| PurposeThe study is the sub-topics of "study on the main body of decision-making ofclinical nursing ", in order to probe into drugs-prescription right of Chinese clinicalnurses under particular situations, looking forward to providing a theoretical basisfor prescription. At last, it aims to determine the prescription content and provide areference for government's making strategic decision.ObjectThe standard of selecting expert is:⑴Worked in his/her field with somepractical experience for more than 20 years.⑵Had the vice-senior professional titleor above.⑶Won a bachelor degree or above.⑷Willing to answer the expertenquiry questionnaire. 2 items was required among the former 3 items. 30 nursingexperts and 10 medical experts who agreed to give clinical nurses prescription rightwere selected to implement the survey. Among the objects, 34 experts engaged inwork for more than 20 years, 39 experts had the vice-senior title or above, and 40experts won the bachelor degree or above.MethodsBased on literature review, the history of British and American nurses prescriptionright and the specific content were definite. Two rounds questionnaire ondrugs-prescription right of clinical nurses under particular situations was conductedamong 30 nursing experts and 10 medical experts by adopting self-designedquestionnaire and Delphi method.Results1. In England, community practical nurses and nurse practitioners have theright of prescription. The prescription form includes independent prescribing,non-independent prescribing and supplementary prescribing.Nurse prescribers canprescribe under specific provisions and requirements, including drugs, appliancesand dressing.2. In United States, advanced practice nurses have the right of prescription.Nurse prescribers can prescribe within their practice places and field by signed anagreement with doctors, including drugs, appliances, dressing, and laboratory ordersand so on. Nursing Committee in 51 states had detailed rules on nurse prescription.3. The particular situations and prescription forms were defined by the resultsof two rounds survey. The particular situations was hold by the recognition rate>80% of medical experts and nursing experts and the prescription forms is figured according to the number of choice , if the number ratio (large: small)≥1.5 showsthat prescription form tended to the more one, or else two prescription forms close toeach other. The experts agree the following 11 particular situations of drugprescription:⑴when patients with high fever prescribing bupleurum andacetaminophen tended to nurse independent prescribing, prescribing dexamethasonetended to protocol prescribing. For infants with febrile convulsions, to prescribechloral hydrate was close of two prescriptions forms, while to prescribephenobarbital tended to protocol prescription.⑵For hypoglycemia, to prescribeglucose solution tended to nurse independent prescribing, while to prescribehydrocortisone tended to protocol prescription.⑶For hypertensive emergency,toprescribe sodium nitroprusside ,furosemide ,and magnesium sulfate tended toprotocol prescription,while to prescribe nitroglycerin was close of two prescriptionsforms.⑷For anaphylactic shock, to prescribe adrenaline, dexamethasone,diphenhydramine, calcium gluconate was close of two prescriptions forms.⑸Forasthma state, to prescribe prednisone, dexamethasone, prednisolone, Doxofyllinetended to protocol prescription, while to prescribe aminophylline, salbutamol wasclose of two prescriptions forms.⑹For acute laryngeal edema, to prescribedexamethasone was close of two prescriptions forms, while to prescribehydrocortisone tended to protocol prescription.⑺For cardiac arrest, to prescribeadrenaline was close of two prescriptions forms, while to prescribe atropine,Lidocaine tended to protocol prescription.⑻For the palliative treatment of cancerunder prolonging prescription situations (only prolong the original prescription, doesnot change the drug type and dose), to prescribe analgesic was close of twoprescriptions forms, while to prescribe antiemetic tended to nurse independentprescribing.⑼For hypertension under prolonging prescription situations, toprescribe antihypertensive drugs tended to protocol prescription.⑽Forhyperglycemic under prolonging prescription situations, to prescribe hypoglycemicagents tended to protocol prescription.⑾For hyperlipidemia under prolongingprescription situations, to prescribe lipid-lowering drugs tended to protocolprescription.ConclusiConclusionBoth nursing and medical experts recognized that to give somedrugs-prescription rights to clinical nurses under particular situations, whichincluding 11 particular situations: 7 emergency treatment (hyperthermia,hypoglycemia, hypertensive emergency, anaphylactic shock, asthma state, acute laryngeal edema, cardiac arrest), and 4 prolonging prescription (palliative treatmentfor cancer, hypertension, hyperglycemic, hyperlipidemia). |
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