Background: Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists.
This paper sets out key challenges related to detection and management of infection in nursing home residents, and then explores the situation in South Africa, and use of decision support tools as a mechanism to improve this area of practice.
In line with global trends, concerns have been raised about the rapidly increasing aging population in South Africa and the ability of the current healthcare system to keep pace with patient demand, particularly nursing home residents. Nursing home residents, who often exhibit atypical signs and symptoms, are at increased risk of infection and unplanned admissions, which account for 65% of all bed days, and cost the US healthcare economy more than a trillion dollars a year. Evidence suggests that the current workforce in South Africa receive limited training in this area and are largely unprepared to meet the demands of the aging population. Building the capacity and skills of the workforce in South Africa is one approach that could help to improve the early detection of infection and assist the nursing home workforce to provide more effective and timely care, particularly during the current COVID-19 pandemic.
Decision support tools, such as the Early Detection of Infection Scale, can help ensure consistency and ensure more timely treatment, minimising unplanned admissions and healthcare expenditure. However, the potential benefits or indeed how easily this could be integrated in to nursing homes in South Africa is unknown. An important first step, as in other parts of the world, is therefore to explore views and opinions of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes.
Aims and objectives. To identify, summarise and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in acute and chronic pain. Background. A diverse range of models of care exist within the services available for the management of acute and chronic pain. Primary studies have been conducted evaluating these models, but, review and synthesis of the findings from these studies has not been undertaken. Design. Literature review. Method. Searches of Pubmed (NLM) Medline, CINAHL, Web of Knowledge (Science Index, Social Science index), British Nursing Index from January 1996-March 2007 were conducted. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by contact with experts in the field. Results. Twenty-one relevant publications were identified and included findings from both primary and secondary care. The areas, in which nurses, caring for patients in pain are involved, include assessment, monitoring, evaluation of pain, interdisciplinary collaboration and medicines management. Education programmes delivered by specialist nurses can improve the assessment and documentation of acute and chronic pain. Educational interventions and the use of protocols by specialist nurses can improve patients understanding of their condition and improve pain control. Acute pain teams, led by nurses, can reduce pain intensity and are cost effective. Conclusions. Nurses play key roles in the diverse range of models of care that exist in acute and chronic pain. However, there are methodological weaknesses across this body of research evidence and under researched issues that point to a need for further rigorous evaluation. Relevance to clinical practice. Nurse-led care is an integral element of the pain services offered to patients. This review highlights the effect of this care and the issues that require consideration by those responsible for the development of nurse-led models in acute and chronic pain. © 2008 The Authors.
Aim. To explore the practices of nurse prescribers who care for people with diabetes. Background. The use of medicines is an important component of the care of patients with diabetes. However, education and support is equally important to the successful management of this group. These are areas of care in which nurses have traditionally been involved. Evidence suggests that combining nursing skills with prescribing may result in shared decision-making and increased medicines concordance. Design and methods. A collective case study of nine practice settings across England in which nurses prescribed medicines for people with diabetes. Data comprised of semi structured interviews (n = 31), patient questionnaires (n = 131) and video-taped observations of nurse consultations (n = 35). Data analysis included thematic analysis and descriptive statistics. Data were collected between October 2007–September 2008. Results. Nurses demonstrated good communication skills, which they integrated with the ability to prescribe. Questionnaire and video data confirmed an exchange of information between nurse and patient about aspects of self-care and medicines management. Additional benefits included improved efficiency, supported by patient satisfaction with access and waiting times. Nurses were inconsistent in explaining the risks and benefits of treatments and side-effects and exploring the use of non-prescribed herbal or over-the-counter medicine. Conclusion. The care nurses are able to provide to people with diabetes is optimised through prescribing. Further evidence is required to evaluate nurse prescribing from the patient’s perspective. Our findings will be of interest to those keen to develop the prescribing role for nurses involved in diabetes service delivery. Relevance to clinical practice. Prescribing is a valuable development through which nurses are able to encourage self-care and work towards shared-decision making with patients in a way that supports national guidance on the care of people with diabetes.
Background Worldwide, 199.5 million women have diabetes mellitus. Preconception care education starting from adolescence has been recommended as an effective strategy for safeguarding maternal and child health. However, traditional preconception care advice provided by healthcare professionals within clinic settings is hindered by inadequate resources, sub-optimal coverage and busy clinics. eHealth which is instrumental in solving problems around scarce health resources could be of value in overcoming these limitations, and be used to improve preconception care and pregnancy outcomes for women with diabetes mellitus. Objective Objectives were to: (1) identify, summarise and critically appraise the current methods of providing PCC education, (2) examine the relationship between preconception care educational interventions (including use of technology as an intervention medium) on patient and behavioural outcomes, and (3) highlight limitations of current interventions and make recommendations for development of eHealth in this field. Method Electronic databases, using predefined search terms for preconception care education in women with type 1 or 2 diabetes mellitus, were searched for quantitative studies from 2003 until June 2016. Of the 1,969 titles identified, 20 full papers were retrieved and 12 papers included in the review. Results The reviewed studies consistently reported that women receiving educational interventions via healthcare professionals and eHealth had significantly improved levels of glycosylated haemoglobin (P<.001 and P<.0001) with fewer preterm deliveries (P=.02) and adverse fetal outcomes (P=.026). Significant improvements in knowledge (P<.001) and attitudes to seeking preconception care (P=.003) and, fewer barriers (P<.001) were also reported. Conclusion Preconception care has a positive effect on pregnancy outcomes for women with diabetes mellitus. However, uptake of preconception care is low and the use of eHealth applications for preconception care of women with diabetes mellitus still in its infancy. Initial results are promising but further research, incorporating smartphones and apps, is needed. Clearly, there is much to be done if the full potential of eHealth preconception care to improve obstetric outcomes for women with diabetes mellitus is to be realised.
Introduction Women with diabetes are at increased risk of adverse maternal and fetal outcomes. Preconception care can minimise risk of complications and improve outcomes, but current provision is inadequate. Mobile technology, particularly smartphone apps, could improve preconception care provision but research is lacking in this area. Aim The study aimed to critically appraise the literature with respect to PCC educational interventions and highlight limitations of current interventions, and to develop a Preconception and Diabetes Information (PADI) app for women with type 1 or 2 diabetes and explore the system’s feasibility and acceptability. Methods A systematic review of the literature and a 2-phase mixed methods study design, (1) development and (2) feasibility and acceptability, were used. The app was developed via a co-design approach with women with diabetes, healthcare professionals and an app development company. A 3-month pre- and post-intervention study assessed preliminary outcome estimates (preconception care knowledge, attitudes and behaviours), user acceptability was also explored. Data collection methods included focus groups, semi-structured interviews and questionnaires. Results The systematic review showed that PCC educational interventions had a positive effect on patient and behavioural outcomes, however, PCC uptake was low and the use of eHealth for PCC of women with DM was still in its infancy. The 2-phase mixed methods study design indicated a high level of enthusiasm and interest towards a preconception care app that could overcome shortfalls in current preconception care service provision. Improvements were recorded in knowledge of pregnancy planning and pregnancy-related risks, perceived benefits and self-efficacy to seek preconception care, and patient activation measure, following the 3-month app usage. Participants found the PADI app acceptable (satisfaction rating was 72%), useful and informative. Usage was episodic and influenced by functionality (manual data input) and personal factors (pregnancy intention, time/memory and conflicting priorities) that participants felt could be overcome via personalisation, automation, improved interactivity and daily reminders. Conclusion This is the first study to explore the acceptability and feasibility of a preconception care app for women with diabetes. It has positive implications in terms of overcoming barriers to preconception care provision and uptake, and changing preconception behaviours. In order that the contribution of the PADI app can be fully realised, further evaluation is required.
With the demand for medication continually growing, Nicola Carey and Karen Stenner discusses how non-medical prescribing can ease the burden; showcasing a new online toolkit ‘Preparing to Prescribe’, that will aid the future training of prescribers
The aim of this study was to explore the role and responsibilities of non-medical prescriber leads in the southwest of England. A questionnaire was completed by 22 leads in this region in 2019. A total of 2388 healthcare professionals were reported to have the prescribing qualification amongst the 22 participating organisations. Just under half (44.5%) of the leads did not have any designated time to undertake the role, and a third (31.2%) did not have the role included within their job description. The demands of the role were evident in the key areas of activities reported by leads in this study. A total of 21 (95.5%) respondents reported that governance and communication with managers/non-medical prescribers was important or essential to their role, whilst only 11 (50%) described the support of designated medical practitioners in this way. The responsibilities of the leads in the southwest of England are complex, however, many of them undertake the role with limited organisational support. Research is required in order to fully understand the role and responsibilities of the Lead role, so that it can be supported appropriately. Without this, the full benefits of non-medical prescribing are unlikely to be realised, as Leads will not have the time or capacity to undertake the role effectively.
Background. Nurse Independent and Nurse Supplementary Prescribing has extended the role that nurses in the UK have in the management of care for patients with diabetes. Concerns surround nurses' pharmacological knowledge and provision of continuing professional development to meet the needs of nurse prescribers. Aim. To examine the continuing professional development needs of nurses who prescribe medicines to patients with diabetes. Design. A questionnaire survey. Methods. The NMC database was used to randomly select and distribute questionnaires to 1992 registered Nurse Independent/Nurse Supplementary Prescribers. One thousand and four hundred questionnaires were returned. Medicines for patients with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. Results. The majority (63%) of nurses worked in general practice. Over 80% reported continuing professional development was available and that they had accessed it to support their prescribing role. Over 40% of nurses had continuing professional development needs in the areas of prescribing policy, pharmacology for diabetes and the management and treatment of diabetes related conditions. Senior nurses reported fewer continuing professional development needs. Conclusion. Access and provision of continuing professional development for nurse prescribers has improved since the initial implementation of nurse prescribing. However, nurse's pharmacological knowledge and the provision of continuing professional development continue to be an area of concern which warrant further investigation. Relevance to clinical practice. Previous concerns have been identified about the provision of continuing professional development to meet the needs of nurse prescribers. Pharmacological knowledge is still the greatest continuing professional development requirement of nurses who prescribe for patients with diabetes. Education providers may wish to consider developing the content of continuing professional development programmes to meet these needs. © 2010 Blackwell Publishing Ltd.
Aims and objectives. To provide information on the profile and practice of nurses in the UK who prescribe medication for pain. Background. Pain is widely under-reported and under-treated and can have negative consequences for health and psychosocial well-being. Indications are that nurses can improve treatment and access to pain medications when they prescribe. Whilst nurses working in many practice areas treat patients with pain, little is known about the profile, prescribing practice or training needs of these nurses. Design. A descriptive questionnaire survey. Method. An online questionnaire was used to survey 214 nurses who prescribed for pain in the UK between May and July 2010. Data were analysed using descriptive statistics and non-parametric tests. Results. Half the participants (50%) worked in primary care, 32% in secondary care and 14% worked across care settings. A range of services were provided, including general practice, palliative care, pain management, emergency care, walk-in-centres and out-of-hours. The majority (86%) independently prescribed 1-20 items per week. Non-opioid and weak opioids analgesics were prescribed by most (95%) nurses, whereas fewer (35%) prescribed strong opioids. Training in pain had been undertaken by 97% and 82% felt adequately trained, although 28% had problems accessing training. Those with specialist training prescribed a wider range of pain medications, were more likely to prescribe strong opioids and were more often in pain management roles. Conclusion. Nurses prescribe for pain in a range of settings with an emphasis on the treatment of minor ailments and acute pain. A range of medications are prescribed, and most nurses have access to training. Relevance to clinical practice. The nursing contribution to pain treatment must be acknowledged within initiatives to improve pain management. Access to ongoing training is required to support nurse development in this area of practice to maximise benefits. © 2012 Blackwell Publishing Ltd.
Aims and objectives. To examine the prescribing practices of nurse supplementary prescribing in diabetes. Background. Nurses in several roles are involved in the management of medicines for patients with diabetes. Nurse prescribing should help optimise these roles. Nurses in the UK have virtually the same independent prescribing rights as doctors. There is little or no evidence on the extent to which nurse supplementary prescribing is used, or the impact and activity of nurse supplementary prescribing for patients with diabetes. Design. Survey. Method. A random sample of 214 nurse supplementary prescribers self-completed a written questionnaire. Results. The majority of nurses held an academic qualification at degree level or higher, had a wealth of clinical experience, worked full-time, were based in primary care and worked in general practice. The majority of nurses prescribed between one and five items a week. Oral anti-diabetic drugs, hypertension and lipid-regulating drugs and insulins were the products most often prescribed. Over 85% had undertaken specialist training in diabetes prior to undertaking the prescribing programme. Conclusion. Supplementary prescribing provides a practical and useful framework within which to prescribe medicines for patients with diabetes and its associated complications. Specialist diabetes training is a necessary prerequisite for nurses prescribing in this area. It is evident that there is still a place for supplementary prescribing. Implications for clinical practice. • Recent legislative changes mean that nurses can now independently prescribe practically any drug. • Nurses in general practice appear to prescribe most frequently as a nurse supplementary prescriber for patients with diabetes. • Nurse supplementary prescribers are likely to use this mode of prescribing to deliver medicines to patients with diabetes. • Over two-thirds prescribe for common but serious complications of diabetes, e.g. hypertension, hyperlipidaemia and cardiovascular disease © 2008 The Authors.
This study aimed to explore the prescriptions issued to patients with diabetes by nurse independent and nurse supplementary prescribers working in general practice. A total of 19 prescriptions were collected and assessed from four case-study sites based in general practice between October 2007 and September 2008. Prescriptions were collected from patients with diabetes whose consultations were video recorded for the purposes of research. Prescriptions were consistently issued on an appropriate computer-generated prescription form, written legibly in ink, used the correct terminology, generic prescribing and contained an accurate/appropriate product dose and preparation. They were less consistent in stating the number of days, quantity of medicine to be supplied, and providing clear and accurate instructions on frequency and timing of treatment. Nurses in general practice are using computer based repeat prescribing systems to issue prescriptions to patients for the management of diabetes and its common complications, such as hypertension, hyperlipidaemia and cardiovascular disease. Whilst nurse prescribers were generally compliant with good practice in prescription writing, they need to ensure that they include ongoing information with respect to the number of days of treatment, quantity of medicine to be supplied, and clear and accurate instructions regarding the frequency and timing of medicines.
Patient redirection can help reduce service demand by providing information about more appropriate services. There is no evidence available regarding the effect of nurse-led patient redirection in an urgent care centre setting. Aim:
Develop and evaluate a nurse led patient self-care and redirection first (SCARF) intervention in an urgent care centre. Methods:
Adopting a prospective observational design, the intervention was delivered to an opportunity sample of patients attending a South London Hospital Urgent Care Centre, June-July 2014, evaluated through patient interviews 5-10 days after initial attendance. Results:
118/1,710 people who attended the urgent care centre participated of whom 81 (69%) were redirected to other services (n=64) (e.g. pharmacist/ GP) or self-care at home (n=17) and 38 transferred to the emergency department. Of 110 (93.2%) participants who completed the questionnaire 97.2% were satisfied. Only 2 accessed different services to those recommended. 72.2% (n=85) reported they would not re-attend the urgent care centre for a similar condition. Conclusions:
Treating minor ailments in an urgent care centre is inefficient use of resources. A nurse led self-care and redirection intervention can help re-direct patients with minor ailments to more appropriate services. Further evaluation of the intervention on service demand and costs is required.
Aim. To explore the views of doctors and clinical leads (CLs), who care for children and young people, on nurse prescribing in one specialist children's hospital. Background. Nearly 14,000 nurses in the UK have virtually the same prescribing rights as doctors. Benefits of nurses adopting this role have been reported, but doctors do have some concerns. Increasing numbers of specialist nurses involved in the care of children in the hospital setting are undertaking prescribing training. No research has explored the views of health care professionals on nurse prescribing in this setting. Design. A subset of qualitative data taken from a larger study that adopted an intrinsic case study design. Method. Interviews were conducted between October 2006-July 2007 with 11 doctors and three clinical leads in one specialist children's hospital. A thematic analysis was conducted on the interview data. Results. Nurse prescribing improved access to medicines and continuity of care. Concerns included the need for doctors to have confidence in the ability of the nurse who wanted to become a prescriber, the selection of nurses for prescribing training, the effects of nurse prescribing on the individual roles and responsibilities of doctors and nurses' clinical skills. Conclusion. Doctors and clinical leads working in a specialist children's hospital in the UK recognise that nurse prescribing makes a positive contribution to the delivery of services. However, it is important that nurses have the appropriate clinical skills and doctors understand nurse prescribing. This will only take place if there is good communication across professional boundaries. Relevance to clinical practice. Selection processes for the prescribing programmes must ensure that students have the necessary course prerequisites. Communication across professional boundaries is crucial to the successful implementation of nurse prescribing in the care of children and young people in the hospital setting. © 2009 Blackwell Publishing Ltd.
Aim. To evaluate the impact of a Diabetes Specialist Nurse prescriber on insulin and oral hypoglycaemic agent medication errors and length of stay. Background. The National Health Service has committed to a 40% reduction in the number of drug errors in the use of prescribed medicines. Drug errors in diabetes care are a common cause of significant morbidity and complications. Nurse prescribing creates an opportunity for nurses to improve care for these patients. Design. A quasi-experiment using six wards in a single hospital trust. Methods. Inpatient care of a convenience sample of patients with diabetes was evaluated before (n = 27) and after (n = 29) the intervention of a Diabetes Specialist Nurse prescriber. Prospective data were collected to measure insulin and oral hypoglycaemic medication errors and length of stay. Results. There was a significant reduction in the total number of errors between the pre-intervention and intervention group (mean reduction 21 errors) (p = 0·016). The median length of stay was reduced by three days. The total number of errors and length of stay were affected by admission category (p = 0·0004). Conclusions. A medicines management intervention, provided by a Diabetes Specialist Nurse prescriber, had a positive effect on the system of delivering medicines to patients with diabetes and significantly reduced the number of errors. This reduction had some effect on length of stay. The cost saving was sufficient to finance a Diabetes Specialist Nurse prescriber post. Relevance to clinical practice. (i) Errors frequently occur in the prescription and administration of medicines to patients with diabetes. (ii) The education of healthcare professionals is a factor contributing to these errors. (iii) Nurse prescribing provides a new system by which to educate patients and staff about their medicines. (iv) A Diabetes Specialist Nurse prescriber can reduce insulin and OHA MEs. This reduction had some effect on LOS. © 2008 Blackwell Publishing Ltd.
Aim. To develop and evaluate an educational intervention on pressure ulceration for formal care workers Objective. To improve the knowledge and understanding that formal care workers have on the significance of skin changes and to improve earlier identification and management of pressure ulceration. Background. Evidence suggests that there is a continuing rise in the elderly population with co-morbidities and the risk of them developing pressure damage is increased. Formal care workers are ideally placed to help identify and alert healthcare professionals about these high risk patients yet current education provision is ad hoc and lacks standardisation. Design. An insider approach to action research was adopted to develop and evaluate an education intervention on pressure ulceration to formal care workers from 10 residential homes and 6 private care agencies. Methods. An education intervention was delivered to 250 participants following which a questionnaire was utilised to evaluate the session including verbal and written feedback from the participants. A pre and post intervention audit was conducted to assess the impact on pressure ulcer prevalence in November 2014 and May 2015.add dates Results. The sessions were evaluated by 86% participants who completed questionnaires, with an average score of 4.95/5. Many of the participants had previously received no training on this subject. There was an overall 29% reduction of all pressure ulcers with a 57% reduction of pressure ulcers across the residential homes. Conclusion. This paper reports on the results from the evaluation of an educational intervention on the prevention and early identification of pressure damage, delivered to formal care workers who support patients either in residential care or in their own home. Relevance to clinical practice. Formal care workers are an under-utilised group and could potentially have an impact on the early identification pressure damage or those patients at high risk, improving the quality and cost effectiveness of pressure ulcer management
Paramedic practice is evolving and the number of advanced paramedics in primary care roles in the UK has risen dramatically. A significant milestone for the paramedic profession, recent legislation granting paramedics independent prescribing rights means UK paramedics are the first worldwide to receive this extension in scope of practice. Paramedic prescribing capability is expected to increase autonomy for independent case management and enhance capacity for service development. Local and national success is however likely to depend on skilful implementation and the avoidance of historical barriers. This article aims to raise awareness of potential barriers to early adoption of paramedic independent prescribing in primary care. It identifies common pitfalls prior to training and provides seven practical steps for paramedics considering pursuing non-medical prescribing training.
In the United Kingdom, non-medical prescribing (NMP) has been identified as one way to improve healthcare quality and efficiency. Healthcare organisations are charged with overseeing the clinical governance of NMP and guidance recommends the identification of a lead director to be responsible for its implementation. While over twelve million items are prescribed each year by the 50,000 qualified NMPs its uptake is inconsistent. Several studies have explored the barriers to NMP at a practice level, however little is known about the role the NMP lead and the implementation of NMP from an organisational perspective. The aim of this research was to explore the role of the organisational NMP lead across a range of practice settings within one Strategic Health Authority (SHA) and consider the development of NMP from a multi-organisational perspective.
Aim. This paper is a report of a survey to provide an overview of nurse independent prescribing and nurse supplementary prescribing across the United Kingdom. Background. Evidence examining the frequency of prescribing by nurses is conflicting, and it is evident that several factors hamper prescribing practice. As of May 2006, legislative changes gave appropriately qualified nurses virtually the same independent prescribing right as doctors. However, there is currently no evidence available about the prescribing practices of these nurses. Method. A random sample of 1992 qualified Nurse Independent/Nurse Supplementary Prescribers registered with the Nursing and Midwifery Council was sent a postal questionnaire in 2006. A total of 1400 (70%) questionnaires were returned, of which 1377 were completed. Findings. Eight hundred and ninety-one (65%) respondents worked in primary care, and 333 (24·3%) worked in secondary care. Three quarters of the sample had more than 5-year clinical experience in the area in which they prescribed prior to entering the prescribing programme. One thousand one hundred and seven (87%) participants had used nurse independent prescribing and 568 (44·6%) nurse supplementary prescribing. Restriction of local arrangements, implementation of the Clinical Management Plan and access to doctors hampered or prevented prescribing. Conclusion. The adoption of prescribing by nurses in the United Kingdom has increased patient choice with regard to access to medicines. A number of factors which hamper or prevent prescribing require further exploration. © 2007 Blackwell Publishing Ltd.
Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA.
There is a need to reduce symptoms, exacerbations and improve quality of life for patients with respiratory diseases. Across the world, increasing numbers of nurses are adopting the prescribing role and can potentially enhance service provision. Evidence suggests improved quality of care and efficiencies occur when nurses adopt the prescribing role. No evidence is available on the views of nurse prescribers who care for respiratory patients. The aim was to explore how nurse prescribing is being used for patients with respiratory conditions in different care settings across one strategic health authority, and whether this has benefited patients, healthcare professionals and the National Health Service.
The findings reported in this paper explore the prescriptions issued to dermatology patients by nurse prescribers. Thirty five prescriptions on which 79 items were prescribed were collected from 10 nurse prescribers and independently assessed. Each nurse formed the focus of a case study, which represented a setting within England in which nurses prescribed medicines for dermatology patients. Data were collected between June 2006 and September 2007. Specialist nurses were more likely than general practice nurses to provide clear instructions regarding the application of topical therapies (P=0.02), hand-write prescriptions, and prescribe by brand name. Nurses in general practice were more likely to computer generate prescriptions, prescribe generically (P=0.02), and provide information about treatment duration. Although omissions on prescriptions were minor, it is important that mechanisms are in place, such as access to electronic prescribing, monitoring and audit of prescribing, to ensure the quality of prescriptions written by nurses.
Background: There is a drive to improve the quality of service provision for patients with diabetes and to enable better self-management of this condition. The adoption of prescribing by nurses is increasing worldwide and can potentially enhance service provision. Evidence suggests that patients prefer services where their lifestyle factors and opinions are considered by healthcare professionals within a partnership approach. Few studies have explored patients’ views about their consultations with a nurse prescriber. Objective: To explore the views patients with diabetes have about their consultations with nurse prescribers and any impact this may have on their medications management. Design: A qualitative study involving semi-structured interviews and thematic analysis. Setting: Six primary care sites in which nurses prescribed medications for patients with diabetes in England. Data was collected in 2009. Participants: Interviews took place with 41 patients with diabetes from the case loads of 7 nurse prescribers. Results: Findings are reported under three themes; the nurse consultation style, benefits of the nurse prescriber consultation and views on involvement and decision-making. Key aspects of the nurse consultation style were a non-hurried approach, care and rapport, approachability, continuity, and providing clear information based on specialist knowledge. Many benefits were described, including improved access to appropriate advice and medication, greater understanding and ability to self-manage, ability to address problems and improved confidence, trust and wellbeing. While patients were happy with the amount of information received and involvement they had decisions about their treatment, there was some controversy over the consistency of information provided on side-effects of treatment. Conclusions: The study provides new knowledge about what patients with diabetes value and benefit from in respect to care provided by nurse prescribers. Continuity of relationship, flexibility over consultation length, nurses’ interpersonal skills and specialist diabetes knowledge were identified as crucial to good quality care. Patients require that nurse prescribers are skilled in providing a person-centred approach and have access to specialist training. The level of information and involvement offered to patients should reflect patients’ requirements.
Title. Preparing nurses to prescribe medicines for patients with diabetes: a national questionnaire survey Aim. This paper is a report of a study to examine Nurse Independent/Nurse Supplementary Prescribing for people with diabetes and the extent to which these nurses feel prepared for this role. Background. An area of care in which nurses, caring for people with diabetes, are involved is the management of medications. There is little or no evidence examining the prescription of medicines by nurses for people with this condition. Methods. The United Kingdom Nursing and Midwifery Council database was used to select a random sample of 1992 Registered Nurse Independent/Nurse Supplementary Prescribers. Of these, 1400 questionnaires were returned. Medicines for people with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The data were collected in 2006. Results. Four hundred and nine (95·1%) participants had used independent prescribing and 214 (49·8%) used supplementary prescribing. The majority of respondents were highly experienced and worked in primary care. Some nurses (7·6%) reported that the prescribing programme did not meet their need. The needs of nurses who had undertaken specialist training in diabetes were met to a statistically and significantly greater extent than those without this training. Nurse prescribing was viewed positively by nurses prescribing for people with diabetes. Conclusion. Prescribing has extended the role that nurses in the United Kingdom are able to play in the management of diabetes. Specialist training is a prerequisite for nurses adopting this role. There is a need to explore the prescribing programme and the extent to which it meets the needs of nurses prescribing for people with diabetes. © 2007 Blackwell Publishing Ltd.
Aims To explore the views of patients with diabetes about nurse prescribing and the perceived advantages and disadvantages. Methods Patients were recruited from the case-loads of seven nurse prescribers in six National Health Service sites in England. Sites reflected the key settings in which nurses typically prescribe for patients with diabetes within primary care. Forty-one interviews were undertaken by trained qualitative researchers. Interviews addressed opinions and experiences of nurse prescribing; audiotapes were transcribed, coded, and themes identified. Results Patients were confident in nurse prescribing. Distinctions were made between the role of the nurse and that of the doctor, and views varied with regard to the extent patients felt nurses should work autonomously. Confidence in nurse prescribing was inspired by nurses’ specialist knowledge and experience, a mutual trusting relationship, a thorough consultation, and experience of the benefits of nurse prescribing. Communication between nurses and doctors about patient care, awareness by nurses of their area of competence, training and experience, specialist diabetes knowledge and access to training updates were considered important for safe prescribing. Patterns of attendance had changed in some cases, with patients tending to see doctors less often. Access to medicines was improved for patients during non-routine/emergency situations. Conclusions Nurse prescribing is acceptable to patients and can increase the efficiency of diabetes service in primary care. Workforce planners need to include the services of nurse prescribers alongside those of doctors.
With life expectancy continuing to rise in the United Kingdom there is an increasing public health focus on the maintenance of physical independence among all older adults. Identifying interventions that improve physical outcomes in pre-frail and frail older adults is imperative.
A systematic review of the literature 2000 to 2017 following PRISMA guidelines and registered with PROSPERO (no. CRD42016045325).
Ten RCT trials fulfilled selection criteria and quality appraisal. The study quality was moderate to good. Interventions included physical activity; nutrition, physical activity combined with nutrition. Interventions that incorporated one or more physical activity components significantly improved physical outcomes in pre-frail and/or frail older adults.
Physical activity interventions are key to maintaining independence in pre-frail and frail older adults. A lack of consensus regarding the definition of frailty, and an absence of core measures to assess this means any attempt to create an optimal intervention will be impeded. This absence may ultimately impact on the ability of older and frail adults to live well and for longer in the community.
The overall aim of the research was to provide a national evaluation of Nurse Independent and Nurse Supplementary Prescribing in diabetes in the UK. A key component was to examine service provision by nurse prescribers for patients with diabetes.The NMC database was used to randomly select and distribute questionnaires to 1992 registered Nurse Independent/Nurse Supplementary Prescribers. 1400 questionnaires were returned. Medicines for patients with diabetes were prescribed by 439 respondents. This paper reports on the findings of these 439 nurses. The majority (63%) of nurses worked in general practice. Over 90% of services were provided to patients in the community. Over 30% made treatment alterations over the telephone to patients they had not met. Nurses with specialist training in diabetes viewed themselves as more competent than nurses without (P=0.000). Nurses who reported higher levels of competence were more likely to make treatment alterations over the telephone (P=0.000). Nurse independent and nurse supplementary prescribers working in a variety of roles are actively involved in the delivery of services to patients with diabetes. This care is predominantly provided in the community. It is evident from our findings that nurse’s competence affects their scope of professional practice in the management of these patients.
Aim. To explore stakeholder views on the impact of nurse prescribing on dermatology services. Background. Nurse led care enhances the services that dermatology patients receive. Research indicates that care delivered by nurse prescribers can improve efficiency and access to medicines. There is no evidence exploring the impact of nurse prescribing on the configuration of dermatology services. Design. Case study. Method. A collective case study of 10 practice settings across England where nurses prescribed medicines for dermatology patients. A thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were qualified nurse prescribers, administrative staff, doctors and non-nurse prescribers. Findings. Nurse prescribing was reported to support and facilitate the modernisation of dermatology services. It enabled nurses to make effective use of their knowledge and skills, overcome delays in treatment and provide faster access to medicines. However several organisational issues restricted the success of the initiative. Conclusion. Nurse prescribing is successfully being used to support and deliver a range of services to dermatology patients. Stakeholders reported that both patients and staff had benefited by the adoption of this role by nurses. However issues over support and access to CPD and capacity of the workforce were identified as potential barriers which could affect the contribution of nurse prescribing to dermatology patients. Relevance to clinical practice. Nurse prescribing contributes to the services provided to dermatology patients; Nurse supplementary prescribing contributes to the ability of dermatology nurse specialists to work in teams and prescribe complex medicines; Provision of adequate support and strategic planning are essential if the impact of nurse prescribing is to be fully realised; © 2009 Blackwell Publishing Ltd.
The aim of this study were to compare nurse prescribers and non-prescribers managing people with diabetes in general practice regarding: (a) patient characteristics; (b) activities and processes of care; (c) patient outcomes (self-management, clinical indicators, satisfaction) and (d) resource implications and costs. Over 28,000 nurses in the UK can prescribe the same medicines as doctors provided that it is in their level of experience and competence. Over 30%, mostly in general practice, prescribe medicines for patients with diabetes. A comparative case study. Nurses managing care of people with Type 2 diabetes were recruited in twelve general practices in England; six could prescribe, six could not. Patients, recruited by nurses, were followed up for 6 months (2011–2012). The patient sample comprised 131 in prescriber sites, 83 in non-prescriber sites. Patients of prescribers had been diagnosed and cared for by the nurse longer than those of non-prescribers. There were no differences in reported self-care activities or HbA1c test results between the patients of prescribers and non-prescribers. Mean HbA1c decreased significantly in both groups over 6 months. Patients of prescribers were more satisfied. Consultation duration was longer for prescribers (by average of 7·7 minutes). Non-prescribing nurses sought support from other healthcare professionals more frequently. Most prescribing nurses were on a higher salary band than non-prescribers. Clinical outcomes of patients managed by prescribing and non-prescribing diabetes nurses are similar. Prescribing nurses had longer relationships with their patients and longer consultations, possibly contributing to higher satisfaction with care. Employment costs of prescribing nurses are potentially higher.
Because role change can be disruptive, the introduction of nurse prescribing could potentially lead to confusion and conflict over role boundaries and definitions. This article considers how adopting prescribing has influenced the role of nurse prescribers who treat and manage patients with diabetes. Interviews with 10 nurse prescribers, nine doctors and three non-prescribing nurses were collected as part of a case study of nine UK sites where nurses prescribed medicines for patients with diabetes. We found that nurses resisted the 'medicalization' of their role. They strove to ensure that their consultations continued to follow a 'nursing model' which involved holistic assessment, health promotion and patient-centred care. There were perceived differences in the level of decision-making between doctors and nurse prescribers. To conclude, nurses adopted prescribing while maintaining a nursing approach to practice. For specialist nurses, this expanded role included higher levels of decision-making more traditionally associated with doctors.
Aim. To explore the views of nurses, doctors, non-nurse prescribers and administrative staff on how nurse prescribing is being used in diabetes services. Background. Nurse-led services enhance care and improve outcomes for patients with diabetes. Research indicates that care delivered by nurse prescribers can improve efficiency and support new ways of working. There is no evidence reported that explores nurses and team member views on how nurse prescribing is being used in diabetes services. Method. A collective case study of nine practice settings across England in which nurses prescribed medicines for patients with diabetes. A thematic analysis of semi-structured interview data collected during 2007 and 2008. Participants were qualified nurse prescribers, administrative staff, doctors and non-prescribing nurses. Findings. Nurse prescribing was reported to enhance and support a variety of models of diabetes care. It enabled nurses to work more independently and provide a more streamlined service. Maintaining a team approach ensured that nurses continued to learn and maintained good relationships with doctors. Conclusion. Nurse prescribing is being successfully used to support and develop more streamlined services for patients with diabetes. Individual and organisational factors, as well as the interpretation of policy initiatives are reported to influence how prescribing is used in practice. Understanding the implications of these forces is important if the full potential of this new and developing role is to be realised. Relevance to clinical practice. Nurses have an important role to play in the medicines management of patients with diabetes. Nurse prescribing supports and enhances established diabetes services. Prescribing allows nurses to develop diabetes services around the needs of the individual and introduce new ways of working such as the single review process.
Self-management interventions have become increasingly popular in the management of long term health conditions; however, little is known about their impact on psychological well-being in people with Multiple Sclerosis (MS). Purpose
To examine the effectiveness of self-management interventions on improving depression, anxiety and health related quality of life in people with MS. Method
A structured literature search was conducted for the years 2000 to 2016. The review process followed the PRISMA guidelines, and is registered with PROSPERO (no. CRD42016033925). Results
The review identified 10 RCT trials that fulfilled selection criteria and quality appraisal. Self-management interventions improved health-related quality of life in 6 out of 7 studies, with some evidence of improvement in depression and anxiety symptoms. Conclusion
Although the results are promising more robust evaluation is required in order to determine the effectiveness of self-management interventions on depression, anxiety and quality of life in people with MS. Evaluation of the data was impeded by a number of methodological issues including incomplete content and delivery information for the intervention and the exclusion of participants representing the disease spectrum. Recommendations are made for service development and research quality improvement.
Background Women with diabetes are at increased risk of adverse maternal and fetal outcomes. Preconception care can improve pregnancy outcomes and is paramount to minimise complications, but, current provision is sub-optimal. Mobile technology, particularly smartphones and apps have the potential to improve preconception care provision but research is lacking in this area. The need to use modern technologies to improve preconception care knowledge and awareness led to the development of a Preconception and Diabetes Information app in stage A of this study. Objective The aim of this paper, stage B of the study, is to explore the feasibility and acceptability of the Preconception and Diabetes Information app to improve preconception care knowledge and attitudes in women with diabetes, and explore the potential for wider implementation. Methods A mixed methods study design adopting a quasi-experimental approach will assess women’s knowledge and attitudes related to preconception care, and level of patient activation (knowledge and confidence for self-management of health) before and after the 3 month intervention period. A log of activity will be used to determine engagement with the app and semi-structured interviews will explore women’s experiences. Conclusions This is the first study to explore the acceptability and feasibility of a Preconception and Diabetes Information app for women with diabetes. The app has potential to change the way preconception care is delivered, improve pregnancy outcomes and be widely implemented in both developed and developing countries. This is important given the considerable shortfalls in current preconception care services in the United Kingdom and around the world.
Making best use of existing skills to increase service capacity is a global challenge. The aim was to systematically review physiotherapy and podiatrist prescribing and medicines management activity, including evidence of impact on patient care, levels of knowledge and attitudes towards extended medicines role. Methods:
A search of MEDLINE, CINAHL, and Cochrane databases, using terms to identify prescribing and medicines management across a range of roles, was conducted from January 1985 to May 2016 for physiotherapy, and January 1968 to May 2016 for podiatry. Hand searching of citations and databases from professional organisations was undertaken. Data were extracted and analysed descriptively, and quality appraised by 2 reviewers using the mixed methods appraisal tool. Results:
1316 papers were identified, and 21 included in the review. No studies were identified that reported prescribing and no studies specific to podiatry met the inclusion criteria. Physiotherapists were highly involved in administering medicines, providing medicines advice, and recommending new medicines. Patient satisfaction, cost and outcomes were equivalent when comparing physiotherapist-led injection therapy to traditional care. Pharmacology knowledge was variable and unmet training needs identified. Conclusion:
Medicines management practices were identified in physiotherapy and positive outcomes of extended scope physiotherapy. There was a lack of evidence regarding podiatric practice. Review of educational preparation for medicines management is recommended along with evaluation of medicines management practice.
Recent United Kingdom government policy emphasises that prescribing by nurses can improve access to medicines. However, the views of nurses prescribing for children have not been explored.
Background: Women with diabetes are at increased risk of adverse maternal and fetal outcomes. Preconception care can minimise risk of complications and improve outcomes, but current provision is inadequate. Electronic health technology, particularly apps, could improve preconception care provision but research is lacking in this area. Aim: The aim of this paper is to explore the views and experiences of clinicians and women with diabetes regarding the use of a mobile app for preconception care. Method: An exploratory study was conducted. Data were collected using focus group and interviews with 19 participants, comprising 10 clinicians and 9 women with type 1 or 2 diabetes. Data were analysed thematically. Findings: Women with diabetes and clinicians highlighted the inadequacy and challenges of current preconception care service provision and expressed a high level of enthusiasm and interest, towards a preconception care app that could support preconception care delivery for women with diabetes and overcome barriers to preconception care service provision and uptake. Conclusion: The acceptability of mobile health technology to both women and clinicians creates an important opportunity to overcome existing barriers to service provision, delivery and uptake, and improve both maternal and fetal outcomes for women with diabetes.
AIM: To examine the prescribing practices of supplementary nurse prescribers (working in both primary and secondary care) who prescribe medicines for patients with skin conditions and the factors that facilitate or inhibit this mode of prescribing. BACKGROUND: Nurses work in a variety of roles, with varying levels of expertise, are involved in the treatment management of a broad range of skin diseases. Skin conditions are those for which independent nurse prescribers prescribe most frequently. The role of the nurse, limitations of the formulary and inter-professional relationships influence the prescribing practices of these nurses. There is no evidence currently available examining the impact and activity of supplementary nurse prescribing for patients with skin conditions. METHODS: A convenient sample of 580 nurses who prescribed for skin conditions and were qualified supplementary nurse prescriber, self-completed a written questionnaire. RESULTS: Five hundred and twenty (89.7%) nurses were based in primary care and worked in general practice. Four hundred and thirty-six (75%) held a degree level qualification or higher, 41 (7%) had specialist dermatology training and 512 (88.3%) had more than 10 years postregistration nursing experience. Supplementary prescribing was used by a minority of nurses. Nurses who had specialist dermatology training used this mode of prescribing most frequently. Doctor and pharmacists lack of understanding of supplementary prescribing, lack of peer support and clinical management plans prevented the implementation of this mode of prescribing. CONCLUSIONS: Supplementary prescribing is used by a minority of nurses to treat skin conditions. A number of factors prevent nurses from using this mode of prescribing including lack of specialist training and lack of support in practice. RELEVANCE TO CLINICAL PRACTICE: Specialist dermatology training, an understanding of supplementary prescribing by the members of the healthcare team, and support in practice are required if supplementary prescribing is to be implemented effectively for the treatment of skin conditions.
This study aimed to explore the views of health care professionals on the implementation of nurse prescribing in a specialist children's hospital. An intrinsic case study approach was taken using thematic analysis on semi-structured interview data collected during 2006 and 2007. Participants were seven children's nurses who were qualified nurse prescribers, 11 doctors and three clinical leads in one specialist children's hospital. Nurses varied in their actual and desired levels of autonomy, and this was reflected in the way that prescribing was used in practice. Some nurses tended to treat existing patients, had less assessment and diagnostic skills and felt little need for support. The original selection of nurses focused around the needs and wishes of individuals, but was quickly superseded by the adoption of a more strategic approach. Nurses' expectations of prescribing may influence the extent to which they use their prescribing qualification and their subsequent support needs. Adopting a strategic approach to workforce planning and preparation should help ensure that the full potential of nurse prescribing is realized.
Recommendations were first made in 1986 for nurses to take on the role of prescribing (Department of Health [DoH], 1986). Eight years later (although limited to district nurses and health visitors), nurses in eight demonstration sites throughout England began to independently prescribe (Morris, 1994). There are now approximately 29000 district nurses and health visitors (DoH, 2005a) qualified to prescribe from the list of appliances, dressings, Pharmacy, General Sales List items, and 13 Prescription Only Medicines included in the Nurse Prescribers' Formulary for Community Practitioners (British Medical Association and Royal Pharmaceutical Society of Great Britain, 2006). This article explores recent advances that have further increased the prescribing power of nurses, namely nurse independent prescribing and nurse supplementary prescribing.
This article examines the literature on non-medical prescribing to establish its impact on UK healthcare. It discusses how better access to medication through non-medical prescribing can improve patient safety and patient-centred care, and how nurse prescribing can help ensure quality of care in the NHS during the current financial crisis.
Title. Nurse prescriber-patient consultations: a case study in dermatology. Aim. This paper is a report of a study exploring the content and processes in consultations between nurse prescribers and patients with dermatological conditions. Background. Communication skills, consultation time, information and follow-up are central to the treatment and management of patients with dermatological conditions. The contribution nurses make to the care of these patients has great potential. Method. A multiple case study was conducted with 10 practice settings across England in which nurses prescribed medicines for patients with dermatological conditions. Data were collected between June 2006 and September 2007 using semi-structured interviews (n = 40), patient questionnaires (n = 165/200) and videotaped observations of nurse consultations (n = 40). Data analysis included thematic analysis, descriptive statistics, chi-square and non-parametric tests. Findings. Nurses believed that their holistic approach to assessment, combined with their prescribing knowledge, improved prescribing decisions. Listening and explanation of treatments were aspects of nurse communication that were rated highly by patients. Listening and dealing sensitively with emotions were also aspects of the videotaped consultations that were rated highly by assessors. Nurses were less consistent in providing information about medicines. Conclusion. Triangulated data from this study suggest that nurse prescribing enhances the care of patients with dermatological conditions through improved prescribing decisions. If patients are to be more involved in this decision-making, nurses must give them more information about their medicines. The benefits of prescribing were most evident in the practices of dermatology specialist nurses. Further evidence is required to identify whether prescribing by specialist nurses offers similar benefits in other therapeutic areas. © 2009 Blackwell Publishing Ltd.
This article aims to explore the views of doctors and nurses, who care for people with diabetes, about the prescribing programme. Interviews with 10 nurse prescribers, nine doctors and three non-nurse prescribers were conducted in nine case study sites across England between October 2007 and September 2008. Prescribing was seen as a natural extension of advanced nursing roles adopted by nurses caring for people with diabetes. Nurses considered it important to obtain sound knowledge in areas in which they intended to prescribe before undertaking the course. Variation across prescribing programmes with regards to the level of work required of students and the way in which courses were run were reported. Most doctors thought it beneficial for nurses to be involved in mentorship, although doctors' continued involvement was considered necessary. Prescribing supports advanced nursing practice in the care of people with diabetes. Nurses considering undertaking the prescribing course need to be aware of the variations across prescribing programmes with regards to the level of work required. There is support for joint mentorship between nurse prescribers and doctors for students undertaking taking the prescribing course.
To explore the practice of nurses who prescribe medication for patients with skin conditions.
In order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic. We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden.
Methods and analysis
An international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents.
Ethics and dissemination
This study was approved using the self-certification process at the University of Surrey and Linköping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information. This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost–benefit analyses as the work progresses.
Physical health needs of people with intellectual disabilities are often overlooked. Inadequate physical health skills (assessment, monitoring) of healthcare professionals working in intellectual disabilities is a barrier to equitable care. Recent reports have called for initiatives to improve training through quality improvement programmes. Aim:
An integrative review was undertaken to 1) identify physical health training needs of healthcare professionals 2) identify challenges of implementing quality improvement skills training. Methods:
Six electronic databases were searched (January 1990-March 2015) and included if they described the physical health assessment/monitoring skills of healthcare professionals and quality improvement programmes designed to impact the physical health of adults with intellectual disabilities. Articles were appraised using the Mixed Methods Appraisal Tool (MMAT). Results:
668 articles were identified, of which 14 were included in the review. Literature was sparse with none reporting training needs of healthcare professionals in intellectual disabilities. Identified training needs of mainstream healthcare professionals included physical assessment, communication, general and syndrome specific knowledge, and health promotion. Quality improvement studies were of limited quality, under evaluated and poorly reported. Lack of staff engagement, role confusion and sustainability were barriers to quality improvement implementation. Conclusion:
Physical health skills of healthcare professionals are key to improving care for people with intellectual disabilities. However, quality improvement is poorly implemented in this area of practice. In order to better meet the needs of this group better implementation and evaluation of intellectual disabilities quality improvement programmes is required.
Infertility is a significant life event affecting around one in seven couples in the UK. The development of Assisted Reproductive Technologies (ARTs) such as In Vitro Fertilisation (IVF) have encouraged the idea that infertility can, and should, be treated. By seeking medical attention to overcome this condition, couples are understood to have begun an ‘infertility journey’. The study aim was to investigate the experiences of couples starting infertility investigations and treatments. Using an ethnographic methodology with a longitudinal design, involving iterative rounds of observation and interviews with the same participants. The findings show couples were resistant to becoming fertility patients and starting treatments, and this was often connected to the meaning that infertility had for them. The discomfort and challenge of this transition, previously described as ‘mazing’, was not always recognised or fully appreciated by the healthcare staff involved with the couples. ARTs are becoming ubiquitous and this has increased the mazing undertaken by couples because of the necessity for multiple treatment cycles. The commercialisation of fertility treatments, often including payment for cycles, is also unhelpful for couples’ decision-making. Couples are jointly involved in negotiating treatments and future planning, but clinics focus almost exclusively on the female partner. The ‘journey’ retains its open-ended quality because treatments, belying their promise and hope, do not usually resolve the uncertainty of infertility. Conclusion Treatments for infertility, including ARTs, are portrayed as straightforward, however this study finds that couples, particularly during the early stages from first GP referral, are reluctant to engage with medical fertility pathways and do not find the processes ‘routine’. By acknowledging this, and showing an interest in the personal and social context of their patients’ infertility, clinical staff can demonstrate they are listening to their patients. Couples may find this altered communication helps improve their experiences of fertility treatments.