NURSING DIAGNOSES

Nursing Diagnoses

Nursing Diagnoses

1. Introduction

Current health care policies and the changing context of health care, driven by social and demographic changes, highlight the importance of nurses' role in providing education to the users of health care services about prescribed medicines. Social, demographic and health care trends include an increasing elderly population, a rise in long-term health problems requiring continuous medication regimes, and faster patient throughput in the acute sector, resulting in an increase in self care in the community, including the successful management of medication. Such changes are outlined in the recent UK Government policy document Making A Difference (DH, 1999a) which calls for a strategy to help nurses, midwives and health visitors:

Respond to changes in society and in patterns of disease, to the possibilities created by developments in pharmaceuticals and technology, to increasing public expectations and to a challenging new policy agenda (DH, 1999, p. 7)

In the UK, the emphasis on health promotion and disease prevention outlined in The Health of the Nation (DH, 1992) and more recently re-iterated in the White Paper Saving Lives: Our Healthier Nation (DH, 1999b) also points to the need for nurses to recognise the importance of information and education about medication as one facet of their health promotion role.

The requirement for health care professionals to base such practice on the best possible available evidence is also clear. Nurses need to be using evidence about what constitutes effective medication education in order to inform their interactions with patients1 and to maximise their clinical effectiveness in this role. Patients also have a right to be informed about the evidence for the efficacy of the treatment options offered. Entwistle et al. (1998) refer to this as 'evidence-informed patient choice' and suggest that this involves giving research-based information about the effectiveness (likely outcomes, both benefits and risks) of alternative interventions, including the option of no intervention.

A re-examination of traditional health care professional role boundaries is also revolutionalising current patterns of service delivery and this too highlights the significance of nurses' potential contribution to medication education. The drive to provide care that is patient-focused, flexible, accessible and responsive to need has led to the creation of more autonomous and extended roles for nurses. Furthermore, the introduction of nurse prescribing in the UK is also a reflection of this trend, and clearly places nurses in a front-line position for the provision of medication education.

Enhancing patients' ability to make informed choices and to administer medication effectively may result in significant benefits for both the health service and the individuals concerned. For the health service, ineffective medication management has financial implications in terms of unnecessary treatment episodes within both primary and secondary care settings. For example, in the USA, Merkatz and Conig (1992) have estimated that 10% of hospital re-admissions and 23% of nursing home admissions were related to elderly patients' inability to administer their prescribed medicines according to instructions. For individuals, their quality of life will also be influenced: informed, safe administration of medication not only reduces symptoms of illness, ...