Physicians' attitudes towards the development of the nurse prescribing role in critical care and emergency departments.

BACKGROUND: The progression of the nurse prescribing role encounters numerous challenges, with physician resistance being a significant obstacle. This study aims to assess physicians' perspectives regarding the expansion of the nurse prescribing role within critical care and emergency departments. METHODS: This cross-sectional study employed convenience sampling to enroll 193 physicians. Data collection instruments included a demographic information form and a researcher-developed questionnaire. Descriptive and inferential statistics were used to analyze the data using SPSS-22 software. RESULTS: A total of 193 physicians participated in the survey, with a mean age of 41.9 ± 10.7 years. Among physicians from various age groups, genders, educational backgrounds, and clinical experiences, more than 60% acknowledged prescribing medicine as an essential component of their professional responsibilities. However, a significant majority of physicians in these categories agreed that in emergency situations, nurses should be allowed to prescribe medication to save patients' lives. It is worth noting that, unlike specialist and fellowship physicians, a majority of general practitioners (83.3%) held the view that nurse-prescribed medications do not contribute to the professional development of nursing. The nurse prescribing role encountered several predominant obstacles, namely legal consequences (78.8%), interference of duties between physicians and nurses (74.1%), and a legal vacuum (77.2%). CONCLUSION: The majority of physicians expressed a favorable attitude towards nurse prescribing in emergency and critical care departments. To facilitate the development of the nurse prescribing role, it is essential to ensure the acquisition of scientific qualifications and implement necessary changes in nursing curricula across bachelor's, master's, and doctoral programs.

The expansion of the role of nurse prescribing in intensive care units in the healthcare system of Iran: a qualitative content analysis.

Intensive Care Unit (ICU) nurses prescribe medication for patients in many countries. However, there is still no evidence on the legitimacy of nurse prescribing roles in the healthcare system of Iran. This qualitative study with 30 experts was conducted to explore the experiences regarding the expanding role of prescribing medication by the ICU nurses. Data were collected through 31 individual semi-structured interviews and analyzed using the conventional content analysis method by MAXQDA 10. One major theme, "applicability of prescribing medication by ICU nurses", together with three sub-themes of "facilitators", "potential risks of nurse prescribing" and "the professional pathway", emerged. The use of successful global experiences, patient-oriented healthcare system policies, current culture and positive professional position of nurses, physician shortage, and high capacity of ICU nurses appeared as facilitators to perform the new role in our context. For the expansion of the new role, different professional pathways such as discussion with physicians and special groups with conflicts of interests, training qualified nurses in this area, and gradual development were proposed by the participants. The next step of the research is to prepare a set of standards for the prescription of medication by the ICU nurses in our context.

Iranian nurses' attitudes towards the necessity and barriers to developing nurse prescribing roles.

BACKGROUND: Prescribing medication by nurses as an approach to rational drug prescription has been proposed in many countries. Nursing prescribing is an effective measure in the management of critically ill patients admitted to intensive care units (ICU). This study investigated the attitude of ICU nurses towards the necessity and the barriers to developing nursing prescribing. MATERIALS AND METHODS: In this cross-sectional study, 136 ICU nurses were included by stratified random sampling. The data collection tool was the researcher-made questionnaire. Cronbach's alpha method was used to evaluate the reliability of the instrument. The validity of the instrument was also verified by the content validity method. To collect the data, the researcher referred to the nurses' workplace and provided them with a questionnaire and collected it after completion.The collected data were analyzed by IBM SPSS 16 using descriptive and inferential statistics. RESULTS: It was revealed that 58.8 % of nurses were familiar with the term 'nursing prescribing'; a majority (92.1 %) of whom considered it vital to develop this role in the ICU. Moreover, 86 % (n = 98) of the nurses assumed that it is possible to implement this role in ICU. The most potential barriers to its implementation were lack of legitimacy, disapproval of physicians, and the reluctance of nursing managers. CONCLUSIONS: Most nurses maintained a positive attitude towards nursing prescribing; hence, its legitimacy seems vital in ICUs. For the development of the 'nurse prescribing' role, the Nursing System Organization may be helpful.

Determining Serum Zinc and Magnesium Levels in Hemodialysis Patients Could be Helpful for Clinicians.

Trace element determination is requested rarely for critically ill patients in Iran, due to the underestimation of the trace element determination by Iranian physicians. The aim was to compare the levels of Zn and Mg in a group of hemodialysis patients and normal individuals. This study shows that trace element determination is helpful for management of hemodialysis patients. Fifty-three hemodialysis patients and 51 control individuals were randomly analyzed for Zn and Mg serum levels. Comparison of before or after dialysis and with normal individuals was done and receiver operating characteristics (ROC) curves were plotted to evaluate the analytical sensitivity and specificity of Zn and Mg determination. Confidence interval for all statistical methods was 95 %. Zinc serum levels were decreased after hemodialysis insignificantly (P = 0.201) but Mg levels were decreased significantly (P = 0.000). Both Zn and Mg levels, before and after hemodialysis were meaningfully lower than normal controls (P < 0.05). ROC analysis showed that the area under the curve was high for Zn levels both before and after hemodialysis but it was high for Mg only before hemodialysis. Current study shows that serum Zn and Mg measurements can have clinical importance. Both before and after hemodialysis, serum Zn = 297.5 µg/L and Mg = 2.295 µg/L are proposed as cut-off values with about 90 % specificity, for monitoring of these two element in hemodialysis patients. It is suggested that clinicians consider the measurement of these trace elements for hemodialysis patients routinely or periodically as clinical chemistry tests.