Independent Nurse Prescriber…….. Homework Help

The legal ethicalcode of conduct for nurses as provided by the Department of Health in the UniteKingdom……

Adverse effects sothat the decision of the patient is base on informed consent…….

Question 1

The roles of a minor illness or injury nurse practitioner within the emergency department involve management of the patient’s conditions and assisting other medical practitioners in treatment of various conditions. According to the Nursing and Midwifery Council of the United Kingdom (2008), a nurse within the emergency department must relate the past medical history of all patients with their current therapeutic program so that an effective treatment plan is reached. The Nursing and Midwifery Council of the United Kingdom (2008) further provides guidelines for minor illness nurses and nurse prescribers within the emergency department that would enable them provide effective management of patients through the application of relevant information gathered from the patient history. The National Institute for Health and Clinical Excellency (2009), both pediatric and adult patients respond to the current therapy based on the past medication and thus it is important for nurses to obtain all relevant information on the patient before reaching a decision to prescribe. The pediatric patient history can be obtained from the parents or guardians. The history of a patient which affects prescription includes the demographic information, past medical conditions, reaction to different drug preparations and the health conditions associated with the current illness.

A nurse prescriber must keep proper records of the patient history and ensure that they are used solely for the purposes of medical care. This is provided by the Nursing and Midwifery Council (2008) as a way of upholding the rights of patients for protection of private information from unauthorized access or disclosure. It is important to note that a nurse prescriber within the emergency department must provide the senior practitioners and physicians with the required patient records for decision making and evaluation. Moreover a nurse prescriber should know her limitations in using the medical history in prescription of certain controlled drugs such as diazepam to the elderly and poly-pharmacy patients hence leave the responsibility to the superior medical officers as explained by Wagle (2011).

The assessment models in patient history taking should be applied by nurse prescribers so that involvement of patients in treatment is made possible. A nurse prescribe should therefore be able to initiate conversations with patients, gather relevant information, do physical examination, explain to the patient about his or her condition and make a proper treatment plan as demonstrated by Adams (2011). In aIDition, the Nursing and Midwifery Council of United Kingdom (2008), illustrates that a nurse practitioner must evaluate the condition of the patient by using either a biomedical or psychosocial perspective as a model of taking the patient history. Though, both these models can be used by nurse prescribers to determine the necessary tests or medical procedures needed to be performed in order to accurately diagnose the medical condition of the patient so that relevant therapy is provided. It is important for a nurse practitioner to ensure that a patient focused care is given so that they are able to give a positive contribute to care through provision of adequate information during history taking. Consultation with other practitioners is also an important consideration in emergency care so that prescription is based in confirmed diagnosis.

Robeznieks (2011) illustrates that a good patient history helps to prevent errors in drug prescription such as prescribing drugs to a patient with known allergy for the medication and miscommunication that leads to failure of checking the correct dosage for a given condition.

The Royal College of Nursing (2008) also provides guidelines in caring for patients by a nurse prescriber which includes using a concordance model of patient care where the patient is given a chance to be involved in deciding the kind of care given by practitioners. Toren & Wagner (2010) aIDs that a nurse practitioner must communicate appropriately and efficiently with other hospital departments such as the laboratory, radiology or pharmacy so that the various procedures on the patient are carried on without delay so that the patient is relieved from the pain as soon as possible.

Question 2

The Royal College of Nursing (2008) provides policies through which nurses in the emergency department use to apply their knowledge and experience on the mechanisms of action of drugs when they are prescribing drugs to the patient as also demonstrated by the National Prescribing Centre (2008). The framework acts as an important guideline in ensuring that therapy is provided according to the requirements of various medical conditions. This is important in prevention of incidences of drug overdose and failure of close monitoring of the drug actions. The contraindications of various drugs must also be considered by emergency care nurses because some conditions in patients may lead to adverse effects of various drugs on the patients. When managing pediatric patients in the emergency department, it is necessary for a nurse prescriber to use proper formulations such as prescribing medicines in volume of liquid in ml rather than the actual adult dose in mg. According to Steiner, Blitz & Stagg (2008), in treatment of patients within the emergency department, physiological parameters that affect the drug dosage such as weight must also be applied in prescribing to ensure that correct amount of dosage is given to the patients.

According to the Department of Health (2010) about 4% of the deaths of adults aged between the ages of 59-84 have been attributed to aripiprazole therapy. In aIDition to drug adjustments to hepatic diseases among the elderly patients, a nurse prescriber should consider the contraindications of drugs in patients with renal diseases so that they are protected from renal failure induced by therapy. Moreover, the nurses in the emergency department should apply the Yellow Card Scheme to report Adverse Drug Reactions (ADRs) suspected to occur from medication of patients of various ages and conditions Culley (2010).

Safe prescription of drugs must be based on the patient history. Therapy which does not consider the patient history would lead to prescription of medication that has failed to provide healing to the patient before hence nurse prescribers should use alternative medications for various illnesses through having an interactive communication with the patient about previous therapy and its medical effect on the patient. As explained by National Prescribing Centre (2008), the cost effectiveness of various drugs in relation to the ability of the patient to pay for them can be obtained from the patient history. In aIDition, the past and current medical conditions of the patient affect the drugs that patients are given. Therefore a nurse prescriber should apply relevant knowledge of patient history such as past reaction to some drugs or conditions such as pregnancy that leads to contraindication of some drugs.

Department of Health (United Kingdom) has reported prescribing errors among children hence the need for professionalism and accuracy in prescribing pediatric patients in the emergency department. The errors usually result to non compliance of correct medical procedures in care of pediatric patients. All nurse prescribers must apply their knowledge on the mechanisms of action of various drugs among child and adult patients so that adverse actions are minimized hence ensure safety in therapy. As a result National Prescribing Centre (2008) demonstrates that it is only competent, skilled and experienced nurses are allowed to prescribe for pediatric patients in the United Kingdom. Standards are reinforced by the Department of Health in UK on the prescription of drugs for children. The prescription of drugs for adult patients in the emergency department within the UK has been challenged by patient factors such as resistance, lack of compliance to therapy and inability to afford the drugs and therefore nurse prescribers should take the patient factors into consideration to enable cost-effective and safe prescribing.

Question 3

The legal ethical code of conduct for nurses as provided by the Department of Health in the Unite Kingdom provides that nurse prescribers must provide compassionate competent and safe medical care to all patients. The care of patients should thus be aimed at promoting the well being and health of the patient while preserving their dignity. Moreover, nurse prescribers must maintain privacy and confidentiality of patient information. According to Wagle (2011), nurse prescribers who fail to promote justice in medical care are taken accountable for their actions through a disciplinary body.

The codes of nursing practice provided by the National Prescribing Centre of the United Kingdom (2008) illustrate that nurses must uphold the principles of health care ethics. The United Kingdom legislation provides that nurses and other medical practitioners must act to promote and not harm the condition of the patient under all circumstances as explained by Lowe (2010). The best interests of the patient therefore must be considered in emergency care so that legal suits do not result from the medical malpractice in prescribing drugs to patients. In the UK, patients have the right to sue medical practitioners if they feel that proper medical practice has not been provided to them and also in cases of medical negligence especially in administration of therapeutic formulations.

The Shipman inquiry has affected drug prescriptions especially for the controlled drugs because doctors are now prevented from stockpiling drugs through false prescriptions of drugs such as diamorphine. A nurse prescriber should therefore take responsibility and accountability for the use of controlled drugs within the emergency department Considine & Winter (2009).

The legislation on medical practice in the United Kingdom provides that nurses must report incidences of abuse to patients. An emergency nurse practitioner therefore has the responsibility of ensuring that any non legal practice in prescription of drugs is reported to the relevant authorities as demonstrated by Wand & White (2007). The legal framework of the UK gives patients the right to determine what happens to them. According to Bray, Dawson & Plowright (2010) competent adults have the legal right to refuse therapy but nurses should take the responsibility of directing patients through professional consultation and advice on various therapies. This will enable the patient to determine what medication is appropriate hence reach an informed decision. Pediatric patients do not have a mental capacity to decide on the kind of medication that they are given hence their parents must be consulted by the nurse so that ethical legal aspects of nursing practice are adhered to.

The legal framework of medical practice within the United Kingdom provides for fair treatment of all patients without prejudice. As demonstrated by Wagle (2011), nurse prescriber must adhere to the legal framework of medical care and follow the correct ethical practices in treatment of both pediatric and adult patients. In an emergency department, treatment of minor illnesses should also be ethical so that the dignity of patients is not violated. Nurse prescribers should also ensure that the privacy of the patients in terms of the therapy prescribed for them is maintained private. Disclosure of patient information to a third party without his or her consent is illegal in the United Kingdom and hence failure to follow the ethical practices in care would lead to legal suit by the patient or disciplinary action to the nurse concerned.

Question 4

The influence of patients in nursing care is inevitable because of their rights in determining what is done to them in medical care. The history taking models such as concordance provides that patients must be involved in treatment so that their legal right to denial or acceptance of a given medical procedure is not denied. It is notable that the medical care provided by a nurse prescriber would also be influenced by the relatives of the patient especially for pediatric patients. This calls for all nurse prescribers to adhere to the legal and ethical standards of practice to ensure that the influence on treatment does not violate the application of justice in nursing care for all patients. Gaudine & Thorne (2011) aID that the diversity among patients in terms of age, social background, financial abilities and educational level and general awareness of medical issues determines the direction of nursing care. A nurse prescriber thus is faced with challenges of managing the various factors that influence care such as the behavior of the patients, parents and compliance to therapy.

In prescribing drugs for patients, nurses should be able to analyze the psychological behavior of patients and attitudes towards treatment because it would determine their compliance to the therapy as explained by Culley (2010). Consultation between the nurse and the patient should thus involve the patient with professional advice on the benefits of the drugs or procedures and the possible adverse effects so that the decision of the patient is base on informed consent. Considine & Winter (2009) say that it is through informed consent that the law of concordance is adhered to by medical practitioners including nurse prescribers.

Nurse prescribers should also apply the health believe model especially in administration of drugs within the public health context because perceptions of individuals play a vital role in the adherence to therapy. The psychological aspect of treatment should be encompassed in the management of patients by nurses so that the constructs of perceived susceptibility, severity, barriers and benefits are included in therapy as demonstrated by Kaufman & Birks (2009). Moreover, various demographic variables must be put into consideration by nurses so that care is effective.

When nurse prescribers provide therapy for pediatric patients, the influence of the parents and guardians is inevitable. As illustrated by National Prescribing Centre (2008), parents tend to be concerned about the drugs that their children are ascribed to hence nurse practitioners should explain all detains of the drug including its action and relevance to the illness of the patient. This is a way of avoiding conflicts with the parents especially when the drugs that must be described have some adverse effects on the pediatric patient. Moreover, the behavior of adult patients determines their compliance to therapy. Some patients may take less than the prescribed dose of a drug because of the fear of the adverse effects hence failure of full recovery due to under dosage. The nurse prescriber should therefore be able to convince the patient the importance of compliance to the mediation through proper communication as said by Courtenay, Carey & Stenner (2010).

The abilities of the patients to afford various drug formulations vary depending on their social economic background. Some patients have access to insurance making them able to pay for expensive drugs. According to Nursing and Midwifery Council (2008), nurse prescribers should provide alternative prescriptions to patients depending on the social economic influences on therapy but the goal of the health care should be aimed at providing cost effective recovery and adherence to the ethical framework of nursing care.

Question 5

Within the emergency department are various health care providers with diverse knowledge, education, experience, behaviors and responsibilities. Because of this diversity, it is inevitable that ethical issues would arise following differences in opinion, judgment, professional behavior and attitudes towards medical care. Therefore, an emergency department nurse prescriber should be able to practice with due consideration of the legal framework so that patients receive justice in care. Responsibility should therefore be taken by a nurse prescriber in case of non ethical behavior within the emergency department. The Nursing and Midwifery Council (2008) explains that a nurse prescriber must use various skills in order to ensure effective and efficient relationship and communications with other health providers in the emergency department. This is because emergency care requires coordination and proper cooperation of the health care providers so that emergency treatment is effectively given to the patient.

In the emergency department there are nurse assistants, students, nurse prescribers and doctors whose roles vary. The responsibilities played by each member of the team should however be aimed at providing effective care to the patient as explained by Lowe Grey (2010). Moreover, genetic enzyme variants in various ethnic groups must be considered by nurse prescribers because they cause diversity in the metabolism of drugs by various individuals.

In an emergency department proper evaluation of patients and keen assessment are important so that justice in health care is provided to patients. Conflict among practitioners may result from non compliance to the proper medical procedures and ethical considerations in care for emergency department admissions. Moreover, the relationship of the patient with a nurse may be jeopardized by the adverse effects of various drugs making the patient prefer some nurses more than others. Therefore, nurse prescribers should be accommodating so that patient needs are taken into consideration. Kaufman & Birks (2009) say that it may be necessary for a nurse to consult a colleague for a second opinion so that the patient feels that all considerations are taken before decisions on medication are made.

The levels of education in nursing vary as their roles within an emergency department. Good relationship is required among nurses so that treatment is focused at relieving the pain of the patient. According to the Department of Health, nurse practitioners in the United Kingdom have the responsibility of guiding student nurses through the medical procedures and prescription of various formulations so that their role in providing training for the next generation nurses is achieved.

Nurses have a big influence in empowering patients and they would determine the decision of patients. A nurse prescriber within an emergency department should adhere to the ethical standards of medical practice so that patient rights for proper care are not neglected. The voice of pediatric patients and the concerns of the parents are heard through the nurse concerned especially in providing a go ahead for some medical procedures such as CT scans. In aIDition, Culley (2010) asserts that a nurse prescriber should perform various roles within limitations and reporting to the physician I charge and the administrative officers on various issues related to care is mandatory.

References

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