This cross-sectional descriptive study was conducted with 280 nurses, physicians and patients in critical care units (ICUs and CCUs) in Tabriz, Iran, from July to September 2020. Participants were selected based on a stratified random sampling technique. Accordingly, each of the 6 teaching hospitals of Tabriz was regarded as a strata and its different ICUs/CCUs were taken as classes of that strata. The nurses, physicians and patients in these classes were included in the list of participants based on random sampling. Considering the ratio of the number of nurses, physicians and patients in each hospital to the whole research population, participants were randomly selected as the sample. The inclusion criteria for nurses and physicians included having at least 6 months job experience in ICUs/CCUs and willingness to participate in the study. The exclusion criteria included the reluctance of the nurses or physicians to continue participating in the study. However, the inclusion criteria for patients were adults over 18 years of age, able to complete the questionnaire, and willingness to participate in the study. Patients were excluded if their condition became worse during the study period.

The sample size was determined using the Cochran formula. The total number of nurses and physicians in six teaching hospitals were 548 and 199, respectively. Also, the total number of active beds of these hospitals were 275. By placing these numbers and considering the error level of 5% and p = 0.5 in the formula, 152 nurses, 53 physicians, and 75 patients were selected as participants. The response rate for those invited to take part was 100 percent.

The data collection technique was questionnaires and consisted of three parts: demographic information, participants’ knowledge about nurse prescribing and participants’ attitude toward nurse prescribing questionnaires. Demographic information included age, gender, employment status, work experience, academic degree, history of prescribing medication to patients, history of prescribing medication to family members or friends, reasons for prescribing, history of working abroad, physicians and patients’ trust in nurses, patients’ occupation, past hospitalization history, existence of a nurse in the family.

Part two of the questionnaire includes questions that determines the participants’ knowledge about nurse prescribing including 10 items scored based on true (1 point) or false (2 point) responses. The highest score was 20 and the lowest was 10 with a lower score indicating more knowledge about nursing prescribing. The authors of this paper prepared their own questionnaire which was subject to validation prior to its use in the presented study.

Part three of the questionnaire measured the participants’ attitude toward nurses prescribing and included 10 items. The items were scored based on a 5-point Likert scale (1: totally disagree, 2: disagree, 3: no comment, 4: agree, and 5: totally agree). The highest and the lowest scores were 50 and 10, respectively. Higher scores indicated more positive attitudes towards nurses prescribing [19]. The nurse prescribing questionnaire (the initiative survey that improved by the National Independent Evaluation of the Nurses and Midwife Prescribing) including statements related to the variables was used to measure attitude and readiness for nurse prescribing. This questionnaire including 20 items on the two mentioned subscales (10 for attitude, and 10 for readiness) [19]. After obtaining the initial permission from the author, the translation and re-translation process of the questionnaire from English to Persian and Persian to English (by an expert in the English language) was completed; and statements related to attitude selescted for present study.

Content validity of the data collection tool was conducted, the questionnaires was sent to 10 nursing professors, 10 patients, 10 nurses, and 10 physicians who rated the clarity and validity of the content. In addition, Cronbach’s alpha coefficient for the knowledge and attitude subscale was 0.728 and 0.722, respectively. However, Cronbach’s alpha coefficient for the measurement tool was 0.725, which confirmed its reliability.

Ethical approval was obtained from the Ethic Committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1398.1245). However, methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki).

After the research project was approved by the research ethic committee of Tabriz University of Medical Sciences, the researcher visited the hospitals in different working shifts to brief participants on the research objectives and procedures and then obtained their written informed consent.

The statistical analysis of the data was performed in SPSS V.22. The demographics were analyzed using descriptive statistics. Since the Kolmogorov–Smirnov test showed that the data distribution was normal, ANOVA and the T-test test were employed to compare the mean scores. The significance level for all tests was determined to be p < 0.05.

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