Nurses' practices in pharmacotherapy and their association with educational level

This paper is a report of a study of the association between educational level and nurses' practices in pharmacotherapeutic activities in three clinical settings.

The preparation and administration of medication are at the core of nursing practice, and nurses' involvement in pharmacotherapy is essential to medication safety. Nursing strategies to improve patient adherence to treatment and to identify adverse drug reactions have been described, but nurses' practice patterns in monitoring adherence and adverse drug reactions remain undocumented.

A cross-sectional correlational survey design was used. Data were collected between 2005 and 2007. Each year, the focus was on a different setting. Nurses were selected by convenience sampling: 260 worked in nursing homes, 82 in community care services and 1070 in hospitals. Questions focused on the provision of medication information, observation of patient medication adherence and identification of adverse drug reactions during the preceding month.

Involvement in providing drug information varied considerably, from 50% among hospital nurses to 82% among nurses in community care services. Statistically significantly fewer nurses observed non-adherence in hospitals (50%) than in the other settings (about 80%). Between 40% and 49% of the nurses had observed an adverse drug reaction. Nurses' information-seeking behaviour and problem responses also varied according to setting. Bachelor's degree holders were 35% more likely than diploma holders to have observed an adverse drug reaction.

Nurses assume considerable pharmacotherapeutic responsibilities. Practice patterns are codetermined by the healthcare setting and nurses' educational level.