Negotiating professional boundaries: professional and organisational contingencies for pharmacist prescribing

Lafond, Natasher A. (2017) Negotiating professional boundaries: professional and organisational contingencies for pharmacist prescribing. MPhil thesis, University of Nottingham.

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Abstract

This thesis explores boundary work, practices and changes in the pharmacy profession. Specifically it examines boundary changes that support non-medical prescribing practice for pharmacists in the context of prescribing policies and strategies which both utilise the skills of the pharmacist and also give patients greater choice and access to services.

The last decade has observed a transformation in the boundaries of health professionals enabled through the creation of new roles and the expansion of traditional roles. With reference to the principles set out in the NHS Plan, NHS modernisation and the subsequent introduction of non-medical prescribing have brought about a number of changes in policy and practice for health care professionals. In addition, The Royal Pharmaceutical Society’s 2013 Medicines Optimisation, good practice guidance outlines guiding principles for medicine optimisation that compliment and support improved patient outcomes and NHS policy – in particular empowering patients and the public to make the most of medicines. Research shows that while there are increasing numbers of pharmacists registered as nonmedical prescribers and the numbers of those who are actually practicing as non-medical prescribers has continued to rise, there are still areas where groups are having to make “significant personal sacrifices” to implement and maintain the necessary competence to prescribe. Research suggests that there is still more that needs to be done in order to achieve more supportive environments for non-medical prescribers.

Pharmacists have been referred to for many years as being “underutilised” and “over trained” and capable of a far greater remit than the dispensing of medication that has typically been associated with pharmacists. In addition, the policies that developed to address different health care needs and outcomes also go some way towards changing boundaries and adapting the roles that pharmacists have.

This thesis first considers, the role of the pharmacist and what their occupational and professional boundaries are perceived to be. The thesis goes on to examine how pharmacists enact extended roles in practice. Lastly, the institutional and organisational factors that impact the subsequent practices of pharmacists and the services they deliver is explored.

Using qualitative research techniques, this study was carried out in three NHS Trusts across a range of settings with a range of health care practitioners. The study was organised in two parts. First, a series of exploratory interviews were carried out with a pharmacists, medical and support staff. Second, ethnographic non-participant observations with pharmacists in different settings were undertaken.

The empirical findings suggest that the boundary work between third parties is not a tension point or a point of conflict as suggested in theory and previous research around boundary work in the health care setting and the inter-professional context. Rather, the boundary is a non-issue in relation to role expansion of pharmacist non-medical prescribers. The findings imply that the ability to share tasks, expand, and change roles is largely shaped by changing contexts and organisational factors. The study data has been used to help develop a model whereby different practices and principles that affect and guide the position of pharmacists and their boundaries as well as negotiations of practice are considered. The model uses the principles Scott’s (2008b) Three Pillar and combines elements of Zietma and Lawrence’s (2010) boundary and practice work cyclical diagram. The model in this thesis is developed alongside the data analysis. The intention of the model is to provide a template that with further refinement could be used when looking at other professionals or professional groups interchangeably. The features of the model in theory will be able to be adapted when considering different professional interactions, task sharing or role identification within an organisation for example. The model and its development will be discussed in further detail throughout the thesis. The overall research findings, suggest that the scale to which non- medical prescribing is practiced by pharmacists across the range of settings is greatly determined by the organisation. This includes the way in which pharmacist nonmedical prescribing is used in practice, its ease of implementation and the subsequent role of the practicing health care professional.

Item Type: Thesis (University of Nottingham only) (MPhil)
Supervisors: Waring, Justin
Anderson, Claire
Keywords: Pharmacists, Pharmacy, Vocational guidance, Drugs, Prescribing, Role expectation
Subjects: R Medicine > RS Pharmacy and materia medica
Faculties/Schools: UK Campuses > Faculty of Social Sciences, Law and Education > Nottingham University Business School
Item ID: 41403
Depositing User: Lafond, Natasher
Date Deposited: 25 Aug 2017 08:12
Last Modified: 25 Aug 2017 08:12
URI: http://eprints.nottingham.ac.uk/id/eprint/41403

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