segunda-feira, novembro 28, 2005

Próximo passo na Enfermagem: a prescrição?

Um pouco por todo o mundo os enfermeiros começam a prescrever. Muito lentamente e cautelosamente o processo habitualmente inicia-se nos cuidados paliativos, onde formalmente os enfermeiros passam a prescrever.

Aos poucos o processo de prescrição abrange outras áreas, embora as situações mais específicas sejam do foro médico. A grande vantagem é o faceta holística que os cuidados passam a ter, sendo o enfermeiro detentor da possibilidade de prescrição.

Esta etapa, não é inicada logo após o terminus da licenciatura (semelhante aos médicos), mas apenas depois de formação farmacologica extra e experiênica profissional. Há uns tempos li que em alguns países essa posibilidade era apenas para os enfermeiros especialistas.

Mesmo em Portugal os enfermeiros especialistas em enfermagem obstétrica, já podem requerer exames complementares de diagnóstico (pelo menos já existe esse normativa europeia).

Deixo alguns excertos do que se vai passando no mundo da prescrição por enfermeiros!


Documento oficial do governo do Reino Undo, que lista as patologias nas quais os enfermeiros podem prescrever, os fármacos e as vias de administração. Fica o link:

http://www.dh.gov.uk/assetRoot/04/08/38/85/04083885.pdf


Outros artigos de interesse:

Where has nurse prescribing got to in England, Northern Ireland and Scotland?

link: http://www.nurse-prescriber.co.uk/Journals/Journals%2003%20archive/PPE2003_general.htm#Opinions


The history of nurse prescribing

link: http://www.nurse-prescriber.co.uk/Journals/Journals%2003%20archive/PPE2003_general.htm#Opinions


Opinions on district nurse prescribing in Sweden

Wilhelmsson S and Foldevi M. Exploring views on Swedish district nurses’ prescribing – a focus group study in primary health care. Journal of Clinical Nursing 2003; 12: 643-650

"This focus group study of Swedish GPs and district nurses (DNs) disclosed positive views among the DNs about nurse prescribing, lack of knowledge about DN training in prescribing among GPs, and lack of discussion between DNs and GPs about DN prescribing.

DNs saw the prescribing of drugs as a serious responsibility and some had introduced systems for self-monitoring. The availability of many drugs without prescription was seen by some as lowering the increased status of the prescriber. Pharmacists were frequent discussion partners for DNs, in contrast to GPs.

Most DNs had experienced resistance to DN prescribing, with some health centres not allowing DNs to take part in the training course. The compulsory training course in pharmacology and drug treatment was regarded very positively. The boundaries between GPs and nurses was expressed in terms of territory and prestige.

GPs felt that DN prescribing was extremely marginal and did not experience much relief in their workload whereas DNs thought that it provided GPs with the chance to spend more time with patients with serious diseases.

DNs in Sweden have been able to prescribe from a limited list of drugs since 1994. The necessary training course on pharmacology and drug treatment is now included in the speciality training course for all DNs. When it followed the speciality course, it was for a minimum of eight weeks.
"


Nurse prescribing education

Griffiths M. Education for nurse prescribers. Journal of Community Nursing 2003; 17(7)

"This article examines the current educational provision for nurse prescribers and how it may develop as nurse prescribing grows. It looks at the different resources available, at how learning is assessed and at the different sources of education and support.

Uptake of the independent prescribing courses has been slow, perhaps because: some nurses were waiting for the introduction of supplementary prescribing; the original Nurse Prescribers’ Extended Formulary was limited to four areas; the number of CATS points in England was originally limited to 20 at level 3; and the original requirement that the course be completed in three months (this has now been extended to six). More nurses are now seeing the potential benefits, with the advent of supplementary prescribing.

Nurses at all levels will be affected as nurse prescribing grows and develops and their life science educational requirements will increase. Research is needed to examine the educational preparation for nurse prescribing and to address concerns about its introduction.
"

Os Enfermeiros dos EUA e a prescrição.

US nurse prescribing

Plonczynski D et al. The past, present and future of nurse prescribing in the United States. Nurse Prescribing 2003; 1(4): 170-174

"Although Advanced Practice Nurses (APNs) have some degree of prescribing authority, there is much variation between states, and many barriers to prescribing exist, according to this review of nurse prescribing in the USA.

Many doctors have opposed prescribing by nurses and the American Medical Association has been a powerful and united lobbying organization for doctors. In contrast, nurses have been represented by numerous professional groups with no unified, nationwide attempt to increase prescriptive authority or recognition.

In many states, APNs’ prescriptive authority is linked to a collaborative agreement with a doctor and many of these agreements remain supervisory. It can be difficult to find a collaborating doctor and some pharmacists and healthcare companies refuse to accept APN prescriptions. Many insurers will not accept APNs on provider panels, effectively preventing them from prescribing. The article discusses these and other barriers and the progress that is being made to overcome them.
"


Em breve haverá mais notícias, acerca de outros países, onde a prescrição dos enfermeiros ainda está em debate.

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