VOL: 96, ISSUE: 45, PAGE NO: 42
Liz Scanlon, MSc, RGN, RM, CertDN, is nurse consultant, tissue viability, Leeds Community and Mental Health Services Teaching NHS TrustThe introduction of nurse prescribing has again prompted discussion on the relationship between nurses and company representatives. Some argue that nurses are poorly equipped to deal with sales people and are likely to be persuaded to use products without the appropriate evidence base or rationale.
The introduction of nurse prescribing has again prompted discussion on the relationship between nurses and company representatives. Some argue that nurses are poorly equipped to deal with sales people and are likely to be persuaded to use products without the appropriate evidence base or rationale.
Proponents of this argument advocate restrictive policies and formularies to guide decision-making. Others argue that nurses are accountable practitioners who should be responsible for keeping themselves up-to-date and making their own treatment decisions (Lipley, 2000).
It is crucial that nurses who are involved in purchasing and providing decisions use product information critically. This is a key factor to bear in mind when meeting company representatives.
How a representative gains access to the nurse will depend on the clinical setting, local policies and the views of managers. It is important for nurses to consider what they want to gain by meeting with a representative. If representatives are the first to make contact, decide whether you really want to see them. Remember, they want to do business with you.
A visit may have a number of advantages:
- By meeting regularly with different representatives you can obtain up-to-date information on a range of products;
- A verbal explanation accompanied by a visual demonstration and the chance to feel and examine the product can enhance your understanding of its use. You may also have the opportunity to try out the product;
- You can ask questions about the product;
- The representative may provide tips on methods of application that are not included in the information leaflets;
- You will have the opportunity to feed information on products back to your colleagues, and to make suggestions for improvements or report adverse reactions to manufacturers;
- You can use representatives as a resource for published material on the subject.
But there may also be disadvantages:
- The representative may not have any new information while you may have other demands on your time;
- A product demonstration may include an inappropriate comparison with a competitor;
- The fact that a product is fresh in your mind may unconsciously influence decision-making. Your professional relationship with a representative may also have this effect;
- Tips and hints can be misleading.
Most companies produce promotional literature and it is important not to take this at face value, so be critical in your approach. What does the literature tell you about the product? Look for information on the properties of any dressing, its indications, any contraindications, details of how to apply and remove it, when to change it and the sizes available.
A promotional leaflet may make statements or claims that should be referenced, such as the volume of fluid a dressing may hold compared with a competitor's product. It is important to read the original research before accepting these claims, and if necessary the representative should be able to supply a copy.
Compare the statements and conclusions in the original article with those used in the promotional literature, and take a close look at the reference list. Papers that have been published in peer-reviewed journals are more likely to be reliable than a collection of data on file, symposium proceedings or personal communications (Leach, 1985).
To fulfil the requirement for evidence-based practice, nurses need to be able to identify relevant information, appraise the quality of research and know which findings are applicable to their own areas of practice (Rosenberg and Donald, 1995).
Once a piece of research has been identified it may be helpful to start the appraisal by considering the following:
- Was the type of trial relevant to the research question? For example, a case study will tell you only whether one treatment worked for one patient;
- Was the study in vitro or in vivo? A dressing that kills bacteria in the laboratory may not do so when used on a patient;
- Are the subjects healthy? Healthy volunteers are likely to have better healing abilities than frail older patients;
- Have specific groups of patients been excluded? For example, many studies exclude patients with diabetes. Would the treatment still work with this patient group?
- Are the wounds described chronic or acute? A dressing tested on an acute burn wound may not be appropriate for a chronic colonised wound;
- Has the product been compared with a suitable alternative? For example, a foam dressing should not be compared with a hydrocolloid dressing for absorbency;
- Are the subjects and wounds comparable in both the treatment and control groups?
- Are all the patients accounted for? How many patients dropped out of each group and why?
- Are the findings relevant to practice? For example, is it clinically significant if one dressing holds 2ml more fluid than another?
Meetings should take place away from patients' bedsides and their purpose should be to inform you about the use and application of products. All meetings with representatives should be held at your convenience and must fit in with your work priorities. And if you ask the advice of a representative, remember that you are accountable for the final decision and that this must be evidence-based.