The prescribing needs of community practitioner nurse prescribers: A qualitative investigation using the theoretical domains framework and COM‐B. (3rd September 2019) - Chater, Angel M.
Abstract: 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. Abstract : 目的: 很多合格的社区执业护士开处方者(CPNPs)并不开处方, 本研究的目的是找出影响该行为的因素。 设计: 定性研究设计。 方法: 以理论域框架(TDF)为基础, 对20个社区执业护士开处方者进行了半结构访谈。采集了2018年三月到七月之间的数据, 直到数据饱和为止。 结果: 九个归纳解释了开处方行为的主题:1)'知识与经验';2)'会诊与沟通技巧';3)'职业自信与职业认同';4)想要最好的结果;5)国民医疗服务体系与病人花费;6)'情绪化决策';7)'时间分配';8)'处方数据库'以及9)'以病人为中心护理的互助环境'。这些主题也就演绎为映射到社区执业护士开处方者和COM‐B。 结论: 帮助社区执业护士开处方者是一个持续需求。用知识和获取的技能来开处方的'能力';让开处方更加简单的'机会', 比如取得有有效临床支持的更加广泛和最新的护士处方集; 与开处方时感到自信, 且在减少诸如开支和不依从之类感官问题时强调积极的病人成果的'动力'。 影响: 研究结果表明, 能力、机会与动力都会影响开处方的决定。负责职业规范和训练的人应该确保社区执业护士开处方者能获取相关的知识、技能和处方集来帮助他们开处方。应该鼓励专业开处方者的信心和认同感, 承认开支与情感等因素的影响。以病人为中心护理的互助环境和最好的结果就意味着增加会诊的分配时间。