A Conceptual Framework of Professional Identity enhanced Reflective Evidence Based Practice Professional Role Taking by Dutch Diabetes Specialist Nurse Prescribers. A Grounded Theory Approach.

Krings, Frans Jozef (2023) A Conceptual Framework of Professional Identity enhanced Reflective Evidence Based Practice Professional Role Taking by Dutch Diabetes Specialist Nurse Prescribers. A Grounded Theory Approach. Doctoral thesis, Birmingham City University.

Frans Jozef Krings PhD Thesis published_Final version_Submitted May 2022_Final Award Dec 2023.pdf - Accepted Version

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Introduction and background

In the Netherlands, supplementary prescribing authority was granted to Bachelor level registered specialist nurses in 2014. A team of Dutch diabetes specialist nurse prescribers, in preparation for the prescriber role, was facilitated in their self-imposed quest to master evidence based practice competencies to substantiate their clinical decisions and contend with physicians doubting their prescribing competency. This provided the opportunity to investigate how these nurse prescribers act to achieve this implementation and learn from their experiences.


The study aimed to develop a conceptual framework of the evidence based practice implementation by Dutch diabetes specialist nurse prescribers, to make recommendations for policy, education and practice for prescribing by nurses in the Netherlands. The preliminary focussing questions where:

- What are the reasons why diabetes specialist nurse prescribers apply or reject evidence based practice, and
- how can these nurses use evidence based practice within their professional role and position, and enhance nurse prescribing practice?


A grounded theory approach was chosen to investigate the nurse prescribers’ uptake process of evidence based practice with a focus on influences. Research data consists of face-to-face interviews held with eight nurse participants, two nursing department managers and two diabetes care physicians and two nursing university lectures. Additional data came from educational evaluations and focus groups held with the nurse participants. Data was collected during the period from November 2014 to January 2019. Data analysis was performed with ATLAS.ti7 initially using Seidel's analysis model.


The conceptual framework describes the process of nurse prescribers taking the role of ‘reflective evidence based practice professional’ enhanced by Professional Identity Formation. This role taking is a means to underpin clinical decision making and derive proposals to tailor a patients’ diabetes care plan in order to discuss this with other healthcare professionals. The findings revealed that a reason for nurse prescribers to use evidence based practice is to better reveal their competence and ability to other healthcare professionals. This helps them to increase their professional status and be trusted and respected as an equal partner. A strong professional identity is developed in this framework, which can be a prerequisite interpersonal condition to being confident to mediate the patient's pharmaceutical care plan, in an interdisciplinary meeting with the acting physician, in order to tailor the patient's diabetes care plan.


In conclusion, from this research project, it is hypothesised that: Professional Identity Formation is a major facilitator for professional role taking. It appears that the personal construct of “Self” can either form a barrier or be a facilitator for professional role taking. It is recommended that educators focus on Professional Identity Formation while facilitating education for nurse prescribers learning to master evidence based practice competencies.

Item Type: Thesis (Doctoral)
31 May 2022Submitted
15 December 2023Accepted
Uncontrolled Keywords: PubMed MeSH: Drug prescriptions; Evidence based Practice; Evidence based Nursing; Grounded Theory; Symbolic Interactionism; Nursing; Nurses’ role, Professional Identity. CINAHL headings: Nurse Prescriber, Nursing practice, Nursing role, Professional Practice, Evidence based; Grounded Theory; Professionalisation, Symbolic Interactionism, Professional Identity.
Subjects: CAH01 - medicine and dentistry > CAH01-01 - medicine and dentistry > CAH01-01-03 - medicine by specialism
CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-02 - adult nursing
Divisions: Doctoral Research College > Doctoral Theses Collection
Faculty of Health, Education and Life Sciences > School of Health Sciences
Depositing User: Jaycie Carter
Date Deposited: 26 Jan 2024 15:43
Last Modified: 26 Jan 2024 15:43
URI: https://www.open-access.bcu.ac.uk/id/eprint/15178

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