Logan Vera, Keeley Sarah, Akerman Kevin, De Baetselier Elyne, Dilles Tinne, Griffin Nia, Matthews Lisa, Van Rompaey Bart, Jordan Sue
Department of Nursing, Swansea University, Swansea, United Kingdom.
Bournemouth University, Poole, United Kingdom.
Nurs Open. 2021 Mar;8(2):592-606. doi: 10.1002/nop2.664. Epub 2020 Oct 24.
To explore UK professionals' interpretations of medicines optimization and expansion of nurses' roles.
This mixed-methods study sought professionals' views on nurses' involvement, competency and engagement in monitoring patients for adverse effects of medicines, monitoring adherence, prescribing and patient education.
An online survey and interviews were undertaken with nurses, doctors and pharmacists in Wales and England, May 2018 to July 2019.
In all, 220 nurses, 17 doctors and 62 pharmacists responded to the online survey, and 24 professionals were interviewed. Nurses were divided over extending their roles, with 123/220 (55.9%) wishing to extend roles in monitoring patients for possible adverse drug reactions (ADRs), 111/220 (50.5%) in adherence monitoring, 121/220 (55.0%) in prescribing and 122/220 (55.4%) in patient education. The best-qualified nurses were the most willing to increase involvement in monitoring patients for ADRs (aOR 13.00, 1.56-108.01). Interviews revealed that both nurses and doctors assumed the other profession was undertaking this monitoring. Respondents agreed that increasing nurses' involvement in medicines optimization would improve patient care, but expressed reservations about nurses' competencies. Collaboration between nurses and doctors was suboptimal (rated 7/10 at best) and between nurses and pharmacists even more so (6/10 at best).
Juxtaposition of datasets identified problems with medicines optimization: although most respondents agreed that increasing nurses' involvement would positively impact practice, their educational preparation was a barrier. Only ~50% of nurses were willing to expand their roles to fill the hiatus in care identified and ensure that at least one profession was taking responsibility for ADR monitoring.
To improve multiprofessional team working and promote patient safety, nurse leaders should ensure patients are monitored for possible ADRs by at least one profession. Initiatives expanding nurses' roles in medicines optimization and prescribing might be best targeted towards the more educated nurses, who have multidisciplinary support.
探讨英国专业人员对药物优化的理解以及护士角色的扩展。
这项混合方法研究旨在了解专业人员对护士参与、能力以及在监测患者药物不良反应、监测依从性、开药和患者教育方面的参与度的看法。
2018年5月至2019年7月，对威尔士和英格兰的护士、医生和药剂师进行了在线调查和访谈。
共有220名护士、17名医生和62名药剂师回复了在线调查，24名专业人员接受了访谈。护士们对于扩展其角色存在分歧，220人中123人（55.9%）希望在监测患者可能的药物不良反应方面扩展角色，111人（50.5%）希望在依从性监测方面扩展角色，121人（55.0%）希望在开药方面扩展角色，122人（55.4%）希望在患者教育方面扩展角色。资质最佳的护士最愿意增加在监测患者药物不良反应方面的参与度（调整后比值比为13.00，1.56 - 108.01）。访谈显示，护士和医生都认为对方专业在进行这种监测。受访者一致认为增加护士在药物优化方面的参与度将改善患者护理，但对护士的能力表示保留意见。护士与医生之间的协作不太理想（最高评分为7/10），护士与药剂师之间的协作更差（最高评分为6/10）。
数据集的并列揭示了药物优化存在的问题：尽管大多数受访者同意增加护士的参与度将对实践产生积极影响，但他们的教育准备是一个障碍。只有约50%的护士愿意扩展其角色以填补所发现的护理空白，并确保至少有一个专业负责药物不良反应监测。
为了改善多专业团队协作并促进患者安全，护士领导者应确保至少有一个专业对患者可能的药物不良反应进行监测。在药物优化和开药方面扩展护士角色的举措可能最好针对那些受过更多教育且有跨学科支持的护士。
