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1. Medication discussion between nurse prescribers and people with diabetes: an analysis of content and participation using MEDICODE. 
Sibley A, Latter S, Richard C, Lussier MT, Roberge D, Skinner TC, Cradock S, and Zinken KM
Journal Of Advanced Nursing[J Adv Nurs] 2011 Nov; Vol. 67 (11), pp. 2323-36. Date of Electronic Publication: 2011 May 19.
Adolescent, Cross-Sectional Studies, Diabetes Mellitus drug therapy, Diabetes Mellitus epidemiology, Education, Nursing, Continuing, England epidemiology, Female, Humans, Male, Middle Aged, Nurse Practitioners, Nursing Methodology Research, Patient Education as Topic, Patient Participation, Practice Guidelines as Topic, Diabetes Mellitus nursing, Drug Prescriptions nursing, Health Knowledge, Attitudes, Practice, Nurse's Role, and Nurse-Patient Relations
Aim: This paper is a report of a study to identify the content of, and participation in, medicine discussion between nurse prescribers and people with diabetes in England.
Background: Diabetes affects 246 million people worldwide and effective management of medicines is an essential component of successful disease control. There are now over 20,000 nurse independent prescribers in the UK, many of whom frequently prescribe for people with diabetes. With this responsibility comes a challenge to effectively communicate with patients about medicines. National guidelines on medicines communication have recently been issued, but the extent to which nurse prescribers are facilitating effective medicine-taking in diabetes remains unknown.
Methods: A purposive sample of 20 nurse prescribers working with diabetes patients audio-recorded 59 of their routine consultations and a descriptive analysis was conducted using a validated coding tool: MEDICODE. Recordings were collected between January and July 2008. The unit of analysis was the medicine.
Results: A total of 260 instances of medicine discussion identified in the audio-recordings were analysed. The most frequently raised themes were 'medication named' (raised in 88·8% of medicines), 'usage of medication' (65·4%) and 'instructions for taking medication' (48·5%). 'Reasons for medication' (8·5%) and 'concerns about medication' were infrequently discussed (2·7%). Measures of consultation participation suggest largely dyadic medicine discussion initiated by nurse prescribers.
Conclusion: MEDICODE discussion themes linked to principles of recent guidelines for effective medicine-taking were infrequently raised. Medicine discussion was characterized by a one statement-one response style of communication led by nurses. Professional development is required to support theoretically informed approaches to effective medicines management.
(© 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.)
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2. The impact of an intervention for nurse prescribers on consultations to promote patient medicine-taking in diabetes: A mixed methods study 
Latter, Sue, Sibley, Andrew, Skinner, Timothy C., Cradock, Sue, Zinken, Katarzyna M., Lussier, Marie-Therese, Richard, Claude, and Roberge, Denis
International Journal of Nursing Studies. Sep2010, Vol. 47 Issue 9, p1126-1138. 13p.
PATIENT compliance, NURSE-patient relations, DIABETICS, HEALTH, NURSES, MEDICAL communication -- Research, HEALTH education, HEALTH self-care, ATTITUDES toward health, ANALYSIS of variance, CHI-squared test, COMMUNICATION, CONCEPTUAL structures (Information theory), DRUGS, INTERVIEWING, RESEARCH methodology, NURSE practitioners, NURSES' attitudes, RESEARCH funding, INDUSTRIAL research, SELF-efficacy, SOUND recordings, ADULT education workshops, JUDGMENT sampling, SOCIAL learning theory (Communication), THEMATIC analysis, INTER-observer reliability, PATIENT-centered care, RESEARCH methodology evaluation, and RESEARCH evaluation
Abstract: Background: Nurse prescribers are in a key position to promote medicine-taking in diabetes. Although patients’ beliefs about medicines are important predictors of medicine-taking, evidence suggests nurses do not routinely explore these. Objectives: To evaluate a theory-based intervention designed to increase nurse prescribers’ exploration of medicines’ beliefs with people with diabetes. Design: Mixed methods concurrent triangulation design. Settings: Nurse prescribers were recruited from 7 Trusts in England. Participants: A purposive sample of 14 nurse prescribers attended four 1 day workshops. Methods: Audio-recordings of each nurse prescribers’ consultations with diabetes patients were collected at baseline, 1 week, 3 months and 6 months after the intervention. Nurse prescribers were interviewed at 1 month and 6 months post-intervention. Changes in medicines’ discussion and participation in consultations were analysed using MEDICODE. Interview data were analysed using Framework Analysis. Results: MEDICODE themes of ‘attitudes towards medication’ showed a significant rise at 1 week (p <0.01) and 3 months (p <0.05). ‘Asks patient opinion about medication’ significantly increased at 1 week (p <0.01). Discussion on ‘concerns about medication’ rose significantly at 1 week (p <0.001) and 6 months (p <0.01). Discussion on ‘expected effects of medication’, ‘action of medication’ and ‘reasons for medication’ showed no change. There were no significant changes in Dialogue Ratio. However, the Preponderance of Initiative moved towards more patient initiative at 1 week (p <0.0001), 3 months (p <0.0001), and 6 months (p <0.0001). In interviews, nurses reported increased attention to patients’ medication beliefs and adoption of patient-centred skills. Contextual factors that positively influenced ability to explore medicines beliefs in practice settings were: support of colleagues and practicing new skills. Inhibiting factors included: patients’ perceived lack of receptivity, time constraints, and concerns about opening a ‘can of worms’. Six months interviews revealed using skills in practice enhanced nurses’ confidence and sustainability of skills requires a nurse–patient relationship. Method triangulation illuminated how the intervention was implemented in practice contexts. Conclusions: The intervention was effective at changing some key dimensions of prescribing consultations. The use of a self-efficacy framework in the intervention, to promote nurses’ confidence in working in a different way, may have been instrumental in effecting the changes found. Contextual factors influencing beliefs exploration in medicine-taking consultations were identified. [Copyright &y& Elsevier]
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