Healthcare for Proceedings of Singapore Healthcare-myassignmenthelp

Question: Discuss about theHealthcare for Proceedings of Singapore Healthcare. Answer: Context The article by Jones et al., (2011) has selected a significant research topic of nurse prescribing roles in the acute role. The role of nurses in acute care settings has evolved through the years to meet the increasing demand for health care services. According to Haririan (2016) prescribing by nurses is a key approach that aims to optimise the ability of nurses to bring improvement in the speed of access to high quality care. Non medical prescribing has bene indicated to bring improvements in clinical decision making across teams. A number of countries have implemented this novice role including Singapore where the practice is in the limelight. On an international basis, prescription rights for Nurse Practitioners varied significantly from limited formulary to full prescriptive authority. In 2014, National Nursing Taskforce (MOH) in Singapore recommended for the hospitals to initiate a prescription framework for nurses to prescribe medicines on the basis of drug formulary (Ayre Bee , 2014). As suggested by Jones et al., (2011) not much information is available regarding the implementation of this role into practice. At the time when the study by Jones et al., (2011) was conducted, there was a lack of suitable studies that evaluated nurse prescription in acute care settings. The majority of the studies was only responsible for reporting nurse prescribers view of the prescribing roles they had. In this regard, the perceptions of other stakeholders were not taken into consideration, which forms an integral element for understanding the suitability of this new emerging role. Further studies were needed that highlight the views of healthcare peers across different settings in relation to nurse prescribing roles as well as the dissimilarities in roles of nurse and medical prescribers. Key Aims The main aim of the study conducted by Jones et al., (2011) was to carry out an assessment of the functioning of nurse prescribing in an acute care hospital setting in the city of England, UK. The purpose of this study was to bridge the gap in existing literature regarding the ways in which nurse prescribers can work and lead to better patient outcomes and satisfaction levels. The author succeded in achieving their aims as the study was flourishing in addressing the research question. Methods The research was carried out following a mixed method single case study approach. The study was conducted in the year 2005-2006. An acute care hospital in England was the setting for the study that was located at a metropolitan borough of England that is densely populated and having it spopualtion from diverse ethnic backgrounds. The study had three clinical departments as units of analysis; namely the hypertension clinic, renal clinic and renal satellite unit. As the study method purposive sampling was done for recruiting the participants. A total number of 18 hospital staff were selected of which 3 were prescribers, seven were colleagues, and 8 were senior hospital staff. In addition, 2 nurses and 2 doctors took part in the study as non-participant observers. Semi-structured interviews was the tool for data collection with these participants. 52 patient-prescriber consultations were done with 47 patients. 122 patients were considered for a questionnaire survey was done with. Qualit ative data analysis was done with the help of data analysis framework porposed by Ritchie and Spencer. This was a deductive approach enabling an accurate sifting, charting and organisation of data depending on themes and key issues. SPSS software was used for quantitative data analysis. Descriptive statistics helped in summarising numerical data (Jones et al., 2011). A mixed method was suitable for the study as it was aligned with the research aim. Since the study wanted to highlight the overall experience of practitioners and stakeholders in relation to nurse prescribing, a mixed method enabled qualitative as well as quantitative approach. Such a method enures deeper, broader and more significant information. Rich datasets can be attained by this method (Nieswiadomy Bailey, 2017). As opined by Parahoo (2014) mixed methods augment the credibility and reliability of all studies with the help of the triangulation of the different evidences. A better understanding of the study problems is achieved through this method. However, it is to be noted that it was inappropriate to conduct the study in one single setting and with only three clinical departments. Due to such an approach, it can be stated that the study results were not generalised as the sample population was not a true representation of the general population. Purposive sampling has certain disadvantages, including researcher bias (LoBiondo-Wood et al., 2014). Findings The staffs taking part in the study pointed out that the main aim of nurse prescribing was directed towards patient benefits and enhanced team working. Further, nurse prescribing holds the potential for ensuring working advancements and legitimisation of practice. Staff satisfaction and increased patient satisfaction could also be achieved through nurse prescribing, as reported by the staff. The nurse practitioners reported that prescribing practice was a key approach for guiding better team work and patient care delivery. Nurses could also use their nursing skills in a better manner. The central themes emerging from the data set were increased confidence to prescribe, improved patient care, increased role fulfilment and successful implementation of nurse prescribing. The data did not point out any statistically significant differences between the manner in which doctors and nurses performed the prescribing roles. Nevertheless, it is to be highlighted that a statistically significant difference existed between the medication-related information satisfaction ratings of patients witnessing a nurse prescriber, compared to those witnessing prescription by a doctor. The findings of the study were easy to follow the flow of information were aligned with the research questions. The findings were also believable to the extent that nurses have come a long way in taking up different roles and additional responsibilities in acute care settings. Agreeing to the authors conclusion that the benefits of nurse prescribing roles can be better assessed with the help of performance indicators having clarity, it is to be stated that multidimensional approaches are required in future for studying such performance indicators based on evidence (Smith et al., 2014). Importance of findings The study findings added to the increasing body of research on the domain of nurse prescribing. It is to be mentioned that the findings were different from the existing literature since in the present case the researchers undertook an exploration of nurse prescribing from the organizational perspective. This was done by using data from different levels; patients from different ethnic groups and senior managers. There were certain aspects known about the research topic prioir to the present research. These were in relation to nurse prescribing works in certain primary care settings. Moreover, it was also known that nurse prescribing allowed physician-nurse substitution in acute care. There was also a pool of evidence indicating the presence of concerns in relation to patient safety. The present paper provided additional information that physicians and nurses provide equivalent care. However, patients report higher satisfaction rate when nurses provided medicine related education. More over, the study was a benchmark to highlight that patients across different ethnic groups can uphold similar viewpoints in this context. Based on the findings of the research healthcare settings can consider increasing the operational and supportive infrastructures for supporting nurse prescribing practices. The variables that are to be considered in this regard are shared vision, action learning, local championship, and peer support. Any restraining forces that hamper the implementation of the change are to be eliminated after analysing the importance of the same. The findings of the study also have implications for policy reforms. Policy makers are to consider setting up policies that guide nurse prescribing roles in varied settings. Changes are also to be sustained in the long run for ensuring best outcomes of the process (Gielen et al., 2014). Ethics There were come ethical issues pertaining to the design of the study. The first cocnenr was the relationship between the researcher and the prescribers. Secondly, there was a risk related to the fact that the study findings could have demotivated the nurses. Thirdly, there was a risk related to the fact that patient respondents might be not maximal in the presence of the researchers. Lastly, there was a risk that patients would indicate dissatisfaction with the service provided. Further research Against the backdrop of a growing evidence supporting nurse prescribing role, there is a requirement to put focus on further research in this direction. Researchers must shift the focus from prescribing performances suitable measures towards the influence of the role in bringing about advancement in care delivery. Future research needs to be carried out for identifying the process by which patient care quality can be enhanced in Singapore settings, and determining the interventions accordingly that suit patient population in Singapore (Hardey Mulhall, 2013). References Ayre, T. C., Bee, T. S. (2014). Advanced practice nursing in Singapore. Proceedings of Singapore Healthcare, 23(4), 269-270. Link : https://journals.sagepub.com/doi/pdf/10.1177/201010581402300401 Gielen, S. C., Dekker, J., Francke, A. L., Mistiaen, P., Kroezen, M. (2014). The effects of nurse prescribing: a systematic review.International Journal of Nursing Studies,51(7), 1048-1061. DOI: https://doi.org/10.1016/j.ijnurstu.2013.12.003 Hardey, M., Mulhall, A. (2013).Nursing research: Theory and practice. Springer. Haririan, H. (2016). Prescribing: A Crucial Factor in the Professionalization of Nursing in Iran.Evidence Based Care,5(4), 65-66. DOI:10.22038/EBCJ.2016.6160 Jones K., Edwards M. While A. (2011) Nurse prescribing roles in acute care: an evaluative case study. Journal of Advanced Nursing 67(1), 117126. doi: 10.1111/j.1365-2648.2010.05490.x LoBiondo-Wood, G., Haber, J., Cameron, C., Singh, M. (2014).Nursing Research in Canada-E-Book: Methods, Critical Appraisal, and Utilization. Elsevier Health Sciences. Nieswiadomy, R. M., Bailey, C. (2017).Foundations of nursing research. Pearson. Parahoo, K. (2014).Nursing research: principles, process and issues. Palgrave Macmillan. Smith, A., Latter, S., Blenkinsopp, A. (2014). Safety and quality of nurse independent prescribing: a national study of experiences of education, continuing professional development clinical governance.Journal of advanced nursing,70(11), 2506-2517. DOI: 10.1111/jan.12392