An exploration of the practices of nurse prescribers who care for people with diabetes: a case study

Aim. To explore the practices of nurse prescribers who care for people with diabetes. Background. The use of medicines is an important component of the care of patients with diabetes. However, education and support is equally important to the successful management of this group. These are areas of care in which nurses have traditionally been involved. Evidence suggests that combining nursing skills with prescribing may result in shared decision-making and increased medicines concordance. Design and methods. A collective case study of nine practice settings across England in which nurses prescribed medicines for people with diabetes. Data comprised of semi structured interviews (n = 31), patient questionnaires (n = 131) and video-taped observations of nurse consultations (n = 35). Data analysis included thematic analysis and descriptive statistics. Data were collected between October 2007–September 2008. Results. Nurses demonstrated good communication skills, which they integrated with the ability to prescribe. Questionnaire and video data confirmed an exchange of information between nurse and patient about aspects of self-care and medicines management. Additional benefits included improved efficiency, supported by patient satisfaction with access and waiting times. Nurses were inconsistent in explaining the risks and benefits of treatments and side-effects and exploring the use of non-prescribed herbal or over-the-counter medicine. Conclusion. The care nurses are able to provide to people with diabetes is optimised through prescribing. Further evidence is required to evaluate nurse prescribing from the patient’s perspective. Our findings will be of interest to those keen to develop the prescribing role for nurses involved in diabetes service delivery. Relevance to clinical practice. Prescribing is a valuable development through which nurses are able to encourage self-care and work towards shared-decision making with patients in a way that supports national guidance on the care of people with diabetes