Nursing Assignment: Learning Outcomes, Prescribing and Patient Care

This nursing assignment addresses various learning outcomes related to patient care, prescribing practices, and ethical considerations. It explores scenarios such as accepting referrals, handling patient refusal of treatment, addressing colleague misconduct, and managing conscientious objections. The assignment also delves into the roles and boundaries of a prescribing team, including interprofessional collaboration and support. Furthermore, it examines the specific considerations for prescribing for children, including assessment, communication, diagnosis, and treatment of conditions like eczema, with a focus on evidence-based practice and ethical decision-making. The assignment emphasizes the importance of the NMC code, patient safety, and the nurse's role in advocating for the patient's best interests.

Running head: NURSING
Learning Outcome In Nursing
Name of the Student
Name of the University
Author’s Note

1
NURSING
Learning Outcome 3 -Activity-
1 - What should you ensure if you accept a referral from another health
professional for a patient who requires a prescription?
Ans- The Nursing and Midwifery Council (2019) asserts that a nurse must prioritise
people’s needs and work in accordance with all health care experts for quality
treatment. The Royal Pharmaceutical Society (2019) suggested that for non-
medical prescribing (NMP), one must assess the patient physiological and physical
condition, consider all available options, consult with other professionals and
prescribe medicines from available charts or by consulting a doctor. I will not
prescribe anything which is not in my area of knowledge and perform follow-ups
for effective patient care. Before prescribing, I will always assess dosage of
medicines and consider side-effects, and inform patients about the same.
2 - How would you act if there was a significant or immediate risk to a patient’s life
and they refused to give consent for treatment?
Ans- The Nursing and Midwifery Council (2019) states clearly that a nurse must
always consider the best interests of people before any action. It asserts that a
nurse must learn to act wisely in situations where the patient refuses treatment
and must learn to balance her act. The Code suggests to take prompt action in
case of emergency for patient safety and public protection. So, naturally it is the
duty of a nurse to respect people’s right to refuse a treatment, but in emergent
conditions the health-expert must act otherwise (Brijnath et al. 2016, Choi 2015)
So, I will have to try to communicate properly and convince the patient to take
medical help immediately.

2
NURSING
3 - What action would you take if you thought a patient’s safety was at risk
because of a colleague’s conduct, performance or health?
Ans- The Code of conduct mentioned in The Nursing and Midwifery Council (2019)
emphasizes a nurse must show prompt action if patient’s safety is at risk due to
any cause. I must likewise raise concern, contact higher authority and
acknowledge the patient’s safety immediately. Fagan and Parker (2016) and Butler
(2018) revealed that the act of a nurse to protest or raise her voice in workplace for
patient interest is largely guided by the environment and presence of supportive
background. But, it is my duty to act promptly and fight for public health and
wellbeing as guided by the ethical standards.
4 - What would you do if you had a conscientious objection that was relevant to
your professional practice?
Ans- Lamb et al. (2017) and Toro-Flores et al. (2017) delineated that to provide
comprehensive care to patients and to practice healthcare following the ethical
standards, a nurse must address the issue of conscientious objection through
proper strategies. The Nursing and Midwifery Council (NMC, 2019) described the
ethical conduct of nurses to maintain professionalism at any context. It was
suggested that a nurse must not bring her personal, religious, cultural or moral
beliefs as a hindrance to deliver proper patient care. So, I must not consider my
conscientious objection in my way of my service and contact help of my co-
workers and senior colleagues to deal with same.
Reference List

3
NURSING
Brijnath, B., Mazza, D., Kosny, A., Bunzli, S., Singh, N., Ruseckaite, R. and Collie,
A., 2016. Is clinician refusal to treat an emerging problem in injury compensation
systems?. BMJ open, 6(1), p.e009423.
Butler, A., 2018. Nurses uniting to better healthcare globally. Australian Nursing
and Midwifery Journal, 25(7), p.10.
Choi, P.P., 2015. Patient advocacy: the role of the nurse. Nursing Standard
(2014+), 29(41), p.52.
Fagan, A., Parker, V. and Jackson, D., 2016. A concept analysis of undergraduate
nursing students speaking up for patient safety in the patient care
environment. Journal of advanced nursing, 72(10), pp.2346-2357.
Lamb, C., Evans, M., Babenko-Mould, Y., Wong, C.A. and Kirkwood, K.W., 2019.
Conscience, conscientious objection, and nursing: A concept analysis. Nursing
ethics, 26(1), pp.37-49.
Nursing and Midwifery Council. (2019). The Code. Access date: 25th July,2019.
[Online]. Retrieved from: https://www.nmc.org.uk/standards/code/
Royal Pharmaceutical Society. (2019). Non-Medical Practitioner. Access date: 25th
July,2019. [Online]. Retrieved from: https://www.rpharms.com/Portals/0/RPS
%20document%20library/Open%20access/Professional%20standards/Prescribing
%20competency%20framework/prescribing-competency-fra
Toro-Flores, R., Bravo-Agüi, P., Catalán-Gómez, M.V., González-Hernando, M.,
Guijarro-Cenisergue, M.J., Moreno-Vázquez, M., Roch-Hamelin, I. and Velasco-
Sanz, T.R., 2019. Opinions of nurses regarding conscientious objection. Nursing
ethics, 26(4), pp.1027-1038.

4
NURSING
Learning Outcome 7 -Activity-
1 - Define the role and boundaries of the other members of your prescribing team
in relation to prescribing, supplying and administering medicines?
Ans- The Section 63 of the Health and Social care Act (2001) permitted the nurses
and NMP s to prescribe medicines in urgent situations (Department of Health, UK,
2006). The Royal Pharmaceutical Society (2019) suggested that NMPs must act
as a multidisciplinary team for better patient care and outcome. The team must
respect each other’s decision and act with trust and responsibility. The team may
consist of dietician, physiotherapist, pharmacist, podiatrist etc. A dietician can refer
food supplements like vitamin, proteins, physiotherapist can recommend
medicines like calcium to deal with physical activity issues, and pharmacist can
recommend a wide range of medicines while podiatrist can prescribe ointments for
foot care.
2 - Do any of the above responsibilities within your team overlap and are there any
omissions that need to be addressed?
Ans- The NMC, 2019 governs the cooperation of nurses with all other medical
professionals for patient-care. Hence, a nurse must act in accordance to the
team’s requirement. But, as a nurse and a pharmacist are both legally and
professionally capable of administering medicines, in situations to decide dosage
of medicines one must rely on the pharmacist’s opinion. Again, if a dietician and
pharmacist wants to prescribe dietary supplements to a person, it should be done
by dietician as he is better qualified to do so (Bourne, Baqir and Onatade 2015).
According to Royal Pharmaceutical Society, there must be appropriate

5
NURSING
understanding between team members.
3 - What support and advice do you expect from the other members of your
prescribing team and what support do they expect from you in return?
Ans- The NMC, 2019 code of nurse’s advices the nurses to provide leadership and
work as a team in situations of need. So, it is a sole responsibility of them to
comply with others and give a team effort for patient care. If the team of
professionals need medical advices regarding simple medical procedures like
dressing of wounds, preparing central line, provide saline, inject medicines a nurse
can help them (Bodenheimar and Bauer 2016). Again, if a nurse requires
guidance about diet chart, consultation regarding exercises, the other members
can help her effectively (Regan et al. 2015 ).
Reference List
Bodenheimer, T. and Bauer, L., 2016. Rethinking the primary care workforce—an
expanded role for nurses. New England journal of medicine, 375(11), pp.1015-
1017.
Bourne, R.S., Baqir, W. and Onatade, R., 2016. Pharmacist independent
prescribing in secondary care: opportunities and challenges. International journal
of clinical pharmacy, 38(1), pp.1-6.
Department of Health, 2006. Improving patients' access to medicines: a guide to
implementing nurse and pharmacist independent prescribing within the NHS in
England. Department of Health.
Nursing and Midwifery Council. (2019). The Code. Access date: 25th July,2019.
[Online]. Retrieved from: https://www.nmc.org.uk/standards/code/

6
NURSING
Regan, S., Laschinger, H.K. and Wong, C.A., 2016. The influence of
empowerment, authentic leadership, and professional practice environments on
nurses’ perceived interprofessional collaboration. Journal of nursing
management, 24(1), pp.E54-E61.
Royal Pharmaceutical Society. (2019). Non-Medical Practitioner. Access date: 25th
July,2019. [Online]. Retrieved from: https://www.rpharms.com/Portals/0/RPS
%20document%20library/Open%20access/Professional%20standards/Prescribing
%20competency%20framework/prescribing-competency-fra
Learning Outcome 8 (prescribing for children) -Activity-
1 - How would you adapt your assessment, communication and consultation style
in order to gather appropriate information from the child? Underpin the rationale for
your approach with supporting literature.
Ans- The NMC (2019) guides nurses to intervene medically by prescribing
medicines and communicating appropriately via verbal and non-verbal
communication methods for proper patient-care. So, it is a nurse’s duty to assess
the problems of the child effectively and provide proper care. I am already
informed that the eczema is 3 months old and is not responding to the standard
treatment. Next, I will try to investigate the extent of the rashes by examining her
whole body. As she is 2years old, I must communicate in a friendly manner with
actions and not through words, so that she feels free to let me examine her. If the
eczema is widespread, it requires proper treatment (Duncan 2019).

7
NURSING
2 - What key factors would you need to consider when undertaking a clinical
assessment of the child and why? It may help to consider the legal, professional
and ethical aspects that underpin clinical assessment in respect of a child of this
age.
Ans- National Institute of Health and Care Excellence (2017) suggests that child
below 5yrs age, must be handled carefully specially antipyretic therapy must not
be used to treat fever related to eczema. They also suggested that secondary
infections in such a small child can be due to vaccination received priorly. So, it is
the nurse’s duty to think critically, assess the situation wisely by gathering all
available information possible before medical intervention (NMC 2019). So, I must
take her medical history properly, and note all necessary information like that of
allergies.
3 - Explain how you would confirm the diagnosis in this case in order to make a
safe prescribing decision. Underpin your explanation with reference to the
evidence base.

8
NURSING
Ans- Molly presented with symptoms of extreme eczema, scratching and apyrexia.
The skin has become reddened but yet not infected. So, it can be diagnosed as a
case of chronic eczema. The infection was seen to gradually spread to an
extended portion and it did not respond to the conventional use of topical
medicines and ointment. Due to excessive scratching and the prevailing infection it
can be confirmed as a case of severe eczema. The case of eczema aggravated
even after 3 months of treatment. So, the diagnosis can be confirmed as atopic
dermatitis (Uldahl –Curiac et al. 2016).
4 - What developmental and physiological factors do you need to consider if you
are to prescribe for the child?
Ans- Atopic dermatitis or eczema is a chronic disease presented in a child as
rashes and skin infections. It is a very common disease to occur in a child but in
some child the condition may worsen with time. So, certain considerations must be
done while prescribing medicines to the child. I should be aware about the daily
cosmetic products like oil, soap used, frequency of fevers and other diseases to
get an idea about her immune system, and also should consider genetic factors,
allergies and current medications. A family history of eczema makes the condition
difficult to treat (Drucker 2017).
5 - What treatment could you prescribe for the child? Justify your choice, eg. what
is the evidence base supporting your decision making.

9
NURSING
Ans- The Royal Pharmaceutical society permits all NMPs to prescribe medicines in
case of emergency. After assessing the case of Molly, I should advice continuing
of the ointments prescribed by previous doctor along with some additional
interventions. Wet wraps and applying of essential oils can be authorized to apply
on affected portion of skin. Antibiotics and antihistamines to suppress immunity
can be prescribed along with vitamin-D and Vitamin-A supplements. Use of soft
clothes and anti-inflammatory medicines can also be prescribed. If the child has
not yet obtained smallpox vaccine, the process must be denied in such a child
(Wollenberg et al.2018).
6 - Reflect on your ability to prescribe for a child in your area of practice, even if
this is not currently part of your role.
Ans- I think I am confident enough to practice nursing with empathy and care but I
think I will be perplexed and nervous to prescribe medicines to a child. I may be
able to treat an adult person, but considerations and precautions are quite different
while treating a small child. Skin disease in children and in adults are quite
different, because the skin is very sensitive in a small child. Though I used proper
medicines with correct dosage, I was tensed as to how the child will react to the
products. Skin products does not suit equally everyone, so I was worried as I was
concerned about inappropriate reactions of my prescribed medicines.

10
NURSING
Handwrite a prescription for the product you are to prescribe using a sample
FP10, and complete a P-formulary for the product (these can be submitted in
Evidence Profile).
Name: Molly
Age: 2 yrs
Initial Diagnosis- Eczema
Duration- 3 months
Medications- Oilatum and emulsifying ointment
Current symptoms- Extreme itching, spreading of infection area in leg and arm,
redness of skin.
Diagnosis- Atopic Dermatitis
Medicines- Benadryl(1mg/ml oral solution)
Triamcinoline -.1
Reference List

11
NURSING
Drucker, A.M., 2017, January. Atopic dermatitis: Burden of illness, quality of life,
and associated complications. In Allergy & Asthma Proceedings (Vol. 38, No. 1).
Duncan, D.L., 2019. Supporting children and young people with atopic
eczema. British Journal of School Nursing, 14(3), pp.117-120.
National Institute for Health and Core Excellence (2019). Guidance. Access date:
25th July,2019. [Online]. Retrieved from: https://www.nice.org.uk/guidance/cg160
Nursing and Midwifery Council. (2019). The Code. Access date: 25th July,2019.
[Online]. Retrieved from: https://www.nmc.org.uk/standards/code/
Royal Pharmaceutical Society. (2019). Non-Medical Practitioner. Access date: 25th
July,2019. [Online]. Retrieved from: https://www.rpharms.com/Portals/0/RPS
%20document%20library/Open%20access/Professional%20standards/Prescribing
%20competency%20framework/prescribing-competency-fra
Uldahl-Curiac, A., Björk, A.K., Lundahl, L., Aberg-Gullstrand, E., Aurell, G. and
Svensson, A., 2016. Compliance difficulties in atopic children, reflections from an
eczema School in Sweden. Journal of Clinical & Experimental Dermatology
Research, 7, p.350.
Wollenberg, A., Barbarot, S., Bieber, T., Christen‐Zaech, S., Deleuran, M., Fink‐
Wagner, A., Gieler, U., Girolomoni, G., Lau, S., Muraro, A. and Czarnecka‐
Operacz, M., 2018. Consensus‐based European guidelines for treatment of atopic
eczema (atopic dermatitis) in adults and children: part II. Journal of the European
Academy of Dermatology and Venereology, 32(6), pp.850-878.

12
NURSING
Learning Outcome 9 -Activity-
1 - Make a list of your responsibilities and organisational requirements regarding
prescription/pad security.
Ans- Pharmaceutical Services Negotiating Community (PSNC 2019) suggests that
nurses can prescribe medicines in case of emergencies in Repeat Dispensing
Prescriptions (RA/RD). They have to be trained in accredited courses as
prescribers to perform this role. They urges the fact that NMPs help meet referral
targets for the organisations. The Advisory guidance by National Health Service
(NHS) recommends the organisations to train nurses suitably in various medicinal
policies, about dosage and proper administration techniques of the medicines.
NHS have issued various protocols for prescription security which involves the fact
that nominated person should take all responsibilities regarding safety of
prescriptions (NHS
2 - Locate, print or download an example prescription use recording log/form that
you could use in your role as a prescriber for use when you are a qualified
prescriber.
Ans- Harada et al. (2016)

13
NURSING
3 - List the actions that you and your employing organisation should take to control
prescription pad issue and deal with loss or suspected theft.
Ans- According to guidelines of Soleymani et al. (2018), if loss of prescriptions or
theft is suspected, I will immediately inform the line-manager or whoever is
concerned. Informing the General practitioner is also mandatory. All details should
be revealed to the whole team including the missing number of prescriptions,
identification number, time noticed, and the exact place of the incident (Erensen et
al. 2018). The local Counter Fraud Team will notify all the local pharmacists or
primary health control group about the issue. I have to also order for a new batch
of pads. I will henceforth have to write prescriptions in red ink for a two month
period. If the missing prescriptions are found they are to be destroyed immediately
by the line-manager (NHS 2019).
4 - Articulate your understanding in relation to remote prescribing utilising your
organisational and professional body requirements/limitations.
Ans- Sometimes, there may be urgent requirement to prescribe medicines via
medium such as telephone, fax, video etc. without personally diagnosing the

14
NURSING
patient. In such case, I have to take detailed history of diseases, medications, and
educate the patients regarding the prescribed drugs if any. The NMC suggests the
nurse to assess efficiently and prescribe medicines and to take responsibility for
the action in near future. So, I have to effectively maintain follow-up and close
monitoring of the patient and have to consult a GP regarding the same issue.
Before prescribing any medical intervention, I have to ensure that there is enough
reason to do so (Graham- Clarke et al. 2018).
5 - Articulate your accountability when prescribing off label and unlicensed drugs
utilising your organisation and professional body guidelines/standards.
Ans- According to Magalhães et al. (2015), Jackson and Carberry (2015), usage of
off-label drugs are problematic because they are not licensed or tested bio
medically. The European Medicines Agency suggested that off-label drug use is
intentional and it generally diverges from basic area of applications. So, I will be
extremely careful while prescribing off-label drugs. The ethical considerations
while prescribing such drugs are patient safety, availability to all, and effective for
all age group of population (NHS 2019). So while recommending such drugs I will
prescribe so in best interest of patient, maintaining all the safety standards and
authorizing those which are in-practice.
6 - State what actions you should take in the event a patient suffers a serious
adverse reaction/allergy to a product you have prescribed.
Ans- Adverse drug reactions are common phenomena which occur in practice
sometimes. Some reactions are predictable side effects of the drugs, while others
happen due to individual reaction to the composition (Marques et al. 2015,
Garaicoechea et al. 2015). The NMC (2019) suggests that a nurse must act in best
interest of patients and should take responsibilities for every action. It also

15
NURSING
recommends to be clear about any mistakes in care and treatment of patients for
effective patient care. It is also significant for a nurse to comply with any
investigation procedure which is to happen (Angelis et al. 2015) So, in case of any
such issue I will follow all the code of the NMC and cooperate with higher authority
and inform a doctor and other colleagues about the same.
Reference List
De Angelis, A., Colaceci, S., Giusti, A., Vellone, E. and Alvaro, R., 2016. Factors
that condition the spontaneous reporting of adverse drug reactions among nurses:
an integrative review. Journal of nursing management, 24(2), pp.151-163. Access
date: 25th July,2019. https://www.ncbi.nlm.nih.gov/pubmed/25974355
Erensen, J.G., Haddox, J.D., Attre, M.S. and Bauza, L.N., 2018. Pharmacy-related
theft of controlled substances: RxPATROL® findings. Journal of opioid
management, 14(5), pp.373-380. Access date: 25th July,2019.
https://www.ncbi.nlm.nih.gov/pubmed/30387860
Graham-Clarke, E., Rushton, A., Noblet, T. and Marriott, J., 2018. Facilitators and
barriers to non-medical prescribing–A systematic review and thematic
synthesis. PloS one, 13(4), p.e0196471. Access date: 25th July,2019.
https://www.ncbi.nlm.nih.gov/pubmed/29709006
Harada, S., Suzuki, A., Nishida, S., Kobayashi, R., Tamai, S., Kumada, K.,
Murakami, N. and Itoh, Y., 2017. Reduction of medication errors related to sliding
scale insulin by the introduction of a standardized order sheet. Journal of
evaluation in clinical practice, 23(3), pp.582-585. Access date: 25th July,2019.
https://www.ncbi.nlm.nih.gov/pubmed/27928867
Jackson, A. and Carberry, M., 2015. The advance nurse practitioner in critical
care: a workload evaluation. Nursing in critical care, 20(2), pp.71-77. Access date:

16
NURSING
25th July,2019. https://www.ncbi.nlm.nih.gov/pubmed/25482585
Magalhães, J., Rodrigues, A.T., Roque, F., Figueiras, A., Falcão, A. and Herdeiro,
M.T., 2015. Use of off-label and unlicenced drugs in hospitalised paediatric
patients: a systematic review. European journal of clinical pharmacology, 71(1),
pp.1-13. Access date: 25th July,2019.
https://www.ncbi.nlm.nih.gov/pubmed/25318905
Mendes Marques, J.I.O., Polónia, J.M.J., Figueiras, A.G., Costa Santos, C.M.N.
and Herdeiro, M.T.F., 2016. Nurses’ attitudes and spontaneous adverse drug
reaction reporting: a case–control study in Portugal. Journal of nursing
management, 24(3), pp.409-416. Access date: 25th July,2019.
https://www.ncbi.nlm.nih.gov/pubmed/26481698
National Health Services. (2019).Advisory Guidance Administration of Medicines
by Nursing Associates. Access date: 25th July,2019. [Online]. Retrieved from:
https://www.hee.nhs.uk/sites/default/files/documents/Advisory%20guidance%20-
%20administration%20of%20medicines%20by%20nursing%20associates.pdf
Nursing and Midwifery Council. (2019). The Code. Access date: 25th July,2019.
[Online]. Retrieved from: https://www.nmc.org.uk/standards/code/
Pharmaceutical Services Negotiating Community. (2019). Repeat Dispensing
Access date: 25th July,2019. [Online]. Retrieved from: https://psnc.org.uk/services-
commissioning/essential-services/repeat-dispensing/
Soleymani, M.H., Yaseri, M., Farzadfar, F., Mohammadpour, A., Sharifi, F. and
Kabir, M.J., 2018. Detecting medical prescriptions suspected of fraud using an
unsupervised data mining algorithm. DARU Journal of Pharmaceutical
Sciences, 26(2), pp.209-214. Access date: 25th July,2019.
https://www.ncbi.nlm.nih.gov/pubmed/30460618

17
NURSING
Zurita-Garaicoechea, A., Reis-Carvalho, J., Ripa-Aisa, I., Jimenez-Mendoza, A.,
Diaz-Balen, A. and Oroviogoicoechea, C., 2015. Nursing role in reporting adverse
drug reactions. Enfermeria clinica, 25(5), pp.239-244. Access date: 25th July,2019.
https://www.ncbi.nlm.nih.gov/pubmed/26099522
Learning Outcome 10 -Activity-
Critical Analysis of Independent and Supplementary Prescribing
Independent prescribing is basically prescription by a medical professional who
have assessed the patients and authorized medicines for use. It consists of steps
such as initial patient diagnosis, interpretation, decision-making, prescription and
monitoring of the patients (NHC 2019, Weglicki, Reynolds and Rivers 2015). The
main aim of independent prescribing is to give patient quality care, choice and
access to medicines. Supplementary prescribing is the process of an effective
Clinical Management Plan (CMP) where the individual prescriber such as a doctor
prescribes a medicine consulting with other professionals such as a nurse. It can
be stated that the practice of supplementary prescribing is extremely significant
and effective because a grouped and agreed plan of patient treatment is always
more effective (Maddox et al.2015). As for example, a nurse who takes care of the
patient daily can have better knowledge about the person medically and personally
to guide the doctor to give proper medical intervention. A doctor may suggest an
obese patient apparently to perform exercises, but a nurse can help intervene here
to inform that the patient is asthmatic even if the patient fails to say so. Hence, it
can be inferred that supplementary prescribing enhances the expertise and

18
NURSING
confidence of prescribing. Like individual prescribers, supplementary prescribers
can also recommend controlled drugs and unlicensed medicines for quality care of
patients (Cope, Abuzuor and Tully 2016, Dreischulte et al. 2016).
Reference List
Cope, L.C., Abuzour, A.S. and Tully, M.P., 2016. Nonmedical prescribing: where
are we now?. Therapeutic advances in drug safety, 7(4), pp.165-172.
Dreischulte, T., Donnan, P., Grant, A., Hapca, A., McCowan, C. and Guthrie, B.,
2016. Safer prescribing—a trial of education, informatics, and financial
incentives. New England Journal of Medicine, 374(11), pp.1053-1064.
Maddox, C., Halsall, D., Hall, J. and Tully, M.P., 2016. Factors influencing nurse
and pharmacist willingness to take or not take responsibility for non-medical
prescribing. Research in Social and Administrative Pharmacy, 12(1), pp.41-55.
National Health Services. (2019).Advisory Guidance Administration of Medicines
by Nursing Associates. Access date: 25th July,2019. [Online]. Retrieved from:
https://www.hee.nhs.uk/sites/default/files/documents/Advisory%20guidance%20-
%20administration%20of%20medicines%20by%20nursing%20associates.pdf
Weglicki, R.S., Reynolds, J. and Rivers, P.H., 2015. Continuing professional
development needs of nursing and allied health professionals with responsibility
for prescribing. Nurse Education Today, 35(1), pp.227-231.

19
NURSING

20
NURSING

21
NURSING