Concepciones de autonomía indígena en Charagua

stages 3 and 4,

“A core formulary is where an individual develops a list of drugs that they will use in their practice and there are certain things they need to know about each of those drugs. They need to know what the drug is, how the drug works, what the pharmacological effects of the drug are, what the likely adverse drug reactions might be for that drug, the interactions. Issues like that they explore in detail for each drug that they use. Then they practise the actual practical aspects of delivering drug information about that drug to a patient so that they can tie in theory with actual practice because they need to translate their technical knowledge into something different for the patient, so that the patient can understand that and we try to get them to think about that well before they actually deal with it in practice”. Course leader.

6.58 Thus conceptualised, the core formulary would provide underpinning knowledge for the supervised learning in practice. It would not replace the broad study of a range of drugs that the generic model implies; rather, it would enable specialist needs to be met within that generic model.

Linking the nurse prescribing course with service needs

6.59 The third theme to emerge from the interviews centred on the relationship between the courses and service needs. Both the practice of nurse prescribing and the programmes of preparation were in early stages of development. Many course leaders felt that meeting service needs depended on further developments in nurse prescribing itself, as well as on closer links between employers and the course organisers in particular.

6.60 Action is needed at both Scottish Government and Trust level to achieve this. Three main issues were identified in the interviews:

• The need to tighten the links between the employers and the courses • The need to develop and clarify the procedures and infrastructure for nurse

prescribing

• The need to provide some form of post-course support for the newly qualified prescribers

The need to tighten the links between employers and courses

6.61 One problematic area is the admission of nurses to the courses. The standard pattern of recruitment is for a Trust to propose nurses for the course and for the university to then send them application forms. If an applicant is admitted, some pre-course preparation might be attempted. One university asks course members to undertake preparatory studies and uses these to diagnose needs for pre-course study skills training. The possibility of offering pre- course preparation in basic physiology and pharmacology was discussed above. However, because of the loose coupling between the courses and the Trusts, this cannot be implemented for everybody;

“We know what will happen is that, maybe three quarters of course members who have applied for and been offered places will come on the course, and then a quarter … will have fallen by the wayside. And unfortunately some of the course members do give their application form to someone else …. if that person hasn’t got funding approved, they will just ditch it up. It is a situation that isn’t very tight between the university and the Trust of getting this list of people named to actually commit to actually appearing on the day that the next course starts”. Course leader.

“Lots of people think that once they have a place in September that it is alright to just say; oh I don’t know I think maybe I’ll just move to January”.

Course leader.

“The last application I had for the course that started in [date] was [2 days earlier]. So you get your cohort together very late? Very, very late. So it would be difficult to have a pre-course preparation? Yes and in fact one of my cohort didn’t start until day 2. … people genuinely have difficulty deciding whether they’re going to be able to accommodate the course until fairly short notice so you couldn’t really offer much preparation … So there is

preparation for those who are able to use it but obviously some people are coming to the course very late”. Course leader.

The need to clarify nurse prescribing structures and procedures

6.62 Another issue was the difficulty of orientating the course to service needs because of the still-evolving structure of nurse prescribing in Scotland;

“One of the ... problems with directing courses is the ever moving goal posts of the …legal issues and the changes to the formularies on medical

conditions. I think these are so difficult to determine …. I don’t understand how a course member can understand where to … find out what they can and cannot prescribe … and there are Scottish legal differences in here that are not well flagged up … as far as directing courses, that for me is the biggest headache”. Course leader.

“It would be nice if nurses in Scotland had some greater support in relation to the roles and requirements of nurse prescribers …”. Course leader.

6.63 A consequence of this was that course members could not evidence all the

competencies in the portfolio because the structure of nurse prescribing was still being put into place. Interviewees highlighted 3 areas that were problematic in this respect: working in teams, clinical governance and auditing.

6.64 Many course members were not working within multi-disciplinary teams, so they have difficulty demonstrating this aspect of their competence;

“The main competence which we have difficulty with is team work … when we talk about team work, we’re actually talking about active communication between other members and making sure everybody in the team knows what you are doing … [course members] have difficulty articulating their actual place and demonstrating that they’ve linked to other members of the team actively to promote good prescribing practice”. Course leader.

6.65 Similarly, systems for the clinical governance and auditing of nurse prescribing had not been established in all parts of the service, so in these respects too the course members’ experience limited opportunities for developing practical competence;

“Clinical governance and audit work … sometimes they have difficulty showing that through their portfolio because … they’re not linking into a structure that’s already there”. Course leader.

Need for post-qualification support

6.66 Course leaders perceived that, on completing the nurse prescribing course, members often lacked confidence and the leaders identified a need for post-qualification support to deal with this;

“I think it would be useful to have a structure for clinical supervision for prescribing aspects of your practice for new practitioners … specific nurse prescribing clinical supervision … there is a definite lack of confidence … there is no point in training people if they don’t have the confidence to actually prescribe when they finish”. Course leader.

6.67 It was pointed also out by some course leaders that currently, there is no funded CPD in Scotland to follow up the nurse prescribing course and this should be an area for future development.

The course members’ perspective

6.68 Ten group meetings were conducted with course members, one group in each centre. The groups were held on the last day of each course (or as soon as possible thereafter). A total of 90 course members attended the 10 group meetings (47% of the cohort).

6.69 As described in Chapter 3 the nominal group technique was used for the group meetings with course members. This technique allows the group to share and discuss all the issues to be evaluated, with each group member participating equally in evaluation. The evaluation works with each participant "nominating" his or her priority issues, and then ranking them on a scale of, say, 1 to 10. The rankings allocated by each participant to each issue are added together to give a final ranking for that issue.

6.70 The categories for each group, which were broadly similar, were consolidated by the research team into 23 overall themes and the comments from all the groups were classified according to this schema. The number of importance-ratings allocated to each theme were then added together.

Findings

6.71 There were 11 positive and 12 negative themes (it should be remembered that the particular group method ensures this by eliciting a balance between positive and negative comments). Tables 6.9 and 6.10 list the themes in order of the importance-ratings they received. In the following sections, the 12 themes ranked of highest importance by the group participants are discussed together with opposing views where appropriate. When reading the following, the significance of each theme should be judged according to the overall

Table 6.9 Summary of positive themes Importance Rating Theme

5914 _A.15 _{The course contributed significantly to increased professional}