Comment letters to the National Commission on Commission on Fraudulent Financial Reporting, 1987 (Treadway Commission) Vol. 1

https://egrove.olemiss.edu/aicpa_sop/1661/thumbnail.jp

A training package for primary care nurses in conducting medication reviews: Their views and the resultant outputs

Aims. To ascertain nurses' views about training in and undertaking of medication reviews and to analyse documented pharmaceutical care issues (PCI) and outputs from nurse reviews. Background. Primary-care nurses in the UK are increasingly expected to contribute effectively to chronic disease management for example by undertaking medication reviews. There are concerns that nurse education is inadequate for these new roles. Little research is published about nurse medication reviews. A pilot study in one Scottish medical practice demonstrated that, after training in systematic medication review, practice-based nurses could identify medication-related problems. The training, consisting of reading material, including self-assessment questions and a training event, was subsequently offered to all practice-based nurses in the Community Health Partnership (CHP); participants then undertook six reviews to achieve CHP accreditation. Design. Survey of participant nurses and analysis of completed documentation from reviews. Methods. A self-completion, postal questionnaire distributed three months post-training. Analysis of documentation from reviews for PCI and outputs. Results. Eighty-one nurses were offered training: 64 (79%) participated; 38 (59%) returned questionnaires. Low confidence levels before training (0, very confident; 6, 16% confident) rose afterwards (8, 21% very confident; 19, 50% confident). Thirty-two (84%) nurses indicated the training had completely or mostly met their needs. A total of 120 nurse reviews were analysed and 188 PCI documented, mean 1·6/patient, with 117 outputs, mean 1·0/patient. Twenty-seven outputs (23%) involved prescribed medicine changes. Conclusions. A pharmacist-supported training package in medication reviews for primary-care nurses is feasible and generally welcome. The training met the needs of most respondents although concerns were expressed regarding time pressures and knowledge base for extended roles. Relevance to clinical practice. Medication reviews are vitally important for both patients and the NHS; this approach may be useful for nurse prescribers and non-prescribers alike although concerns expressed will require attention

Conscientious objection to termination of pregnancy: the competing rights of patients and nurses

Aims To highlight the potential difficulties in the management of staff with a conscientious objection to abortion, in light of expanding role of nurses. Background Recent years have seen changes in the provision of abortion services. Medical procedures are now gaining popularity and some areas are seeing the integration of outpatient clinics into ward settings. This may involve nurses being required to provide care to women undergoing termination of pregnancy, which may not have previously been within their remit. This has implications for staff with a conscientious objection. Methods A review of the academic literature. Results The advent of medical abortion has led to changes in the way in which abortion services are provided which in turn has re-ignited the debate of the competing rights of nurses with a conscientious objection and those of the patient accessing abortion services. Conclusions This extended role of nurses creates challenges for staff working in clinical areas offering termination of pregnancy and these are further compounded when staff have expressed a conscientious objection to abortion. Implications for Nursing Management Managers face new challenges in achieving the fine balance between the rights of staff with a conscientious objection to abortion and women accessing abortion services