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Registered nurses’ perceptions of their professional role in medication in elderly care
Örebro University, School of Health and Medical Sciences. (Family Medicine Research Centre, Örebro, and National Board of Health and Welfare, Regional Supervisory Unit Central, Örebro, Sweden)
Örebro University, School of Health and Medical Sciences. (Family Medicine Research Centre, Örebro, Sweden)ORCID iD: 0000-0002-5316-0492
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-9209-5179
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The role of the municipal registered nurse (RN) is rarely discussed with regard to multimedication. The aim of this study was to describe RNs’ perceptions of their professional role especially regarding medication management in elderly care. The study is descriptive with a qualitative approach. Interviews with 16 RNs at nursing homes for the elderly were analysed. The RNs described an undefined profession lacking leadership. The findings can be categorized into seven roles showing different aspects of their work: controller, executer, messenger, supervisor, initiator, visionary and solitary worker. Health assessment and medication management should be promoted in elderly care. There must be sufficient and adequate reporting based on the RNs’ nursing and medical skills to monitor and evaluate the drug treatment in teamwork with the physician. This requires leadership with understanding of the integration process in care of the elderly, of the medical processes and nursing skills involved.

Keywords [en]
collaboration, elderly, medication management and quality, multi-medication, nursing process
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-20728OAI: oai:DiVA.org:oru-20728DiVA, id: diva2:474098
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-10-17Bibliographically approved
In thesis
1. Rational drug treatment in the elderly: "To treat or not to treat"
Open this publication in new window or tab >>Rational drug treatment in the elderly: "To treat or not to treat"
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to examine the effect of interventions on the usage of inappropriate and hazardous multi-medication in the elderly ≥75 years with ≥5 drugs.

Methods: Paper I describes a cluster randomization of nursing homes, the outcomes were; number of drugs, health status and evaluations. A randomized controlled trial concerning elderly in ordinary homes was performed in paper II and the outcomes were; EQ-5D index, EQ VAS and prescription quality. In paper III a cohort study was carried out and the outcomes were; medication appropriateness index, EQ-5D index and EQ VAS. In paper IV, registered nurses from the nursing homes study were interviewed in a descriptive study with a qualitative approach.

Results:There was a significant reduction of number of drugs used per patient at the intervention nursing homes (p<0.05). Monitoring and evaluation of medications were significantly more frequent at the intervention homes (p<0.01). The registered nurses at the nursing homes described a self-made role in their profession and the leadership was not at sight. Drug treatment seems to be a passive process without own reflection. Extreme polypharmacy was persistent in all three groups of elderly living in ordinary homes and there was an unchanged frequency of drug-risk indicators. In the cohort study a lower medication quality was shown to be associated with a lower quality of life. EQ-5D index was statistically significantly different among the groups as was EQ VAS.

Conclusion: The nursing home study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. More attention must be focused on the complexity of the nursing process; medication management must be promoted in teamwork with the physician. The resistance to change prescriptions in accordance with the intervention underlines the need of new strategies for improving prescription quality. Since medication quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment in shared decision with the patient.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 84
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 64
Keywords
Elderly, polypharmacy, drug evaluation, nursing process, monitoring, inappropriate prescribing, quality of life, patient participation
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-20618 (URN)978-91-7668-843-4 (ISBN)
Public defence
2012-02-03, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-12-22 Created: 2011-12-22 Last updated: 2017-10-17Bibliographically approved

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Nordin Olsson, IngerWätterbjörk, IngerBlomberg, Karin

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