Читать книгу The Advanced Practice Registered Nurse as a Prescriber - Группа авторов - Страница 27

APRN prescribing is based on recommendations about medications that reflect the patient’s best interests. Decisions also reflect patient preferences. Additionally, the APRN should guard against participating in relationships that conflict with the patient’s best interests. Licensed prescribers in the District of Columbia’s Medicare Part D program who accepted gifts from pharmaceutical companies were more likely than those who did not to take gifts to prescribe more medications, more expensive medications, and more brand‐name drugs (Wood et al., 2017). Although voluntary rules are in place to limit the relationships with and gifts from pharmaceutical companies, sample medications provided at the clinic by a company’s representative and educational programs continue to influence practitioners.

One of the most challenging aspects to prescribing can occur when patients have strong, erroneous, or unrealistic beliefs about their care. Some patients may be demanding, complaining, or rude, and require more extensive interaction than other patients. While these situations may prompt the label of “difficult patient,” alternative terminology such as “difficult patient situations” or “complex patient interactions” is more appropriate. “Standing one’s ground” with rational prescribing can be difficult in the face of patients’ demands for specific medications such as antibiotics. How can the APRN handle situations in which the patient assumes an adversarial role? Chapter 6, Managing Difficult and Complex Patient Interactions, has a full discussion of this topic. There are times, however, when a patient’s specific medication request may be appropriate to consider. For example, when the next step in treatment of depression is medication, a patient may request the specific drug a family member had success with. Provided there are no contraindications to that specific drug and there is not a superior option, working with the patient’s preference can build rapport.