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Introduction The introduction of prescriptive authority for Irish nurses in 2007 was a significant change to the traditional function of the nurse’s role which extends the horizons for the future of the nursing profession in Ireland. However to-date there is limited evidence and research undertaken on the impact the initiative has had in the clinical setting. Therefore, the aim of this work was to: (i) review the literature relating to nurse prescribing to establish both nationally and internationally perspectives, (ii) identify the most applicable method of assessing issues established, (iii) examine the impact of nurse prescribing intervention on the appropriateness of prescribing for older adults and (iv) explore the use of a medication evaluation tool in practice. Methods Initially a comprehensive review of the literature was undertaken to establish the national and international perspectives of nurse prescribing. To understand the complexities of nurse prescribing and the interplays between the organizational structures, professional issues and patient impact on medication, a mixed methods study was undertaken that specifically allowed data to be viewed both objectively and subjectively. The researcher interprets to what extent and in what ways the two sets of data converge, diverge, relate to each other, and/or combine to create a better understanding in response to the study’s overall purpose. Results Evidence form the literature suggests that the impact of nurse prescribing on clinical practice is positive from a patient, healthcare professional and organisational perspective. However, the nurse prescriber’s role is ambiguous because it does not have a specific role description. Data collected through the MDS are restricted, incomplete and inaccurate especially pertaining to nurse prescriber’s workloads which have increased significantly since the introduction of the initiative. In addition, the collaborative practice agreement is proving to be restrictive in practice and reaffirms that overall responsibility for nurse prescribing remains with the doctor. Using an evaluation tool has the potential to improve safety and quality of prescribing that has an immediate effect on patient care. The competence and confidence levels of nurse prescribers in Ireland are comparable to their counterparts in the UK and Canada. Conclusion This thesis shows that nurse prescribing is highly prevalent to appropriate and timely care delivery in clinical practice. This work further demonstrates that the use of a structured medication evaluation tool in practice can significantly improve the appropriateness of prescribing and reduce the incidence of potentially inappropriate prescriptions and potential prescribing omissions for older individuals in hospital. |
