Exploring nurse independent prescribers’ beliefs about prescribing antimicrobials for upper respiratory tract infections

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Antimicrobial resistance (AMR) is an urgent public health concern. Resistance can be accelerated with the imprudent use of antibiotics. Previous research suggests that inappropriate prescribing is apparent in practice; however, much of this has focused on doctors. With a growing number of nurses potentially prescribing antimicrobials, their practice is of particular concern.

The Reasoned Action Approach (RAA) model proposes that behavioural (advantages/disadvantages of carrying out the behaviour), normative (individuals or groups who would approve/disapprove; likely/unlikely to carry out this behaviour) and control beliefs (enablers or inhibitors to carrying out the behaviour) are the psychological foundation for human behaviour. In order to assess the beliefs of nurse prescribers, one-to-one, open-ended telephone interviews were carried out using the RAA model’s guidance. Interviews were recorded and content analysed to identify the population’s modal (most frequently occurring) salient (accessible) beliefs.

Twenty-seven nurse independent prescribers (NIPs), from a variety of settings across Scotland, were interviewed. The most frequently occurring advantage for managing patients presenting with upper respiratory tract infections without prescribing an antibiotic was the prevention of AMR (n=21, 78%), the disadvantage was stress from patient pressure/expectation (n=11, 41%). Other NIPs were most frequently mentioned as being most likely to manage patients without prescribing (n=11, 41%), with GPs least likely (n=16, 60%). Finally, having the time to educate/reassure/advise the patient was the most frequently mentioned enabler (n=24, 89%) and patient pressure was the greatest inhibitor (n=18, 67%).

Some of these findings are similar to those found in the literature; however, many others have emerged – one of the main categories being patient expectation and the challenges this creates when trying to manage patients without prescribing an antibiotic. This elicitation work has therefore identified the salient beliefs for this population and will be used to develop a national questionnaire.

Declaration of interest
I do not have any conflict of interests to declare.
Original languageEnglish
Pages (from-to)S3
JournalJournal of Infection Prevention
Issue number1S
Publication statusPublished - 2016


  • nursing
  • prescriptions
  • upper respiratory tract infections


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