Non-medical Prescribing Students Research Articles

The feasibility, acceptability and perceived impact of a theory-based intervention on non-medical prescribing students’ antibiotic prescribing behaviour: an experimental study

Abstract Introduction Acute upper respiratory tract infections (URTI) are one of the most common infections. URTIs usually resolve spontaneously but 60% of all prescriptions issued in UK primary care are for URTIs1 contributing to antimicrobial resistance. Non-medical prescribers are a growing group of prescribers but there are few if any antimicrobial stewardship (AMS) interventions to support their prescribing practices. Introducing AMS interventions when learning to prescribe can play an important role to embed appropriate practice at the start of a prescribers’ journey. Aim To test the feasibility, acceptability and perceived impact of a theory-based electronic learning intervention on the antibiotic prescribing behaviour of non-medical prescribing students. Methods Non-medical prescribing students registered at the study setting (university) were recruited via email and word of mouth. Following consent, participants completed an online pre-intervention questionnaire that explored their perceived prescribing behaviour and confidence in treating patients with URTIs. Participants then completed the intervention, accessible from any internet-enabled device via a weblink. The intervention was previously developed2 using the behaviour change wheel and comprised an animation of a prescriber opting against prescribing antibiotics for an adult with self-limiting URTI using a motivational interviewing approach. The patient felt satisfied and confident about their care. Four questions followed the scenario. Participants then completed an online post-intervention questionnaire that explored the usefulness of the intervention, and the same pre-intervention confidence questions. A one-to-one online audio-recorded semi-structured interview followed, exploring participants’ experiences of using the intervention. Questionnaire and interview questions were informed by the Capability Opportunities Motivation-Behaviour model. Questionnaire data were analysed using descriptive statistics. Interviews were transcribed verbatim and analysed using thematic analysis3. Ethical approval was given by the School Research Ethics Committee where the researchers were based. Results Twelve participants (of 50 approached) consented to take part. Eight completed the pre- and post-intervention questionnaires and the intervention. Seven completed all stages of the study. 87.5% of participants worked in a hospital setting. All were qualified for at least two years. Interviews lasted between 9-15 minutes. Participants’ confidence in treating patients with URTI increased in all statements; gain information on patient expectations, support patients’ comprehension of health information, build rapport, communicate effectively, help patients to see and examine different viewpoints (highest mean increase) and patients understand and are happy with their prescribing decision. These increases aligned with qualitative accounts. Participants agreed that the intervention would be useful to them and would change their practice positively. Participants found the intervention easy to use; access was straightforward and took between 5-20minutes to complete. The addition of a wider range of complex, challenging scenarios to the intervention were suggested. Discussion/conclusions The intervention was feasible to complete and acceptable to the participants. Participants’ confidence in treating patients increased; even though many were familiar with AMS, the intervention gave them further confidence to support a no antibiotic prescribing strategy. Participants suggested including more complex patient scenarios; this will be considered in a future study. Study limitations includes a small sample size and most participants worked in hospital settings but the intervention was set in primary care.

Influences on paramedic prescribing: student and prescriber perspectives.

Paramedic prescribing has been permitted in legislation from 2018. In 2019 one of the first cohorts of paramedic prescribers in the country was invited to share their experiences, thoughts and perceptions around the new and evolving role of paramedic prescribing practice. To explore the opinions of student and newly qualified paramedic prescribers regarding the impact and effectiveness of paramedic independent prescribing on their clinical practice. A qualitative study was undertaken within the North East of England with a group of experienced paramedics undertaking non-medical prescribing education. A focus group and dyad interview were undertaken with a purposive sample of paramedics recruited from a higher education institution providing V300 independent and supplementary prescribing education. The focus group was undertaken with paramedics on the non-medical prescribing (NMP) programme of study. The dyad interview was undertaken with participants once qualified as prescribers, and actively prescribing. The focus group and interview were audio recorded, transcribed verbatim and subjected to thematic analysis to identify key themes. A total of n = 7 and n = 2 paramedics undertook the focus group and dyad interview, respectively. Paramedics in this sample represented a range of paramedic practice areas. Paramedic NMP students noted four key themes around role, expectations, governance and opportunities and challenges in relation to prescribing practice. The returning sample of paramedics, now practising as prescribers, noted themes of organisational and infrastructure challenges, monitoring of prescribing practice and the evolution of paramedic roles. Paramedic prescribing is rapidly expanding and evolving into new clinical areas. As such, careful consideration should be given to not only the resourcing of prescribers as individuals, but also the wider organisational and technological support and structures needed to be in place to allow paramedic prescribers to fulfil their roles and utilise their advanced practice skills.

A critical review of the development of advanced practice competency frameworks and their contribution to autonomous practice

A critical review of the development of advanced practice competency frameworks and their contribution to autonomous practice

Triggering language and maths anxiety in non-medical prescribing students

Maths anxiety is a debilitating fear of mathematics, which often stems from early learning experiences. Despite their ability to confidently perform complex numerical tasks, such as drug calculations, as an intrinsic part of their role, health professionals often disclose experiencing maths anxiety. Health professionals who have returned to education to study non-medical prescribing are required to undertake a numeracy exam, which can trigger symptoms of maths anxiety. This study explores the use of language in teaching and learning numeracy with non-medical prescribing students, and identifies that use of terminology more closely aligned with health professionals' language results in lower levels of anxiety than using school-like mathematical terminology. The findings of this study can be used to inform supportive teaching practices for health professional educational courses that have a numeracy component.

Inter-professional prescription safety workshop for non-medical prescribing and pharmacy students: A cross-sectional study.

This article reports on an evaluation of a prescribing workshop to increase ‘sharedlearning’ between registered practitioners undertaking a non-medicalprescribing (NMP) course (midwifery, nursing, physiotherapy, and podiatry) andundergraduate pharmacy students to increase awareness of, and understanding of theroles.  The focus was on three domains ofsafe prescribing: Knowledge (of commonly prescribed medicines and theirsuitability for individual patients); Process (of legal requirements and supplyof medicines and associated patient information); and Relationships (betweenprescribers and pharmacists). A cross-sectional evaluation was utilized with6-point Likert-style items and a free text section, completed by 337participants.  Participants reported positivelyabout the workshop content and their learning experience, although somedifferences between pharmacy and NMP participants were noted in the knowledgedomain. Quantitative analysis revealed significant differences (p<0.001) oflow-to-moderate magnitude (partial-2=0.146) between NMP and Pharmacy studenton all 3 domains, with NMP students reporting slightly more positive outcomes(between 0.4 and 1.5 points higher) in all cases. However, both groups scoredpositively; with mean domain scores of 15.6 to 16.5 on scales with maximumscores of 18.

Perceptions of ePortfolio adoption in a non-medical prescribing programme

This article focuses on initial findings from a small study considering students' and staff's perceptions of the future adoption of an ePortfolio summative assessment. Aim: The study aimed to determine non-medical prescribing (NMP) students' and staff's perceptions of the potential future adoption of ePortfolio as a technological enhancement of the summative assessment. Background: The integration of ePortfolios in post-graduate nurse education is supported using current learning technologies within Higher Education Institutions and professional nursing bodies, yet little research has specifically focused on this group in the UK. Methods: This study employed a qualitative research approach with the methodology chosen to reflect pragmatic time-frames and access to the audience needed (NMP students and academic staff). The different qualitative approaches also afforded maximum opportunities for response, with no financial implication or ethical challenges. These approaches comprised a student focus group (seven NMP students), an online questionnaire (an additional seven NMP students) and an online questionnaire (five lecturers within the NMP module team). Results: Findings suggest there remains misapprehension around the terminology used to define ePortfolio, which may lead to heightened anxiety within the post-qualifying NMP student population. Overall, students and staff had positive perceptions of the future adoption of ePortfolio as an enhancement of the existing portfolio summative NMP assessment. Several themes emerged relating to the perceptions of staff and students including changing validation requirements of nursing governing body requirements, recognition of developing technologies in education and flexibility of online tools. Conclusion: There is scope to explore technological advances, including ePortfolio, within nurse prescribing education that may increase engagement of students and module staff to enhance development as well as allow innovative co-production.

The views of non-medical prescribing students and medical mentors on interprofessional competency assessment – A qualitative exploration

BackgroundThe United Kingdom (UK) is one of the least restrictive countries in terms of scope of prescribing practice for non-medical prescribers and is a rapidly expanding group of professionals. In the United Kingdom nurse prescribers are assessed in practice by Designated Medical Practitioners (DMP) (doctors) which is a unique approach. In light of proposals to permit nurses to assess each other the benefits and challenges associated with current approach to interprofessional assessment warranted further exploration. ObjectiveThe aim was to explore interprofessional competency assessment with nurse non-medical prescribing students and their DMPs. DesignA descriptive qualitative research design was undertaken using semi-structured interviews and focus groups. SettingThe study was completed in a Scottish University that provides non-medical prescribing education to nurses, midwives and allied health professionals. Participants and methodsStudents (n=6) participated in two focus groups at the start and end of their supervised learning and assessment in practice. DMPs (n=6) participated in semi structured telephone interviews on completion of supervision. Utilising Clark's theory of interprofessional education, a thematic analysis was conducted. FindingsProfessional identity influenced interpretation of prescribing competence with regards assessment and scope of practice. Students and DMPs learned with, from and about each other, and provided a platform for two-way learning and mutual professional respect. The interprofessional learning experience developed relationships and provided ratification for the prescribing role post qualification. ConclusionsFurther exploration with key stakeholders and service users is recommended, prior to any changes to the designated professional group assigned to assessing non-medical prescribing competence.

Supporting practice learning time for non-medical prescribing students: managers' views.

Managers in healthcare services have ever-increasing demands to consider in relation to front line care, including the continuing professional education needs of qualified practitioners who are advancing their roles. One advancement is non-medical prescribing, and this article reports part of the findings from a survey undertaken in Scotland which explored managers' views of the clinical support of staff enrolled on a non-medical prescribing programme. The article discusses how managers have an important role to play in supporting these learners in practice, and suggests all stakeholders should be aware of the pressure this adds to managers, and seek creative solutions to support the process of learning.

Inter-professional prescribing masterclass for medical students and non-medical prescribing students (nurses and pharmacists): a pilot study.

Prescribing errors cause significant patient morbidity and mortality. Current legislation allows prescribing by different health professions. Inter-professional collaboration and learning may result in safer prescribing practice. This study aimed to develop, pilot and test the feasibility of a simulated inter-professional prescribing masterclass for non-medical prescribing students, medical students and pharmacists. A three-scenario, simulated patient session was designed and implemented by an expert panel. Medical students, non-medical prescribing students and pharmacists worked together to formulate and implement evidence-based prescriptions. The Readiness for Inter-professional Learning Score (RIPLS) and a self-efficacy score were administered to the students and the Trust in Physician Score to the simulated patients. Overall, the RIPLS and self-efficacy scores increased. Pharmacists showed the highest rating in the Trust in Physician score. Post masterclass group discussions suggested that the intervention was viewed as a positive educational experience. An inter-professional prescribing masterclass is feasible and acceptable to students. It increases self-efficacy, readiness for inter-professional learning and allows students to learn from, about and with each other. A larger study is warranted and the use of feedback from simulated patients explored further.

Implementing an e-portfolio for non-medical prescribing modules

This article discusses the implementation of a web-based e-portfolio into non-medical prescribing (NMP) modules at the University of Huddersfield. The e-portfolio adopted has all the elements of the former paper-based document. A key advantage of implementing an e-portfolio is the contribution it makes to the National Information Board's (2015) digital priorities for health and social care. The e-portfolio can equip NMP students, as part of the wider health-care workforce, with digital skills and knowledge that are appropriate to their role and also their impending prescribing role. Adopting an e-portfolio within the NMP modules has brought many benefits, including strengthened assessment methods in terms of authenticity, reliability and mentor preparation. The main challenges experienced were related to the IT literacy and skills of participants, as well as computer or internet access issues in the workplace; these challenges were similar to those faced by Moule et al (2011) . The module team overcame these issues through continual review of the assessment strategies being deployed and the functionality of the e-portfolio.

Use and evaluation of a mentoring scheme to promote integration of non-medical prescribing in a clinical context.

BackgroundGrowing numbers of non-medical health professionals are attaining prescribing rights through post-registration non-medical prescribing (NMP) courses in the UK. However, not all implement prescribing post-qualification. This study evaluated the uptake and perceived usefulness of a mentoring scheme for two cohorts of NMP students at the University of Nottingham. The scheme paired students with qualified mentors with whom they had an opportunity to discuss the integration of prescribing theory into practice.MethodsMentors were allocated on days 2–5 of the course. Surveys were distributed to students who completed the NMP course [n = 63] and their mentors. Likert-scale and open-ended questions addressed: use, perceived usefulness, and positive and negative aspects of the mentoring scheme. Semi-structured interviews were conducted with both students (n = 6) and mentors (n = 3) to explore their experience of the mentoring scheme in more detail. Students were purposively selected for interview depending on their level of use of the mentoring system. Interviews were analysed using thematic analysis.ResultsThe response rates were 65.1% (n = 41) and 56.3% (n = 36) for students and mentors respectively. Just over half of students (57.1%) accessed their mentor. Having a sufficient support network was the key reason for not using the scheme. Students found mentors helpful for: moral support (68.2%); contextualising prescribing (71.4%); and helping them to think about implementing prescribing in practice (72.7%). Fewer mentors felt they helped in relation to contextualising (57.9%) or implementing prescribing (31.6%). Less than half the students and mentors surveyed agreed that they received/provided assistance related to the integration of prescribing theory into practice (38.1% and 42.2% respectively) and assistance with assignments (36.3% and 45.5% respectively).Interviews suggested that students found it difficult to focus on implementing prescribing because of the academic demands of their course, which impacted on uptake and use of the mentoring scheme. Students emphasised the importance of being paired with a prescriber who was successfully prescribing. Mentors benefited from sharing and refreshing their academic knowledge.ConclusionsStudents and mentors derived benefits from participation in this scheme. This intervention may be better as a post-qualification support resource when students are ready to consider their future prescribing practice.

Using Audience Response Technology to provide formative feedback on pharmacology performance for non-medical prescribing students - a preliminary evaluation

BackgroundThe use of anonymous audience response technology (ART) to actively engage students in classroom learning has been evaluated positively across multiple settings. To date, however, there has been no empirical evaluation of the use of individualised ART handsets and formative feedback of ART scores. The present study investigates student perceptions of such a system and the relationship between formative feedback results and exam performance.MethodsFour successive cohorts of Non-Medical Prescribing students (n=107) had access to the individualised ART system and three of these groups (n=72) completed a questionnaire about their perceptions of using ART. Semi-structured interviews were carried out with a purposive sample of seven students who achieved a range of scores on the formative feedback. Using data from all four cohorts of students, the relationship between mean ART scores and summative pharmacology exam score was examined using a non-parametric correlation.ResultsQuestionnaire and interview data suggested that the use of ART enhanced the classroom environment, motivated students and promoted learning. Questionnaire data demonstrated that students found the formative feedback helpful for identifying their learning needs (95.6%), guiding their independent study (86.8%), and as a revision tool (88.3%). Interviewees particularly valued the objectivity of the individualised feedback which helped them to self-manage their learning. Interviewees’ initial anxiety about revealing their level of pharmacology knowledge to the lecturer and to themselves reduced over time as students focused on the learning benefits associated with the feedback.A significant positive correlation was found between students’ formative feedback scores and their summative pharmacology exam scores (Spearman’s rho = 0.71, N=107, p<.01).ConclusionsDespite initial anxiety about the use of individualised ART units, students rated the helpfulness of the individualised handsets and personalised formative feedback highly. The significant correlation between ART response scores and student exam scores suggests that formative feedback can provide students with a useful reference point in terms of their level of exam-readiness.

Students’ perceptions of learning in practice for NMPs

Non medical prescribing (NMP) is integral to the modernisation of the NHS. Strong educational preparation of students in theory and practice is required to ensure patient and practitioner safety. This study takes an interpretive phenomenological approach to explore students’ perceptions of learning in practice and the effect of mentorship by their designated medical practitioner. A purposive sample of ten students from diverse clinical backgrounds, who had completed the NMP course from one HEI took part. The interviews explored specific themes including the time that students had with their mentors and the approach they took to learning and teaching. Students were asked if they perceived their mentor able and willing to give them the support they required to meet the prescribing competencies, as defined by the Nursing and Midwifery Council. Content analysis of the data was undertaken and presented using excerpts of transcriptions. The findings suggested that mentors and students had difficulties in getting quality time together, and mentors were not fully prepared in the course learning outcomes. Learning and teaching was largely directed by written course work, and mentors had limited knowledge of the prescribing competencies by which to assess the students. The study identified the need for further research into the difficulties of learning and teaching in practice for NMP students and their mentors. There is a need for greater collaboration between education, health care managers and medical practitioners to improve the standards of learning and teaching in practice for students in the future. It suggests that mentorship within the NMP course should be given greater recognition and that prescribing competencies should be generic to all prescribers.

Pharmacology podcasts: a qualitative study of non-medical prescribing students' use, perceptions and impact on learning

BackgroundThere is growing research on student use of podcasts in academic settings. However, there is little in-depth research focusing on student experience of podcasts, in particular in terms of barriers to, and facilitators of, podcast use and students' perceptions of the usefulness of podcasts as learning tools. This study aimed to explore the experiences of non-medical prescribing students who had access to podcasts of key pharmacology lectures as supplementary learning tools to their existing course materials.MethodsSemi-structured interviews were carried out with seven non-medical prescribing students (average age = 43 years), all of whom were nurses, who had access to seven podcasts of key pharmacology lectures. These podcasts took the form of downloadable audio lecture recordings available through the virtual learning environment WebCT. Low, medium and high users of the podcasts took part in the interviews in order to access a variety of student experiences. Interview data was analysed using thematic template analysis to identify key themes surrounding student experience of podcast availability, particularly in relation to barriers to and facilitators of podcast use, and students' experiences of podcasts as a learning tool.ResultsStudents used podcasts for a variety of reasons such as revisiting lectures, preparing for exams, to clarify or revise specific topics and, to a lesser extent, to catch up on a missed lecture. Barriers to podcast use centred mainly around technological issues. Lack of experience of the technology required to access podcasts proved a barrier for some students. A lack of access to suitable technology was also a reported barrier. Family assistance and I.T. assistance from the university helped facilitate students' use of the podcasts. Students found that using podcasts allowed them to have greater control over their learning and to gauge their learning needs, as well as helping them build their understanding of a complex topic.ConclusionsStudents used podcasts for a variety of reasons. Barriers to podcasts use were generally related to technological issues. Students often found that once assistance had been gained regarding these technological issues, they accessed the podcasts more easily. Students felt that access to podcasts added value to their learning materials by allowing them to better manage their learning and build their understanding. Podcasts represent a valuable additional learning tool for this specific group of older students.

Audience response technology: Engaging and empowering non-medical prescribing students in pharmacology learning

BackgroundNon-medical prescribing (NMP) is a six month course for nurses and certain allied health professionals. It is critical that these students develop a good understanding of pharmacology; however, many students are mature learners with little or no formal biological science knowledge and struggle with the pharmacology component. The implications for patient safety are profound, therefore we encourage students not just to memorise enough pharmacology to pass the exam but to be able to integrate it into clinical practice. Audience response technology (ART), such as the KeePad system (KS) has been shown to promote an active approach to learning and provide instant formative feedback. The aim of this project, therefore, was to incorporate and evaluate the use the KS in promoting pharmacology understanding in NMP students.MethodsQuestions were incorporated into eight pharmacology lectures, comprising a mix of basic and clinical pharmacology, using TurningPoint software. Student (n = 33) responses to questions were recorded using the KS software and the percentage of students getting the question incorrect and correct was made immediately available in the lecture in graphical form. Survey data collected from these students investigated student perceptions on the use of the system generally and specifically as a learning tool. More in depth discussion of the usefulness of the KS was derived from a focus group comprising 5 students.Results100% of students enjoyed using the KS and felt it promoted their understanding of key concepts; 92% stated that it helped identify their learning needs and 87% agreed that the technology was useful in promoting integration of concepts. The most prevalent theme within feedback was that of identifying their own learning needs. Analysis of data from the focus group generated similar themes, with the addition of improving teaching. Repeated questioning produced a significant increase (p < 0.05) in student knowledge of specific pharmacological concepts.ConclusionsThe use of ART enhanced non-medical prescribing students' experience of pharmacology teaching. Student perceptions were that this system increased their ability to identify learning needs and promoted understanding and integration of concepts. Students also reported that the technology aided exam revision and reduced associated anxiety.

Pharmacology as a foreign language: A preliminary evaluation of podcasting as a supplementary learning tool for non-medical prescribing students

BackgroundNurses and other health professionals in the U.K. can gain similar prescribing rights to doctors by undertaking a non-medical prescribing course. Non-medical prescribing students must have a thorough understanding of the pharmacology of prescribing to ensure safe practice. Pharmacology education at this level is complicated by the variation in students' prior subject knowledge of, and anxiety about, the subject. The recent advances in technology, particularly the potential for mobile learning, provide increased opportunities for students to familiarise themselves with lecture materials and hence promote understanding. The objective of this study was therefore to evaluate both the subjective (student perception) and objective (student use and exam results) usefulness of podcasts of pharmacology lectures which were provided as an extra learning tool to two cohorts (n = 69) of non-medical prescribing students.MethodsThe podcasts were made available to students through the virtual learning environment WebCT. Use of podcasts by two successive cohorts of nurse prescribing students (n = 69) was tracked through WebCT. Survey data, which was collected from 44 of these students, investigated patterns of/reasons for podcast use and perceived usefulness of podcasts as a learning tool. Of these 69 students, 64 completed the pharmacology exam. In order to examine any impact of podcasts on student knowledge, their exam results were compared with those of two historical cohorts who did not have access to podcasts (n = 70).ResultsWebCT tracking showed that 91% of students accessed at least one podcast. 93% of students used the podcasts to revisit a lecture, 85% used podcasts for revision, and 61% used the podcasts when they had a specific question. Only 22% used the podcasts because they had missed a pharmacology session. Most students (81%) generally listened to the entire podcast rather than specific sections and most (73%) used them while referring to their lecture handouts. The majority of students found the podcasts helpful as a learning tool, as a revision aid and in promoting their understanding of the subject. Evaluation of the range of marks obtained, mode mark and mean mark suggested improved knowledge in students with access to podcasts compared to historical cohorts of students who did not have access to pharmacology podcasts.ConclusionsThe results of this study suggest that non-medical prescribing students utilised podcasts of pharmacology lectures, and have found the availability of these podcasts helpful for their learning. Exam results indicate that the availability of podcasts was also associated with improved exam performance.

Evaluating the learning experience of non medical prescribing students with their designated medical practitioners in their period of learning in practice: Results of a survey

To evaluate the learning experience of non medical prescribing (NMP) students during their period of learning in practice and to explore strategies for improvement. A self-administered questionnaire was used to collect data from two consecutive NMP student cohorts. Of 57 NMP students, the majority (64.9%) worked in primary care setting. In contrast to those from primary care setting, the students working in secondary/tertiary care setting had significantly greater chance of knowing their designated medical practitioner (DMP) prior to starting their course (p=0.044). However, this did not influence whether the student did a learning agreement and time schedule agreement with the DMP at the beginning of practice setting. A learning agreement and time schedule was done by 91.2% and 57.9% students, respectively, at beginning of the course. Prior time schedule agreement was a significant determinant in determining the number of hours that student spent subsequently under direct supervision of DMP: 75.8% of those who did a prior time schedule spent >30% of practice hours under the direct supervision of DMP as compared to only 50% of those who did not. Spending >30% of the practice hours under direct supervision of the DMP was significantly associated with student satisfaction (p=0.025). There was greater likelihood of a student being assessed formatively if a prior learning agreement had been done (p=0.035) resulting in increased student satisfaction. Time and workload constraints, organisational issues and peer support emerged as barriers to student learning. Students commented on difficulties in getting doctors as a DMP; and therefore suggested that learning experience can be enhanced if a qualified practicing Non Medical Prescriber could act as a "co-mentor". There were also suggestions of providing incentives to doctors and giving them more information about the role of NMP to encourage more doctors to act as DMP. Learning agreement and a time schedule with DMP at the beginning of the supervised period in practice significantly improved the students' learning experience, and was a major determinant of subsequent student satisfaction. Those who spent at least 30% of practice development time under direct supervision of their DMP were likely to be more satisfied with the learning process.