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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    • "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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    • "Information specific to specialty areas is not included and is expected to be acquired in practice. Consequently, an MHN can prescribe psychotropic medication without receiving specific formal training in its use (Skingsley et al., 2006) as there is no mandatory requirement for training courses to include detailed input on psychotropic medication. Nationally there is considerable variation in how the implementation of MHN prescribing is being supported (NPC, 2005). "
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    ABSTRACT: What is already known about the topic? To date there are in excess of 400 qualified mental health nurse prescribers in the UK but uptake has been slower than was initially anticipated. Some have suggested that one of the main barriers for implementation is the unsupportive behaviours of psychiatrists. A proportion of the medical profession has expressed grave concerns about the safety of nurse prescribing whereas others appear supportive. What this paper adds Overall both professional groups were in favour of mental health nurse prescribing, although significantly more psychiatrists expressed concerns. General beliefs, impact and uses were inter-related constructs as evidenced by high correlation co-efficients. Psychiatrists in particular were concerned with aspects of clinical and legal responsibility and the appropriate Background: In the United Kingdom, mental health nurses (MHNs) can independently prescribe medication once they have completed a training course. This study investigated attitudes to mental health nurse prescribing held by psychiatrists and nurses. Method: 119 MHNs and 82 psychiatrists working in South-East England were randomly sampled. Participants completed a newly created questionnaire. This included individual item statements with 6-point likert scales to test levels of agreement which were summated into 7 subscales. Results: Psychiatrists had significantly less favourable, albeit generally positive attitudes than MHNs regarding general beliefs (63% vs. 70%, p < 0.001), impact (62% vs. 70%, p < 0.001), uses (60% vs. 71%, p < 0.001), clinical responsibility (69% vs. 62%, p < 0.001) and legal responsibility (71% vs. 64%, p < 0.001). More MHNs than psychiatrists believed that nurse prescribing would be useful in emergency situations for rapid tranquilisation (82% vs. 37%, p < 0.001), and that the consultant psychiatrist should have ultimate clinical responsibility for prescribing by an MHN (42% vs. 28%, p < 0.001). Approximately half of all participants agreed nurse prescribing would create conflict in clinical teams. Conclusions: The majority of both groups were in favour of mental health nurse prescribing, although significantly more psychiatrists expressed concerns. This may be explained by a perceived change in power balance.
    International Journal of Nursing Studies 04/2009; Volume 46,(Issue 11):1467–1474. · 2.25 Impact Factor
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