Nuttall Dilyse
Principal Lecturer,School of Community Health and Midwifery,University of Central Lancashire,Preston,Lancsashire,UK.
Prim Health Care Res Dev. 2018 Jan;19(1):7-22. doi: 10.1017/S1463423617000500. Epub 2017 Aug 8.
Aim The aim of this metasynthesis was to develop an understanding of the existing theoretical perspectives around nurse prescribing and to identify any gaps in knowledge, which would support further research into the lived experience of the nurse prescriber in the primary care setting.
Nurse prescribing has been the focus of many research studies since its introduction, with many benefits to the patient, the prescriber and service identified; however, there remains variation in the utilisation of the prescribing qualification, particularly in primary care settings. Although a range of quantitative and qualitative studies have been undertaken, which aimed to explore the influences on prescribing, few have used a research methodology that supports the in-depth exploration of the nurse prescriber's experience.
An extensive literature search was undertaken in April 2015 (20-24), which included UK and non-UK studies since 1999. Inclusion and exclusion criteria were applied to search for studies in which participants included nurse prescribers who practiced in primary or community care settings. Studies that only used a quantitative methodology and those not available in English were excluded. The literature search yielded 124 papers, with 50 papers remaining after the initial screen of full papers against the inclusion/exclusion criteria. The papers were reviewed and graded for their quality, with a further 13 papers excluded. A three-step qualitative analysis technique of metasynthesis was applied to the remaining 37 papers. Identification of similarities and differences enabled first-order interpretations to be identified, which were grouped into broader themes (second-order interpretations) by identifying concepts that applied to two or more studies. Further interpretation through synthesis of translation enabled third-order interpretations to emerge. Findings From the metasynthesis of the 37 papers, nine themes emerged: patient-centred care; benefits to the service; the need for knowledge; professional accountability and boundary setting; safety consciousness; barriers to effective prescribing; role preservation; power-shifts and inter-professional relationships; and culture of prescribing.
目的 本元综合分析的目的是加深对围绕护士处方的现有理论观点的理解，并找出知识空白，以支持对基层医疗环境中护士处方者的生活经历进行进一步研究。
自护士处方引入以来，一直是许多研究的焦点，已确定对患者、处方者和服务有诸多益处；然而，处方资格的使用仍存在差异，尤其是在基层医疗环境中。尽管已经进行了一系列定量和定性研究，旨在探讨对处方的影响，但很少有研究采用支持深入探究护士处方者经历的研究方法。
2015年4月进行了广泛的文献检索（20 - 24），包括1999年以来的英国和非英国研究。应用纳入和排除标准来搜索参与者包括在基层或社区医疗环境中执业的护士处方者的研究。仅使用定量方法的研究和非英文可得的研究被排除。文献检索产生了124篇论文，在根据纳入/排除标准对全文进行初步筛选后，剩下50篇论文。对这些论文进行了质量审查和评分，又排除了13篇论文。对剩下的37篇论文应用了元综合分析的三步定性分析技术。通过识别异同来确定一阶解释，通过识别适用于两项或更多研究的概念将其归纳为更广泛的主题（二阶解释）。通过综合翻译进行进一步解释，从而得出三阶解释。结果 从对37篇论文的元综合分析中，出现了九个主题：以患者为中心的护理；对服务的益处；知识需求；专业责任与界限设定；安全意识；有效处方的障碍；角色维持；权力转移与跨专业关系；以及处方文化。
