Hall Jason, Cantrill Judith, Noyce Peter
School of Pharmacy and Pharmaceutical Sciences, University of Manchester, UK.
J Clin Nurs. 2006 Apr;15(4):403-12. doi: 10.1111/j.1365-2702.2006.01227.x.
(i) To identify barriers that could either prevent community nurses from prescribing altogether or reduce the number of times that a nurse might prescribe. (ii) To determine how wide spread the barriers identified above were.
Many community nurses who are trained to prescribe are either not prescribing at all or not routinely doing so.
(i) Qualitative semi-structured interviews with nurses prescribers and Trust prescribing leads. (ii) Postal questionnaires sent to the nurse prescribing leads in each Primary Care Trust across three strategic health authorities in England.
Several barriers were identified in this study. Those that (i) prevented prescribing included roles with no patient contact, prescription pads not issued, opposition from general practitioners and lack of confidence; (ii) prevented some prescribing included lack of time in clinics, inability to prescribe for patients registered with another Trust, security concerns, lack of access to patient medical records and the use of alternative methods of supply; (iii) made prescribing more difficult included keeping records, informing general practitioner of items prescribed, delivering prescribed items to housebound patients and situations requiring items from more than one prescriber.
Many barriers have been identified that have the potential to reduce the impact of nurse prescribing on patient care. Trusts should monitor the prescribing of their nurse prescribers, target appropriate support and encouragement to address problems with prescriber confidence, develop strategies to integrate their nurse prescribers into the healthcare team to improve access to patient's medical notes, and improve the efficiency of the prescribing process.
There is a danger that the anticipated benefits to patient care resulting from the introduction of nurse prescribing may not materialize if the barriers identified in this study are not addressed.
（i）识别可能完全阻止社区护士开处方或减少护士开处方次数的障碍。（ii）确定上述已识别障碍的广泛程度。
许多接受过开处方培训的社区护士要么根本不开处方，要么不经常开处方。
（i）对开处方的护士和信托机构开处方负责人进行定性半结构化访谈。（ii）向英格兰三个战略卫生当局的每个初级保健信托机构的开处方护士负责人发送邮政问卷。
本研究识别出了几个障碍。那些（i）阻止开处方的障碍包括没有患者接触的角色、未发放处方笺、全科医生的反对以及缺乏信心；（ii）阻止部分开处方的障碍包括诊所时间不足、无法为在另一个信托机构注册的患者开处方、安全问题、无法获取患者病历以及使用替代供应方法；（iii）使开处方更困难的障碍包括保存记录、告知全科医生所开药品、将所开药品递送给居家患者以及需要多个开处方者提供药品的情况。
已识别出许多有可能降低护士开处方对患者护理影响的障碍。信托机构应监测其开处方护士的处方情况，针对性地提供适当支持和鼓励以解决开处方者信心问题，制定策略将其开处方护士融入医疗团队以改善获取患者病历的机会，并提高开处方流程的效率。
如果本研究中识别出的障碍得不到解决，引入护士开处方对患者护理预期的益处可能无法实现。
