Enhance nursing consultation and non-medical prescribing skills through Gibbs’ reflective cycle, evidence-based heart failure management, ethical decision-making and structured CPD planning.
Healthcare practices across non-medical prescribing (NMP) offer trained professionals the authority to write prescriptions and enhance treatment methods to maximize positive patient results within their specific practice areas (Cope, Abuzour and Tully, 2016). An examination of a clinical consultation focuses on Mr Sigma (pseudonym), who is a 70-year-old Heart Failure with Reduced Ejection Fraction (HFREF) patient, forming the basis of this UK assignment within nursing practice. Gibbs’ Reflective Cycle (1988) serves as the foundation to organize the discussion about clinical decisions and patient-oriented care, and professional advancement.
A heart failure specialist nurse managed this patient evaluation, medication prescription, and treatment management process in an acute setting of the Cardiology Virtual Ward. The assessment will examine Independent (Non-Medical) Prescribing's Professional, Legal and Ethical dimensions by connecting this reflection to The Royal Pharmaceutical Society (RPS) Competency Framework (2021), The NMC Code (2018, 2024) as well as the NICE Guidelines (2018).
The reflection assesses the main difficulties encountered during prescribing by evaluating patient consent procedures, adherence to evidence-based practice guidelines, deprescribing protocols, and MDT teamwork approaches. The action plan for CPD will detail the strategies to enhance practitioner skills in prescribing while improving patient educational methods.
This section outlines the clinical context and key events of the nursing consultation, focusing on the assessment, prescribing considerations, and patient interactions that occurred. It provides a factual account of the consultation with Mr Sigma, highlighting the nurse’s role, the clinical setting, and the decisions made in relation to heart failure management.
I consulted in the Cardiology Virtual Ward at my acute care facility, where I function as a Heart Failure Specialist Nurse (HFSN). I am responsible for improving Heart Failure treatments while modifying medications through patient education to both patients and carers with the mission of delivering long-term disease management to minimize hospital admissions. This clinical review forms part of An Analysis of the Event in a Nursing Consultation, focusing on professional nursing responsibilities within non-medical prescribing practice. The clinical review focused on Mr Sigma (pseudonym), who turned 70 years old and received HFREF Heart Failure with Reduced Ejection Fraction diagnosis recently after acute hospitalization.
Mr Sigma sought hospital admission because he developed new breathing troubles together with swelling in both legs that healthcare professionals later diagnosed as HFREF decompensation. His medical care at the hospital required intravenous diuretics while healthcare providers conducted a detailed cardiac examination to establish the diagnosis. The echocardiogram showed his left ventricle (LV) was enlarged together with an enlarged left atrium (LA), and his ejection fraction (EF) measured at 35%. His NTproBNP levels were high at 4536 pg/mL, while his chest X-ray showed cardiomegaly. He received a post-discharge referral to the Cardiology Virtual Ward for medical management of his decompensated heart failure and medication adjustment, as well as sustained disease surveillance.
Mr Sigma granted permission before the consultation for medical staff to review his records from the hospital and GP clinics. In this consultation, we reviewed his medical condition while optimizing medications in compliance with NICE (2018) directives, explored medication-related concerns, and taught disease management techniques to strengthen his control outcomes (NICE, 2015). A vital component of this evaluation required examining his psychosocial requirements for sustaining independence and a high life quality.
In consultation, the nurse practitioner used the ICE Model to identify which ideas, concerns and expectations were important to Mr Sigma. The patient felt uncertain about the appointment because he learned minimal information about his health condition while in the hospital. The HFREF progression worries him, especially after his neighbour developed HF and displayed social withdrawal symptoms (Maddox et al., 2021).
The four pillars of HF treatment had already been instituted to Mr Sigma but medical staff needed to adjust his medications for maximum safety and efficacy and evidence-based rationale. He takes multiple medications, combining Ramipril with Bisoprolol and Dapagliflozin as well as Spironolactone with Amlodipine and Furosemide together with Atorvastatin.
Mr Sigma had started on the four pillars of HF treatment but required further titration and deprescribing considerations:
| Medication | Dosage | Action Taken |
|---|---|---|
| Ramipril | 5 mg BD | Stopped (prior to initiation of Entresto) |
| Bisoprolol | 2.5 mg OD | Continued |
| Dapagliflozin | 10 mg OD | Continued |
| Spironolactone | 12.5 mg OD | Continued |
| Amlodipine | 5 mg OD | Stopped (Potential interaction with Entresto, risk of hypotension) |
| Furosemide | 40 mg OD | Under review (Consider deprescribing if weight/symptoms remain stable) |
| Atorvastatin | 20 mg OD | Continued |
The HFSN NMP evaluated whether Entresto (Sacubitril/Valsartan) treatment should begin while recommending the termination of Amlodipine treatment, followed by assessing Furosemide's need at subsequent medication reviews for Mr Sigma. This prescribing decision-making process is central to An Analysis of the Event in a Nursing Consultation, demonstrating the application of evidence-based guidelines in clinical nursing practice. Entresto's effectiveness in reducing cardiovascular death rates and minimizing HF hospital admissions was validated by NICE (2018) guidelines and the PARADIGM-HF study results (NICE, 2024).
Initiation of Entresto 49/51 mg twice daily triggered a follow-up renal function assessment aiming to detect changes related to renal function and hyperkalaemia within two weeks. The administration of Amlodipine 5 mg once daily was terminated because Entresto required an increased risk of hypotension between the medications. The following review will determine if Furosemide 40 mg OD should be deprescribed when weight stays stable, and fluid overload does not occur.
An essential aspect of the consultation included teaching Mr Sigma about his health condition while presenting available treatment choices and self-care abilities. The health care provider delivered written materials to Mr Sigma with two documents: an HF information booklet, a BP monitoring guide, and an appointment diary for tracking weight and symptoms. The healthcare provider instructed him to watch his blood pressure regularly and notify the team for any indications of low pressure, worsening shortness of breath, and substantial weight changes.
I supported his HF management skills by explaining how sticking to prescribed medicine, changing fluid and salt intake, and knowing the early signs of symptom decline make the most significant difference. Modern HF treatment strategies provide patients with improved quality of life and decreased hospitalization rates despite untreatable conditions (Bloom et al., 2017).
Follow-Up Plan and Documentation
Mr Sigma received a follow-up appointment for blood testing to assess his renal function after Entresto initiation during the next ten days. An HF Clinic follow-up appointment was booked to occur within 4-6 weeks to evaluate medication adjustments alongside monitoring symptom development. The healthcare provider documented the complete consultation on SystemOne, which contained information regarding medication modifications, patient instruction, and subsequent follow-up arrangements.
This section critically examines the consultation by exploring the rationale behind clinical and prescribing decisions and their impact on patient care. It links practice to evidence-based guidelines, professional standards, and ethical principles, while reflecting on learning outcomes and areas for professional development within non-medical prescribing practice.
The consultation revealed critical perspectives about clinical decision-making, patient-dedicated care, and Non-Medical Prescribing complexities. A systematic method guided the process by promoting evidence-based approaches to improving medication administration while following established professional guidelines for deprescribing and patient support (Titler, 2018). These reflections align with An Analysis of the Event in a Nursing Consultation, highlighting the importance of reflective practice in developing safe, effective, and patient-centred nursing care.
The vital lesson learned during this experience was about co-decision-making. Mr Sigma initially resisted Entresto's initiation but eventually accepted the treatment by understanding its advantages when these facts were presented. Patient education significantly contributed to treatment adherence, and healthcare providers received additional support when introducing new medications (Baryakova et al., 2023).
My work adhering to my professional scope (RPS 7.1) proved essential to this case. As a non-prescribing professional, I joined the HFSN NMP to prescribe medicines in compliance with NICE (2018) standards and local authority protocols (NICE, 2024). The consultation deepened my knowledge about deprescribing medication practices, especially for evaluating Amlodipine and Furosemide treatment risks against benefits.
The experience showed how complete patient assessment incorporates physical examinations, clinical background information, and social aspects (Nori et al., 2023). The patient's main goal was to sustain his independence, which required a complete patient-oriented approach to HF treatment management. The team's attention to these patient concerns supported the development of trust and improved their interaction, producing better consultation results.
The clinical visit successfully addressed all important medical goals and issues that mattered to the patient (Drossman et al., 2021). Mr Sigma and his wife acknowledged the effort to detail his HFREF condition and suitable treatment approaches, which reduced their uncertainty and anxiety regarding his situation.
The clinical consultation succeeded by implementing the ICE Model (Ideas, Concerns, Expectations) (Verhoeven et al., 2020). Through this approach, the therapist could identify Mr Sigma's traumatic thoughts, which led to an individualized treatment plan that followed his personal objectives. By sustaining his social activities through chess club, the team showed that patient care extends past monitoring medications to focus on maintaining the quality of the patient's lifestyle.
A primary advantage arose from using evidence-based prescribing techniques. The physician initiated Entresto based on NICE recommendations and cardiovascular benefits reported in the PARADIGM-HF trial. The healthcare provider made a proper decision to stop Amlodipine treatments because both drug interactions and hypotension risks exist (Carey et al., 2018). The established follow-up system enabled secure prescribing practice and improved patient protection by monitoring renal function and blood pressure self-evaluation.
The key members of multiple disciplines worked together to validate that medication choices complied with legal requirements and professional standards. Consulting the HFSN NMP for medication changes solidified my dedication to practising within my abilities and following established professional and governance requirements.
The consultation achieved positive effects while presenting some areas for further development. Mr Sigma encountered problems processing all domains of his HF management during the single supervision appointment. To increase patient participation and retain learned information, the scope of information delivery should be divided across several sessions through smaller discussions.
As an improvement method, more detailed investigations into psychosocial and emotional support must be included (van Agteren et al., 2021). I addressed Mr Sigma's concerns about independence and quality of life, but I should have also referred him to coping resources, heart failure support networks, and mental health services. Patient well-being, starting from emotional aspects, proves essential for disease control and following healthcare plans, thus becoming a fundamental part of multispectral medical attention.
Self-monitoring digital tools should be implemented since they can potentially boost patient involvement (Lancaster et al., 2018). Mobile applications for BP tracking and weight monitoring should be promoted because they offer enhanced symptom control and improved reporting capabilities for medical professionals.
The consultation used standards and competencies from the Royal Pharmaceutical Society (RPS 2021) and NMC Code 2018 2024 (Nursing and Midwifery Council, 2018). Premising medication falls within the boundaries of my professional practice (RPS 7.1). I acknowledged the limits of my knowledge and prescribing abilities by referring these decisions to the correct prescriber designated by HFSN NMP. Patient security and professional responsibility require this step.
Proof-based medication choices represented another critical element of practice (RPS 2.8). National guidelines, clinical trials, and patient-specific factors were used to decide between initiating Entresto and discontinuing Amlodipine (Nursing and Midwifery Council, 2018). Additional written information about heart failure management and medication support tools strengthened correct medication administration practices. The consultation revealed elements of interprofessional teamwork in the treatment approach (RPS 1.14). The prescribing HFSN team, the GP, and cardiology professionals coordinated comprehensively for Mr Sigma's health care delivery according to clinical governance standards.
The consultation followed the main ethical principles of beneficence, non-maleficence, autonomy, and justice. Mr Sigma experienced full autonomy because the healthcare team provided comprehensive information regarding his medical state and all available therapeutic options (UK Government, 2012). The ICE Model could resolve his uncertainties while engaging him in collaborative care decisions to promote person-centred medication prescription.
Patient outcomes received top priority after starting Entresto medication since this drug enhanced the prognosis for people with HFREF. Bailey et al. (2020) conducted the deprescribing of Amlodipine while reviewing Furosemide to preserve non-maleficence in polypharmacy management and drug interaction prevention (UK Government, 1968). Mr Sigma received the same opportunities to benefit from guideline-directed medical therapy, and all treatment decisions focused on clinical needs rather than financial limitations.
The consultation demonstrated public health importance by teaching patients self-management techniques to reduce their chances of being readmitted to the hospital (Pollack et al., 2016). The delivery of information about fluid management, sodium restriction, weight tracking, and symptom awareness guidance matched public healthcare goals for managing chronic diseases. Assessment for safeguarding revealed no risks of neglect during this consultation, while the patient had both no abuse concerns and no mental capacity limitations (Gov.uk, 2005). It is recommended to integrate regular mental health assessments into future consultation practices because HF patients exhibit significant depression and anxiety levels.
The discussion with Mr Sigma demonstrated the multiple challenges associated with deprescribing, which required assessing the risks and benefits of discontinuing amlodipine and furosemide. I will work to make my deprescribing decisions better through evidence-based methods that prioritize patients and follow official national guidelines.
The large amount of information provided to Mr Sigma demonstrated the significance of using structured communication and health literacy approaches to communication. The enhancement of my patient interactions will depend on three key strategies: I will simplify medical information while using visual aids, and I will adopt a stepwise educational approach to improve understanding and treatment adherence.
The current need exists to improve understanding of public health strategies and preventative approaches for heart failure treatment. For patients with heart failure, maintaining self-management skills is the most critical process for reducing hospital admissions and achieving a better quality of life. The target of my professional development includes behaviour transformation models and digital therapeutic methods, along with cardiac rehabilitation system knowledge.
I followed the required legal frameworks, including the Medicines Act (1968), Human Medicines Regulations (2012) and the Mental Capacity Act (2005), but understand the necessity of continuous learning about prescribing governance together with consent and safeguarding policy management. My approach to compliant practice will guarantee that I fulfil all regulatory requirements until becoming an independent prescriber.
CPD Action Plan Table
| Development Area | Objective | Action Steps | Resources & Learning Activities | Evaluation & Evidence of Progress |
|---|---|---|---|---|
| Deprescribing & Medicines Optimisation | Build confidence in evaluating when to deprescribe and optimize HF medications | Attend webinars and workshops on deprescribing | NICE Guidelines (2018), STOPP/START criteria, British Journal of Cardiology case studies | Reflective logs, competency assessment in deprescribing decisions |
| Advanced Patient Communication | Improve ability to communicate complex medical information clearly | Undertake training in health literacy and motivational interviewing | Online CPD courses, shadowing experienced NMPs, reviewing patient feedback | Pre- and post-training self-assessment, patient satisfaction surveys |
| Public Health in Heart Failure | Expand knowledge of preventative HF strategies | Engage in cardiac rehabilitation sessions, study behavioural change models | NICE Public Health guidance, WHO chronic disease prevention reports | Case study evaluation, MDT discussions |
| Legal & Ethical Aspects of Prescribing | Ensure ongoing compliance with NMP regulations | Review latest prescribing laws, attend governance meetings | NMC Code (2024), RPS prescribing competencies, Bolam & Montgomery cases | CPD portfolio documentation, clinical supervision reviews |
The CPD document is a developmental roadmap to help me become an Independent Prescriber. I will provide safe, patient-centred care through more extraordinary deprescribing skills combined with the sharpening of communication with patients and enhancing public health expertise and legal and ethical prescribing standards.
6 Years | MSc
Concusion
Using Gibbs’ Reflective Cycle, the consultation highlighted the importance of evidence-based prescribing, shared decision-making, and adherence to professional, legal, and ethical standards in nursing practice. The experience reinforced the value of effective communication, multidisciplinary collaboration, and ongoing patient education in optimising treatment outcomes. Furthermore, the reflection identified areas for professional development, particularly in deprescribing, psychosocial support, and public health approaches. Overall, this analysis demonstrates how reflective practice supports continuous professional development and contributes to safe, effective, and compassionate nursing care within non-medical prescribing roles.
References
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