Evidence Critique for Clinical Nurse Specialist - myassignmenthelp

Question: Discuss about theEvidence Critique for Clinical Nurse Specialist. Answer: Context The nursing prescribing role is important because it expands the scope of the nursing practice, improves the quality of care and allows nurses to offer holistic care. I think this role is vital because it has created new nursing roles, allowed genuine autonomy and benefited the patients. It allows better access to medicines and smooth service delivery. The tenet of nursing prescribing is that patients would experience less delay in getting medicines (Dowen, 2016). The number of unessential appointments and the risk of hospitalisation would be reduced. Recent studies reveal that the standard of the care delivered by nurse prescribers is equivalent to that delivered by the traditional model of care (Carey Stenner, 2011). Based on a personal opinion, patients would report a high level of satisfaction and confidence if they receive care from a nurse prescriber. In Singapore, the advanced practice nursing is a hybrid of Clinical Nurse Specialist (CNS) and Nurse Practitioner (NP) programmes (Ayre Bee, 2014). Although the advanced nursing practice has come a long way, nurses in Singapore have not been given the prescribing role. Research on the nursing prescribing role is still minimal. However, the Ministry of Health (MOH) is planning to expand the role of nurses by offering experienced nurses the rights to prescribe (Yong, 2014). The nurses might only be allowed to prescribe for stable patients only. The studys key aims The main intention of the study was to prepare a report on the assessment of the adoption of nurse prescribing in an acute hospital in England. Prior studies on nurse prescribing had been done in community settings, and that is why this particular research was tailored for the acute hospital only (Jones, Edwards, while, 2011). The objective of the study was justified by the fact that it was a new field that would reveal a new professional role for the nurses. Other three aims were pursued to aid the achievement of the primary aim. Firstly, it aimed to explore the intention of nurse prescribing roles. Secondly, the authors had an aim of determining the experience of nurse prescribers and their colleagues. This objective is justified by the fact that nurse prescribers tend to have a different curriculum. For instance, in the UK nurse prescribers are taken through a 26-day theory and 12 days mentored practice as well as five assignments (Avery James, 2007). Finally, the authors had an objective of determining the difference between the role of medical and nurse prescribers. I think the authors achieved their aim due to several things. The aim is straightforward, objective and directive. It states what the authors sought to investigate as well as the setting. Methods The study used mixed methods single-case study to explore its aims. In this research article, both quantitative and qualitative methods were used to collect and synthesise data within a single case study. I think this method was inappropriate since the focus of the authors was the acute hospital alone. They should have used a single case study. Purposive sampling was used to recruit participants in the study. Purposive sampling is a method mainly used in qualitative research to identify and select information-rich cases. The method entails identifying and choosing candidates or groups of individuals that are specifically expertise about or experienced with a particular phenomenon (Palinkas, Horwitz, Green, Wisdom, Duan, Hoagwood, 2015). Purposive sampling was appropriate for the study because it helped in the selection of nurses who have a prescribing role only. Besides, this method assisted the authors to identify and select patients who had experienced nurse prescribing. Another m ethod was a semi-structured interview. Semi-structured interview combines a pre-determined set of open questions allowing the interviewer to explore certain themes further. This method was appropriate for achieving the aim of the study since it allowed the authors to explore the theme of nurse prescribing. An observation was also used in the study. I think the observation method was undesirable for the study because it does not contribute adequate information towards achieving the aim. The last method was a questionnaire survey. The questionnaire survey was suitable for the study since it is self-reported meaning that the authors got information from individuals who had experienced nurse prescribing. Findings The authors found that nurse prescribing was beneficial to patients since led to improved service delivery and use of staff skills differently. In another study, Jones supports this finding by asserting that independent nurse prescribing makes better use of nurses skills while improving patient care (Jones, 2009). The authors also found that nurse prescribers were positive about the role of prescribing and service changes. Most of the nurses were particularly positive due to their impact on patient care. Positive results have also been reported for nurses who prescribe medicines for patients with diabetes (Stenner, Carey, Courtenay, 2010). The nurses were confident prescribing and noted that their confidence had advanced over time. They noted that the support gotten from medical colleagues and peers was fundamental to the success of their prescribing roles. The study found no difference between how doctors and nurses conducted prescribing roles. There were no differences in the foll owing domains: length of consultation, approach to patients, management of follow-up consultations, number of patients who got prescription and frequency of prescribing (Jones, Edwards, while, 2011). However, there was a substantial difference between patients satisfaction based on whether they had seen a nurse prescriber or a doctor. The findings were believable and easy to follow. I fail to agree with the authors conclusion that doctors and nurses offer equivalent care because there was a difference in patient satisfaction. Otherwise, I agree with the conclusion that shared vision, action learning and peer support are the enabling factors in nurse prescribing. Further research For Singaporean setting, the pertinent research is whether nurses would be positive about the prescribing role. The MOH has hinted that nurses would be given a prescribing role, but there is no research on the reaction of the nurses. Another research that is relevant to the Singaporean setting is whether nursing prescribing role would conflict with doctors and the effects on the patients. These pieces of research would form a solid base to guide the adoption of a nursing prescribing role in the country. Ethics The main ethical concern I have around the study is patient consent. Valid or informed consent should have been sought from involved patients. The authors argue that participants were provided with study information sheets and allowed time to decide whether they would participate in the study. I think the elements of valid consent were compromised in the study. The basic elements of consent are disclosure, understanding and voluntary agreement. Before the research, there should be full disclosure of all relevant information to the patients in the acute hospital. Elements of the disclosure are the procedure of the research, possible risks and benefits as well as the available alternatives (Nijhawan et al., 2013). These pieces of information should be precise and accurate. Comprehension is another element of valid consent, which was ignored during the study. Researchers should ensure all participants understand the aspects of the research before being involved. The researchers should i dentify and attempt to overcome barriers such as language, ethnicity and cultural beliefs that may interrupt comprehension. The participants should voluntarily agree to take part in the research (Nijhawan et al., 2013). In case a potential candidate is competent, they should be allowed to make a decision independently without undue influence by the researchers. References Avery, A. J., James, V. (2007). Developing nurse prescribing in the UK. BMJ , 335 (7615), 316. Ayre, T. C., Bee, T. S. (2014). Advanced Practice Nursing in Singapore. Proceedings of Singapore Healthcare , 23 (4), 269-270. Carey, N., Stenner, K. (2011). Does non-medical prescribing make a difference to patients? Nursing Times , 207 (26), 14-16. Dowen, A. (2016). The expanding role of nurse prescribers. Prescriber , 27 (6), 24-27. Jones, K. (2009). Developing a prescribing role for acute care nurses. Nursing Management , 16 (7), 24-28. Jones, K., Edwards, M., while, A. (2011). Nurse prescribing roles in acute: an evaluative case study. Journal of Advanced Nursing , 67 (1), 117-126. Nijhawan, L., Janodia, M., Muddukrishna, B., Bhat, K., Bairy, K., Udupa, N., et al. (2013). Informed consent: Issues and challenges. Journal of advanced pharmaceutical technology research , 4 (3), 134-140. Palinkas, L., Horwitz, S., Green, C., Wisdom, J., Duan, N., Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research , 42 (5), 533-544. Stenner, K., Carey, N., Courtenay, M. (2010). How nurse prescribing influences the role of nursing. Nurse Prescribing , 8 (1), 29-34. Yong, G. K. (2014). Speech by Mr Gan Kim Yong, Minister for Health, at the Nurses' Merit Award 2014 Presentation and Lunch, 6 Aug 2014. Retrieved 10 19, 2017, from Ministry of Health: https://www.moh.gov.sg/content/moh_web/home/pressRoom/speeches_d/2014/speech-by-mr-gan-kim-yong--minister-for-health--at-the-nurses--m.html