The aim of this study was to analyse the role of the registered nurse in the management of pro re nata (PRN) medication in a care home (nursing) for older people. Studying PRN medication provides insights into the role of the nurse in care homes (nursing) who act as assessor, decision maker and evaluator in residents' care. It also provides a lens by which to explore how residents and their carers interact and participate in day-to-day care decisions about residents' health. The case study draws on ethnography. It is a multi-method study, using documentary and medication reviews, observations and interviews to answer the research questions. Thirty-four residents were recruited to the study and 60 care home staff. Findings showed that 88.2% of residents (n=30) were prescribed PRN medication and that all residents were on a minimum of 1 and a maximum of 7 medication. During each 28-day MAR sheet period between 35 and 44 PRN prescriptions were written. They contributed 12.7% of all medication prescribed, accounting for between 1.2 and 1.5 medication per resident. Nurses were found to administer PRN medication, but a finding of this study was that this activity could be delegated to carers who were identifying resident needs. There was some evidence of resident engagement but this was often a three-way process between resident, GP and family or resident, carer and nurse. A percentage of medication that could have been PRN were routinely prescribed. Observations also identified that nurses would decide not to administer routine medication in certain circumstances and that this was directly related to their assessment of the resident. The process of medication management was dominated by the regulations and governance processes of the care home. Observations and interviews found that care home staff recognised and affirmed residents' pain but did not take action for analgesia to be administered. They were familiar with the use of pain assessment tools for older people living with dementia and had received training in dementia care. Many of the staff were also able to interpret signs and symptoms of a resident's distress. Nevertheless, their preoccupation with meeting internal and external regulator standards was a barrier to addressing residents' needs. This is the first study that has looked at an aspect of medication management to understand how nurses and care home staff work for and with residents to moderate and address their health care needs. It suggests that additional training in aspects of medication management and resident assessment may not be able to address deeper seated issues of autonomy and how the nursing role is understood and enacted in care home settings.

Esta investigación es una revisión y análisis documental que permitió reflexionar en torno a los desafíos culturales, tecnológicos y curriculares que la educación STEM1 presenta en Occidente, específicamente en la formación primaria. Así mismo, se quiere abrir nuevas líneas de indagación en torno a un marco conceptual para lo que sería un análisis más detallado y minucioso sobre la temática estudiada. Esta propuesta es creada desde la iniciativa de enseñar las ciencias y matemáticas desde un aprendizaje activo; donde se busca que los estudiantes puedan realizar algunas indagaciones científicas y hacer uso de la tecnología como un recurso conveniente en las experiencias de aprendizaje. En la investigación se podrán observar las aproximaciones al concepto de STEM, así como los desafíos y algunas experiencias de aplicación en docentes del grado primaria. / This research is a documentary review and analysis that allowed us to reflect on the cultural, technological and curricular challenges that STEM education presents in the West, specifically in primary education. Likewise, it wants to open new lines of inquiry around a conceptual framework for what would be a more detailed and thorough analysis of the subject matter studied. This proposal is created from the initiative of teaching science and mathematics from active learning; where it is sought that students can carry out some scientific inquiries and make use of technology as a convenient resource in learning experiences. In the investigation, the approaches to the STEM concept will be observed, as well as the challenges and some experiences of application in primary grade teachers. / Trabajo de investigación