Groves, Winnifred (2012) Diagnosing and prescribing by nurses in different health care settings: perceptions and experiences of key stakeholders in Cameroon. (PhD thesis), Kingston University, .
Abstract
Declining resources are a global phenomenon. One of the consequences has been the reorganization of health care provision in different countries. Doctor shortages and scarcity of resources particularly in developing countries like Cameroon have resulted in nurses providing frontline care to patients and taking on roles traditionally performed by doctors in developed economies, such as diagnosing and prescribing. However, little is known about the exact role of nurses, the process of providing care, how key stakeholders influence the nurse’s role and the consequences of this role of nurses on the various parties concerned in the context of Cameroon. An empirical study was conducted with (n= 42) key stakeholders; (government representatives, doctors, nursing managers, nurses and patients). Semi-structured taped-recorded interviews were carried out on a one-to-one basis to explore the perceptions of multiple key stakeholders of the role of nurses in diagnosing and prescribing. Interviews were transcribed and data analysed using framework analysis. Nurses are the first point of contact for patients in Cameroon in all health care settings and most have a far greater role in diagnosing and prescribing than their counterparts in developed economies. However their involvement was found to vary significantly depending on a number of factors, including: the organisational context, the type of facility (whether public / private or mission owned), individual nurse characteristics, doctors’ attitudes and practices, resources and experience of nursing managers, level of income and characteristics of patients. Most patients (including women) prefer to consult with doctors and in their absence, male nurses rather than female nurses. Some nurses, patients and doctors felt that a preoccupation with diagnosing and prescribing left nurses with little time for compassion and caring. In addition, the key stakeholders felt that some nurses were overstepping their professional boundaries, or had inadequate knowledge and were acting in a manner detrimental to patient care. Extended roles for nurses have the potential to enhance accessibility to care, to enhance the status and job satisfaction of nursing staff and maximise the use of scarce resources. Despite the benefits, there is growing concern that nurses do not have the advanced level of training and behaviour necessary to take on this expanded role and that some are neglecting the traditional caring side of their profession in pursuit of a more medical oriented disease-focused approach.
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