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15 An evaluation of palliative care nurse prescribing: a mixed methods study in uganda
  1. J Downing,
  2. G Kivumbi,
  3. E Nabirye,
  4. A Ojera,
  5. R Namwanga,
  6. R Katusabe,
  7. M Dusabimana,
  8. K Kalema,
  9. B Yayeri,
  10. A Apollo,
  11. M Batuli,
  12. C Komunda,
  13. R Nabukalu,
  14. J Mwesige,
  15. M Sekyondwa,
  16. M Kasirye,
  17. JO Amoris,
  18. E Nandutu,
  19. W Acuda,
  20. D Adong,
  21. E Luyirika,
  22. E Namisango,
  23. F Kiyange,
  24. R Kiwanuka,
  25. J Amandua,
  26. J Logan,
  27. E Haraldsdottir,
  28. B Moback,
  29. C Lesley,
  30. L Grant and
  31. M Leng
  1. Makerere and Mulago Palliative Care Unit Makerere University Kampala, Global Health Academy University of Edinburgh, Dr Ambrosoli Memorial Hospital Agago, Hospice Africa Uganda Kampala, Kabale Hospital Kabale, Bwera Hospital Kasese, CARO Kasese, MJAP Bwizibwera Health Centre Mbarara, Palliative Care Association of Uganda, Kampala, Kibuli Hospital Kampala, Kagadi Hospital Kibale, Mildmay Uganda, Management Sciences for Health Busia, Tororo Hospital, Uganda People’s Defence Force (UPDF) Bombo, African Palliative Care Association Kampala, Ministry of Health Kampala, St Columba’s Hospice Edinburgh, Cairdeas International Palliative Care Trust UK


Background Access to palliative care (PC) in Uganda has been hampered by the lack of prescribers. Thus PC care trained nurses have been able to prescribe since 2004, however, no full scale evaluation had been undertaken, despite the fact that PC stakeholders are advocating for nurse prescribing in other countries. Thus an evaluation was undertaken to determine the effectiveness of PC nurse prescribing in Uganda.

Methodology The mixed methods evaluation was undertaken in three parts:

  • Preparation of the nurses for the role;

  • Assessing and managing pain & symptoms;

  • An appraisal of the system in which the nrses are working.

Ethical approval was gained prior to the evaluation commencing.


  • Training: the curriculum prepares the nurses well, however, a few adaptions are recommended to strengthen it further. Themes identified from 18 interviews included: the training itself, supervision and mentorship, compentency, and beliefs.

  • Assessing and managing pain: 22 nurses were recruited to care for 20 PC patients each, visiting them on at least 2 occassions, assessing and managing their pain and other symptoms, and utilising the APCA POS. Analysis demonstrates nurses are able to assess and manage pain, giving appropriate mediciations and reassessing.

  • The appraisal in 10 districts, showed nurses are working in a system which can impact negatively on care provision e.g. stck–outs of analgesics, limited understanding of PC generally: and many myths exist re the use of morphine and provision of PC.

ResultsTrained palliative care nurses can assess and manage patients pain, prescribing morphine and associated medications appropriately. Whilst challenges exist, recommendations are made to improve the system, this evaluation has clearly shown the benefit and safety of nurse prescribing for PC in Uganda. This study has important implications for the global debate on issues of access to oral morphine and task shifting.Conclusion

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