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文献阅读21 | IF=3.3 | 护士神经精神病学处方实践的全球格局：一项范围界定综述

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2026-01-12

1. 文献信息

标题：The Global Landscape of Neuropsychiatric Prescribing Practices of Nurses: A Scoping Review

来源：International Journal of Mental Health Nursing

DOI：10.1111/inm.70101

IF：3.3

2. 摘要翻译

ABSTRACT:Mental healthcare service access in South Africa is currently strained due to, among others, shortages of specialised mental healthcare professionals. The National Strategic Plan for HIV, TB and STIs (2023-2028) recommends enabling nurses to diagnose, prescribe and dispense neuropsychiatric medication for promoting mental health services. The aim was to explore and describe the existing practices, strengths and challenges for nurses prescribing neuropsychiatric medication globally through a scoping and document review. A standardised search was conducted across PubMed, CINAHL and EBSCOHost electronic databases. An online Google search was conducted across governmental legislative and regulatory websites. The Joanna Briggs Institute scoping review framework was followed using relevant MeSH terms and free-text words. South African governmental and parastatal documentation relating to relevant regulatory frameworks affecting such prescribing authorisation in South Africa was analysed following Bowen (2009) guidelines. Of 817 citations identified, 20 reports were included. The included reports originated mostly from developed countries, with only one from South Africa. Patients and healthcare professionals were mostly positive towards including the prescription of neuropsychiatric medication in the nursing care model. Prescription of Schedule 5 and 6 controlled substances by nurses is already authorised in the USA and UK. In South Africa, nurses are not yet permitted and will require amendments to the legislative framework that guides nursing practice. Nurses can prescribe neuropsychiatric medications in certain developed countries; however, contextual research is necessary to ascertain whether South African stakeholders will support such an authorisation. Educational and interprofessional concerns will need to be thoroughly assessed to ensure that appropriate competencies are obtained, ensuring the boundaries of the scope of practice. Investigation of potential professional overlap of responsibilities and perceptional biases, as well as transformation of educational platforms, will be needed should such a recommendation come to pass. Furthermore, legislative changes will be required to authorise the prescription of neuropsychiatric medications.

摘要：南非的精神卫生服务获取当前面临压力，其中一个原因是专业精神卫生人员短缺。《国家艾滋病毒、结核病和性传播感染战略计划（2023-2028）》建议授权护士进行诊断、开具和配发神经精神药物，以促进精神卫生服务的发展。本研究旨在通过范围性综述和文献回顾，探究并描述全球范围内护士开具神经精神药物的现有实践、优势及面临的挑战。研究在PubMed、CINAHL和EBSCOHost电子数据库中进行了标准化检索，并在政府立法和监管网站上进行了谷歌在线搜索，遵循乔安娜·布里格斯研究所的范围性综述框架，使用相关的医学主题词（MeSH）和自由文本词进行检索，同时参照鲍文（2009）的指南，对南非政府及半官方机构中与影响此类处方授权的相关监管框架有关的文件进行了分析。在检索到的817篇文献中，最终纳入20篇报告，这些报告主要来自发达国家，仅有1篇来自南非。结果显示，患者和医疗专业人员大多对将神经精神药物处方纳入护理模式持积极态度；在美国和英国，护士已被授权开具5类和6类管制药物的处方，而在南非，护士尚未获得此项许可，这需要对指导护理实践的立法框架进行修订。尽管在某些发达国家，护士可以开具神经精神药物处方，但需要开展情境研究以确定南非的利益相关者是否会支持此类授权；若该建议得以实施，还需全面评估教育和跨专业方面的问题以确保护士具备相应能力并明确执业范围边界，调查潜在的专业职责重叠和认知偏见问题，对教育平台进行改革，此外还需要通过立法改革来授权神经精神药物的处方开具。

3. 前言思路

该前沿思路按 “问题现状 — 应对潜力 — 政策背景 — 研究缺口 — 研究目标” 展开：首先，指出全球心理健康障碍高发且常被忽视，南非情况严峻，25.7% 人口可能患抑郁症，治疗缺口大（75% 患者未获治疗），且神经精神科处方者严重短缺；其次，说明护士在南非覆盖率高于精神科医生，具备承担更多心理健康服务的潜力，扩大护士处方权（如开具神经精神药物）被视为缓解治疗缺口的途径；接着，提及南非相关政策（如《国家战略计划》）支持护士接受心理健康培训以拓展执业范围；最后，点出目前对护士神经精神科处方权的态度、认知及实施利弊缺乏明确研究，本研究旨在通过梳理文献和分析法规，探索该实践的认知与潜在影响，明确监管考量。

4. 相关分享

1、乔安娜・布里格斯研究所（Joanna Briggs Institute，JBI）的范围性综述框架：

乔安娜・布里格斯研究所的范围性综述框架是基于 Arksey 和 O'Malley 的原始框架扩展而来，通常包括明确研究问题（常依据 PCC 指南确定人口、概念、背景）、文献检索（至少检索 3 个数据库）、研究筛选、数据图表绘制、结果整理等步骤，旨在全面了解某一领域现有研究情况，为相关实践、政策制定等提供全面证据支持，且需按照系统评价和荟萃分析优先报告的条目扩展到范围综述的声明进行规范报告。

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