The purpose of this study was to explore issues relating to the implementation of independent nurse prescribing (IP) in mental health settings. Nurse prescribing in mental health has been promoted through various policy documents and has been subject to extensive research enquiry. Independent nurse prescribing is the latest form of prescriptive authority although little is known about how it can be used in mental health settings. Focus groups were used to collect qualitative data. In total, 22 nurses and three psychiatrists joined one of five focus groups. A form of grounded theory was used to analyse the data. Three major findings will be discussed. The first theme related to how IP could support system redesign and new ways of working. The second theme revolved around the form of future training and competency requirements to support an IP role, and the third theme was about the types of setting and diagnostic restrictions that need to be considered for IP. Findings suggest an overall cautious view on IP for a range of clinical settings. Implications for practice include the impact on new roles for nurses and psychiatrists and how nurses can best be trained and supported to carry out IP safely.

The ethanol contained in alcoholic beverages is rapidly absorbed from the gastrointestinal tract and the maximum blood‐alcohol concentration (BAC) is usually reached between 10 and 60 min postdosing. Once in the bloodstream, ethanol is distributed into the total body water (TBW) compartment, which comprises ~55–60% of body weight in nonobese males and ~50–55% in females. The volume of distribution (V d) of ethanol depends on a person's age, gender, and degree of adiposity (ratio of fat to lean tissue). Studies have shown that the average V d for healthy men and women are ~0.70 and ~0.60 L/kg, respectively. Elimination of ethanol from the body occurs primarily through metabolism (92–98% of dose) by hepatic alcohol dehydrogenase (ADH), an enzyme located in the liver cytosol and a microsomal enzyme, denoted CYP2E1. A small fraction (0.1–0.2%) of the dose of ethanol ingested undergoes nonoxidative metabolism by phase II conjugation reactions leading to formation of ethyl glucuronide and ethyl sulfate. Only between 2 and 10% of the dose of ethanol is excreted unchanged in urine, breath, and in sweat/perspiration. Ethanol exhibits dose‐dependent pharmacokinetics, because the hepatic ADH enzyme is saturated with substrate at BAC above 15–20 mg/100 mL (15–20 mg%). Zero‐order kinetics operate for most of the postabsorptive elimination phase and the BAC decreases at a constant rate per unit time ranging from 10 to 35 mg% per hour (average 15 mg% per hour for moderate drinkers). Examples of various pharmacokinetic calculations are presented because these are often necessary in forensic science and legal medicine casework. This article is categorized under: Toxicology > Alcohol Toxicology > Analytical Toxicology Toxicology > Drug‐Impaired Driving

The aim of this paper is to report on findings identifying some of the difficulties encountered by the multidisciplinary team in the development and implementation of a care pathway for patients diagnosed with schizophrenia. Policy direction has shifted towards greater team working and blurring of professional boundaries. Moreover, there is greater need to deliver care according to set standards and for patients to reach particular outcomes of care. Care pathways are relatively new for psychiatry and will potentially uncover tensions within the team. Data were collected by participant observation and semistructured interviews over a period of 12 months on an acute psychiatric unit. The care team developed the care pathway and the process of development and implementation was observed through action research. Cross-sectional indexing was used to analyse the data, and themes were developed using interview and observational data collection methods. Clinicians argued strongly for clear role boundaries but also defended their perceived control over health care from other professions. The findings indicate that designing a care pathway for people with schizophrenia may produce conflicting perceptions from the team. Conflict may arise through professions being unwilling to accept plurality over roles, which may hinder progress in meeting the needs of patients. The findings also counter the impression that care pathways can be implemented with little impact on the team.

The findings are particular to this research environment, although some wider issues could be applicable to other sites such as the nature of representing psychiatric work on the care pathway; the evidence-based practice movement and the role of the user and individualized care.

Supplementary nurse prescribing holds the key to rapid developments in psychiatric nursing and the care received by patients. In this paper, the origins, context and research data on nurse prescribing are reviewed, as a backdrop to a discussion on potential application of supplementary prescribing in a number of mental health settings. We describe a number of practice settings where nurse prescribing could be implemented, and argue that given service changes and informative educational preparation, access to care and user experience of that care will be enhanced. We conclude the paper by reviewing a number of clinical, organizational and research factors important for the success of nurse prescribing.