Factors associated with independent nurse prescribers’ antibiotic prescribing practice: A mixed methods study using the Reasoned Action Approach

Link to article at PubMed

J Hosp Infect. 2021 Apr 14:S0195-6701(21)00159-6. doi: 10.1016/j.jhin.2021.04.008. Online ahead of print.

ABSTRACT

BACKGROUND: Numbers of nurse prescribers is increasing, yet little evidence exists about their antibiotic prescribing behaviour.

AIM: This paper presents the findings of a study which measured nurse independent prescribers' (NIPs) intention to manage patients, presenting with an Upper Respiratory Tract Infection (URTI) for the first time, without prescribing an antibiotic and to examine the determinants of this behaviour.

METHODS: This was a mixed method study using the Reasoned Action Approach (RAA). Content analysis of data from 27 telephone interviews with NIPs informed the development of a questionnaire which was tested for validity and reliability and used in a national survey of NIPs across Scotland. Descriptive and inferential statistical analysis was carried out to determine intention to manage patients without prescribing an antibiotic and the significant influences on this intention.

FINDINGS: Results from 184 participants found that NIPs intend to manage patients, presenting with an URTI for the first time, without prescribing an antibiotic. Key determinants were perceived norm, perceived behavioural control and moral norm. Significant beliefs were, positive social influence from other non-medical prescribers (p=0·007) and nurse prescribers (p=0·045), the enablers of prescriber experience and confidence (p=<0·001) and the barrier of pressure from patients/carers (p=0·010).

CONCLUSION: Nurse prescribing is expanding globally and these findings have international relevance. This paper is significant as it is the first to explore the determinants of NIP antibiotic prescribing intentions using a rigorous theoretical model. Findings provide reassurance that NIPs intend to prescribe appropriately. The identification of nurse-specific barriers and enablers to this intention should be acknowledged and targeted in future interventions to manage this behaviour.

PMID:33864894 | DOI:10.1016/j.jhin.2021.04.008

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