No abstract

This article describes the construction of a tool to measure concordance in clinical practice. The second of two parts, it details the strategic background underpinning concordance and expands the rationale as this relates to the construction of individual items within the evaluation tool used and described. Cribb (2011) considers that while policy drivers extol the rhetoric of shared decision-making and person-centred care, the application of this is complex. Cribb's thesis is summarised to show that the evaluation tool is grounded in the right type of evidence to support the facilitation of concordance in clinical practice.

NHS Ayrshire and Arran nurse director Fiona McQueen is professionally accountable to the board for every aspect of nursing practice, writes Derek Barron. She is politically accountable for healthcare-associated infections, patient safety, public involvement, releasing time to care and all complaints.

This article describes the development of an advanced nurse practitioner (ANP) service in mental health. The ANPs worked within an existing hospital at night team based at Crosshouse Hospital, a district general hospital in Kilmarnock. Set against the agenda of Modernising Nursing Careers and Modernising Medical Careers, the article describes the professional and organisational background to the development, broad training requirements and skills set of this new team of ANPs. The role played by mental health ANPs in replacing junior psychiatric doctors in the out-of-hours period is of significant importance. In addition, these mental health ANPs covered the general wards in the hospital alongside their general ANP colleagues. The competency framework that the ANPs need to complete is discussed as well as the challenges faced in developing the service.

This article provides evidence to suggest that mental health nurses may not be as competent in medicines management as they believe themselves to be. A psychological model of skills awareness is used throughout the article to offer a theoretical explanation of this putative deficit and provide discussion of the possible causes. Training directed towards improving medicines management skills will be introduced. Training such as this is essential if mental health nurses are to offer the best care to those in receipt of their services and make best use of the opportunities provided by prescribing legislation.