EVALUATION ON ATTITUDES OF THE PUBLIC AND MEDICAL PROFESSIONALS TOWARD NURSE PRESCRIBING: A CASE STUDY OF DUTSE PRIMARY HEALTH CENTER

CHAPTER ONE

INTRODUCTION

Background to the Study

Medical prescription has become a significant component of modern healthcare systems globally. According to Silverman & Brousseau (2019), medical prescription refers to a written or electronic order given by a licensed medical practitioner, usually a physician, to a pharmacist or patient, specifying the treatment, medication, or therapy that should be administered. Traditionally, the authority to prescribe medications has been confined to doctors and specialists, given their extensive medical training and responsibility for diagnosing conditions and determining the appropriate course of treatment. Medical prescriptions serve as a vital component of healthcare, ensuring that patients receive the correct medications in the correct dosages, and that there is a clear record of the treatment plan. The physician’s role in prescribing is often seen as a core part of their professional authority and expertise, especially when it comes to managing chronic conditions or complex medical cases (World Health Organization, 2018).

Over time, nurse prescribing, on the other hand refers to the legal authority granted to nurses to prescribe medications or treatments within the scope of their practice This practice, which allows qualified nurses to prescribe medication, has been adopted in various countries, including the United Kingdom, Australia, and New Zealand, with positive outcomes in enhancing healthcare delivery. According to Courtenay (2019) nurse prescribing is supported by additional training in pharmacology, clinical assessment, and medication management that equips nurses with the necessary skills to make prescribing decisions. Nurse prescribing was first introduced in the United States and the United Kingdom to address healthcare shortages and increase access to care, particularly in rural and underserved areas (Courtenay et al., 2019). Nurses, especially those in primary and community care settings, are often the first point of contact for patients, and enabling them to prescribe helps to reduce delays in treatment, thereby improving patient outcomes. Research has shown that nurse prescribing is generally well-received by patients, who often trust nurses due to their continuous involvement in patient care (Stenner & Courtenay, 2019).

In developing countries like Nigeria, the inclusion of nurses in the prescription of medications in primary healthcare settings could address issues of healthcare access and efficiency, especially in under-served areas. Ross & Zicko (2020) highlighted that there are several reasons for the implementation of nurse prescribing, especially in countries facing healthcare workforce shortages. One of the primary reasons is to reduce the burden on doctors, allowing them to focus on more complex cases while nurses handle routine prescriptions and follow-up care. other reason is to enhance the efficiency of healthcare services, reducing waiting times for patients and ensuring faster access to treatment. Bowskill & Timmons (2021) pointed that the introduction of nurse prescribing in many healthcare systems has been associated with improved patient satisfaction, reduced waiting times, and better management of chronic illnesses. This shift in responsibility allows nurses to extend their clinical roles, particularly in rural and primary healthcare settings where physicians are often in short supply

Surprisingly, public perception and the attitudes of medical professionals toward nurse prescribing have been a debate especially in regions where the primary healthcare system faces significant challenges (Adekunle et al., 2020). Studies conducted in other parts of the world suggest that both the public and medical professionals may harbor reservations about nurse prescribing. According to Kroezen, Ismail & Adebola (2018), some concerns include the adequacy of nurse training in pharmacology, fears of increased medication errors, and the potential for nurses to overstep their professional boundaries. These concerns are likely to manifest in contexts where nurse prescribing is a relatively new or unfamiliar practice.  According to Ndufo & Aniekeme (2022), nurse prescribing has been recognized as a means of enhancing the autonomy of the nursing profession, allowing nurses to take a more active role in patient care. However, with this increased responsibility comes a need for proper regulation, training, and awareness among both healthcare professionals and the public. If these factors are not adequately addressed, nurse prescribing could face opposition from other healthcare workers, particularly doctors, who may feel that their professional roles are being undermined. 

Additionally, public acceptance of nurse prescribing is critical to its success. Research by Stenner and Courtenay (2019) highlights that patients tend to have positive experiences when nurses prescribe, especially when nurses have spent time building trust with their patients. Nonetheless, concerns about the adequacy of nurses' knowledge in complex medical cases persist. In Dutse, where the healthcare system is primarily focused on basic care and public health, understanding public perception is key to determining whether nurse prescribing can be a viable and sustainable option for improving healthcare delivery. This study, therefore, seeks to evaluate the attitudes of both the public and medical professionals towards nurse prescribing at Dutse Primary Health Center.

1.2 Statement of the Problem

In recent times, the shortage of physicians in Nigeria, especially in rural areas like Dutse, has necessitated a reevaluation of healthcare delivery models (World Health Organization, 2020). Nurse prescribing has emerged as one such model, allowing nurses to take on some responsibilities traditionally reserved for doctors. However, despite its potential benefits, the implementation of nurse prescribing in Nigeria has been slow, largely due to concerns from both medical professionals and the public (Olubodun & Okafor, 2018). These concerns revolve around issues of competence, trust, and the perceived blurring of professional boundaries, particularly between nurses and physicians. A study conducted by Adekunle et al. (2020) indicated that many doctors in Nigeria are apprehensive about nurse prescribing, fearing that it could lead to diminished professional authority and increased competition in clinical decision-making. Similarly, patients have expressed reservations, with some questioning the ability of nurses to prescribe medications safely and effectively. These concerns suggest that there are significant attitudinal barriers to the acceptance of nurse prescribing in Nigeria. 

While international studies suggest that nurse prescribing can improve healthcare delivery, the socio-cultural and professional dynamics in Nigeria may produce different outcomes. Also is remains a fact that existing research on nurse prescribing in Nigeria is limited, with most studies focusing on urban centers where healthcare infrastructure is relatively advanced.  This gap in the literature underscores the need for a case study focused on Dutse Primary Health Center to assess the attitudes of both the public and medical professionals toward nurse prescribing in this specific context.

1.3 Objectives of the Study

The objective of this study is focused on evaluation on attitudes of the public and medical professionals toward nurse prescribing: a case study of Dutse Primary Health Center. Specifically, the study seeks to:

Evaluate the attitudes of the public towards nurse prescribing at Dutse Primary Health Center.

Assess the perceptions of medical professionals regarding nurse prescribing at Dutse Primary Health Center.

Identify the factors that influence public and professional attitudes toward nurse prescribing.

Provide recommendations for improving the implementation of nurse prescribing in Dutse.

1.4 Research Questions

What are the attitudes of the public toward nurse prescribing at Dutse Primary Health Center?

How do medical professionals perceive nurse prescribing at Dutse Primary Health Center?

What factors influence the attitudes of the public and medical professionals towards nurse prescribing?

What are the potential strategies for improving the implementation of nurse prescribing at Dutse Primary Health Center?

1.5 Research Hypotheses

H₀: There is no significant difference between the attitudes of the public and medical professionals toward nurse prescribing at Dutse Primary Health Center.

Hi: There is a significant difference between the attitudes of the public and medical professionals toward nurse prescribing at Dutse Primary Health Center.

1.6 Significance of the Study

Practically, it will provide valuable insights for policymakers and healthcare administrators in Dutse and similar rural areas regarding the implementation of nurse prescribing. Understanding public and professional attitudes is crucial for developing effective strategies that promote acceptance and smooth integration of nurse prescribing into primary healthcare systems. Additionally, this study will offer recommendations to enhance the training, regulation, and awareness surrounding nurse prescribing in Dutse, contributing to improved healthcare delivery and patient outcomes.

Theoretically, this study will contribute to the body of knowledge on healthcare policy and practice in developing countries. By exploring nurse prescribing in the context of a rural Nigerian primary health center, the study will provide data that can inform future research and policy decisions in similar settings. It will also add to the global discourse on the expansion of nursing roles and the challenges of implementing nurse prescribing in culturally diverse and resource-constrained environments.

1.7 Scope of the Study

The content of this study focuses on the attitudes of the public and medical professionals toward nurse prescribing. The research will assess perceptions, attitudes, and influencing factors specific to this rural healthcare setting. Geographically, the study is limited to Dutse, Makarantha Primary Health Center in Bwari Area Council, Abuja, Nigeria

1.8 Limitations of the Study

Like it is with academic endeavor, one limitation of the study is the geographical focus on Dutse Primary Health Center, which may limit the generalizability of the findings to other regions in Nigeria. The attitudes of both the public and medical professionals in other rural or urban centers may differ due to varying healthcare dynamics, socio-cultural factors, and healthcare infrastructure.  Another limitation is the reliance on self-reported data from participants, which may introduce bias due to social desirability or misrepresentation of true attitudes. Additionally, the study may encounter challenges in ensuring a representative sample, especially given the size of the target population in Dutse.

1.9 Definition of Terms

Nurse Prescribing: This is the authority granted to nurses to prescribe medication and treatment for patients, typically following specific training and regulation.

Primary Health Center: A healthcare facility that provides basic medical services, primarily in rural or under-served areas.

Attitude: A psychological construct that represents an individual's degree of like or dislike for something, which in this study refers to perceptions toward nurse prescribing.

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