What are the views and experiences of professional stakeholders about non-medical prescribing in the local chemotherapy clinic?

Abstract

The recent introduction of open formulary non-medical prescribing has created opportunities to radically change health care delivery. This thesis is the first of its kind to document the process of undertaking an examination of NMP in a chemotherapy setting. A purposeful sample of 23 stakeholders connected with the chemotherapy service in a local cancer setting was used including 12 doctors, 5 nurses, 4 pharmacists and 4 managers. A serial data collection technique with individual interviews followed by uni professional focus groups was adopted. Finally a multi professional focus group was held to determine the strategic way forward. A systematic qualitative data management package -NUDIST was used to code and theme data and this data was used as the basis for discussion.

This thesis offers an insight into the working of the multidisciplinary team in relation to NMP. It establishes the concerns and issues of the professional stakeholders as well as areas of concurrence. It charts the complexities and difficulties faced when shifting responsibilities of professionals. It has used a novel approach to engage with stakeholders from within the day to day practices of the clinic and developed a framework for monitoring agreed progress. An action oriented approach was inherent to the study and dovetailed to understand the service and concurrently create an opportunity for development. Through its insider perspective it has highlighted the complexes of changing practice and attempted to move forward using a negotiation process. The study illuminated the key features necessary to maximise success of NMP in chemotherapy clinics and captures the importance of good working relationships. Whilst different models of nurse-led practice will emerge, fundamental and core to services is the need for good team working, established and effective communication strategies and perhaps most importantly avoiding isolation in practice. This study additionally reinforced that any evaluation takes place within pre- existing political contexts and in particular medical dominance. Not all medical colleagues agreed with or wanted NMP for their patients highlighting difficulties of developing new models of working within a resisting culture. Medical dominance should be acknowledged and strategies developed to work within this dominance to ensure the unique contribution of nursing is valued and seen. Insights from this study raise the need for further research and exploration of the usefulness and acceptability of NMP in chemotherapy.

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Identifiers

ORCID for Sue Latter: orcid.org/0000-0003-0973-0512

ORCID for Claire Foster: orcid.org/0000-0002-4703-8378

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