Date of Award

Spring 3-31-2020

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Amanda Alonzo

Second Advisor

Amy Hite

Third Advisor

Anuradha Ghosh


Antibiotics save lives and are one of the most widely used medications of modern medicine. However, the widespread use of antibiotics has led to the development of antimicrobial resistance (AMR). AMR is a major public health crisis with disastrous consequences on national and global healthcare systems. AMR is associated with increased healthcare costs, increased morbidity and mortality, longer hospital stays, increased readmission rates, and overall poorer patient outcomes. The use of antibiotics is the single most important leading factor involved in the development of resistance. Current estimates suggest that at least 30% and up to 50% of all antibiotics prescribed are unnecessary. The majority of antibiotic consumption takes place in the outpatient setting. Acute upper respiratory infections (URIs) are the most common reason for which antibiotics are prescribed in the outpatient setting. However, the majority of common acute URIs are self-limiting, viral infections that rarely require antibiotic treatment. To determine underlying factors involved in prescribing behaviors, a pre-validated survey adapted from Rodrigues et al. (2016) was used to identify and explore provider’s knowledge, attitudes, perceptions (KAPs) and prescribing behaviors regarding antibiotic use and resistance in the primary and secondary care setting. The survey was distributed to 116 providers from three separate practice settings in Southeast Kansas and Southwest Missouri. A total of 54 (N=54; 46.6% response rate) provider responses were analyzed using descriptive statistics and univariate analysis of variance (ANOVA). The findings suggest that inappropriate antibiotic use is not the result of provider ignorance or unfamiliarity with clinical practice guidelines. Rather, inappropriate prescribing may better be explained as the result of complex interactions involving both patient-related and provider-related factors. Patient-related related factors include lack of education, satisfaction, and pressure applied on providers to prescribe antibiotics. Provider-related factors include time constraints, patient workload, gender differences, questionable follow-up, and clinical uncertainty. Based on these findings, targeted educational resources and strategies developed by the Centers for Disease Control and Prevention (CDC) were identified and included in the scholarly project.

Saunders_Approval Sheet copy (1) - signed.pdf (217 kB)
Electronically Signed Approval Page