Construcción del Estatuto Autonómico Guaraní

assignments, workbooks and library facilities, with combined importance-ratings totalling 16. 6.91 The remaining themes were judged of less importance overall by group participants and are not discussed here with the exception of Theme N (negative) which was also raised in the case studies. This theme was concerned with the problems in obtaining supervised clinical practice.

6.92 The concern was not the quality of the supervision but the lack of time the designated medical prescribing practitioners were able to devote to it;

“The Scottish Government must give time to mentors for mentoring, if this is very important you have to make sure that we have the support. We mentor student nurses - it is mandatory, but it is not mandatory for Doctors to do this”.

“The mentors need protected time and a financial carrot”

6.93 Particular difficulties were reported in the Islands where face to face contact with visiting GPs may be limited and much of the communication was by telephone.

6.94 There was also variability in support from practices. One nurse who worked in 2 separate practices found totally different attitudes to nurse prescribing. One practice had a positive attitude to nurse prescribing while the GP at the other practice suggested the nurse prescriber knocked at his door to have prescriptions signed. There was a view that the system was not ready for nurse prescribers.

Summary and conclusions

6.95 The evaluation covered all 7 courses running in Scotland in the first half of 2005. Data were gathered from nearly all the 192 nurses enrolled, from all the course leaders and from the main lecturers in each course. Data sources included course documentation; an initial questionnaire to course members (participation rate 97%); interviews with course

providers; and end-of-course focus groups in which 47% of the course members participated. 6.96 All 7 courses were implementing the NHS Education (Scotland) outline curriculum. However, there were minor differences in the emphasis placed on different objectives and also in the weighting of different elements of the assessment. All the courses blended on-site study days at the university with off-site private study. They differed in the relative weight assigned to these, some courses being predominantly campus-based and others predominantly distance learning. This met the requirements of a diverse user population. Interviews with course providers identified 2 main challenges: configuring the generic course to meet the needs of the range of specialties now taking it; and the task of teaching pharmacology to students with limited preparation for such study. Solutions to these problems were being implemented, but further curriculum development is needed to build on these advances. 6.97 The course-member focus groups had a strongly-felt conviction that the course contributed significantly to their professional expertise; that it provided essential knowledge of pharmacology and that it enabled a beneficial networking with other nurses and

professions. The main difficulty, however, was insufficient time for study. Only 27% of the course members had been allocated any protected study time beyond the timetabled contact days at their university – which in the case of the distance learning courses were as few as 5 or 7 days for the entire 6 month course. Many other students were still trying to negotiate study time at the beginning of the course. Assessment procedures were another source of anxiety, and in some (but not all) centres students felt that the course was poorly organised with regard to the scheduling of sessions and the provision of classroom facilities.

Application of the Findings

6.98 Based on the findings, a number of recommendations have been made about the future development of the courses. These have been considered by the course leaders and by the Research Advisory Group in Scottish Government Health Department (formerly Scottish Executive Health Department) and as a result an extensive programme of course development was begun in 2006.

6.99 The study has described and evaluated different approaches to nurse prescribing training with regard to learning experiences and preparation for practice. This has been nested in the larger studies and was informed by our 2005 nurse prescribing questionnaire.

Implications of this work

6.100 There are difficulties which some course members experience in obtaining protected time for private study in addition to the time they are given for attending course contact days. If employers reviewed their policies for allocating such time and courses made their

requirements explicit, especially where the course involves a low ratio of on-site to off-site study, this would be addressed.

6.101 The courses should continue to treat nurse prescribing generically, providing a systematic coverage of pharmacology and a full range of the nurse specialties represented on each course. Best practice in meeting the needs of specialists within the generic framework should be shared between centres.

6.102 Whilst different universities should be free to develop their provision in ways that meet the needs of their particular intakes, curriculum development projects should be undertaken at a national level to create a body of educational practice and curriculum

materials on which course leaders could draw as appropriate. These resources could underpin the cumulative development of the courses and guard against the loss of expertise when key members of course teams leave. This work could usefully concentrate on the following:

• Materials for pre-course preparation;

• Ways of customising the course to the needs of different specialities;

• Pedagogic techniques for meeting the learning needs of mature course members who are anxious about the academic study of pharmacology, portfolio writing and formal examinations after a long period away from study;

• Further articulating the generic model of nurse prescribing as the underpinning for all nursing prescribing practice, and as a common reference point for the different parts of the course;

• How to facilitate and assess the compilation of a personal core formulary within a generic course, and how to incorporate this learning experience in a comprehensive nurse prescribing curriculum;

• Course-specific assessment techniques, including the possibility of constructing a question bank for access by all the courses; and

• Course-specific formative evaluation techniques.

6.103 There is a need for closer liaison between NHS Boards and some course providers to ensure that the course rationale is fully understood by the former and a need for a planned admission process with sufficient advance notice to course leaders.

6.104 Services need to ensure that nurse prescribing practices are underpinned by adequate clinical governance and the courses should refer to this.

6.105 The PDPs of nurses who have completed the course in nurse prescribing should include plans for relevant CPD and this should be arranged by the services concerned. 6.106 Internal course evaluations should include anonymous course member evaluation instruments which cover the issues of course quality identified in the focus groups and this should be monitored by NES.

6.107 Mentoring was largely viewed in a positive way. However, nurses sometimes found it extremely difficult to get any allocated time with designated mentors (Designated Medical Practitioner DMP). Mentors themselves highlighted ‘finding time’ problems and difficulties in understanding their role. One solution proposed related to nurse prescribers in training having 2 mentors: one clinical and one nurse prescriber who had experienced the course. 6.108 Changes in the education of nurse prescribers may impact on service delivery and subsequent uptake of courses. There should be adequate consideration and funding for the backfill of nurses undertaking prescribing training.