References

Atlas of palliative care in Europe 2019. 2019. https://dadun.unav.edu/handle/10171/56787 (accessed 24 January 2022)

Avery AJ, Pringle M. Extended prescribing by UK nurses and pharmacists. BMJ. 2005; 331:(7526)1154-1155 https://doi.org/10.1136/bmj.331.7526.1154

Broad JB, Gott M, Kim H, Boyd M, Chen H, Connolly MJ. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health. 2013; 58:(2)257-67 https://doi.org/10.1007/s00038-012-0394-5

Cannaby AM, Carter V, Rolland P, Finn A, Owen J. The scope and variance of clinical nurse specialist job descriptions. Br J Nurs. 2020; 29:(11)606-611 https://doi.org/10.12968/bjon.2020.29.11.606

Care Quality Commission. GP mythbuster 66:advanced nurse practitioners (ANPs) in primary care. 2021. https://tinyurl.com/4fnxcr6w (accessed 24 January 2022)

Carey N, Stenner K, Courtenay M. An exploration of how nurse prescribing is being used for patients with respiratory conditions across the east of England. BMC Health Serv Res. 2014; 14 https://doi.org/10.1186/1472-6963-14-27

Clegg A, Meades R, Broderick W. Reflections on nurse independent prescribing in the hospital setting. Nurs Stand. 2006; 21:(12)35-8 https://doi.org/10.7748/ns2006.11.21.12.35.c6385

Overcoming the barriers of non-medical prescribing in palliative care to improve patients' care experience. 2015. https://tinyurl.com/5n8wus3e (accessed 24 January 2022)

Cooper RJ, Bissell P, Ward P Further challenges to medical dominance? The case of nurse and pharmacist supplementary prescribing. Health (London). 2012; 16:(2)115-133 https://doi.org/10.1177/1363459310364159

Cope LC, Abuzour AS, Tully MP. Nonmedical prescribing: where are we now?. Ther Adv Drug Saf. 2016; 7:(4)165-172 https://doi.org/10.1177/2042098616646726

Courtenay M, Berry D. Comparing nurses' and doctors' views of nurse prescribing: a questionnaire survey. Nurse Prescribing. 2007; 5:(5)205-210 https://doi.org/10.12968/npre.2007.5.5.23740

Courtenay M, Carey N, Stenner K. An overview of non medical prescribing across one strategic health authority: a questionnaire survey. BMC Health Serv Res. 2012; 12:(1) https://doi.org/10.1186/1472-6963-12-138

Creedon R, Byrne S, Kennedy J, McCarthy S. The impact of nurse prescribing on the clinical setting. Br J Nurs. 2015; 24:(17)878-885 https://doi.org/10.12968/bjon.2015.24.17.878

Compassion in practice: Nursing, midwifery and care staff, our vision and strategy. 2012. https://tinyurl.com/5n7yyw5k (accessed 24 January 2022)

Davies N, Maio L, Vedavanam K, Manthorpe J, Vernooij-Dassen M, Iliffe S Barriers to the provision of high-quality palliative care for people with dementia in England: a qualitative study of professionals' experiences. Health Soc Care Community. 2014; 22:(4)386-94 https://doi.org/10.1111/hsc.12094

Dawson S. Independent non-medical prescribing in a nurse-led hospice: strengths and challenges. Journal of Prescribing Practice. 2020; 2:(8)434-439 https://doi.org/10.12968/jprp.2020.2.8.434

Department of Health. End of life care strategy. 2008. https://tinyurl.com/27667vv2 (accessed 24 January 2022)

Dowden A. Improving the efficiency of out-of-hours prescribing. Prescriber. 2016; 27:(9)28-34 https://doi.org/10.1002/psb.1497

Fisher R. Nurse prescribing: a vehicle for improved collaboration, or a stumbling block to inter-professional working?. Int J Nurs Pract. 2010; 16:(6)579-585 https://doi.org/10.1111/j.1440-172X.2010.01884.x

Graham-Clarke E, Rushton A, Noblet T, Marriott J. Facilitators and barriers to non-medical prescribing: a systematic review and thematic synthesis. PLoS One. 2018; 13:(4) https://doi.org/10.1371/journal.pone.0196471

Hall S, Thompson J, Phair T, Davies AN. Clinical nurse specialist prescribing in a cancer centre supportive and palliative care team. BMJ Support Palliat Care. 2020; 10:(1)111-113 https://doi.org/10.1136/bmjspcare-2019-001867

Health Education England, NHS England, Skills for Health. Core capabilities framework for advanced clinical practice (nurses) working in general practice/primary care in England. 2020. https://tinyurl.com/32wzxtsj (accessed 25 January 2022)

Hoare S, Morris ZS, Kelly MP, Kuhn I, Barclay S. Do patients want to die at home? A systematic review of the UK literature, focused on missing preferences for place of death. PLoS One. 2015; 10:(11) https://doi.org/10.1371/journal.pone.0142723

Hospice UK. Future needs and preferences for hospice care: challenges and opportunities for hospices. 2013. https://tinyurl.com/5xr8ja44 (accessed 25 January 2022)

Kroezen M, Mistiaen P, van Dijk L, Groenewegen PP, Francke AL. Negotiating jurisdiction in the workplace: a multiple-case study of nurse prescribing in hospital settings. Soc Sci Med. 2014; 117:107-115 https://doi.org/10.1016/j.socscimed.2014.07.042

Khalil H, Downie A, Ristevski E. Mapping palliative and end of care research in Australia (2000-2018). Palliat Support Care. 2020; 18:(6)713-721 https://doi.org/10.1017/S1478951519001111

Latham K, Nyatanga B. Community palliative care clinical nurse specialists as independent prescribers: part 2. Br J Community Nurs. 2018; 2:(3)126-133 https://doi.org/10.12968/bjcn.2018.23.3.126

Latter S, Campling N, Birtwistle J Supporting patient access to medicines in community palliative care: on-line survey of health professionals' practice, perceived effectiveness and influencing factors. BMC Palliat Care. 2020; 19:(1) https://doi.org/10.1186/s12904-020-00649-3

Leadership Alliance for the Care of Dying People. One chance to get it right. Improving people's experience of care in the last few days and hours of life. 2014. https://tinyurl.com/287uer2n (accessed 25 January 2022)

Lennon R, Fallon A. The experiences of being a registered nurse prescriber within an acute service setting. J Clin Nurs. 2018; 27:(3-4)e523-e534 https://doi.org/10.1111/jocn.14087

Lim AG, North N, Shaw J. Navigating professional and prescribing boundaries: implementing nurse prescribing in New Zealand. Nurse Educ Pract. 2017; 27:(27)1-6 https://doi.org/10.1016/j.nepr.2017.08.009

Lockwood EB, Fealy GM. Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists. J Nurs Manag. 2008; 16:(7)813-820 https://doi.org/10.1111/j.1365-2934.2008.00853.x

Maltoni M. Opioids, pain, and fear. Ann Oncol. 2008; 19:(1)5-7 https://doi.org/10.1093/annonc/mdm555

McBrien B. Personal and professional challenges of nurse prescribing in Ireland. Br J Nurs. 2015; 24:(10)524-8 https://doi.org/10.12968/bjon.2015.24.10.524

McCance T, Telford L, Wilson J, Macleod O, Dowd A. Identifying key performance indicators for nursing and midwifery care using a consensus approach. J Clin Nurs. 2012; 21:(7-8)1145-54 https://doi.org/10.1111/j.1365-2702.2011.03820.x

McGleish E, Sivell S, Nelson A. The potential for nurse independent prescribing by the clinical nurse specialist in palliative care in the community; attitudes and experiences of general practitioners. BMJ Supportive & Palliative Care. 2015; 5 https://doi.org/10.1136/bmjspcare-2014-000838.11

National Institute for Health and Care Excellence. Care of dying adults in the last days of life. Quality standard QS144. Quality statement 3: anticipatory prescribing. 2017. https://www.nice.org.uk/guidance/qs144/chapter/quality-statement-3-anticipatory-prescribing (accessed 25 January 2022)

National Institute for Health and Care Excellence. Palliative care—general issues. Clinical knowledge summary. 2021. https://cks.nice.org.uk/topics/palliative-care-general-issues/ (accessed 25 January 2022)

National Palliative and End of Life Care Partnership. Ambitions for palliative and end of life care: a national framework for local action 2015-2020. 2015. https://tinyurl.com/2p8mw9ph (accessed 25 January 2022)

NHS Scotland. Scottish palliative care guidelines. 2014. https://tinyurl.com/mrxpm262 (accessed 25 January 2022)

Nursing and Midwifery Council. Standards of proficiency for nurse and midwife prescribers. 2006. https://tinyurl.com/yhevmhcm (accessed 25 January 2022)

O'Brien T, Christrup LL, Drewes AM European Pain Federation position paper on appropriate opioid use in chronic pain management. Eur J Pain. 2017; 21:(1)3-19 https://doi.org/10.1002/ejp.970

Quinn B, Lawrie I. Developing nurse independent prescribing in a specialist palliative care setting. Int J Palliat Nurs. 2010; 16:(8)401-405 https://doi.org/10.12968/ijpn.2010.16.8.401

Ross JD. Mental health nurse prescribing: the emerging impact. J Psychiatr Ment Health Nurs. 2015; 22:(7)529-542 https://doi.org/10.1111/jpm.12207

Royal College of Nursing. RCN fact sheet. Nurse prescribing in the UK. 2014. https://tinyurl.com/2p8bnyn6 (accessed 25 January 2022)

Royal College of Nursing. Royal College of Nursing standards for advanced level nursing practice. 2018. https://tinyurl.com/fx6khs73 (accessed 25 January 2022)

Royal Pharmaceutical Society. A competency framework for all prescribers. 2016. https://tinyurl.com/2p9rm5m5 (accessed 25 January 2022)

Ryan-Woolley BM, McHugh GA, Luker KA. Prescribing by specialist nurses in cancer and palliative care: results of a national survey. Palliat Med. 2007; 21:(4)273-277 https://doi.org/10.1177/0269216307079047

Salamanca-Balen N, Seymour J, Caswell G, Whynes D, Tod A. The costs, resource use and cost-effectiveness of clinical nurse specialist-led interventions for patients with palliative care needs: a systematic review of international evidence. Palliat Med. 2018; 32:(2)447-465 https://doi.org/10.1177/0269216317711570

Saunders C. Watch with me: inspiration for a life in hospice care.Lancaster: Observatory Publications; 2003

Scrafton J, McKinnon J, Kane R. Exploring nurses' experiences of prescribing in secondary care: informing future education and practice. J Clin Nurs. 2012; 21:(13-14)2044-2053 https://doi.org/10.1111/j.1365-2702.2011.04050.x

British Social Attitudes Survey. Dying: discussing and planning for end of life. 2013. https://www.bsa.natcen.ac.uk/media/38850/bsa_30_dying.pdf (accessed 25 January 2022)

Sleeman KE, Davies JM, Verne J, Gao W, Higginson IJ. The changing demographics of inpatient hospice death: population-based cross-sectional study in England, 1993-2012. Palliat Med. 2016; 30:(1)45-53 https://doi.org/10.1177/0269216315585064

Stenner K, Courtenay M. Benefits of nurse prescribing for patients in pain: nurses' views. J Adv Nurs. 2008; 63:(1)27-35 https://doi.org/10.1111/j.1365-2648.2008.04644.x

Stenner K, Carey N, Courtenay M. How nurse prescribing influences the role of nursing. Nurse Prescribing. 2010; 8:(1)29-34 https://doi.org/10.12968/npre.2010.8.1.46022

Briefing: emergency hospital admissions in England: which may be avoidable and how?. 2018. https://tinyurl.com/2p88pbvu (accessed 25 January 2022)

Visser C, Hadley G, Wee B. Reality of evidence-based practice in palliative care. Cancer Biol Med. 2015; 12:(3)193-200 https://doi.org/10.7497/j.issn.2095-3941.2015.0041

Woo JA, Maytal G, Stern TA. Clinical challenges to the delivery of end-of-life care. Prim Care Companion J Clin Psychiatry. 2006; 8:(6)367-372

Ziegler L, Bennett M, Blenkinsopp A, Coppock S. Non-medical prescribing in palliative care: a regional survey. Palliat Med. 2015; 29:(2)177-181 https://doi.org/10.1177/0269216314557346

Introducing nurse prescribing in Gibraltar: the impact on palliative care

10 February 2022
13 min read
Volume 31 · Issue 3

Abstract

This article critically explores the impact of the introduction of nurse prescribing on palliative care in Gibraltar. A preliminary audit review of the prescriptions issued by the two palliative independent nurse prescribers over their first full calendar year of prescribing (2020) revealed two primary areas of impact: facilitating end-of-life care at home and improving anticipatory prescribing for end-of-life symptom management. These initial findings will be discussed in the context of the challenges and facilitators encountered during the first year of prescribing practice. Challenges were primarily related to the introduction of an advanced nursing role into an existing medical paradigm. Identified facilitators included comprehensive record keeping, collaborative working and the development of local guidelines, as well as the support of management and peers. The article concludes with a recommendation for further audits of prescribing data as a way to measure the impact of the new role and to inform future palliative service development.

As a British overseas territory, Gibraltar enjoys a unique position in Europe. Healthcare services are provided by the Gibraltar Health Authority (GHA) to approximately 35 000 residents and the healthcare model is closely based on that of the UK. In Gibraltar, as in the rest of the world, there is little consensus on the definition or scope of the specialist nurse (Cannaby et al, 2020). However, the authors' current palliative nurse specialist role may be comparable with that of a nurse practitioner role in the UK, which is defined by meeting four pillars of advanced competence and practice: clinical practice, leadership and management, education and research (Royal College of Nursing (RCN), 2018; Health Education England et al, 2020; Care Quality Commission, 2021). The two palliative nurse specialists employed by the GHA cover both acute and community sectors and practise with no palliative consultant input, although a part-time palliative doctor joined the team towards the end of the first year of independent nurse prescribing.

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