The Role of the Registered Nurse Managing Pro Re Nata (PRN) Medicines in the Care Home (Nursing): a Case Study of Decision-Making, Medication Management and Resident Involvement

The aim of this study was to analyse the role of the registered nurse in the management of pro re nata (PRN) medication in a care home (nursing) for older people. Studying PRN medication provides insights into the role of the nurse in care homes (nursing) who act as assessor, decision maker and evaluator in residents’ care. It also provides a lens by which to explore how residents and their carers interact and participate in day-to-day care decisions about residents’ health. The case study draws on ethnography. It is a multi-method study, using documentary and medication reviews, observations and interviews to answer the research questions. Thirty-four residents were recruited to the study and 60 care home staff. Findings showed that 88.2% of residents (n=30) were prescribed PRN medication and that all residents were on a minimum of 1 and a maximum of 7 medication. During each 28-day MAR sheet period between 35 and 44 PRN prescriptions were written. They contributed 12.7% of all medication prescribed, accounting for between 1.2 and 1.5 medication per resident. Nurses were found to administer PRN medication, but a finding of this study was that this activity could be delegated to carers who were identifying resident needs. There was some evidence of resident engagement but this was often a three-way process between resident, GP and family or resident, carer and nurse. A percentage of medication that could have been PRN were routinely prescribed. Observations also identified that nurses would decide not to administer routine medication in certain circumstances and that this was directly related to their assessment of the resident. The process of medication management was dominated by the regulations and governance processes of the care home. Observations and interviews found that care home staff recognised and affirmed residents’ pain but did not take action for analgesia to be administered. They were familiar with the use of pain assessment tools for older people living with dementia and had received training in dementia care. Many of the staff were also able to interpret signs and symptoms of a resident’s distress. Nevertheless, their preoccupation with meeting internal and external regulator standards was a barrier to addressing residents’ needs. This is the first study that has looked at an aspect of medication management to understand how nurses and care home staff work for and with residents to moderate and address their health care needs. It suggests that additional training in aspects of medication management and resident assessment may not be able to address deeper seated issues of autonomy and how the nursing role is understood and enacted in care home settings

Evaluation of the Scottish Prison Service Transitional Care Initiative: Interim Findings - Client Interviews and Monitoring Data

This is the fourth in a series of reports on the evaluation of the Scottish Prison Service Transitional Care arrangements. The first report provided information about the Transitional Care service, and described the views of staff providing the service. The second report presented early results of 4 month post-release interviews with ex-prisoners who had initially agreed to take up the offer of Transitional Care. The third report presented the results from a larger sample of ex-prisoners interviewed 4 months post-release and the early results from ex-prisoners surveyed 7 months post-release. This report summarises the key findings from the completed survey of exprisoners 4 and 7 months after release and an analysis of Transitional Care monitoring data. The final report will be published in the autumn of 2005

Evaluation of the Reducing Reoffending Change Fund

The aim of this evaluation was to assess the extent to which the Public Social Partnerships model delivers effective mentoring services that reduce the risk of reoffending. It was carried out by Ciaran Mulholland, Jane Eunson, Lorraine Murray and Louise Bowen (Ipsos MORI Scotland) in collaboration with Professor Gill McIvor, Dr Margaret Malloch, Professor Bill Whyte, Dr Steve Kirkwood and Professor Fergus McNeill

Evaluation of the Scottish Prison Service Transitional Care Initiative: Interim Findings - Four Month & Seven Month Client Interviews

This is the third in a series of reports on the evaluation of the Scottish Prison Service Transitional Care arrangements. The first report provided information about the Transitional Care service and described the views of staff providing the service. The second report presented early results of 4 month post-release interviews with ex-prisoners who had initially agreed to take up the offer of Transitional Care. This third report presents the results from a larger sample of ex-prisoners interviewed 4 months post-release and the early results from ex-prisoners surveyed 7 months post-release. It is important to point out, however, that these findings are based on small numbers. Further, the data has not yet been linked to other contextual data and so does not differentiate between sub-categories of respondent (e.g. in terms of previous level of substance use, age, sex, length of sentence etc). The final report will be published in the Autumn of 2005