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Abstract (DISPENSING MEDICATION BY NON REGISTERED NURSE)
Purpose – This research project DISPENSING MEDICATION BY NON REGISTERED NURSE aimed to investigate the impact of dispensing medication by non registered nurse in health and social care homes in United Kingdom.
Literature review – Relevant theoretical frameworks pertaining to dispensing medication by non registered nurses in health and social care homes in United Kingdom were presented and analyzed.
Methodology – The deductive approach and the survey strategy were adopted. The sample included people who had been patients in any health and social care home.
Originality/value – The study contributed to bridging the research gap indicated in the academic literature review regarding the lack of knowledge on the effect of dispensing medication by unregistered nurses in health and social care homes on the overall health management system and the impact of policies and regulations on the administration of medication system in United Kingdom.
Findings – The research finds out that 33.3% people considers that proper dispensing improves the standard of treatment by providing a higher level of safety and security. However, only 6.94% of the respondents regarded quick service as a result of proper dispensing. The data implies that 100% of respondents have a perception that it is important to follow the medical policies and regulations. The results of the questionnaire also demonstrate that most of the people do not consider the supervision of unregistered and untrained staff necessary.
The research Dispensing medication by non registered nurse in health and social care homes provides this information that the 100% of the respondents were affiliated with any health care organization and they had a view that social and health care organizations play a very important role in the health management system of United Kingdom. It had been found out that two most important benefits of health care organizations are social and health awareness and information on health related issues. In addition to this, it had been identified through this research that staff training in social and health care homes is very important. In this research 100% of the respondents had a view that it is important to update the staff about the latest techniques in health and social care homes. As well as most of the research respondents had given a higher grade to the standard of medication in United Kingdom, which shows the level of satisfaction of the respondents.
Research limitations – The sampling frame included the patients of a limited number of health and social care homes and the research was done within limited timescales.
Dispensing medication by non registered nurse in health and social care homes
Acknowledgements
Table of Contents
Research objectives and Research Questions: 9
CHAPTER TWO: LITERATURE REVIEW… 17
2.1. Administration of Medication. 18
2.1.1. Policies and regulations. 19
2.1.3. Managing information system.. 21
2.1.4. Documentation and verification. 22
2.2. Health Management system.. 24
2.2.1. The role of policies and guidelines in health management system.. 26
CHAPTER THREE: METHODOLOGY. 28
3.4. Data Collection Methods: 31
Chapter Four: Results Analysis. 34
4.1 Screening of the respondents: 34
4.2. Profiling of the respondents: 37
4.3. Medication Usage Patterns of the respondents: 40
4.4. Attitudes Change of the respondents: 44
4.5. Health care Organizations: 48
4.7. Standard of medication in United Kingdom: 55
Chapter Five: Discussion of Results. 58
5.1. Relating findings to the Literature reviewed: 60
5.2. Relating findings to the research questions: 63
Chapter Six: Conclusions and Recommendations. 65
6.3. Recommendations and Implementation: 67
CHAPTER ONE: Introduction
Introduction:
“Dispense means to deliver a drug to an ultimate user or research subject by or pursuant to the lawful order of a practitioner, including the prescribing and administering, packaging, labelling or compounding necessary to prepare the substance for delivery.” (Department of health professions, 2011)
Dispensing is an important part of medicines management, medicines management is defined as; “The clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit from the medicines they need, while at the same time minimizing potential harm.” (The Nursing and Midwifery council, 2004)
The Department of Health in the UK has been working to raise awareness about the policies and regulations regarding dispensing of medicines and the methods for dispensing, along with this it emphasizes on the critical requirement to collect information about dispensing errors, which occur within an organization as well as inside the boundary of health and care homes. The idea for providing this information is essential, because it adds value in the methods and procedures as well as identifies areas for enhancement and further improvement and advancement in dispensing systems. (Department of health professions, 2011)
Therefore the main objective of this research is to create understanding in the field of dispensing medication and identifying the role of registered and unregistered nurses to properly manage the whole system of dispensing and medication. This research also identifies the relationship between registered and unregistered nurses and the responsibilities of registered nurses to manage the position of unregistered nurses in dispensing the medicines. A data collection method was planned and modified for use after a detailed observation of the main idea and the people who are affected by it. A questionnaire had been designed to properly and accurately identify the perception of relevant people regarding the selected topic for research.
Keeping in mind the importance of dispensing and the influences it can have in the field of health management, various policies and legislations have been made by government for common public as well as people who are related to the handling, management and storage of medicines. (The department of health, 2010)
The supply, storage and administration of drugs is regulated and guided by the following:
| • Medicines Act 1968 |
| • The Prescription Only Medicines (Human Use) Order 1997, SI No 1830. |
| • Misuse of Drug Regulations 2001 (MDR) and Misuse of Drugs Regulations Northern Ireland (NI) 2002 |
| • Misuse of Drugs (Safe Custody) Regulations 1973, Misuse of Drugs (Safe Custody) Regulations Northern Ireland 1973 |
| • Misuse of Drugs (Supply to addicts) Regulations 1997 and Misuse of Drugs Notification and Supply to Addicts (Northern Ireland) Regulations) 1973 |
| • Health Act 2006 |
| • Controlled Drugs (Supervision of Management and use) Regulations 2006 |
| • Health and Safety at Work Act |
| • NMC Code of Professional Conduct 2002 |
| • NMC Standards for Medicine Management 2008 |
| • NMC Covert Administration of Medicines 2001 |
| • NMC Guidelines for Records and Records Keeping 2002 |
| • General Social Care Council Code of Conduct |
| • National Minimum Standards for Care Homes for Adults (18-65) DoH 2003 |
| • Care Homes Regulations 2001 |
| • National Minimum Standards for Independent Health Care DoH 2002 (These standards apply to Elsadene & Fairfield only) |
| • The Administration and Control of Medicines in Care Homes and Children’s Services (RPSGB) 2003 |
| • The Safe Management of Controlled Drugs in Care Homes CSCI. Professional Guidance. Jan 2008 |
Table 1.1 Drugs regulation .Source: DRH Supporting Independence 2008
Research objectives and Research Questions:
The ultimate goal of the following research project is to evaluate the role of registered and unregistered nurses in the field of dispensing medication in health and care homes in the United Kingdom.
The following research objectives and the corresponding research questions have been identified for this research project:
| Research Objectives
|
| 1. Identify the importance of dispensing in the field of health management. |
| 2. Evaluate the effectiveness of policies and regulations for the improvement of dispensing and other relevant issues identified in the field of medicine. |
| 3. Compare the role of registered and unregistered nurses in the area of dispensing. |
| 4. Determine the relevant legislations for making the dispensing of medication to be done in an appropriate manner in United Kingdom. |
| 5. Propose and recommend methods to create awareness in the field of dispensing and medication. |
| 6. Explore the new ideas that can be introduced for the enhancement of understanding for dispensing in health and social care homes. |
| 7. Identify the role of health management system in the life of common people. |
| 8. Evaluate the existence of various health organizations in spreading the information about health related issues such as dispensing. |
| 9. Compare the performance of trained and untrained staff in health and social care homes. |
| 10. Determine the importance of training the staff at a health care organization, for the proper management of all the medical services in United Kingdom. |
Table 1.2 Research Objectives
| Research Questions
|
| 1. What are the policies that have been introduced in United Kingdom related to the field of health management? |
| 2. What is the importance of dispensing in the area of healthcare management? |
| 3. What are the suitable methods for dispensing, at a health care organization? |
| 4. What is the difference between registered and unregistered nurses? |
| 5. How is training important for creating awareness among the staff members? |
| 6. What is the difference between the duties and responsibilities that should be performed by a registered and an unregistered nurse? |
| 7. How can the proper methods for dispensing be further promoted in United Kingdom? |
| 8. Which organizations are working in creating awareness in the field of health and medication? |
| 9. How can organizations working in the field of health and medication keep themselves updated? |
| 10. What are the main issues and problems with the organizations working in the area of health and medication specifically dispensing of medication and its affects? |
Table 1.3 Research Questions
1.2. Research Rationale:
Dispensing medication by nonregistered nurses is a topic which is recognized as extremely important for a wide range of people as well as organizations. The importance of dispensing medication can be identified by considering the importance of health and well being for people in United Kingdom. (Glennester, 1998) However the increasing population has been an important factor for the importance and change in the idea of proper health management in United Kingdom.
Office for National Statistics cited in Keynote (2010b), estimated the UK population to be 61.8 million people in mid-2009 and this figure has been forecasted to grow steadily by 0.7% each year between 2010 and 2014. As the population increases, the demand for proper dispensing medication grows with the same speed in the same direction.
In addition to this, several other factors have been held responsible to change the health care delivery process and the most essential of these are the varying expectations. Patients are used to pleasant service from other different industries and expect superior performance than they observe on the delivery sector. Patients naturally wonder whether their insurance will cover the medical services they require. In addition to this however, they are also worried about the kind of service they get and whether the quality of service is accurate, reliable, and trustworthy and the convenience through which they are treated. Better outcomes are expected by the employers and in return they as well as the patients expect fewer faults, issues and problems related to patients by providing proper health care that’s required to cure their ailment. (European Agency on Safety and Health at Work, 2009)
Due to most of the crucial innovations not being technological they are relevant to the way the organization of health care delivery is done. As mentioned previously, the crucial issues include management programs related to ailment which target the most challenging patients, and further includes tools and systems that are helpful in allowing patients to be more effectively involved in their own health care. (Nursing and Midwifery council, 2011)
Up till now, the existing model of innovation has been that knowledge which flows into medical and nursing practice comes from funded external research. In the prevailing model the role of provider organizations is to bring knowledge which is published in the medical and nursing literatures to bear on individual patients by selecting the right therapies and the right way of implementing them, which is a one-way flow of information from the research community to the delivery community and then to each individual patient. (Department of health, 2011) However, general practice in itself is a productive source of innovations, in both what to do and how to do it. Medical knowledge is a self learn process and a person can learn through taking care of patients and delivery organizations create knowledge for themselves. This information flow from process to process in a linear way. Novel approaches derived from practice can be used to the advantage of each individual patient.
Many health care organizations are a much better at capturing these innovations than others, due to different reasons one of which is that some organizations are technologically better placed as compared to other organizations, which helps them to be innovative and motivation to work and perform better increases. (Department of health, 2011). The concept of knowledge evolution has to be understood by the managers and the directors of the organizations. As delivery organizations start to focus on how to manage the care, learning their own knowledge about it becomes comparatively more important. The most important aspect of innovation must be the creation of organizational structures, processes and motivation to promote learning in routine practice along with forming better models of care delivery. (European Agency on Safety and Health at Work, 2009). There exists a belief amongst people that health care and business do not and must not mix together.
The most disturbing factor that they associate is the profit making in health care businesses. However, for business schools, the motivation is not making money but management. There exists a belief amongst business schools that non-profit organizations need to be managed as well as profit making organizations. The absence of profit making motive doesn’t imply that the organization be poorly managed or it be tolerated, especially if it affects the organizational performance and the ability to give the individual patient the best clinical outcome (DRH, 2008).
1.3. Research Context:
The area of management of dispensing medication in health and social care homes is dependent on three main functions: (Glennester,1998)
- The policies and legislations by government related to the field of dispensing medication.
- The increasing demand for health related services in United Kingdom.
- The methods for improving the ways for training the staff and creating awareness for medication, at health and social care homes.
Due to the changing of the basic needs and requirements of people, the health management system is changing rapidly so as to cater to different requirements every day. United Kingdom is the same as every other place, where the requirements change day-to-day. So as to properly understand the modern needs of patients, the most important thing is the existence of an effective communication system so as to maintain an exceptional health management system. Therefore, health management system is similar to management in any other organization, as a good communication is equally essential for any other type of management as it is for proper health management system.
Furthermore, the second most important thing in health management system is the existence of a health policy (Glennester, 1998). The policies play a just as important role in the overall health management system. The policies help the professionals working in the health management systems to improve their performance and keep themselves updated with the changing requirements. As the professionals working in health management systems are worried about their own health and safety, the formation of policies regarding health care will drastically improve the quality of performance. So keeping the importance of health care policies in mind, it becomes evident that government of any country can change the whole picture of health management system by changing its policies. In addition to this he Government also intends to use International evaluations to recognize where the UK is underperforming. The Government deems this will be useful in understanding where quality enhancement may be possible. (Department of health, 2011)
In addition to this, these days, general practice is much more than just family doctors. These days requirements of nurses and professionals from the field of technology are a must so that the large number of technical machines can be operated without any problems and professionals are also required in the field of management so as to process the increasingly large number of patients without any errors. The wider practice team is managing increasingly complex patient and public requirements. So this wider practice team requires a higher effort on maintaining the motivational level. Therefore in order to increase the level of performance different innovative ideas needed to be applied. But Innovation is more than just being clever. Innovation requires creativity that results in a practical and cost effective solution for the buyer. Just being creative or different is not a true measure of innovation. Solving a problem in a cost effective manner with excellence in quality are the ingredients of innovation. Creativity alone offers a pleasing aesthetics or cleverness, but creativity alone does not necessarily mean the person will perceive added value.
UK health care practice is recognized throughout the world as one of the most cost-effective, high quality means to deliver care. Despite the changing political imperatives, general practice is still an important and fundamental part of healthcare. This role of health care practice in promoting public health should be more widely recognized and enhanced. Governments always rightly want to maximize better care, better patient experience, and better value for money in health care practice. (Department of health, 2011)
The broad pattern of reforms in the healthcare sector across Europe , showing that reforms have been designed with similar objectives, that reforms have been incremental, and much focused on altering the behaviour of patients rather than the suppliers of care. More radical reform has been chiefly though conflicts over fundamental questions relating to who pays, who gets care and who gets paid; conflicts which have been played out mainly between government, powerful professional and private interests and unions. Then using the example of the National Health service in England, it has described the direction of travel of policies now being developed and how and why government has been able to design and begin to implement more radical reform relative to other European countries. It suggests that the institutional mix in England at least has broadly favoured the government’s agenda and suggests that the power of managers to shape reforms in short to medium term future will be limited. (Nursing and Midwifery Council, 2011)
1.4. Statistics:
The department of health notifies that the net cost of all prescriptions dispensed was £6,117 million; which implies an increase of 9.5 per cent or 6.9 per cent in real terms on 2000.
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Table 1.4 Statistics. Source: Department of Health
As for as the care homes are concerned, the idea of dispensing is also important for care homes, because according to department of health in United Kingdom, it had been found that residents with an average age of 85 years were being observed to take an average of 8 medicines each on any one day 7 out of 10 patients had experienced at least one medication error, nonetheless this shows the need for more awareness and information in the field of medication. (The department of health, 2010)
CHAPTER TWO: LITERATURE REVIEW
The importance of literature review has been emphasized for the purpose of identifying and understanding the key issues that have already been stated about the topic. (Christopher Hart, 1998) This chapter intends to reassess the most applicable and noteworthy research on the selected topic. Moreover, the literature review will cover:
- The basic policies and rules for dispensing medication in health and social care homes.
- Importance of staff and their training as well as documentation of the tasks performed by them.
- The impact of dispensing medication by non registered nurses in any health and social care homes.
- The benefits of being precautious while dealing with medication and its dispensing procedures in an efficient health management system.
- The role of government policies in maintaining the standard of health management system.
By significantly reviewing the work done by the experts and academics in the areas of administering medication and health management, the author intends to develop her subject awareness and determines any gaps and recent trends that have appeared in these fields. In addition to this the author intends to collect the relevant information for the purpose of illustrating every critical issue related to the main objective of research.
Introduction
The idea of dispensing and medication is one of the oldest concepts in the field of health management system and the development it has gone through. This chapter will extensively identify the role of dispensing and medication in the advancement and improvement of health management system. Up till now, the existing model of innovation has been that knowledge flows into medical and nursing practice from external research that has is funded. In this model it is the role of provider organizations to bring knowledge published in the medical and nursing literatures to bear on individual patients by selecting the right therapies and the right way of implementing those therapies: a one-way flow of information from the research community to the delivery community to each individual patient. (Carl, 2001)
2.1. Administration of Medication
For the purpose of handling and administration of medicine, it is important to train and update the staff about the latest techniques and advancement in the field of medication and health management. (The health foundation, 2011)
The difference between a registered and unregistered health care professional is very important in terms of law and its policies. The Registered Healthcare Professional is responsible to appropriately deal with the accountability of any delegation relevant to the administration of medicines; to ensure adequate awareness and supervision is available (NMC 2004, 2006). This individual is accountable for ensuring that related information concerning medication is obtained and recorded and for helping in the achievement of this policy in liaison with significant others. Where a registered nurse is accountable for the delegating any aspects of the administration of medication, they are responsible to ensure that the unregistered member of staff is competent to carry out the task.( National centre for biotechnology, 2003) The beginning of medicines should only be conducted out by a registered nurse as regular administration is required. The unregistered member of staff should only be affiliated in the management of constant ongoing therapy. (Environmental health unit, 2008) The unregistered member of staff must not undertake transcribing, that is copying an instruction for medication made by the prescriber from the prescription on to any other format. (Southern health and social service board, 2002) In accordance with the policies of law it is mandatory that an unregistered healthcare professional should work under a registered healthcare professional. The unregistered member of staff must not undertake the dispensing of medicines himself without the concern or approval of any registered healthcare professional that is, removing the medication from the container in which it was dispensed by the pharmacist to another container. The unregistered member of staff must not administer medications using patient group directions (PGD).
In addition to this, the other requirement is that an unregistered member of staff must not administer controlled medications. Controlled medications are not common and their use has to be registered properly by the registered staff only. The unregistered member of staff must not administer medication via intramuscular route. Where unregistered member of staff carry out the administration as part of their role, (not delegated by a registered nurse) the accountability lies with the employer. This means that the registered member should properly ponder while delegating the responsibilities to an unregistered staff member, since any lacking from the side of unregistered staff has to be answered by the immediate supervisor that should be a registered member. However the responsibility for delegation must be clearly defined. Unregistered member of staff involved in the administration of medicines must ensure they understand their role and follow advice if there is any query, concern, uncertainty or difficulty arising out of the administration of medicines. (Barnet, Enfield and Haringey, 2011)
2.1.1. Policies and regulations
The responsibility for proper management and the well being of people is of National Governments (World Health Report 2000). In the WHO European Region, the liability for the performance of the countries’ health systems falls onto the national health ministry. National health ministry provides the vision for health system development, and are also responsible for legislation, regulation and applicability of health policies. Furthermore, the national government is held responsible for gathering updated information on health and its social, economic and environmental determinants. (Thoe Jans, 2007). They also have to perform the proper governance and management of health sector at all levels and is held responsible for the management and achievement of the health management goal and objectives ( Howlett and Ramesh, 2003).
Health ministry is expected to carry out six different types of activities as part of their health system maintenance process; firstly they define a vision for health care services, and strategies and policies for the purpose of achieving better health; they have influence over all sectors of government and create assurance for the availability of better health; they ensure good governance supporting the achievement of health management objectives; they ensure the clearance and better understanding of the health management system; they utilize legal, regulatory and policy instruments to maintain health system performance; and they gather, verify and apply appropriate health information and research proofs. (The health foundation, 2011)
2.1.2. Staff Training
All the staff members and the tasks performed by them are the key factors for the administration of medication in an appropriate and reliable manner. Staff should acquire training in accordance with the current policies and procedures for the sensible handling and arrangement of medication. Staff must be provided with the information and training in the current and past policies for the handling and the administration of the medicines within home as part of the induction and training program along with periodic updates. The manager must appoint a person for the safe handling, administration, storage and custody of the medicines and the surgical and miscellaneous instruments. The manager has to ensure that the staff are properly trained and have the right skills before they are given the opportunity to administer and use the medicines.
If training is not given previously, then it is necessary that the care staff who are involved in the administration of medicines must receive training, additional or otherwise. (Southern health and social service board, 2002)
All staff training should be documented. The manager is required to maintain a record, created in such a clear and understandable way as to clearly explain that each designated person has been provided with appropriate instruction and deemed to have illustrated the necessary knowledge and ability to safely and effectively handle and administer medicines within the home. (Royal Pharmaceutical Society of Great Britain, 2003)
Review and evaluation of the training of staff is essential. This should be fully documented.
There should be a policy and procedure detailing the arrangements for staff medication training. In addition to this, some the staff members should be qualified with some special and useful qualities and facilities to ensure an effective staff performance, these qualities and facilities include: (The health foundation, 2011)
- Leadership: The staff should be able to handle and lead any difficult and complicated situation. However the staff should be appropriately trained to make decision and carry out the essential requirements.
- Staffing levels: The staff should be divided into clear and manageable levels.
- Staff medication awareness: The staff should be properly aware about all the necessary information about the medication.
- Training and awareness: All these requirements can be fulfilled only with a quality training and awareness.
- Support from health professionals: The staff is required to be guided by the health professional in a supportive and cooperative way.
- Accountability and independent: The staff should be able face accountability and they should be independent.
2.1.3. Managing information system
The staff and the rest of organization should be provided with the needed records and other required necessary information. The top management requires to identify everything that is being happening in the company. However, this does not imply that they should be overburdened with too much information. The information should be properly and intelligently processed i-e including all the relevant data and excluding all the unimportant and outdated data. The bottom line is that the information systems should be able to enable them to execute, manage, and examine plans, strategies, procedures, novel products, new business models or new business missions. The reporting should be made periodically. They should however be vigilant immediately when noteworthy events take place. (Royal Pharmaceutical Society of Great Britain, 2003)
In every organization, communication is necessary in one way or the other. Furthermore, there should not exist any communication gap, for the purpose of an appropriate decision making process, this communication of information can be done through a proper information processing system. Information system performs three vital roles in a business organization. It helps in operations, decision making tactics and strategies to sustain and compete in the market. (Margerison, 1996)
There can be many difficulties in setting up a proper communication process, and these difficulties can arise from many different reasons, depending on situation and circumstances, and in order to avoid these difficulties one should try to properly understand the communication process and act accordingly. (McCormack, 1999)
2.1.4. Documentation and verification
Documentation and verification refers to proper recording of all facts and figures relevant to the dispensing of medication in a safe and secure manner. Considering the research hypothesis it is mandatory for all health and social care homes to properly document and record all the policies and regulations regarding the dispensing of medication. In addition to this, it is important to keep all the documents in an updated and clear manner, so that they are easily accessible and understandable. Since, in a health care service the patients are required to be treated on time and in an accurately prescribed way. (Donabedian, 2005)
From the records being prepared, all the staff members that are accessible to the records should be able to understand exactly what the care worker has done and be able to take charge for all of the medicines and service you have managed for an individual. The service provider is required to decide the way in which the records should be kept in a health care home. Depending on that type of format that is being chosen with the consult of all the registered and unregistered medical service providers, the records must be complete, legible, up to date, reliable, understandable and signed to show who has made the record. (Royal Pharmaceutical Society of Great Britain, 2003)
For this need of the patients it is mandatory to manage the proper standardization and administration of medication, and therefore it makes it highly crucial and important to properly record and document all the essential and necessary details about the medication and related issues. In addition to safety purpose, it is legally mandatory to properly record the essential documents. (Southern health and social service board, 2002) The documents that are needed to be recorded include:
- Use and control of medicine document
- Guidelines for the control and administration
- Guidelines for records and record keeping
- Prescription record
- Record of medicine disposal
- Supply of medicine
- Labelling
The type and number of documents needed to be recorded can vary with the type of health care home and the people working and being treated there. (Unger, Macq, Bredo, Boelart, 2000) Furthermore in addition to theses general documents, some other specifications should also be recorded to keep all the information updated and clear. Such as, it is very essential for every attendant specifically unregistered nurses/attendants to record what they do when they do it. They should not rely on their memory to record information accurately at a later time. However there is no point making that record when the medicines that are prescribed, are being prepared, but the record should be made when the person has accepted and taken it. In this way, the record prepared notifies that that the patient has been given this particular medicine at this time, so this will make the further medical procedures fast and accurate. (Donabedian, 2005)
Along with this, an up dated list of current medicines prescribed by the service providers for each person is equally essential and crucial as any other related information. However a care plan should be prepared and managed that should make it clear whether the person requires any further support to look after and take any specific medicines or if care workers are responsible for giving them. The responsibilities of the health care service providers should be notified along with their identities, so that no misunderstanding or communication error takes place. Nonetheless a written confirmation of the medicine a person is taking should be obtained in a clear format from an authoritative person, and the person having the authority for confirmation should use a clear and easy mode of transferring information and should make sure that all the information provided is properly understood and the task is being carried out accurately. (Royal Pharmaceutical Society of Great Britain, 2003) Since, it is mentioned in the law that in result of any irresponsible action both the persons, the person who has performed the task as well as one who has confirmed the task to be taken place by that person are liable. Although this condition varies from situation to situation and place to place, nevertheless, the responsibility of confirmation and supervision should be performed properly and dedicatedly. (Southern health and social service board, 2002)
If a person is being made responsible for requesting and collecting medicines for a child or adult, that person is required to record some specific information which includes:
- What you received that includes the name, strength and other important specifications about the medicine.
- How much is being received.
- And lastly, the date and time when the medicine is received should be notified and recorded as well.
For example, in residential settings, this is an essential record when the person first arrives with the medicine being provided or supplied from any health care home or hospital or another social care setting. (Royal Pharmaceutical Society of Great Britain, 2003)
2.2. Health Management system
Proper Management provides better and innovative ways to utilize organizational resources, in a productive and useful direction, which leads into an improved organizational performance. However an appropriate managing system requires a well established communication system for the purpose of a stable flow of information in a clear and organized way.
The importance of communication in managing can hardly be over-emphasized. It is the life-stream of modern business management. Communication is a tool of management to get the things done through people. Communication is the art of persuasion and motivation. The functions of management of decision-making process and control involve effective communication. (N Willis, 1984)
Management is an extremely wide concept, which includes a number of areas; such as health management. Health management is one of the important issues during these times, as people are more concerned about their well being and physical and mental health. (Walshe and Smith, 2006)
The World Health Organization has provided the critical definition of health as health is a state or feeling of entire physical, psychological and social comfort and security and not merely the absence of disease, this definition serves the purpose for emphasizing the importance of general human health. (World Health organization, 2011)
In the field of health management system several factors are responsible to change the health care delivery process, and the most essential of these is varying expectations.( American college of physicians, 2011) Patients are used to satisfactory service from other industries and expect better performance than they observe on the delivery sector. They obviously ponder a lot about whether their insurance will bear the medical services they require, whereas in addition to this they are also concerned about the quality of service they get: how accurate, reliable, and trust worthy it is, and the responsiveness and convenience they provide. Employers expect better outcomes, and in return they and patients desire fewer flaws and fewer issues related to patients by providing proper health care that was required to cure their ailment. (Carl, 2001)
2.2.1. The role of policies and guidelines in health management system
The makers of health policy face the challenge of matching rising demand for health care services with an ample supply of experts and professionals in the field of health sciences in the current situation of existing and projected health workforce shortages. The working conditions and environment make up an essential factor in the recruitment as well as retention of experts and professionals, and the facilities, surroundings, benefits, atmosphere and characteristics of the workplace affect the level of quality of healthcare service process in a direct and indirect manner.( Southern health and social service board, 2002)
All staff should be offered training covering basic information about common medicines and how to recognize and deal with medication problems. Nursing staff will be expected to keep themselves up to date as specified in the NMC Guidelines for the Administration of Medicines. Additional training will be offered to those fulfilling the Designated Person role. (Department of health, 2010)
European countries bear common challenges to ensure appropriately performing health professionals in the current situation of existing and projected shortages. One of the multiple aspects that determine the quality of supply and performance of health workers is the work environment, which plays a very essential role. (Unger, Macq, Bredo Boelart, 2000)
For Example: National policies designed to improve nurse recruitment and retention by Czech Republic:
To address a serious shortage of nurses, the Czech Republic launched a program of stabilization measures in 2008. The mix of interventions included the following:
Financial measures which includes grading nurses into higher salary grades and improving benefits in public-health facilities; however professional development comprises better access to nurse-specialist education, with subsidies from government; support of modern continuous professional development programs; along with this professional autonomy deals with negotiations and legislative changes to broaden nurse competences; family work balance support to assist return from maternity leave, including provision of child-care facilities, flexible working hours and part-time contracts; and workforce data monitoring of workforce and student numbers via a register of health care professionals.
With the aim to improving the attractiveness of the nursing profession and the quality of care, a four-year national plan was launched in 2008, supported by significant public investment. A combination of interventions is being implemented in the following four main action areas.
Workloads and stress levels of nurses are being eased via more staff, supportive action for upgrading auxiliary qualifications, and provision of information technology systems for reducing administrative work. (E notes, 2011)In addition to this qualifications are being addressed using more continuous training, more specialization, and the introduction of master’s degrees. Remuneration is being changed, and pay was increased for recognized specialties and nurse-executive positions. Social recognition and participation in decision making are being addressed through support of nurse representation within health authorities and bodies.( World health organization, 2011)
CHAPTER THREE: METHODOLOGY
Introduction:
“This chapter aims to provide a detailed explanation of the research methodology for this project dissertation. Firstly, the research philosophy, research approach and research strategy will be identified and justified; subsequently, it will be explained how the research questions will be answered and the research objectives will be addressed, and which data collection methods and sampling methods and size will be used and why. In conclusion, the main ethical issues associated with the research will be covered.” (Saunders, 2009).
3.1. Research Philosophy:
“Research philosophy is about the way knowledge is developed in a particular field of research and the nature of this knowledge. There exist four approaches to research philosophy – realism, interpretivism, pragmatism, and positivism” (Saunders, 2009).
“The implications of these different approaches are an important consideration when undertaking any research project as the choice of research philosophy will influence the design of the research methodology and the interpretation of the investigation at hand” (Easterby-Smith, 1991).
The difference between humans in their social actors is emphasized by Interpretivism (Saunders, 2009, p. 593). As a result, in the collection of qualitative data, the researcher is actively involved. “However, as some scholars argue (Easterby-Smith, 1991) the data collected may be unclear and imprecise, or lack credibility as may be prone to distortion imposed by the values and purposes of the researcher (Stiles, 2003).”
“Realism assumes a scientific approach to the development of knowledge. According to this approach people‘s understanding of the social world affects their behavior and that knowledge must, therefore, be considered from the inside (Stiles, 2003).”
Pragmatism discusses that the main essential aspect of the research philosophy undertaken is the research question, arguing that this is achievable to work within both positivist and interpretive positions.
“Positivism advocates working with an observable social reality and the result of the research can be law like generalisations comparable to those created by the physical and natural scientists” (Saunders 2009). “The positivist approach is chosen to be the philosophical framework of this study. This approach is deemed the most appropriate one as it tends to generate clear results that fulfil the requirements of both generalization and reliability” (Stiles, 2003). “The positivist research philosophy typically involves highly structured methodology (the use of questionnaires for data collection), the researcher is not an active participant of the data collection process and analytical statistical analysis such as hypothesis testing, random sampling, aggregation, precision and measurement (Stiles, 2003) is used.”
3.2. Research Approach:
“There are two principal research approaches that can be applied to a research dissertation project, the deductive and the inductive approaches.” (Sauders, 2009) “The former involves the development of theory or hypotheses which will be tested by the data collected. The inductive approach, on the contrary, assumes that data should be collected first and then theory will be developed.”
As there is a lot of literature on the subject of medication dispensing by unregistered nurses in health and social care homes, in here, one can define theoretical frameworks and further due to the time available, the deductive has been chosen. The second reason for choosing this research approach is its partnership with quantitative research methods which ensure the validity of the data and the statistical significance of the results which can be generalised.
3.3. Research Strategy:
Research strategy refers to the common preparation of how the researcher will proceed regarding defining the research question or questions (Saunders, 2009, p. 600). The main strategies in the literature include; experiment, case study, survey, action research, grounded theory, ethnography and archival research.
The research strategy of the experiment involves the allotment of the sample population to diverse experimental circumstances followed by predefined change on one or more of the variables and calculation and management of variables (Saunders, 2009).
Case study is defined as a strategy for conducting research which includes a pragmatic examination and identification of a particular contemporary observable fact within its real life situation using a number of sources of confirmation (Robson, 2002, p.178)
Action research is related with the identification of a variation and concerning a close interaction between the practitioners and the researchers. (Saunders, 2009)
The inductive approach is typically Grounded approach. This theory involves the development of theory from data that is collected through observations and interviews.
Ethnography is also more typical of the inductive approach and is a long term approach. This strategy is of a naturalistic nature and its focus is on describing and understanding the social world by means of first-hand field study (Saunders, 2009).
“Archival research is the analysis of managerial records and documents as the major source of data since they are results of day to day activities.” (Saunders, 2009)
Due to the research purpose being essentially exploratory and as the deductive approach is chosen, the survey research strategy has been chosen. The reason of choice for this survey research strategy for this dissertation is also guided by the research questions, objectives as well as the knowledge, that is existing, on dispensing medication by unregistered nurses in health and social care homes, the resources and the time available for it.
The benefit of using the survey research strategy is that it permits the gathering of a huge amount of information from an ample amount population in a highly feasible and economical way (Saunders, 2009, p. 144). This strategy will help to get insights into the dispensing medication by unregistered nurses in health and social care homes, due to this strategy being normally utilized to respond to who, what, where, how much and how many questions (Saunders, 2009, p. 144).
3.4. Data Collection Methods:
“Data collection methods and procedures explain how, when and where data will be collected. Scholars such as Wilson (2006) distinguish between two types of data collection techniques: secondary data collection and primary data collection.”
“Secondary data is information that has been previously gathered for some purpose other than the current research project (Wilson, 2006, p. 414).” The collection of data in the secondary collection has been based on books, peer reviewed academic journal articles and market reports by leading market research organizations. Even though the data collected is of a very high quality, their collection being cost-efficient and time-saving, they have, however, been collected for purposes which are different from those of the present study, some of the data may be biased or may relate to a different geographic area (e.g. the US or Australia) or they may be too complex to understand or too large in volume which prevents the researcher from choosing the desired information.
Therefore, this research project will use both, primary and secondary data collection techniques, as this will allow addressing the research questions by analyzing the information that has already been published and making conclusions based on the information gathered through primary sources.
“Primary data is data collected specifically for the project being undertaken” (Saunders, 2009, p. 598) and is, therefore, essential to be gathered in order to answer the specific research questions of the present dissertation project. The methods of collecting primary data can be observation, semi-structured or unstructured interviews and questionnaires.
The evaluation of all of the above will be done to evaluate which is more effective and most appropriate to the research questions and objectives.
Observation:
Observation is a primary data collection technique in which the information is collected by observing the behavior of people, objects and organizations without any questions being asked from the participants (Wilson, 2006, p. 409).
Observation eliminates the problems associated with surveys and interviews such as the lack of willingness to participate in the study. However, the method of observation only measures behavior nor does it give the underlying reasons for this behavior. Due to this, this method is not viable for this research which aims to find out how unregistered nurses are impacting the method of dispensing medication in health and social care homes.
Interviews:
According to Kahn and Cannell (1957), “an interview is a focused conversation between two or more people. Interviews are used to collect qualitative data.
Saunders et al (2009) distinguish between semi-structured, in-depth and group interviews. All of them can be conducted face to face, via telephone or electronically.
Semi-structured interviews contain a list of topics and questions that need to be covered during the discussion. In-depth interviews are very informal and allow even greater flexibility for the interviewer as there is no list of predetermined questions to follow. Group interviews or focus groups are non-standardized interviews performed with two or more people (Saunders, 2009, p. 343).” Interviews are used to investigate people’s opinions when there a large number of questions which are complex and open-ended.
Interviews are very effective in gauging the insights into consumers’ attitudes and opinions, the fact remains that they are not so easy to administer and nor are they very time efficient. Secondly, some secondary issues concerned with interviews consist of limited access to participants and associated costs of the interview. As the questions are not preset or standardized, rather are formed in the interview itself, there is a concern about the reliability of the findings and a small and unrepresentative number of cases may even be used to form generalized views of findings (Saunders et al, 2009, p. 335).
Questionnaires:
DeVaus (2002) as cited in Saunders et al (2009, p. 360) describes a questionnaire as a procedure or method of data collection in which each and every person is enquired about the similar set of questions and situations in a prearranged sequence. Questionnaires are usually self-administered or interviewer administered. For the purpose of data collection, questionnaires have been selected as a source of data in this research. The reason for using questionnaires as a source for data collection is that, questionnaires are less time consuming as compared to other methods of data collection. In addition to this they are much more flexible and feasible to formulate a logical and reliable conclusion. Questionnaires can also be estimated with the help of graphs and tables, which further increases the appropriateness and understanding of the results.
3.5. Questionnaire Design:
The questionnaire is a combination of 6 sections and included a total of 18 questions:
- Screening (Q1 & 2)
- Profiling (Q3-5)
- Medication Usage patterns (Q6-9)
- Attitudes change (Q10 & 11)
- Health care organizations (Q12-15, 17-18)
3.6. Research Ethics:
During the researcher process the researcher needs to reflect on lots of ethical issues may arise. Commonly speaking, research ethics is related to the behavior of the researcher in regard of the rights of respondents. “According to Saunders et al (2009, p. 184), research ethics relates to how we formulate and clarify our research topic, design our research and gain access, collect data, process and store our data, analyze data and write up our research findings in a moral and responsible way.”
“While collecting primary data, the researcher explained the purpose of the study and the nature of the research procedure to the participants in the invitation letter. The respondents were also notified that their involvement in the survey was intentional and that they had the right to withdraw at any time. The researcher ensured the strictest confidentiality and anonymity of all responses and the research did not cause embarrassment, discomfort, stress, harm or any other negative consequences to the research population. By undertaking the procedures described above, the author hopes she had ensured that ethical practices were maintained throughout the research.”
Chapter Four: Results Analysis
This chapter presents the analysis of the results obtained in the fieldwork from the responses to the questionnaires as they affect each of the ten research questions. The questionnaire designed for this research contained eighteen questions overall. The questions were divided into four categories, these categories include:
- Screening (Q1 & 2)
- Profiling (Q3-5)
- Medication Usage patterns (Q6-9)
- Attitudes change (Q10 & 11)
- Health care organizations (Q12-15, 17-18)
The main reason for dividing the questionnaire into these five categories, is that it not only provides the information relevant to the identification of the perception of people regarding the dispensing medication by unregistered nurses in health and social care homes; but it also helps in proper screening and profiling of the respondents.
4.1 Screening of the respondents:
This questionnaire was sent to fifty people, who had been a patient in any health or social care home, but only 24 of the respondents provided the complete information that was required for the purpose conducting research. So the response rate is 48%.
The screening of the respondents is show in Table 4.1
Table 4.1 Screening of respondents
| Medication background of the respondents | Response Percent | Response Count |
| Affiliation with any health and social care home as patient.
Yes
No
Total
|
79.16%
20.83%
100% |
19
5
24 |
| Treated by registered or unregistered nurse
Registered nurse
Unregistered nurse
Total
|
0%
100%
100% |
0
24
24 |
Figure 4.1.1 Affiliation with any health and social care home of all respondents
The above figure identifies the affiliation of the respondents with any health and social care home in United Kingdom, the data presents that about 79.16% of the respondents had connection with health and social care homes.
Figure 4.1.2 Treatment of all respondents
The above diagram presents the number of sample that had been treated by registered and unregistered nurses. However it signifies that 100% of the sample was treated by the non registered nurses. This fact identifies the importance of the role of non registered nurses in health and social care homes in United Kingdom.
4.2. Profiling of the respondents:
The profiling of the respondents shows the background and level of understanding f the respondents, which is very important for the proper analysis of the data.
The profile of the respondents is shown below in Table 4.2
Table 4.2 Profile of respondents
| Respondents Characteristics | Response Percent | Response Count |
|
Age
18-24
25-34
35-44
45-54
55 +
Total
|
12.5%
45.8%
29.167%
4.167%
8.33%
100% |
3
11
7
1
2
24 |
|
Gender
Female
Male
Total
|
41.67%
58.33%
100% |
10
14
24 |
|
Occupation
Employed Full-time
Employed Part-time
Unemployed
Student
Total
|
0%
0%
100%
0%
100% |
0
0
24
0
24 |
Figure 4.2.1 Age groups of all respondents
The above diagram presents the age group of the sample, which shows that 45.80% of the people were from the age group of 25-34., and the least number of people were from the age group of 45-54.
Figure 4.2.2 Gender of all respondents
This figure represents that 58.33% of the respondents were male, however only 41.67% of respondents were female.
Figure 4.2.3 Occupation of all respondents
This diagram shows that all the respondents were unemployed.
4.3. Medication Usage Patterns of the respondents:
The idea of dispensing and medication is one of the oldest concepts in the field of health management system and the development it has gone through. There is an overlap between activities relevant to dispensing a drug and activities related to administering medication. Assessing the appropriateness of a medicine, selection of the medicine, appropriate health awareness and providing medication information to a client occurs in dispensing and administering a medication.
The medical usage patterns of the respondents is show in Table 4.3
Table 4.3 Medical usage patterns of respondents
| Medication Usage Patterns of the respondents | Response Percent | Response Count |
| Usage of medicines
Yes
No
Total
|
79.16%
20.83%
100% |
19
5
24 |
| Frequency of medicine usage
Once in a quarter
Once in a month
Twice in a month
Once in a week
Daily
Total
|
0%
0%
8.33%
12.5%
79.16%
100% |
0
0
2
3
19
24 |
| Impact of proper administration of medicine on treatment
Yes
No
Total
|
100%
0%
100% |
24
0
24 |
| Impact of proper dispensing on the standard of treatment
Safety
Satisfaction
Quick
Security
Total
|
33.3%
26.38%
6.94%
33.3%
100% |
24
19
5
24
72 |
Figure 4.3.1 Medicine usage of all respondents
The above diagram shows that 79.16% of the sample had used medicine before.
Figure 4.3.2 Frequency of medicine usage of all respondents
The data identifies that out the sample 79.16% percent of the people were using medicine on the daily basis. However 12.5% and 8.33% of the people were taking medicine on once in a week and twice in a month basis respectively.
Figure 4.3.3 Impact of proper administration of medicine on treatment
The above diagram implies that the 100% of the people in the sample agreed that proper administration of medicine has a great impact on the treatment of the patients.
Figure 4.3.4 Impact of proper dispensing on the standard of treatment
This figure identifies that 33.3% people considers that proper dispensing improves the standard of treatment by providing a higher level of safety and security. However only 6.94% of people regards quick service as a result of proper dispensing.
4.4. Attitudes Change of the respondents:
The difference between a registered and unregistered health care professional is very important in terms of law and its policies. The Registered Healthcare Professional is responsible to appropriately deal with the accountability of any delegation relevant to the administration of medicines; to ensure adequate awareness and supervision is available (NMC 2004, 2006). This individual is accountable for ensuring that related information concerning medication is obtained and recorded and for helping in the achievement of this policy in liaison with significant others. Where a registered nurse is accountable for the delegating any part of the administration of medication, they are responsible to ensure that the unregistered member of staff is competent to carry out the task.( National centre for biotechnology, 2003) The beginning of medicines should only be conducted out by a registered nurse as regular administration is required. The unregistered member of staff should only be affiliated in the management of constant ongoing therapy. (Environmental health unit, 2008) The unregistered member of staff must not undertake transcribing, that is copying an instruction for medication made by the prescriber from the prescription on to any other format. (Southern health and social service board, 2002) In accordance with the policies of law it is mandatory that an unregistered healthcare professional should work under a registered healthcare professional. The unregistered member of staff must not undertake the dispensing of medicines himself without the concern or approval of any registered healthcare professional that is, removing the medication from the container in which it was dispensed by the pharmacist to another container. The unregistered member of staff must not administer medications using patient group directions (PGD).
In addition to this, several other factors are accountable to change the health care delivery process and the most essential of these is the varying expectations. Patients are already used to good customer service from other industries and have expectations of better performance then they observe on the delivery sector. “They obviously ponder a lot about whether their insurance will bear the medical services they require, whereas in addition to this they are also concerned about the quality of service they get: how accurate, reliable, and trust worthy it is, and the responsiveness and convenience they provide. Employers expect better outcomes, and in return they and patients desire fewer flaws and fewer issues related to patients by providing proper health care that was required to cure their ailment.” (European Agency on Safety and Health at Work, 2009)
“Some of the most critical innovations are not technological hence they are relevant to the way health care delivery is organized. As mentioned, these include ailment management programs that target the most challenging patients, and tools and systems that are useful to allow patients to be more effectively involved in their own health care.” (Nursing and Midwifery council, 2011)
The attitude changes of the respondents is show in Table 4.4
Table 4.4 Attitude changes of respondents
| Attitudes Change of the respondents | Response Percent | Response Count |
| Perception of the patients about the following of medical policies and regulations.
Yes
No
Total
|
100%
0%
100% |
24
0
24 |
| Importance of supervision for unregistered nurses and untrained health care staff.
Yes
No
Total
|
29.167%
70.8%
100% |
7
17
24 |
Figure 4.4.1 Perception of the patients about the following of medical policies and regulations.
The data implies that 100% of respondents have a perception that it is important to follow the medical policies and regulations.
Figure 4.4.2 Importance of supervision for unregistered nurses and untrained health care staff.
The results of the questionnaire show that most of the people does not consider the supervision of unregistered and untrained staff necessary.
4.5. Health care Organizations:
“In the field of health management system several factors are responsible to change the health care delivery process, and the most essential of these is varying expectations.” (American college of physicians, 2011) “Patients are used to satisfactory service from other industries and expect better performance than they observe on the delivery sector. They obviously ponder a lot about whether their insurance will bear the medical services they require, whereas in addition to this they are also concerned about the quality of service they get: how accurate, reliable, and trust worthy it is, and the responsiveness and convenience they provide. Employers expect better outcomes, and in return they and patients desire fewer flaws and fewer issues related to patients by providing proper health care that was required to cure their ailment.” (Carl, 2001)
Keeping this fact in mind, health care organizations perform the role of an intermediary between the patients and the staff and administration of health and social care homes.
The awareness of the respondents about health care organizations is show in Table 4.5
Table 4.5 Awareness of respondents about health care organizations
| Awareness of the respondents about the health care organizations | Response Percent | Response Count |
| Affiliation with any health care organization
Yes
No
Total
|
100%
0%
100% |
24
0
24 |
| Importance of social and health care organizations
Very important
Important
Indifferent
Unimportant
Total
|
100%
0%
0%
0%
100% |
24
0
0
0
24 |
| Benefits of health care organization to the society
Social and health awareness
Information on health related issues
Satisfaction
Guidance
Total
|
50%
50%
0%
0%
100% |
24
24
0
0
48 |
Figure 4.5.1 Affiliation with any health care organization
The above figure provides this information that the 100% of the respondents were affiliated with any health care organization.
Figure 4.5.2 Importance of social and health care organizations
This diagram identifies that social and health care organizations play a very important role in the health management system of United Kingdom.
Figure 4.5.3 Benefits of health care organization to the society
This diagram states that two most important benefits of health care organizations are social and health awareness and information on health related issues.
4.6. Staff Training:
All the staff members and the tasks performed by them are the key factors for the administration of medication in an appropriate and reliable manner. Staff should acquire training in accordance with the current policies and procedures for the sensible handling and arrangement of medication. “Staff must receive training in the current policies and procedures for the handling and administration of medicines within the home as part of the induction program for new staff and as periodic updating. Responsibility for the safe handling, administration, storage and custody of medicines must be that of a person designated by the manager. The manager must ensure that staff who supervise or undertake the administration of medicines have the right training and skills to do so safely and regular opportunities for updating their knowledge.” (Southern health and social service board, 2002)
“Care staff involved in the administration of medicines should receive any necessary additional training to enable them to administer medicines to residents.” (Southern health and social service board, 2002)
In addition to this, the staff and the rest of organization should be provided with the needed records and other required necessary information. The top management requires to identify everything that is being happening in the company. However, this does not imply that they should be overburdened with too much information. The information should be properly and intelligently processed i-e including all the relevant data and excluding all the unimportant and outdated data. The bottom line is that the information systems should be able to enable them to execute, manage, and examine plans, strategies, procedures, novel products, new business models or new business missions. The reporting should be made periodically. They should however be vigilant immediately when noteworthy events take place. (Royal Pharmaceutical Society of Great Britain, 2003)
“In all organizations, it is necessary for people to communicate with each other in various ways. In the same way all the important information needs to be communicated as well, for the purpose of an appropriate decision making process, this communication of information can be done through a proper information processing system. Information system performs three vital roles in a business organization. It helps in operations, decision making tactics and strategies to sustain and compete in the market.” (Margerison, 1996)
“There can be many difficulties in setting up a proper communication process, and these difficulties can arise from many different reasons, depending on situation and circumstances, and in order to avoid these difficulties one should try to properly understand the communication process and act accordingly.” (McCormack, 1999)
The understanding of the respondents about staff training is show in Table 4.6
Table 4.6 Understanding of respondents about the staff training
| Understanding of the respondents about the importance of staff training | Response Percent | Response Count |
| Importance of staff training in health and social care homes
Yes
No
Total
|
100%
0%
100% |
24
0
24 |
| Importance of updating the staff about the latest techniques in health and social care homes
Yes
No
Total
|
100%
0%
100% |
24
0
24
|
Figure 4.6.1 Importance of staff training in health and social care homes
It had been identified through this research that staff training in social and health care homes is very important.
Figure 4.6.2 Importance of updating the staff about the latest techniques in health and social care homes
In this research 100% of the respondents had a view that it is important to update the staff about the latest techniques in health and social care homes.
4.7. Standard of medication in United Kingdom:
So as to address a serious issue shortage of nurses, the Czech Republic launched a program of stabilization measures in 2008. It consisted of interventions which were included in the following:
Financial measures included putting nurses into higher salary grades as well as improving benefits in public health facilities; however professional development comprises of better access to education related to nurse speciality, with subsidies support from the government; support of modern continuous professional development programs; along with this professional autonomy deals with “negotiations and legislative changes to broaden nurse competences; family work balance support to assist return from maternity leave, including provision of child-care facilities, flexible working hours and part-time contracts; and workforce data monitoring of workforce and student numbers via a register of health care professionals.”
“With the aim to improving the attractiveness of the nursing profession and the quality of care, a four-year national plan was launched in 2008, supported by significant public investment. A combination of interventions is being implemented in the following four main action areas.”
“Workloads and stress levels of nurses are being eased via more staff, supportive action for upgrading auxiliary qualifications, and provision of information technology systems for reducing administrative work.” (E notes, 2011) “In addition to this qualifications are being addressed using more continuous training, more specialization, and the introduction of master’s degrees. Remuneration is being changed, and pay was increased for recognized specialties and nurse-executive positions. Social recognition and participation in decision making are being addressed through support of nurse representation within health authorities and bodies.” ( World health organization, 2011)
The view of the respondents about the standard of medication in United Kingdom is show in Table 4.7
Table 4.7 View of respondents about the standard of medication in United Kingdom
| Standard of medication in United Kingdom
|
Response Percent | Response Count |
| Standard of medication in United Kingdom
( 1 being the best)
1
2
3
4
5
Total
|
62.5%
33.3%
4.167%
0%
0%
100% |
15
8
1
0
0
24 |
Figure 4.7.1 Standard of medication in United Kingdom (1 being the best)
Most of the research respondents had given a higher grade to the standard of medication in United Kingdom, which highlights the medical care position in United Kingdom that it is at a good standard.
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