Understanding antibiotic-seeking behaviour: A qualitative case study of mothers of children aged 5 and under.

BACKGROUND: Antibiotics savelives and have been effectively and reliably used for decades to treat infections and improve health outcomes. This trust in antibiotics has contributed to over prescribing and the emergence of antimicrobial resistance. Significant amounts of antibiotics are still widely prescribed and taken, especially in young children. However, there is a paucity of existing literature relating to how mothers, who are the main carers of young children, may be influenced by their trust in antibiotics. AIMS: To explore what factors influence mothers' decisions to seek antibiotics for their young children. DESIGN: Qualitative case study using postcode boundaries. METHODS: Thematic analysis of qualitative data from mothers of children under 5, recruited via community playgroups within the case. Data were collected between October 2018 and May 2019, from six focus groups (n = 19) and one-to-one interviews (n = 14). Thematic analysis of the data consisted of six phases: data familiarization; generating initial codes; searching for themes; reviewing themes; defining and naming themes; and producing the report. RESULTS: Mothers were influenced by their belief and trust in antibiotics. Antibiotics were identified as symbolic of recovery, healing and of providing protection and safety. CONCLUSION: By understanding the symbolic power of antibiotics on maternal decision making, all antibiotic prescribers may be able to offer and provide reassuring alternative and acceptable treatment options to mothers, rather than using antibiotics. IMPACT: This paper introduces the concept of antibiotics as powerful symbols which influence antibiotic seeking behaviour. This in turn may result in inappropriate use of antibiotics which contributes to the risk of antimicrobial resistance developing. Although the majority of antibiotics are still prescribed by doctors, the number of nurse prescribers has been increasing. Therefore, an increased awareness of antibiotic symbolism, in all prescribing clinicians, is important to enable future local and national strategies to be developed, to support maternal decision making and reduce antibiotic seeking behaviour.

The prescribing needs of community practitioner nurse prescribers: A qualitative investigation using the theoretical domains framework and COM-B.

AIM: With a number of qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour. DESIGN: A qualitative research design. METHODS: Semi-structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March-July 2018 and continued until data saturation was reached. RESULTS: Nine themes inductively explained prescribing behaviour: 1) 'Knowledge and experience'; 2) 'Consultation and communication skills'; 3) 'Professional confidence and identity'; 4) 'Wanting the best outcome'; 5) 'NHS versus patient cost'; 6) 'Emotion-led decisions'; 7) 'Time allocation'; 8) 'Formulary access' and 9) 'Supporting environment for patient-centred care'. Themes were then deductively mapped to the TDF and COM-B. CONCLUSION: There is an ongoing need to support community practitioner nurse prescribers' 'Capability' to prescribe in terms of knowledge and aquired skills; 'Opportunity' to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and 'Motivation' to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non-adherence. IMPACT: Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient-centred care and the best outcome should be supported, this may mean increasing time allocated to consultations.

Community nursing and antibiotic stewardship: the importance of communication and training.

Antimicrobial stewardship (using antimicrobials responsibly) can reduce the risk of antimicrobial resistance (AMR). Many health professionals identify themselves as 'antibiotic guardians', but patient expectations, time constraints, and a lack of confidence or underdeveloped communication skills can influence decisions to prescribe. Nurse prescribers have an important role to play in antibiotic stewardship, and their numbers continue to grow. While nurse prescribers welcome this extension to their traditional role, they are often faced with barriers to antibiotic stewardship activities. These barriers may relate to their Capability (knowledge/skill), Opportunity (norms of practice, influence of patients, environmental factors), and Motivation (attitudes and beliefs, concern over outcome, emotion and habit) [COM-B]. Education, training and enablement can help to overcome these barriers, and the development of knowledge, confidence and effective communication skills should be of priority. Further, communication skills can help nurse prescribers understand patient expectations, with the use of open-ended questions, active listening and creation of a patient-centred consultation that leads to a mutually agreed end goal and way forward.

Establishing priorities on the range of conditions managed by UK community practitioner nurse prescribers: A modified Delphi consensus study.

AIM: To provide national consensus on the range of conditions community practitioner nurse prescribers manage and for which it is considered important that they can prescribe. BACKGROUND: Around 35,000 community practitioner nurse prescribers in the United Kingdom are able to prescribe from a limited formulary. Although prescribing is a key role for these nurses, there has been a decline in the numbers of community practitioner nurse prescribers who prescribe. It is evident that changing patterns of client and service delivery, changes the role of community nurses and the conditions they manage, however, little is known about the conditions community practitioner nurse prescribers manage. DESIGN AND METHODS: A modified Delphi approach comprising three on-line surveys delivered to a national Expert Panel of 89 qualified community practitioner prescribers. Data collection took place between January-March 2017. RESULTS: Panelists reached a consensus, with consistent high levels of agreement reached, on nineteen conditions for which it is believed community practitioner nurse prescribers should be able to prescribe. Conditions identified by school nurses (N = 12) and health visitors (N = 7) were mainly acutely focused, whereas those identified by district nurses (N = 9) and community staff nurses (N = 6) included both long-term and acute conditions. CONCLUSION: Given the high degree of consensus, this list of conditions should influence any decisions about the items community and public health nurses should be able to prescribe. The findings should also influence the education and training of these nurses.

The experiences of being a registered nurse prescriber within an acute service setting.

AIMS AND OBJECTIVES: To explore the experiences of nurse prescribers in an acute service setting. DESIGN: A descriptive phenomenological design underpinned by Husserl's philosophy was used as the guiding framework. METHODS: Data were collected using semistructured interviews and purposive sampling of 11 current registered nurse prescribers from two acute hospitals. Colaizzi's seven steps were employed to analyse the data and develop themes which reflected the participants' experiences of prescribing. RESULTS: The study identified three themes: Enhanced Patient Care, Impact on the Nurse as a Prescriber and the Challenges of Nurse Prescribing. The nurses interviewed were proud to be prescribers and perceived their prescribing practice as safe. This was a unique finding, not described by other research. Increased job satisfaction was also important to those interviewed as identified in previous studies pertaining to prescriptive authority. Ongoing challenges affecting prescribers included staff shortages, extra workload arising from prescribing and the need to educate colleagues about nurse prescribing. Those interviewed also suggested standardising both the prescribing course and local Drugs and Therapeutics Committees nationally, to overcome identified issues. CONCLUSIONS: Further research into the safety of nurse prescribing is recommended to ascertain if what was described locally applies nationally. A larger study into the experiences of nurse and midwife prescribers is also required, to promote and maintain this practice and to ensure future prescribers embrace this extended scope of practice. RELEVANCE TO CLINICAL PRACTICE: Insight into how nurse prescribers feel about prescriptive authority. Highlights the advantages and disadvantages of this extended scope of practice. RNPs describe how to overcome some of the barriers they have encountered with useful suggestions being made for practice development and further research.

Beginners in prescribing practice: Experiences and perceptions of nurses and doctors.

AIMS AND OBJECTIVES: To investigate and compare the experiences and perceptions of nurses and doctors in becoming prescribers. BACKGROUND: The development of core skills, knowledge and attitudes as a prescriber is among the present foci of current medical education, and the requirements for ongoing mentorship, support and education for novice medical prescribers have been identified as important training components. However, little is known of the prescribing practices of other health professionals who are also new to prescribing, for example, nurse prescribers. DESIGN: This qualitative study was guided by a constructivist narrative approach using a multiple case narrative strategy. METHODS: A purposive sampling approach was used, with a view to selecting participants to best illuminate the experiences of beginning to prescribe. Individual interviews were conducted, 26 in total, lasting approximately one hour each and were audio-recorded. RESULTS: Common themes were found across prescribing groups: fear and anxiety when taking on prescribing responsibility; the strategy of using a personal list of medicines to support safe practice; how this list was expanded over time; referring to senior colleagues in prescribing decision-making. CONCLUSIONS: This study shows that the journeys are similar for nurses and doctors as beginning prescribers. The effort required for a novice prescriber to select the most appropriate medication and write prescriptions can be extensive as development of expertise takes time and occurs over months or years. RELEVANCE TO CLINICAL PRACTICE: Medical and nurse prescribers differ in term of educational preparation, their journeys as beginner prescribers share common behaviour and practices. Clinical experience and mentorship important to enhance skill development in prescribing and should be advocated for all prescribers. Beginner prescribers require ongoing education and support when prescribing for high risk patients or when prescribing new drugs.

Prescribers' views and experiences of assessing the appropriateness of prescribed medications in a specialist addiction service.

Background Mental and physical health problems are common in people with substance misuse problems and medications are often required in their management. Given the extent of prescribing for service users who attend specialist addiction services, it is important to consider how prescribers in this setting assess the appropriateness of service users' prescribed medications. Objective To explore prescribers' views and experiences of assessing the appropriateness of medications prescribed for service users coming in for treatment as well as the differences between prescribers. Setting A specialist addiction service in the North of England. Method A phenomenological approach was adopted. Semi-structured interviews were conducted with four nurse prescribers and eight doctors. Data were analysed using thematic framework analysis. Main outcome measure Prescribers' views and experiences of assessing the appropriateness of prescribed medications. Results Assessment of the appropriateness of prescribed medications involved reviewing medications, assessing risk, history-taking, involvement of service users, and comparing guideline adherence and 'successful' prescribing. Doctors and nurse prescribers assessed the appropriateness of medications they considered to be within their competency. Doctors provided support to nurse prescribers and general practitioners (GPs) when dealing with issues around prescribing. Conclusion Assessment of the appropriateness of prescribed medications is complex. The recent reduction in medical expertise in specialist addiction services may negatively impact on the clinical management of service users. It appears that there is a need for further training of nurse prescribers and GPs so they can provide optimal care to service users.