Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses’ responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses’ level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86–97%), patient education (85–96%), medication safety (83–95%), monitoring adherence (82–97%), care coordination (82–95%), and drug monitoring (78–96%). The most prevalent level of responsibility was ‘with shared responsibility’. Prescription management tasks were considered to be nurses’ responsibility by 48–81% of the professionals. All contextual factors were indicated as being relevant for nurses’ role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks.
BackgroundInterprofessional collaborative practices (IPCP) are considered to be a crucial factor in the optimal support of young children (3–6 years) with speech, language and communication needs (SLCN) in inclusive early childhood education and care (ECEC).AimsTo investigate IPCP in interventions using a collaborative approach for young children with SLCN in ECEC, by identifying mechanisms within IPCP and how these mechanisms relate to specific context factors and professional and child-related outcomes.MethodsA realist review of 22 empirical intervention studies, published between 1994 and 2019, was conducted to synthesise context-mechanism-outcome (CMO) configurations, combining context factors, IPCP mechanisms and outcomes at staff and child level.Main ContributionReciprocal IPCP mechanisms were reported together with interprofessional intervention practices, whereas one-directional IPCP mechanisms were restricted to gains in professional development. Our review further suggests that collective ownership of intervention goals, combined with personal cooperation and communication skills of staff, is vital for inclusive practices and functional communication of children with SLCN.ConclusionOur review has revealed indications for effective IPCP mechanisms, context factors at staff level, and positive outcomes for the professional development of staff working with children with SLCN. In addition, our findings support a link between IPCP and child-related outcomes regarding speech, language and communication development. Future studies should increase our insight into how practitioners, children and families profit from daily collaborative practices.WHAT THIS PAPER ADDSWhat is already known on this subjectInterventions using a collaborative approach for young children (3-6 years) with SLCN in ECEC are considered to be part of the optimal support of these children.What this paper adds to existing knowledgeConducting a realist review of 22 empirical studies on collaborative intervention offered the possibility to identify specific context factors, IPCP mechanisms and professional and child-related outcomes and to synthesise CMO configuations. Findings suggest multiple routes from effective delivery of SLCN services to improvement of speech, language and communication development, supporting the suggested beneficial function of collaboration between multiple professions. Collective ownership of intervention goals, combined with personal cooperation and communication skills of staff, seems to be vital for inclusive practices and functional communication of children with SLCN. Reciprocal IPCP mechanisms were reported together with interprofessional intervention practices, whereas one-directional IPCP mechanisms were restricted to gains in professional development.What are the potential or actual clinical implications of this work?High-quality collaborative intervention for children with SLCN in requires awareness of and critical reflection on IPCP mechanisms in order to improve outcomes for both professionals and children. Both, institutional structural support and individual communicative and cooperative skills are required to increase interprofessional collaboration with the aim to meet the needs of every individual child with SLCN.
Background: Nurses play an important role in pharmaceutical care. They are involved in: detecting clinical change; communicating/discussing pharmacotherapy with patients, their advocates, and other healthcare professionals; proposing and implementing medication-related interventions; and ensuring follow-up of patients and medication regimens. To date, a framework of nurses' competences on knowledge, skills, and attitudes as to interprofessional pharmaceutical care tasks is missing. Objectives: To reach agreement with experts about nurses' competences for tasks in interprofessional pharmaceutical care. Methods: A two-phase study starting with a scoping review followed by five Delphi rounds was performed. Competences extracted from the literature were assessed by an expert panel on relevance by using the RAND/UCLA method. The experts (n = 22) involved were healthcare professionals, nurse researchers, and educators from 14 European countries with a specific interest in nurses' roles in interprofessional pharmaceutical care. Descriptive statistics supported the data analysis. Results: The expert panel reached consensus on the relevance of 60 competences for 22 nursing tasks. Forty-one competences were related to 15 generic nursing tasks and 33 competences were related to seven specific nursing tasks. Conclusions: This study resulted in a competence framework for competency-based nurse education. Future research should focus on imbedding these competences in nurse education. A structured instrument should be developed to assess students' readiness to achieve competence in interprofessional pharmaceutical care in clinical practice.
