Nicola Carey

Dr Nicola Carey


Reader in Long Term Conditions
PhD, MPH, Bsc.(Hons), RGN, RM , Specialist Practitioner in Practice Nursing, Nurse Independent and Supplementary Prescriber
+44 (0)1483 684512
HSM 01
Mon-Fri 9.00- 5.30 by appointment only

Academic and research departments

Faculty of Health and Medical Sciences.

Biography

Areas of specialism

Quality improvement; Workforce development; Non-medical prescribing; Mixed methods research

Research

Research interests

Research projects

My teaching

My publications

Publications

Nwolise Chidiebere Hope, Carey Nicola, Shawe Jill (2016) Preconception care education for women with diabetes: a systematic review of conventional and digital health interventions, Journal of Medical Internet Research 18 (11) e291 pp. 1-10 JMIR Publications
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="" with="" fewer="" preterm="" deliveries="" adverse="" fetal="" outcomes="" significant="" improvements="" in="" knowledge="" attitudes="" to="" seeking="" preconception="" care="" barriers="" were="" also="" reported.="" conclusion="" has="" a="" positive="" effect="" on="" pregnancy="" for="" women="" diabetes="" mellitus.="" however="" uptake="" of="" is="" low="" the="" use="" ehealth="" applications="" mellitus="" still="" its="" infancy.="" initial="" results="" are="" promising="" but="" further="" research="" incorporating="" smartphones="" apps="" needed.="" clearly="" there="" much="" be="" done="" if="" full="" potential="" improve="" obstetric="" realised.="">
Courtenay M, Carey N (2008) Preparing nurses to prescribe medicines for patients with diabetes: a national questionnaire survey, JOURNAL OF ADVANCED NURSING 61 (4) pp. 403-412 BLACKWELL PUBLISHING
Stenner K, Carey N, Courtenay M (2010) Implementing nurse prescribing: a case study in diabetes, JOURNAL OF ADVANCED NURSING 66 (3) pp. 522-531 WILEY-BLACKWELL PUBLISHING, INC
Courtenay M, Carey N (2008) Completeness of prescriptions issued to dermatology patients, Nurse Prescribing 6 (9) pp. 391-396 Mark Allen Group
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.
Courtenay M, Carey N, Gage H, Stenner K, Williams P (2015) A comparison of prescribing and non-prescribing nurses in the management of people with diabetes, JOURNAL OF ADVANCED NURSING 71 (12) pp. 2950-2964 WILEY-BLACKWELL
Courtenay M, Carey N, Stenner KL (2009) Nurse prescribing in dermatology, Dermatology Nursing 8 (1) pp. 24-30
Stenner K, Carey N, Courtenay M (2009) Nurse prescribing in dermatology: doctors' and non-prescribing nurses' views, JOURNAL OF ADVANCED NURSING 65 (4) pp. 851-859 WILEY-BLACKWELL PUBLISHING, INC
Courtenay M, Carey N, James J, Hills M, Roland J (2007) An evaluation of a specialist nurse prescriber on diabetes in-patient service delivery, Practical Diabetes International 24 (2) pp. 69-74
The aim of this study was to evaluate the impact of a diabetes specialist nurse (DSN) prescriber on insulin and oral hypoglycaemic agent medication errors, length of hospital stay, and patients' ability to self-manage their diabetes whilst in hospital. The setting was six wards in a single United Kingdom district general hospital trust. The standard in-patient care of a convenience sample of diabetic patients treated with insulin and/or oral hypoglycaemic agents was evaluated before (n=187) and after (n=266) the intervention of a DSN prescriber. Prospective data were collected in order to measure insulin and oral hypoglycaemic medication errors, and length of stay (i.e. primary outcome measures). A secondary outcome, the extent to which patients felt able to manage their care, was measured using a self-report questionnaire. The results showed that the median number of insulin and oral hypoglycaemic agent medication errors was lower in the intervention group (four vs six, p
Carey N, Stenner K (2011) Does non-medical prescribing make a difference to patients?, Nurs Times 107 (26) pp. 14-16
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.
Courtenay M, Carey N (2006) Nurse-led care in dermatology: a review of the literature, BRITISH JOURNAL OF DERMATOLOGY 154 (1) pp. 1-6 BLACKWELL PUBLISHING
Carey N, Courtenay M, Burke J (2007) Supplementary nurse prescribing for patients with skin conditions: a national questionnaire survey, JOURNAL OF CLINICAL NURSING 16 (7) pp. 1230-1237 BLACKWELL PUBLISHING
Courtenay M, Carey N, Burke J (2007) Independent extended nurse prescribing for patients with skin conditions: a national questionnaire survey, JOURNAL OF CLINICAL NURSING 16 (7) pp. 1247-1255 BLACKWELL PUBLISHING
Courtenay M, Carey N (2008) The impact and effectiveness of nurse-led care in the management of acute and chronic pain: a review of the literature, JOURNAL OF CLINICAL NURSING 17 (15) pp. 2001-2013 WILEY-BLACKWELL
Stenner K, Carey N, Courtenay M (2012) Prescribing for pain - how do nurses contribute? A national questionnaire survey, Journal of Clinical Nursing 21 (23-24) pp. 3335-3345
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.
Stenner K, Carey N, Courtenay M (2012) Prescribing for pain - how do nurses contribute? A national questionnaire survey., J Clin Nurs
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.
Carey N, Courtenay M (2008) Nurse supplementary prescribing for patients with diabetes: a national questionnaire survey, JOURNAL OF CLINICAL NURSING 17 (16) pp. 2185-2193 WILEY-BLACKWELL
Courtenay M, Carey N, James J, Hills M, Roland JM (2007) An evaluation of a Specialist Nurse prescriber on diabetes in-patient service delivery, PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 16 (5) pp. 589-589 JOHN WILEY & SONS LTD
Carey N, Stenner KL, Courtenay M (2009) Prescription writing for diabetes: compliance with good practice, Nurse Prescribing 7 (10) pp. 464-468 Mark Allen Group
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.
Carey N, Stenner K, Courtenay M (2009) Adopting the prescribing role in practice: exploring nurses' views in a specialist children's hospital., Paediatr Nurs 21 (9) pp. 25-29
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.
Courtenay M, Carey N (2008) The prescribing practices of nurse independent prescribers caring for patients with diabetes: Findings from a national questionnaire survey, Practical Diabetes International 25 (4) pp. 152-157
The aim of this study was to examine the prescribing practices of nurse independent prescribers caring for patients with diabetes. Medication management is an area of care in which nurses, caring for patients with diabetes, are involved. Prescribing should optimise the role of these nurses. Although nurses in the United Kingdom have virtually the same independent prescribing rights as doctors, there is limited evidence concerning the extent to which nurse prescribing is used to treat diabetic patients, the medicines and conditions for which these nurses prescribe, and nurses' level of experience or training. In this study, data were derived from a national questionnaire survey. The findings were based on replies from a random sample of 409 nurse independent prescribers who self-completed a written questionnaire. The results showed that the majority (62.6%) of participants worked in general practice. Nurses with specialist training prescribed more frequently (p=0.015). The majority (51.8%) of nurses prescribed between one and five items a week for patients with diabetes. Monitoring equipment, oral antidiabetic drugs, and insulins were the products most often prescribed. A lack of continuing professional development and clinical knowledge were the biggest factors which hampered prescribing. It was concluded that nurses are using independent prescribing to prescribe medicines for patients with diabetes. However, in order that this role is optimised, it is important that nurse independent prescribers have the appropriate specialist knowledge and are able to access continuing professional development. Copyright © 2008 John Wiley & Sons.
Stenner KL, Carey N, Courtenay M (2010) How nurse prescribing influences the nursing role, Nurse Prescribing 8 (1) pp. 29-34
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.
Courtenay M, Carey N, Stenner K (2009) Nurse prescriber-patient consultations: a case study in dermatology, JOURNAL OF ADVANCED NURSING 65 (6) pp. 1207-1217 WILEY-BLACKWELL PUBLISHING, INC
Carey N, Stenner KL, Courtenay M (2009) Views on implementing nurse prescribing in a specialist children's hospital, Nurse Prescribing 7 (5) pp. 205-2010
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.
Courtenay M, Carey N, Burke J (2007) Independent extended supplementary nurse prescribers, their prescribing practice and confidence to educate and assess prescribing students, NURSE EDUCATION TODAY 27 (7) pp. 739-747 CHURCHILL LIVINGSTONE
Carey N, Stenner K, Courtenay M (2014) An exploration of how nurse prescribing is being used for patients with respiratory conditions across the east of England., BMC Health Serv Res 14 (1)
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.
Courtenay M, Carey N, Stenner KL (2009) Dermatology patients' views on nurse prescribing, Dermatological Nursing 8 (2) pp. 38-44
Courtenay M, Carey N (2007) A review of the impact and effectiveness of nurse-led care in dermatology, JOURNAL OF CLINICAL NURSING 16 (1) pp. 122-128 BLACKWELL PUBLISHING
Courtenay M, Carey N, Burke J (2007) Independent extended and supplementary nurse prescribing practice in the UK: A national questionnaire survey, INTERNATIONAL JOURNAL OF NURSING STUDIES 44 (7) pp. 1093-1101 PERGAMON-ELSEVIER SCIENCE LTD
Carey N, Courtenay M, James J, Hills M, Roland J (2008) An evaluation of a Diabetes Specialist Nurse prescriber on the system of delivering medicines to patients with diabetes, JOURNAL OF CLINICAL NURSING 17 (12) pp. 1635-1644 WILEY-BLACKWELL
Courtenay M, Stenner KL, Carey N (2009) An exploration of the practices of nurse prescribers who care for people with diabetes: a case study, Journal of Nursing and Healthcare of Chronic Illness 1 (4) pp. 311-320
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.

Carey N, Stenner K, Courtenay M (2010) Stakeholder views on the impact of nurse prescribing on dermatology services, JOURNAL OF CLINICAL NURSING 19 (3-4) pp. 498-506 WILEY-BLACKWELL PUBLISHING, INC
Carey N, Courtenay M (2010) An exploration of the continuing professional development needs of nurse independent prescribers and nurse supplementary prescribers who prescribe medicines for patients with diabetes, JOURNAL OF CLINICAL NURSING 19 (1-2) pp. 208-216 WILEY-BLACKWELL PUBLISHING, INC
Courtenay M, Carey N (2009) Nurse prescribing by children's nurses: views of doctors and clinical leads in one specialist children's hospital, JOURNAL OF CLINICAL NURSING 18 (18) pp. 2668-2675 WILEY-BLACKWELL PUBLISHING, INC
Carey N, Stenner KL, Courtenay M (2010) How nurse prescribing is being used in diabetes services: views of nurses and team members, Journal of Nursing and Healthcare of Chronic Illness 2 (1) pp. 13-21 Wiley-Blackwell
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.

Carey N, Courtenay M (2007) A review of the activity and effects of nurse-led care in diabetes, JOURNAL OF CLINICAL NURSING 16 (11C) pp. 296-304 BLACKWELL PUBLISHING
Courtenay M, Carey N (2006) Independent extended and supplementary nurse prescribing practice: A national questionnaire survey, PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 15 (4) pp. 283-284 JOHN WILEY & SONS LTD
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.
Courtenay M, Carey N, Stenner K, Lawton S, Peters J (2010) Patients' views of nurse prescribing: effects on care, concordance and medicine taking, BRITISH JOURNAL OF DERMATOLOGY 164 (2) pp. 396-401 WILEY-BLACKWELL
Carey N, Courtenay M (2006) An evaluation of a diabetic specialist nurse prescriber on service delivery in secondary care, PHARMACOEPIDEMIOLOGY AND DRUG SAFETY 15 (4) pp. 283-283 JOHN WILEY & SONS LTD
Stenner KL, Courtenay M, Carey N (2011) Consultations between nurse prescribers and patients with diabetes in primary care: A qualitative study of patient views, International Journal of Nursing Studies 48 (1) pp. 37-46 Elsevier
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.
Carey N, Courtenay M, Stenner K (2013) The prescribing practices of nurses who care for patients with skin conditions: a questionnaire survey., J Clin Nurs 22 (13-14) pp. 2064-2076 Wiley
To explore the practice of nurses who prescribe medication for patients with skin conditions.
Courtenay M, Stenner KL, Carey N (2009) Nurses? and doctors? views about the prescribing programme, Nurse Prescribing 7 (9) pp. 412-417 Mark Allen Group
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.
Courtenay M, Stenner K, Carey N (2010) The views of patients with diabetes about nurse prescribing, DIABETIC MEDICINE 27 (9) pp. 1049-1054 WILEY-BLACKWELL
Cross C, Hindley J, Carey NJ (2017) Evaluation of a formal care worker education intervention on pressure ulceration in the community, Journal of Clinical Nursing Wiley
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
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.
Courtenay M, Carey N, Burke J (2006) Preparing nurses to prescribe medicines for patients with dermatological conditions, JOURNAL OF ADVANCED NURSING 55 (6) pp. 698-707 BLACKWELL PUBLISHING
Courtenay M, Carey N (2008) Nurse independent prescribing and nurse supplementary prescribing practice: national survey, JOURNAL OF ADVANCED NURSING 61 (3) pp. 291-299 BLACKWELL PUBLISHING
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.
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.

Groom N, Kidd T, Carey N (2018) Urgent care centre redirection: evaluation of a nurse-led intervention, Emergency Nurse 25 (9) pp. 25-30 Royal College of Nursing
Background:

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.

Kidd T, Carey N, Mold F, Westwood S, Miklaucich M, Konstantara E, Sterr A, Cooke D (2017) A Systematic Review of the Effectiveness of Self-Management Interventions in People with Multiple Sclerosis at Improving Depression, Anxiety and Quality of Life., PLoS ONE 12 (10) e0185931 Public Library of Science
Background

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.

Edwards J, Mold F, Knivett D, Boulter P, Firn M, Carey N (2017) Quality improvement of physical health monitoring for people with intellectual disabilities: an integrative review, Journal of Intellectual Disability Research 62 (3) pp. 199-216 Wiley
Background:

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.

Stenner Karen, Edwards Jude, Mold Freda, Otter Simon, Courtenay Molly, Moore Ann, Carey Nicola (2018) Medicines management activity with physiotherapy and podiatry: A systematic mixed studies review, Health Policy 122 (12) pp. 1333-1339 Elsevier
Objective:

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.

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.

Kidd Tara, Mold Freda, Jones Claire, Ream Emma, Grosvenor Wendy, Sund-Levander Märtha, Tingström Pia, Carey Nicola (2019) What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials, BMC Geriatrics BMC

Background: 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.

Methods: A systematic review of the literature 2000 to 2017 following PRISMA guidelines and registered with PROSPERO (no. CRD42016045325).

Results: 10 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.

Conclusions: 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.

Kidd Tara, Mold Freda, Jones Claire, Ream Emma, Grosvenor Wendy, Sund-Levander Märtha, Tingström Pia, Carey Nicola (2019) What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials, BMC Geriatrics 19 (184) BMC

Background:

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.


Methods:

A systematic review of the literature 2000 to 2017 following PRISMA guidelines and registered with
PROSPERO (no. CRD42016045325).


Results:

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.


Conclusions:

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.

Nwolise Chidiebere, Carey Nicola, Shawe Jill (2020) Exploratory study of clinician and patient views regarding the use of a Preconception Care app for women with diabetes, Health Informatics Journal SAGE Publications
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.