University of Tasmania
Browse

File(s) under permanent embargo

The impact of an intervention for nurse prescribers on consultations to promote patient medicine-taking in diabetes: A mixed methods study

journal contribution
posted on 2023-05-17, 09:01 authored by Latter, S, Sibley, A, Skinner, TC, Cradock, S, Zinken, KM, Lussier, M-T, Richard, C, Roberge, D

Background: Nurse prescribers are in a key position to promote medicine-taking in diabetes. Although patients’ beliefs about medicines are important predictors ofmedicinetaking, evidence suggests nurses do not routinely explore these.

Objectives: To evaluate a theory-based intervention designed to increase nurse prescribers’ exploration of medicines’ beliefs with people with diabetes.

Design: Mixed methods concurrent triangulation design.

Settings: Nurse prescribers were recruited from 7 Trusts in England.

Participants: A purposive sample of 14 nurse prescribers attended four 1 day workshops.

Methods: Audio-recordings of each nurse prescribers’ consultations with diabetes patients were collected at baseline, 1 week, 3 months and 6 months after the intervention. Nurse prescribers were interviewed at 1 month and 6 months post-intervention. Changes in medicines’ discussion and participation in consultations were analysed using MEDICODE. Interview data were analysed using Framework Analysis.

Results: MEDICODE themes of ‘attitudes towards medication’ showed a significant rise at 1 week (p < 0.01) and 3 months (p < 0.05). ‘Asks patient opinion about medication’ significantly increased at 1 week (p < 0.01). Discussion on ‘concerns about medication’ rose significantly at 1 week (p < 0.001) and 6 months (p < 0.01). Discussion on ‘expected effects of medication’, ‘action of medication’ and ‘reasons for medication’ showed no change. There were no significant changes in Dialogue Ratio. However, the Preponderance of Initiative moved towards more patient initiative at 1 week (p < 0.0001), 3 months (p < 0.0001), and 6 months (p < 0.0001). In interviews, nurses reported increased attention to patients’ medication beliefs and adoption of patient-centred skills. Contextual factors that positively influenced ability to explore medicines beliefs in practice settings were: support of colleagues and practicing new skills. Inhibiting factors included: patients’ perceived lack of receptivity, time constraints, and concerns about opening a ‘can of worms’. Six months interviews revealed using skills in practice enhanced nurses’ confidence and sustainability of skills requires a nurse–patient relationship. Method triangulation illuminated how the intervention was implemented in practice contexts.

Conclusions: The intervention was effective at changing some key dimensions of prescribing consultations. The use of a self-efficacy framework in the intervention, to promote nurses’ confidence in working in a different way, may have been instrumental in effecting the changes found. Contextual factors influencing beliefs exploration in medicine-taking consultations were identified.

History

Publication title

International Journal of Nursing Studies

Volume

47

Issue

9

Pagination

1126-1138

ISSN

0020-7489

Department/School

Tasmanian School of Medicine

Publisher

Pergamon-Elsevier Science Ltd

Place of publication

The Boulevard, Langford Lane, Kidlington, Oxford, England, Ox5 1Gb

Rights statement

The definitive version is available at http://www.sciencedirect.com

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

Usage metrics

    University Of Tasmania

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC