| Purpose:In this study,by consulting relevant information on the prescription rights of foreign nurses,in the context of China’s medical background,in combination with China’s actual clinical situation,and on the basis of previous research.We explore the specific prescription content and prescription forms that can be issued by nurses in tertiary hospitals in China about the central nervous system,urinary system,and narcotic drugs,with a view to providing reference for the development of future nursing prescription rights and the formulation of related policies.Methods:1.Literature survey method By searching foreign databases such as Science Direct,Pub Med,and Chinese databases such as CNKI and Wanfang,and consulting the central nervous system,urinary system,and anesthetic drugs of nurse prescriptions in the United States,United Kingdom,Australia,New Zealand,and Africa Prescription related content,combined with the relevant research content of the "Clinical Drug Handbook"(Fifth Edition)in China,preliminary determination of expert consultation questionnaires on the content of the central nervous system,urinary system and anesthetic drugs.2.Semi-structured interview method Based on a large number of literature surveys,the content of the interviews was determined.Among the experts who agreed that the nurses had the prescription right,3nursing experts and 2 medical experts in central nervous system neurology were selected.3 medical experts and 2 nursing experts in psychiatry were selected;3 nursing experts and 2 medical experts in urinary system and 3 medical experts and 2 nursing experts in the Department of Anesthesiology were selected,to conduct semi-structured interviews.Expert selection criteria are:(1)Have more than ten years of work experience;(2)Deputy senior title or above;(3)Have a bachelor degree or above;(4)Have a rigorous and realistic attitude and voluntary participation.((1)(2)(3)meet two items).Then revised the expert consultation questionnaire based on the interview results to form the first round of expert consultation questionnaires.3.Delphi method Among all experts who agree that nurses have the prescription right,experts are selected according to the expert selection criteria.The selection criteria for this research expert are:(1)Have clinical work experience and have worked in their research field for more than 10 years;(2)Deputy senior title or above;(3)Have a bachelor degree or above;(4)Have enthusiasm for this research and volunteer to participate.((1)(2)(3)meet two items).The central nervous system drug expert consultation questionnaire mainly invited19 medical experts from Shanxi,Shaanxi,Hainan and other places(10 neurologists,9psychiatrists),21 nursing specialists(15 neurologists,psychiatry 6 experts)conducted 2rounds of expert consultation;the urological drug expert consultation questionnaire mainly invited 10 medical experts and 13 nursing experts from Shanxi,Hubei,Beijing and other places to conduct 2 rounds of expert consultation;the narcotic drug expert consultation paper is 9 medical experts and 7 nursing experts from Shanxi,Zhejiang and other places were invited for expert consultation.A statistical analysis of the results of expert consultation was conducted to determine the specific content and prescription form that the nurse’s central nervous system,urinary system,and anesthetic drugs can prescribe.4.Statistical method Using spss22.0 software and Microsoft Excel database to describe and analyze expert recognition rate,authority coefficient and positive coefficient of experts.Results:1.Determination of content and form of central nervous system drug prescription1.1 Determination of the content and form of the prescription of Neurology medicine The positive coefficients of the two rounds of expert consultation were 96.43% and100%,and the authoritative coefficients were 0.78 and 0.86.The consultation results were reliable.And 3 drugs that can be prescribed in Independent prescription or agreement prescription: diclofenac sodium,ibuprofen and donepezil;2 drugs that can be prescribed in agreement prescription or extended prescription: pregabalin and indomethacin;2 drugs that can be prescribed in extended prescription: Ginkgo biloba extract and alprostadil;12drugs that can be prescribed in agreement prescription: naproxen,sulindac,meloxicam,piroxicam,Carbamazepine,levetiracetam,oxcarbazepine,levodopa/benzhydrazine,levodopa,piracetm,clopidogrel,aspirin.1.2 Determination of the content and form of the prescription of psychotropic drugs The positive coefficients of the two rounds of expert consultation were 88.24% and100%,and the authoritative coefficients were 0.81 and 0.87.The consultation results were reliable.All psychiatric drugs have an expert approval rate of less than 80%,and nurses are not recommended to prescribe.Include drugs: Aripiprazole(66.67%),chlorpromazine(53.33%),haloperidol(66.67%),clozapine(60.00%),droperidol(66.67%),perphenazine(60.00%),thiolidazine(53.33%),olanzapine(73.33%),amitriptyline(53.33%),citalopram(60.00%),imipramine(53.33%),doxepin(66.67%),duloxetine(60.00%),escitalopram(73.33%),fluoxetine(60.00%),paroxetine(66.67%),Sertraline(73.33%),trazodone(66.67%),venlafaxine(60.00%),alprazolam(66.67%),nitrazepam(60.00%),lorazepam(53.33%),buspirone(60.00%).2.Determination of contents and forms of urinary system drugs The positive coefficients of the two rounds of expert consultation were 92.59% and100%,and the authoritative coefficients were 0.78 and 0.85.The consultation results were reliable.Nurses in the nephrology department can prescribe 2 drugs in agreement prescription or extended prescription: bumetanide and sodium citrate;1 drug in independent prescription or agreement prescription: calcitriol;10 drugs in agreement prescription: hydrochlorothiazide,spironolactone,ampicillin,mannitol,glycerol,furosemide,sevelamer,heparin,low molecular weight heparin,protamine sulfate.3.Determination of the content and form of anesthetic drugs The expert approval rate for all narcotic drugs is less than 51%,and nurses are not recommended to prescribe.The expert consultation positive coefficient and authority coefficient were 85% and 0.82.Include drugs: Bupivacaine(43.75%),ropivacaine(37.50%),lidocaine(31.25%),prilocaine(43.75%),tetracaine(37.50%),procaine(31.25%),Mepivacaine(43.75%),propofol(37.50%),ketamine(25.00%),etomidate(37.50%),sodium hydroxybutyrate(18.75%),sodium thiopental(31.25%),Nitrous oxide(25.00%),desflurane(31.25%),isoflurane(43.75%),sevoflurane(37.50%),fentanyl(37.50%),morphine(43.75%),naloxone(18.75%),methadone(31.25%),alfentanil(37.50%),remifentanil(50.00%),rocuronium bromide(37.50%),chlorosuccinylcholine(50.00%),vecuronium bromide(43.75%),cis-atracurium(31.25%),and micurium chloride(31.25%).Conclusion:1.Among the central nervous system drugs,experts suggest that the prescription drugs that nurses can prescribe include 19 drugs in 8 categories of neurology,of which 3 drugs can prescribe in independent prescription or agreement prescription,2 drugs can prescribe in agreement prescription or extended prescription,2 drugs can prescribe in extended prescription,The remaining 12 drugs are prescribed by agreement prescription.psychiatric nurses are not recommended to prescribe all drugs in psychiatry.2.Among urinary system drugs,experts suggest that nurses can prescribe prescription drugs in 3 categories with a total of 13 drugs.Including 2 drugs can prescribe in agreement prescription or extended prescription,1 drug can prescribe in independent prescription or agreement prescription,and the remaining 10 drugs can prescribe in agreement prescription.3.Experts do not advise anesthesia nurses to prescribe all anesthetic drugs. |
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