title: Medication knowledge and willingness to nurse-initiate medications in an emergency department: a mixed-methods study.
abstract: OBJECTIVE
  To assess the medication knowledge of emergency department nurses and determine the factors affecting their nurse-initiated medication practices.
  
  
  BACKGROUND
  Nurse-initiated medications is a vital practice for all nurses in emergency departments which improves pain assessment, provides safe pain management and reduces time-to-analgesia and other meaningful treatments.
  
  
  METHODS
  Mixed methods. Between September 2014-January 2015, data were collected by questionnaire assessing medication knowledge and face-to-face interviews determining factors affecting practice.
  
  
  RESULTS
  Nurse-initiated medications frequency of the Registered Nurses ranged from 0-36 times per week dependent on employed hours and emergency department area worked. Medication knowledge was consistent among nurses, but there was an overall deficit in nurses' knowledge of mechanism of action. Four major themes were identified from the 24 interviews: patient-centred care, caution and safety as principles of practice; continuing support and education; improvement of practice over time. All nurses regard the practice positively and to be extremely beneficial to patients. Although apprehensive at the start of their nurse-initiated medications practice, confidence improved with exposure and experience. Nurses sought additional information from colleagues and the available evidence-based resources.
  
  
  CONCLUSIONS
  Medication knowledge is not the sole determinant of nurse-initiated medications practice. The practice is motivated by multiple factors such as patients' needs, safety and nurses' confidence.
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: Cabilan
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Eley
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
authors.forename: James A
authors.initials: JA
authors.lastname: Hughes
authors.affiliation: Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|The University of Queensland, School of Medicine, Brisbane, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Sinnott
mesh_terms: D000328:Adult; D001315:Australia; D002983:Clinical Competence; D003657:Decision Making; D004358:Drug Therapy / Q000451:nursing*; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D055553:Prescription Drugs / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D055553:Prescription Drugs
keywords: accident and emergency; clinical decision-making; medication; mixed method design; non-medical prescribing; nurse prescribing; nursing