealed considerable variation in reported adherence and beliefs about medicines within and between illness groups. Most patients (89%) believed that their prescribed medication was necessary for maintaining health. However, over a third had strong concerns about their medication based on beliefs about the dangers of dependence or long-term effects. Beliefs about medicines were related to reported adherence: higher necessity scores correlated with higher reported adherence (r=0.21, n=324, p<0.01) and higher concerns correlated with lower reported adherence (r=0.33, n=324, p<0.01). For 17% of the total sample, concerns scores exceeded necessity scores and these patients reported significantly lower adherence rates (t=-4.28, p<0.001). Stepwise multiple linear regression analysis showed that higher reported adherence rates were associated with higher necessity-concerns difference scores (beta=0.35, p<0.001), a diagnosis of asthma (beta= -0.31, p<0.001), a diagnosis of heart disease (beta=0.19, p<0.001), and age (beta=0.22, p<0.001). Gender, educational experience, or the number of prescribed medicines did not predict reported adherence. Medication beliefs were more powerful predictors of reported adherence than the clinical and sociodemographic factors, accounting for 19% of the explained variance in adherence. These data were consistent with the hypothesis that many patients engage in an implicit cost-benefit analysis in which beliefs about the necessity of their medication are weighed against concerns about the potential adverse effects of taking it and that these beliefs are related to medication adherence.
Journal of Psychosomatic Research 12/1999; 47(6):555-67. DOI:10.1016/S0022-3999(99)00057-4 · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aims of this paper are to review a theoretical model useful for developing nursing knowledge related to nurse-patient interaction, review the literature on nurse-patient interaction, and discuss areas for further research. THEORETICAL MODEL: Goffman's theory of face work.
Nurse-patient interaction is a central element of clinical nursing practice. This paper shows how Goffman's model can be used as a theoretical framework for understanding nurse-patient communication.
Issues such as power, the social and cultural context, and interpersonal competence are shown to be important in the quality of nurse-patient interactions and nurses need to take cognizance of these factors in their interactions with patients.
Sergio Bracarda, Claudia Caserta, Luca Galli, Paolo Carlini, Ilaria Pastina, Michele Sisani, Simona Scali, Alketa Hamzaj, Lisa Derosa, Alessandra Felici, Marta Rossi, Amelia Altavilla, Aldo Chioni, Verena De Angelis
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