Article

Neuropharmacology and mental health nurse prescribers

Faculty of Health Sciences, Staffordshire University, Stoke-upon-Trent, England, United Kingdom
Journal of Clinical Nursing (Impact Factor: 1.23). 09/2006; 15(8):989-97. DOI: 10.1111/j.1365-2702.2006.01378.x
Source: PubMed

ABSTRACT To outline the development and content of a 'top-up' neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice.
Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid-1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication.
Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles.
The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they prescribe coupled with the information they provide to service users can be improved as a result of specific educational support. It would appear that adopting a prescribing dimension to one's role requires nurses to revisit a number of skills that are integral to the work of the mental health nurse, e.g. good communication, establishing empathy, listening to what clients say, responding to what is required and involving clients in their own care.
Mental health nurses from one particular Trust in the West Midlands were provided with a 'top-up' course in neuropharmacology and, although they found this challenging, ultimately they found this to be helpful. As nurse prescribing is 'rolled out' to other nursing specialities it is important that local Trusts and Workforce Development Directorates maintain a dialogue about nurse prescriber training to ensure that nurse prescribers receive the appropriate time and support for their ongoing Continued Professional Development. As increasing numbers of nurses from different specialities qualify as nurse prescribers it is vital that they are supported by their employing organizations and given the opportunity to maintain their competency and confidence in their prescribing practice.

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    • "It is hoped that independent nurse prescribing (INP) could contribute to this agenda in the following ways: • enable redesign and streamlining of mental health services; • increase service user access to medicines; • improve information and education provided to service users; • address difficulties with concordance and adherence. Despite the proposed benefits, MHNs have been relatively slow to take on prescribing roles (Gray et al. 2005, Norman et al. 2007) and a number of barriers have been identified including: • generic prescribing training course which does not meet the needs of MHNs (Skingsley et al. 2006); • support during and after training (Bradley et al. 2008); • concerns about keeping prescribing practice within competency (Bradley et al. 2007). Research evidencing that NP is safe and therapeutic in mental health settings has lagged behind service developments , although evidence now exists that suggests SP by MHNs is as safe as that by psychiatrists (Norman et al. 2007) and that service users tend to prefer it (Jones et al. 2007, Norman et al. 2007). "
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    ABSTRACT: ACCESSIBLE SUMMARY: •  A growing number of mental heath nurses have trained to become non-medical prescribers but many of them have not actually taken this new role once qualified. •  Individual or team formularies can help reduce uncertainty about what each nurse can prescribe and can therefore increase their confidence and willingness to take up new prescribing responsibilities. •  Formularies can also be used to enhance communication about medication with service users and promote their involvement in decision making about their own treatment. ABSTRACT: Mental health nurses have been entitled to train to become independent prescribers since May 2006; although the number of trained nurse prescribers seems to have increased steadily, a significant number of them have not actually undertaken prescribing roles on completion of their training or have limited their practice to supplementary prescribing. In order to support existing independent prescribers and to assist those nurses who have trained but are yet to prescribe independently, a mental health trust has piloted the use of individual and team formularies. An evaluation of this project indicated that formularies were well received by existing independent prescribers and were seen as a helpful instrument to support newly qualified and supplementary prescribers in their bid to become independent. Formularies can clarify and formalize each prescriber's area of competence, thus setting clear boundaries, reducing uncertainty and enhancing prescribers' confidence and willingness to take on this new role. Formularies may also be used to enhance communication with service users and further develop shared decision making. Effective procedures need to be in place to ensure formularies are up to date and reflect local practice.
    Journal of Psychiatric and Mental Health Nursing 03/2012; 20(1). DOI:10.1111/j.1365-2850.2012.01885.x · 0.98 Impact Factor
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    • "There was much diversity as to the main focus of the included publications. Nevertheless, a number of recurring themes could be discerned, such as the views of nurses, doctors and other parties involved concerning nurse prescribing [45,47,51,53,81,94,108,109,115,121,139], prescribing behaviours of nurses [36,43,124,126,128,129,131,137], and nurse prescribing in relation to specific diseases [38,44,84,89,91-93,101,108,116,125] - most notably concerning nurse prescribing in mental health care [21,32,39,67,76,83,100,102,104-106,132,135]. Also, a number of publications focussed on the history and evolution of (nurse) prescribing of medicines, but these remained relatively limited [5,6,46,48,49,75,90,96,103,142]. "
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    ABSTRACT: A growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor. A comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods. One hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians. Differences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some countries, nurses share (full) jurisdiction with the medical profession, whereas in other countries nurses prescribe in a subordinate position. In most countries the jurisdiction over prescribing remains predominantly with the medical profession. There seems to be a mechanism linking the jurisdictional settlements between professions with the forces that led to the introduction of nurse prescribing. Forces focussing on efficiency appear to lead to more extensive prescribing rights.
    BMC Health Services Research 05/2011; 11:127. DOI:10.1186/1472-6963-11-127 · 1.66 Impact Factor
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    • "It is hoped that independent nurse prescribing (INP) could contribute to this agenda in the following ways: • enable redesign and streamlining of mental health services; • increase service user access to medicines; • improve information and education provided to service users; • address difficulties with concordance and adherence. Despite the proposed benefits, MHNs have been relatively slow to take on prescribing roles (Gray et al. 2005, Norman et al. 2007) and a number of barriers have been identified including: • generic prescribing training course which does not meet the needs of MHNs (Skingsley et al. 2006); • support during and after training (Bradley et al. 2008); • concerns about keeping prescribing practice within competency (Bradley et al. 2007). Research evidencing that NP is safe and therapeutic in mental health settings has lagged behind service developments , although evidence now exists that suggests SP by MHNs is as safe as that by psychiatrists (Norman et al. 2007) and that service users tend to prefer it (Jones et al. 2007, Norman et al. 2007). "
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    ABSTRACT: Mental health nurses can now train to become independent prescribers as well as supplementary prescribers. Independent nurse prescribing can potentially help to reorganize mental health services, increase access to medicines and improve service user information, satisfaction and concordance. However, mental health nursing has been slow to undertake prescribing roles, and there has been little work conducted to look at where nurse prescribing is proving successful, and those areas where it is less so. This survey was designed to collect information from directors of nursing in mental health trusts about the numbers of mental health prescribers in England, gather views about prescribing in practice, and elicit intentions with regards to the development of nurse prescribing. In some Trusts, the number of mental health nurse prescribers has increased to the point where wider impacts on workforce, the configuration of teams and services are inevitable. Currently, the way that prescribing is used within different organizations, services and teams varies and it is unclear which setting is most appropriate for the different modes of prescribing. Future work should focus on the impact of mental health nurse prescribing on service delivery, as well as on service users, colleagues and nurses themselves.
    Journal of Psychiatric and Mental Health Nursing 08/2010; 17(6):487-93. DOI:10.1111/j.1365-2850.2009.01541.x · 0.98 Impact Factor
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