Morphine prescribing by nurses. An evaluation of the impact of a morphine prescribing programme in Sub Saharan Africa

Background: Nurse prescribing is undergoing major reforms in the western world to expand the prescribing powers of nurses, although the move to allow opiod prescribing is still met with some debate and concern. Yet nurses have been prescribing morphine in sub Saharan Africa since 200�. A lack of access to doctors coupled with the large number of patients with cancer and HIV resulted in the development of an innovative programme to allow nurses to prescribe morphine. Following policy changes in 200� nurses who have completed a nine month Community Palliative Care Course at Hospice Africa Uganda are permitted to prescribe morphine. The aim of this study was to evaluate the impact of this extended prescribing Methods: A qualitative methodology using focus group interviews was adopted for the study to enable group discussion and interaction to take place (Bloor et al 200�, Vaughn et al �996). A purposive sample of members from clinical and educational teams and current students from Hospice Africa Uganda were invited to participate in the study. 24 volunteers and participated in three audio taped focus groups. Data was analysed for emerging themes using thematic analysis. Results and Discussion: There was a general consensus that nurses’ being allowed to prescribe morphine was having a positive effect of patients, their families and the clinical team. Benefits including pain relief and enhancing the patient’s quality of life were noted. Economic impacts of reduced travelling costs to obtain the morphine were stressed. Course students referred to their initial concerns surrounding prescribing morphine and the importance of the course in preparing them for the role. The ongoing problem of a limited supply of morphine was also noted. This paper discusses these findings and potential explanations given. Ongoing research to assess measurable clinical outcomes is discussed