Perceptions and practice of concordance in nurses' prescribing consultations: findings from a national questionnaire survey and case studies of practice in England.
BACKGROUND
The number of nurses able to independently prescribe medicines in England is increasing. Patient adherence to prescribed medicines remains a significant problem [Department of Health, 2000. Pharmacy in the Future: Implementing the NHS Plan. A Programme for Pharmacy in the NHS. Stationary Office, London]. Concordance-a partnership approach to medicine consultations-is advocated as an effective solution [Medicines Partnership, 2003. Project Evaluation Toolkit. Medicines Partnership, London].


OBJECTIVE
To investigate whether nurses were practising the principles of concordance within their prescribing interactions.


METHODS
Phase (i) postal questionnaire survey. Phase (ii): case studies of practice.


METHODS
Phase (i) primary and secondary care trusts throughout England in which nurse prescribers were practicing. Phase (ii) six general practice settings; one community midwifery service; one specialist community palliative care service; one secondary care ophthalmology unit; one NHS walk-in centre.


METHODS
Phase (i) a random sample of 246 nurses registered as independent nurse prescribers with the Nursing and Midwifery Council in 2002/2003. Phase (ii) purposively selected sample of 14 nurse prescribers who participated in Phase (i) of the study; a total of 208 purposively selected patients completed self-administered questionnaires.


METHODS
Phase (i) postal questionnaires. Phase (ii) structured non-participant observation of 118 nurse prescribing consultations; 115 post-consultation patient questionnaires; 93-patient postal questionnaires.


RESULTS
99% of the nurses in the national survey stated they were practising the principles of concordance. The majority of patients surveyed also reported experiencing concordance in practice. Observation of practice revealed that although some principles of concordance were regularly integrated into nurses' practice, other principles were less often in evidence. Some evidence from both observation of practice and patient questionnaires suggested that a professionally determined 'compliance' agenda may still be partially operating in practice.


CONCLUSIONS
Most nurses believe they are practicing concordance in their prescribing consultations. The majority of patients also reported that they had experienced some of the principles of concordance in practice. Observation of practice highlighted that the shift from a professionally determined compliance agenda to the integration of concordance into nurses' prescribing consultations had not yet taken place.
Latter
Sue
S
School of Nursing & Midwifery, University of Southampton, Building 67, Highfield, Southampton SO17 1BJ, England. sml@soton.ac.uk
Maben
Jill
J
Myall
Michelle
M
Young
Amanda
A
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence; D003142:Communication; D003299:Cooperative Behavior; D011307:Drug Prescriptions / Q000451:nursing*; D004739:England; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D009718:Nurse Administrators / Q000193:education / Q000458:organization & administration / Q000523:psychology; D009720:Nurse Clinicians / Q000193:education / Q000458:organization & administration / Q000523:psychology; D009722:Nurse Practitioners / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D010353:Patient Education as Topic; D010358:Patient Participation / Q000379:methods* / Q000523:psychology; D010687:Philosophy, Nursing; D017009:Professional Autonomy; D020377:Self Efficacy; D011795:Surveys and Questionnaires