Effectiveness Of Non Medical Nurse Prescribing Primary Care

Effectiveness Of Non Medical Nurse Prescribing Primary frettingNurse-led clinics learn been vary magnitude for some time and Marsden (1992) determine the take ins of using specia listen incurs to compliment services already offered by doctors. Read (1999) defined bear-led cautiousness as being the interface between nursing and medicine. Miles (2003) advertd ten undivided authors as saying that re calculate shows that nurses argon capable of carrying appear procedures unremarkably in the domain of doctors, often resulting in greater enduring mirth. diligent satis faction is an main(prenominal) quality indicator. Yellen (2002) felt that the cadence of tolerant delight with nursing make do was fare thoroughlyicularly grand as it provided a keen measure of over each(prenominal) satisfaction with services. Ford (1997) agreed with this principle just now c formerlyntrated a good deal on the competitive edge and financial excerpt being reflected in patient rol e satisfaction. Cohen (1994) advocated the utilization of satisfaction questionnaires, just both(prenominal) Avis (1997) and Westbrook (1993) doubted their qualification, questioning the hardihood of questionnaires and the way in which they are measured. Westbrook (1993) felt that questionnaires whitethorn be limiting and piteously evaluated, giving rise to a misfortunate reputation for satisfaction questionnaires. Duffin (2002) commented that questionnaires with tick boxes appear to comport limited use and may include leading questions where there is no scope for the patient to enlarge upon their terminations.Both Robson (1993) and Wiles (1996) warned that the results of sees crumb sometimes paint a wrong exacting try and may be difficult to translate into a course of action. However, Backhouse (2000) says that the power of a successful nurse-led user satisfaction descry lies in the immediacy and relevance of the results. This may score enormous authorisation to t ransform work out, especi wholey if the staff are able to remain positive ab appear any possible negative feedback. Backhouse (2000) commented that nurses may tend to evolve praise for granted, as a regular stream of cards and thank is often the only feedback they receive. This may produce the belief that the service is satisfactory, merely it has been found that although there is a great deal of satisfaction, there is in homogeneous manner some dissatisfaction, particularly with respect to information (McColl (1996), Backhouse (2000), Byrne (2000), Duffin (2002)).As a transaction Manager in General manage in an affluent bucolic environment, the author has found that there are increasing frustrations and point of accumulations with time and resources where a competent health oversee professional could manage a patients care to a greater extent(prenominal) than adequately during unitary mesh. Additionally, continuity of care and health care centering in a much patient centred, balanced way could benefit the patient. Discussion around the anxiety of their medicines and common health education could sanction to the patient taking responsibility for their own health care management.The welch Assembly Government (WAG) (WAG 2001, WAG 2005) has prioritised patient access to unproblematic care services for the last few years which has impacted on patient expectation around the need for an urgent appointment. This has caused pressure on appointment systems, and subsequently transplants have been made to deal with the demand. One way in which the practice would like to cope with these demands is by enabling the Senior Practice Nurse to give more holistic care, making the consultation broadloom for the patient, thus reducing the need for additional appointments, having already consulted with an captivate healthcare professional (WAG 2001, WAG 2005).This practice nurse is currently undertaking the unaffiliated Nurse Prescribing (non-medical). When q ualified, this will tie in with the nurse-led diabetes clinic and Minor Illness clinics for which she is qualified. The indwelling progression would be for her to prescribe appropriate medicine or dressings in relation to the competencies she has accumulated following evidence based practice in these disciplines.A nurse may spend a considerable make out of time dealing with the assessment and management of a patient, indeed waiting outside a GPs door for a prescription to be signed. This location is far from ideal, and with the enhancement of the prescribing qualification, this could be d adept in a more appropriate way. This publications analyse demeanors at aspects of nurse prescribing in radical care, and how this cigarette lead to patient satisfaction, autonomy and job satisfaction for nurse prescribers.Literature Search Strategy (Method 10% c350 words) 582LoBiondo-Wood (2002) describes a lit search as an efficient retrieval of scholarly books related to the progeny of interest, while Cormack (2000) describes a books search as a review of previously written literature on a related exit in rear to provide the looker and the referee with familiarity of the sports stadium being interrogati integrityd.Research literature tolerate originate from many sources. The mickle of literature would be unmanageable if careful selection was non carried out (Cormack 2000, LoBiondo 2002). Polit (2004) recommends using electronic databases to locate relevant query information and points out the demarcation lines of manual and ne 2rk sources as being time consuming and inconvenient, internet searching possibly not providing required results and bibliographic information. Polit (2004) likens locating all relevant information on the chosen topic to being like detective work.Primary explore only was sought. CINAHL Plus (Cumulative Index of nurse and Allied Health Literature) with Full Text and MEDLINE were used to search for name words non-medical AND nurse prescib AND primary care with published dates between January 2004 to portray, resulting in 209 hits. These were restricted to interrogation, years 2004-2010 and English-only articles in order to reduce the proceeds of articles to 29.Playle (2000) suggests that the entitle of a question article is extremely important and should cover centralize as well as distinguishing the enquiry get along used (McCaughan, 1999 Stevens et al, 1993).In the authors case, an informative rear facilitates the choice of research article.The abstract or introduction, as Bailey (1991) suggests it should prepare the layer for the problem to be investigated, as well as being brief.As suggested by Playle (2000) a well written abstract identifies the main points of the issue, although the main help slightness can be the word prohibition as suggested by burn down and woodlet (2001). It should represent an accurate picture (Reid, 1993) of the study with concise regularityology, sample subject, reported findings and finish. This would enable any indorser to base a decision to read the article (Reid, 1993).The rationale for choosing the look back guidelines from Benton Cormack (2000) is based on the convenience and manageability of a well integrated military operation that enables to author to appraise with ease.A literature review is an important element of a research question. Rees (2003 p. 17) indicates that a thorough review of the literature is essential to provide the theoretical and conceptual context for the study. Parahoo (1997) acquits this stating a literature search provides the identification and locating up to date material, relevant to the publication under review. It involves the scanning along with critical narration of the literature chosen to assess usefulness to the question under intervention.The authors sleep togetherledge and prior interpreting of literature directed at change management in primary care dictated the final choice of research articles to Richards, L.A Richards, A Gilead, L Stessman, J blab la bla and Raz, I (1999) title of an article supranational Journal of Dermatology 38, 623-627 (appendix 1).Those chosen for review were three qualitiative and one decimal research articles relating to the question under evaluation.AUTHORSAll eleven authors have either the appropriate professional qualifications or academic qualifications, for example MD or PhDs. A further research on the authors names and using databases CINAHL and Medline xx to present showed that between them they have published xxx articles in various medical journals with different topics. Most have no expression on the subject of maggots and wounds blab la bla, while most of them have some bearing.The review (50% c1750 words) 2168THE check out(PAULAs)LITERATURE REVIEWA ripe literature review draws on a wide range of sources (McCaughan, 1999) and will identify the need for research. Nevertheless, A poor literature does not invalidate the findings but a good one does enhance the status of the research (Stevens et al, 1993135). surmisalA hypothesis is not include and an explanation could be that the commit of this study is to provide new information by utilising a descriptive research method. Burns and Grove (2001) suggested that if there is genuinely little or no research being administered on a particular question, then researchers state objectives or questions and there is an objective.OPERATIONAL DEFINITIONSQuantitative research should have all terms explained or defined. Stevens et al (1993) refer to public error by researchers in the assumption that readers are knowledgeable intimately the jargon and terminologies engaged.METHODOLOGYThe research approach is not acknowledged inwardly the article. Howedver, it can be tolerated that the approach is valued, in that it involves manipulation of the freelance variable.. On the other hand, to provide the strongest evidence with a greater full point of .. Also included are certain soft components such as .. that would indicated possible combination of the two approaches, soft and decimal. Using this combination in approach to research may not appear to be in truth scientific, however Docherty (2000) suggests that this method may produce a more meaty and richer data. Even so, there is strength and weakness to both approaches and neither have been say at bottom this study. On the other hand but support up with . And the author agreed with this subject of approach as it enables a reader to scrutinise the data, without having to be familiar with research methodology, data statistics or the terminology.SUBJECTSThe subjects are identified as 43xx in five depts. Of xx hospital . Nevertheless, many potential or suitable candidates for this type of research may be unwilling to participate (burns Grove, 2001 and Reid Boore, 1987) due to the xxxx.SAMPLE SELECTIONThe approach to the sample selection is not all the way stated and a g ood research study should explain the sample selection method as suggested by Baxter (2001b). However On the other hand, all the subjects are typically,. information COLLECTIONData aggregation procedures are.. not acknowledged..The hardness and reliability are undefined at bottom this study and McCaughan (1999) suggests that if the researcher has not mentioned testing for reliability and validity then it is unlikely that it has been done.ETHICAL CONSIDERATIONSXxxxx respectable committee .. In the authors opinion, respectable consideration should have been an important part of this article..NonethelessAppendix 3 shows/..As suggested by Matthews Venables (1998) either published research report should include a description on how the informed consent is given. On the other hand, lack of acknowledgement of anonymity, confidentiality as well as the description of informed consent does not needfully mean they have not been considered (Firby, 1995 McCaughan, 1999), merely that the researchers assumed that the results and method were more interesting to the reader.RESULTSThe results are presented as xxxxx and backed up by xxx, which showed that xxx. However, quantifiable data is limited wtug xxxx. In spite of this, there is sufficient peak that would enable a reader without any research experience to look at the results and understand what they signify and to judge with confidence the findings.DATA abbreviationThe data analysis is appropriate to the type of data collected that is portionages and for the type of read that xxx was aiming for. In some ways the method employed is simple and easy to retroflex. However, thereClarke (1999c) suggests that the data analysis relies heacily on the researchers expertness and judgement to see that it is accurately exeuted, also not reported are values such as test values df and p. In addition, poor quality analysis will render the data anecdotal and unfocused, merely the analysis is focused, credible and to improve upon this, the author would suggest the inclusion of statistical tables.DISCUSSIONThe discussion is not really balanced, as it only mentions and draws upon xxxxHowever, what is discussed is very concise and knowledgeable. There is also no acknowledgement of the limitations or weakness of this particular stify and there is only one reference to disadvantages, THAT IS ..(Teresas)LITERATURE REVIEWThe aim of the literature review was to find out what the nurses role is in primary care, in relation to providing xxxxx. To assist in the critiquing process, quantitative and qualitative papers were reviewed using the Benton and Cormack (2000) framework. Although the author finds this framework comprehensive and simplistic, it is noted Rees (2003) states qualitative and quantitative research are extremely different, and same method of critiquing cannot be used. This opinion is not upheld by Benton and Cormack (2000) as they promote the use of one framework for both.Within the articles reviewe d the evident themes that emerged are xxx and xxxx.In order to guide the reader to continue reading a paper, the abstract should habilitate the scene for the rest of the report. Playle (2000) states an abstract that is goodishly written will list the main points of a study. It is noted three out of the four articles reviewed have concise expatiate abstracts. Although, that by xxx (2006) lacked depth, understanding and did note cite up to date government papers to support the topic of xxxx. Burns and Grove (2001) broad(prenominal)light that a potential weakness noted wihin Gibbs et al (2004b) paper was the difficulty the reader encountered at determining whether the paper was quantitative or qualitative. Parahoo (1997) concedes this should have been obtained in spite of appearance the abstract, as this should briefly summarise the method, sampling and main findings within a study. Within the abstracts of the articles reviewed, the researchers have clearly depicted and accurate image of all study methodologies, reported findings, sample subjects and closedowns. teachingGibbs et al (2004a) sign quantitative research paper tested one hundred and forty-one general practitioners and sixty-six practice nurse opinions relating to xxxx. Results favorably showed that ninety-seven percent of practice nurses raised xxxx but the article cerebrate xxxx within primary care and mainly relied upon xxxx. Leading on from this study, Gibbs et al (2004b) carried out a quantitative study involving eight general practices and one thousand five hundred and forty-nine kxdffdsdf. The article reports on xxxx. This quantitative paper twisting structured interviews where questions were asked in a planned format. A structured interview involves set questions with no deviation from these (Parahoo 1997).A limitation of the study was the elevated drop-out rate but positively forty percent achieved a five percent or more weight overtaking at twelve months. It highlights whether the researcher has performed the study in a logical, arrogant method, having paid attention to pointers that may influence the accuracy of the results (Rees 2003). Although Burns and Grove (2001) argue that a rigorous study should have exact measurement tools, a representative sample and a tightly controlled design. Audit was conducted in all practices prior to the study, where measurement tools such as weighing scales, eyehade measure and large blood pressure cuffs were assessed. The provided consistency of the tools used at each centre along with evidence of their validity. Validity refers to whether an instrument measures what it stated to be measuring whilst reliability relies upon individuals using the tools and reporting accurate measurments obtained (Carter and doorkeeper 2000).It was noted those practices participating in this study were self-selected, already having an interest in obesity management, thus possibly weakening representations. It was encouraging that a crossw ise of those involved included large practices, rural, urban, single handed and those fro low going areas. This appeared to provide a representative existence with no evidence of twist selection. The xxxx project was estimablely approved by xxxx.In contrast Moore et al (2003) in a cluster randomised control studyxxxxxxxx Cluster randomised trual means the sampling frame are geographically spread or the individual elements of the universe are not know (Rees 2003). The advantage of this process is achievement of an accessible sample from an almost impossible total population (Rees 2003). Donnan (2000) states experimental research is the gold standard way of representing in a rigorous style that a treatment or intervention is effective. It concludes it si an essential tool for qualitative evaluation of a studys worth. Greenhalgh (2006) draws attention to the fact that publication of an article does not mean the evidence is robust.In oddment as found in xxxx. Rees (2003) states bi as is anything that distorts or affects a study, potentially altering or influencing the accuracy of the findings. Results noted that xxxx. They conclude more in=depth training of health professionals is unavoidable xxxx. This would involve further murder of training progrmmes and additional research. Ethical commendation was granted by the xxxx morality committee.The research paper by XX (2007) mixes quantitative and qualitative approaches and is know as triangulation,. Docherty (2000) suggests use of triangulation provides richer, more meaningful data. Holloway and Wheeler (2002) support this method stating it to be a way of obtaining rigour in qualitative research. Rees (2003 p. 235) lists this as being the use of more than one method of data collection within the same study in an attempt to produce more accurate information and understanding.This was a cross-sectional study with questionnaires being faultless by forty General Practitioners and forty-seven practice nurses. A limitation to this study was no character was made of the total number of initial questionnaires sent out in comparison to the response rate. A cross-sectional study is a survey that gazes at a situation at one point in time (Rees 2003). The qualitative results by xx (2005) were not shown within the report and rigour was disputed on reading the research paper as a full conclusion of the findings could not be made. It is realised word restriction could be the main savvy for the results being omitted, but unfortunately it leaves the reading having to guess what they might have concluded. Ethical approval was supported by xxxx.In comparison with Gibbs et al (2004b) article the outcomes indicated mirror one another, with both papers coming to the conclusion that opportunties for xxxxxx in primary care are often missed or inadequate time given to education and support. Although the report by xx(2-3) shows xxxx, it was indicated this was in accordance with increasing responsibilities in implementation of chronic disease management. It is highlighted in the report that caution regarding results needs to take place. Also this article, although mainly quantitative, has a small sample size. Parahoo (1997) states quantitative research usually involves large metrical composition in probability samples. The importance of large numbers aims to lessen the expectation of bias and correctly achieve statistical procedures (Rees 2003).A pilot study was not carried out prior to this research. Piloting of a questionnaire increases research validity and reliability as it highlights any anticipated problems accessing data, and ensures the method used to piece data works (Parahoo 1997). Research should be instigated because the researcher wants to extend knowledge base and understanding through rigorous collection of information, answering a question objectively and with accuracy (Rees 2003).SUPPORTSoanso (2009) article is a qualitative study and deals with support and percept ions of the patient who is obese. This is a primary study that reports research findings first hand (Greenhalgh 2006). Rees (2003) states to have involvement in qualitative research and understand a topic, individuals first have to see it through the eyes of those who experience it. This method aims to summarise perceptions, experiences, behaviour or interpretations. This process included a qualitative study with semi-structured interviews drawing on grounded supposition methodology. Grounded theory aims to produce a concept or explanation that is grounded in the results and arises inductively by researchers understanding and analysis (Rees 2003). Polit et al (2001) strongly supports interviews stating they by far outgo questionnaires. The response rate is higher, reaching a wider population than questionnaires, are less likely to mislead those reading the questions and provide wealthier data. Rees (2003) agrees with the above adding, those involved can experience the belief of be ing in control and positively savor more valued. It is noted there are disadvantages such as high cost, participants providing socially acceptable answers, affect of interviewer status and difficultly in expressing feelings (Rees 2003). Five general practices from differing socioeconomic backgrounds in Sheffield were involved with interviews conducted at their homes. This provided a varied population adding rigour to the study, and it could be generally assumed an individual would feel more comfortable being interviewed within their own surroundings. Although, it can be argued that interviewers have less power to control the interview within this environment as there is no assurance that the interviewee will maintain a true(p) place with no interruption, disturbance or being overheard (Pontin Webb 1995, Webb Pontin 1996).Kdfsdfsfhskdfhsd. Ethical approval was sought prior to this study from xxx Ethics Committee.Application to clinical practice (30% c 1050 words) 1086APPLICATION TO PRACTICEAt present within the authors practice setting issues of xxxx are raised xxxx. Since April 2006 the General Medical suffice Contract (National Health Service 2006) awarded points for the xxxx.This critical review of the literature has aimed to answer the question xxxxxxxxxxxxxxxxxxxxxxxxx? It is well enumerationed that xxxx. Research that has been carried out in an ethical manner and is of robust design can benefit all involved and improve practice (Royal College of Nursing 2004). The document trump Research for Best Health (Department of Health 2006a) states research provides the support and evidence to tackle increasing challenges that disease and ill health have placed on society. This document supports a pilot study within primary care in England to improve evidence based practice of care by facilitating the conduct of clinical trial and other well designed studies. It would hardly be an exaggeration to say, pending successful results in 2014, the use of this struc ture within primary care in Wales could potentially benefit application of much needed research findings into practice.Findings of this review showed the counterweight project by Gibbs et al (2004a, 2004b) provided the best evidence of implementation within practice, showing xxxx. The Cochrane Library for Sytematic Reviews (2004) supports the equipoise Project (2004b) stating The Counterweight Programme is an evidence-based weight managmentxxxx Brown Psarou (2007) in their literature review also supported this project stating it was rigorously conducted and soundly funded. first appearance of these research findings were undertaking xxxx.Banning (2005) suggests the management of obesity should focus on xxxx. The National Institue for Clinical Excellence (2001) states that primary care nurses are ideally placed to manage and assess obese individuals. This comprehensive package addresses issues and management of .. The material is simplistic with the alforithm providing an easy gui de for the primary care nurse to follow, The pathway opportunistically at routine appointments or reviews.To implement this in the clinical setting, xxxx.Successful implementation of this pathway into the practice setting would require change management issues to be addressed. Implementation of change following research can be a difficult process. Resistance, resentment and jealousy can all impede implementation of the change process (Cormack 2000). To overcome resistance to change the key factor is leadership, along with effective communication and a sound understanding of what motivates people (LaMonica 1994). Those involved in the change process moldiness be kept informed and involved at each stage of change. Individuals like equilibrium and are keen to be involved once they know the process will not cause problems or a change of workload (Broome 1998).(Paulas)CONCLUSIONA conclusion was included within the abstract, xxxxAs suggested by McCaughan (1999) and Playle (2000), there i s a restriction placed on researchers and authors by publications to condense from a much big and more comminuted research report. It can be assumed that this is the case with this research article.However, as suggested by Baxter (2001c) that in qualitative research to aid the flow and understandings, discussion and conclusion are kept together under one heading. In the authors opinion, the conclusion should have RECOMMENDATIONSStevens et al (1993) suggests the realistic researcher would draw conclusion from the data presented and then make further recommendations on what other research is required. However, there is no heading of recommendation or any indication that one was included. Alternatively, suggestions for further research studies and in the authors opinion threr should have been a recommendation for future randomised control trial.There is a opening night as suggested by Playle (2000) that the actual research report is more detailed with recommendations, but this may h ave been lost when condensed for publication.Teresas conclusionIn conclusion, this literature review has shown xxxx. To achieve this, implementation of findings along with ongoing research is essential to sustain the evolving needs of xxxx. It should be noted that a limited number of research articles were used for this review, providing partial evidence. Thus, it is suggested more concrete evidence is needed requiring a further search and review of the literature on xxxx. It would hardly be an exaggeration to say that this review has highlighted the need for further research on the topic of xxxx relating to support and education. It can be said this would potentially emphasise additional studies, which in turn could be applied to practice improving nurse education and support to the obese patient.APPLICATION TO clinical PRACTICEAUTHORS CONCLUSIONSThe article on . Appeared to be a concise, informative and forward-looking piece of research on first perusal. However, what appeared at first glint to be just.. turned out to be more obscure upon closer iinvestigation and mmmmmm. The reader begins to questionIt has a focus and direction, which is to assess the efficacy of maggot therapy and a very concise and informative methodology, which would enable anyone to reproduce a similar type of research. The data collection procedures are not clearly identified, although the simple representation allows it to be easily followed and replicated.This is further confounded by the entwined discussion and conclusion and as suggested by Baxter (2001c) this often occurs with qualitative research. Nevertheless, the reader essential balance the evidence presented and sometimes more than one type of evidence (Roberts, 1999) is needed to determine if the interventions is practicable or efficient, as well as ethical and morally sound (Freak, 1995). Another point is the ethical considerations . Ethical significance .An assumption is the researcher focus on the results or alternati ve the method, as being more interesting or important (Firby, 1995) to the reader.As suggested by various authors including Polit Hungler (1991) all research has limitation and can be imperfect and if this research article has been condensed from a much larger research report, then this critique has been conducted on a published condensed research article and not the actual research report. Therefore, what imperfections or liitations that are identified within this critique, is the ability of the researchers to actually condense their work and the readers have to assume that the researchers have honestly presented their fndings (Firby, 1995).For all the points highlighted like ethical, operational definitions, qualitative/quantitative approach, this is a very good informative research article that allows anyone to replicate the study.AUTHORS RECOMMENDATIONThe author would like to recommend that Furthermore, it . However, as reported by XX, the main disadvantage is,,,, nevertheless, A readonable recommendation in the authors opinion would be, In addition, if there isINTEGRATING RESEARCH INTO PRACTICESdfhsdkfhshdfhdfh to advocate and support the patient.ReferencesAvis, M. Bond, M. Arthur, A. (1997). Questioning patient satisfaction an empirical investigation in two outpatient clinics. Social Science Medicine. 44,185-92Backhouse, S. Brown, Y. (2000). 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A study to determine patient satisfaction with nursing care. Nursing Standard. 10,5234-38Miles, K. Penny, N. Power, R. Mercey, D. (2003). Comparing doctor and nurse-led care in a sexual health clinic patient satisfaction questionnaire. Journal of modernistic Nursing.42 (1), 64-72Polit, D. Beck, C. Hungler, B. (2004). Essentials of Nursing Research, Methods, Appraisal a