Introduction
This essay provides a critical reflection and evaluation of a specific episode of care encountered during my studies in non-medical prescribing. The purpose of this analysis is to demonstrate systematic and critical appraisal skills alongside informed decision-making in a clinical context. Non-medical prescribing, a vital component of modern healthcare delivery in the United Kingdom, empowers qualified practitioners to prescribe medications independently, thereby enhancing patient access to timely care (Cope et al., 2016). This essay focuses on an episode involving a patient with hypertension, exploring the decision-making process, the application of evidence-based guidelines, and the challenges faced in ensuring optimal patient outcomes. The discussion is structured into three key areas: the context and assessment of the episode, the critical appraisal of decision-making, and the ethical and professional considerations that influenced the process. Through this reflection, I aim to highlight the importance of integrating theoretical knowledge with practical skills to address complex clinical situations effectively.
Context and Assessment of the Episode of Care
The episode of care under review involved a 58-year-old male patient, Mr. Smith (a pseudonym to maintain confidentiality), who presented with poorly controlled hypertension during a routine consultation at a primary care setting. Hypertension, a significant public health concern, is a leading risk factor for cardiovascular diseases, affecting approximately one in four adults in the UK (Public Health England, 2019). Mr. Smith had a documented history of hypertension for over five years but reported inconsistent adherence to his prescribed antihypertensive medication, citing forgetfulness and perceived lack of symptoms as barriers. My role as a non-medical prescriber in training was to assess his condition, review his treatment plan, and make informed decisions regarding his ongoing care.
The initial assessment followed the National Institute for Health and Care Excellence (NICE) guidelines for hypertension management (NICE, 2019). I measured his blood pressure, which read 160/95 mmHg over multiple readings, indicating stage 2 hypertension. Furthermore, a review of his medical history revealed additional risk factors, including a family history of heart disease and a borderline high body mass index (BMI). Despite these observations, Mr. Smith expressed reluctance to escalate his medication regimen, voicing concerns about potential side effects. This situation required a balanced approach, integrating clinical evidence with patient preferences to formulate a care plan. The complexity of his case underscored the need for systematic appraisal, ensuring that all relevant factors—clinical, personal, and social—were considered before proceeding.
Critical Appraisal of Decision-Making
Informed decision-making in non-medical prescribing hinges on the ability to critically appraise available evidence and apply it to individual patient needs. For Mr. Smith, the decision-making process began with a review of his current medication, a low-dose angiotensin-converting enzyme (ACE) inhibitor. According to NICE guidelines (2019), patients with persistently high blood pressure despite initial treatment should progress to a combination therapy, often incorporating a calcium channel blocker or a diuretic. However, implementing this recommendation was not straightforward given Mr. Smith’s hesitancy. I consulted recent literature to explore strategies for improving adherence, finding that patient education and shared decision-making significantly enhance treatment outcomes (Sabaté, 2003). This evidence prompted me to dedicate time to discussing the risks of untreated hypertension, such as stroke and heart attack, while addressing his concerns about side effects with accessible information on common reactions and their management.
Additionally, I considered non-pharmacological interventions, such as lifestyle modifications, which are well-supported by research as effective adjuncts to medication in hypertension management (Mills et al., 2016). I advised Mr. Smith on dietary changes, including reducing salt intake, and encouraged regular physical activity. To facilitate adherence, I proposed a tailored medication schedule aligned with his daily routine, a strategy supported by studies indicating improved compliance through simplified regimens (Schroeder et al., 2004). Reflecting on this process, I recognise that while my decisions were grounded in evidence, there was limited exploration of alternative psychological factors, such as stress or health beliefs, which could have further influenced his adherence. This gap highlights a potential limitation in my approach, suggesting a need for broader assessment tools in future practice.
Ethical and Professional Considerations
Ethical considerations played a central role in managing Mr. Smith’s care, particularly in balancing autonomy with beneficence. As a non-medical prescriber, I am bound by professional standards to respect patient autonomy while promoting their best interests (Nursing and Midwifery Council, 2018). Mr. Smith’s initial resistance to intensifying treatment challenged me to ensure his decisions were informed rather than uninformed refusals. I provided detailed explanations and engaged in shared decision-making, ensuring he understood the implications of non-treatment. However, I must critically acknowledge that time constraints during the consultation may have limited the depth of this discussion, potentially affecting the extent to which true informed consent was achieved.
Moreover, professional accountability required me to document the consultation thoroughly and seek supervision from a senior colleague to validate my prescribing decisions. This step aligns with the principles of safe prescribing practice, which emphasise collaboration and reflection to minimise errors (Royal Pharmaceutical Society, 2016). Indeed, reflecting on this episode, I recognise that while my actions adhered to ethical and professional guidelines, there remains room for improvement in managing patient engagement under time pressures—an ongoing challenge in primary care settings. This experience has reinforced the importance of continuous professional development to refine communication skills and decision-making processes.
Conclusion
In conclusion, this critical reflection on an episode of care involving a patient with hypertension demonstrates the application of systematic appraisal skills and informed decision-making in non-medical prescribing. The assessment and management of Mr. Smith’s condition required integrating clinical guidelines, patient preferences, and ethical principles to devise a tailored care plan. While my decisions were largely evidence-based, as supported by NICE guidelines and relevant literature, limitations in addressing psychological barriers and time constraints highlight areas for improvement. This episode underscores the complexity of prescribing practice, where clinical knowledge must be complemented by effective communication and professional accountability. Moving forward, I aim to enhance my skills in patient engagement and interdisciplinary collaboration to ensure more holistic care delivery. Ultimately, such reflective practice is essential for personal growth and for improving patient outcomes in the dynamic field of non-medical prescribing.
References
- Cope, L.C., Abuzour, A.S. and Tully, M.P. (2016) Nonmedical prescribing: where are we now? Therapeutic Advances in Drug Safety, 7(4), pp. 165-172.
- Mills, K.T., Bundy, J.D., Kelly, T.N., Reed, J.E., Kearney, P.M., Reynolds, K., Chen, J. and He, J. (2016) Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation, 134(6), pp. 441-450.
- National Institute for Health and Care Excellence (NICE). (2019) Hypertension in adults: diagnosis and management. NICE Guideline [NG136].
- Nursing and Midwifery Council (NMC). (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. NMC.
- Public Health England (PHE). (2019) Health matters: combating high blood pressure. Public Health England.
- Royal Pharmaceutical Society (RPS). (2016) A Competency Framework for all Prescribers. RPS.
- Sabaté, E. (2003) Adherence to long-term therapies: evidence for action. World Health Organization.
- Schroeder, K., Fahey, T. and Ebrahim, S. (2004) Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database of Systematic Reviews, (2), CD004804.
