Introducing nurse prescribing in Gibraltar: the impact on palliative care
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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