Being mentored by a mental health nurse prescriber has inspired me to share an experience that challenged me to draw upon skills I learned in theory sessions and was keen to put into practice
The role of a nurse prescriber is not simply about prescribing drugs. It is about ensuring that the medicines are safe and effective, particularly when a combination of drugs are used.
“It is about ensuring that the medicines are safe and effective, particularly when a combination of drugs are used.”
A prescriber uses their own expertise and experience, as well as the knowledge of other professionals, to achieve the best evidence-based treatment available for an individual.
They will consider a person’s physical and mental health and study their medical history to make sure that any prescribed drugs do no interact to produce unwanted adverse effects.
“A prescriber uses their own expertise and experience to achieve the best evidence-based treatment available for an individual”
This made me reflect on my responsibilities as a student nurse, to strive for a greater understanding and knowledge of the drugs that are prescribed to patients I see in clinical practice.
The nurse prescriber had seen me studying the BNF and suggested that I help her do some research finding the safest and most effective anti-depressant for a patient who had a renal impairment and was undergoing dialysis.
Upon studying their notes I noticed the patient had tried other therapies including cognitive behavioural therapy and some solution-focused therapy and was insistent that they wanted an anti-depressant to lift their mood in order to help them through a particularly stressful period in their life.
“These symptoms can sometimes be difficult to differentiate from depression”
The research helped to me focus on the patient’s physical and mental health, which of course are inextricably linked, and to consider any contraindications that any other medications may have posed.
Further study helped me to understand that patients diagnosed with chronic kidney disease can commonly have difficulty sleeping, low energy levels and cognitive impairment. These symptoms can sometimes be difficult to differentiate from depression and again, this helped me to achieve a deeper understanding of how a physical condition can impact on someone’s mental health.
“This trial helped me to understand the rational of why one particular drug was considered to be most suitable”
My quest to find the safest and most effective anti-depressant started with the BNF and the NICE website, the latter of which has guidance and advice that is up-to-date and evidence-based.
Further searches utilising the university health library revealed an important study, the Chronic Kidney Disease Anti-depressant Sertraline Trial (CAST), which helped me to understand the rational of why one particular drug was considered to be most suitable. I recognised the importance and validity of this randomised, double-blind and placebo controlled trial, something which I had learned during theory about how to critique a study.
“My learning is clicking into place and it feels empowering to be using my new skills”
Lastly, I made a telephone call to a pharmacist to get their opinion on whether the anti-depressant in question, sertraline, was in fact safe for use in this case. The pharmacist confirmed it was considered safe in a low dose and this advice was supported by information in the Maudsley Prescribing Guide.
My learning is clicking into place and it feels empowering to be using my new skills assisting a professional and ultimately ensuring a patient receives the safest and most effective and appropriate treatment available.
In addition, taking part in this exercise ensured this new learning was truly memorable. I will never forget the importance of being knowledgeable about the drugs I administer.
Lastly, this exercise helped to reinforce my accountability and responsibility as a student and the importance of giving a thoroughly researched rationale for my clinical decisions.
Mandy Mould is a current student nurse.