The research team, led by investigators at Bogomolets National Medical University, set out to assess the awareness, attitudes, and readiness of pharmaceutical professionals regarding pharmacist prescribing. The timing is significant: Ukraine’s Law on Medicinal Products, adopted in July 2022, provides for the introduction of comprehensive pharmaceutical services in pharmacies from 2027 as a distinct professional activity. Against the backdrop of martial law, workforce shortages, and damaged medical infrastructure, the question of whether pharmacists could take on prescribing duties has moved from theoretical discussion to practical policy consideration.

Perhaps the most striking finding was the profession’s limited familiarity with the very concept it was being asked to evaluate. Only 9.0 percent of respondents reported being well informed about international pharmacist prescribing models, while 55.4 percent were entirely unfamiliar with the practice. This knowledge gap is not surprising given the current legal landscape: pharmacist prescribing is not an established professional function in Ukraine, so pharmacy students receive no specialized training in prescribing competencies. Familiarity with international models can only be acquired through independent learning or professional initiatives.

To give respondents a foundation for evaluation, the researchers introduced them to four models of pharmacist prescribing drawn from international experience. These ranged from collaborative prescribing under agreements with physicians, through restricted independent prescribing limited to specific conditions or medication lists, to full independent prescribing for both diagnosed and undiagnosed conditions. The models reflect a spectrum of professional autonomy seen across countries, from the United Kingdom and Switzerland, where independent prescribing is established, to Ireland and France, where protocol-based supply of selected medicines has recently been introduced.

When asked to rate these models, respondents revealed a clear pattern: support rose as professional autonomy decreased. Collaborative prescribing, in which pharmacists work under agreements with physicians, received the most favorable assessments, while full independent prescribing for undiagnosed conditions drew the strongest opposition. This gradient suggests that Ukrainian pharmacists envision a phased implementation path, beginning with team-based models and gradually expanding autonomy as regulatory and educational systems mature. The preference mirrors international experience, including Slovenia’s collaborative pilot programs and the United Kingdom’s staged evolution from supplementary to independent prescribing.

Despite the overall skepticism, respondents recognized meaningful potential benefits. Improved access to pharmacotherapy and reduced physician workload ranked highest among perceived advantages. These views align with a substantial body of international evidence. A cost-effectiveness analysis in the United States found that managing half of hypertension patients through pharmacist prescribing would save over $10,000 per person across a 30-year horizon, translating to roughly $1.13 trillion in population-level savings. Australian research in emergency departments showed that collaborative prescribing models reduced medication errors and improved documentation of adverse drug reactions.

The barriers identified by respondents were predominantly structural rather than attitudinal. The lack of a clear regulatory framework topped the list, followed by limited access to patient medical records, insufficient interprofessional collaboration, and concerns about professional liability. These concerns are well founded: expanding pharmacists’ clinical roles inevitably increases exposure to legal claims, and professional indemnity insurance has emerged internationally as a key protective mechanism. Respondents also emphasized the need for legal acts, clinical protocols, prescribing standards, and a defined list of medicines eligible for pharmacist prescribing as priority measures.

The survey also probed which medicines pharmacists believed could safely fall under their prescribing authority. Respondents favored lower-risk medicines with well-established safety profiles, particularly anti-inflammatory and analgesic drugs. Support dropped sharply for vaccines, immunobiologicals, and hormonal medicines, reflecting awareness of the higher clinical responsibility and more comprehensive patient assessment these categories demand. This cautious triage of therapeutic categories is consistent with the stepwise approaches adopted in Poland and Spain, where initial prescribing rights were limited to narrowly defined conditions.

Education emerged as perhaps the most formidable challenge. A striking 92.9 percent of respondents considered pharmacists’ existing knowledge insufficient or only partially sufficient for prescribing practice. Yet willingness to undergo specialized training was lukewarm: only about 30 percent expressed readiness to pursue such credentials, while 43.7 percent remained uncertain, likely because the regulatory framework, responsibilities, and practical conditions for applying new competencies remain undefined. When asked about preferred training formats, 42.4 percent favored workplace-based training under experienced professionals, ahead of continuing professional development courses and short-term certificate programs.

The study’s authors conclude that pharmacist prescribing in Ukraine should initially be introduced through collaborative or protocol-based models, with gradual expansion tied to regulatory, educational, and organizational readiness. The wartime context adds urgency: with physicians scarce, medical infrastructure destroyed in affected regions, and rural populations facing uneven access to care, expanding pharmacists’ roles could serve as a critical mechanism for maintaining continuity of treatment. Whether Ukraine’s pharmacy profession, currently cautious and under-informed, can be prepared for this transition will depend on sustained investment in postgraduate education, digital health infrastructure including electronic health records, and the legal architecture that defines professional responsibility.

Subject of Research: Pharmacist prescribing implementation in Ukraine

Article Title: Pharmacists’ perspectives on the implementation of pharmacist prescribing in Ukraine: a nationwide survey

Article References: Komarida, O., Kosyachenko, K., & Sakhnatska, N. (2026). Pharmacists’ perspectives on the implementation of pharmacist prescribing in Ukraine: a nationwide survey. Pharmacia, 73, Article e196917. https://doi.org/10.3897/pharmacia.73.e196917

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e196917

Keywords: pharmacist prescribing, Ukraine, pharmacy practice, nationwide survey, professional autonomy, collaborative prescribing, healthcare reform, pharmaceutical education, regulatory framework, martial law, interprofessional collaboration, continuing professional development

The research team, led by Betülay Kılıç of the University of Health Sciences’ Gülhane Faculty of Nursing in Ankara, together with colleagues from Gazi University and Başkent University, set out to answer a question that has been surprisingly underexplored. While nurses’ knowledge is widely acknowledged as fundamental to early sepsis recognition and timely management, its relationship with nursing decision-making styles and professional autonomy had not been systematically quantified. The team surveyed 125 of 143 eligible intensive care nurses working at a university hospital, achieving a response rate of 87.4 percent through a total population sampling approach, and reported the work in accordance with the STROBE guidelines for observational studies.

The participants were a relatively young cohort, with a mean age of 30.06 years and a standard deviation of 5.6, suggesting a workforce with substantial career years ahead but potentially limited accumulated clinical experience. Each nurse completed three validated instruments: the Sepsis Knowledge Questionnaire, which probes understanding of sepsis definitions, recognition criteria, and management principles; the Nursing Decision-Making Instrument, which distinguishes between intuitive and analytical decision-making tendencies; and the Attitude Toward Professional Autonomy Scale, which measures how independently nurses view their own clinical role. The data were analyzed using descriptive statistics, non-parametric group comparisons, Spearman’s rank correlation, and multiple linear regression.

The headline number from the study is a mean sepsis knowledge score of 20.24 out of a possible 30, with a standard deviation of 4.21. On its face, that suggests a workforce with a reasonable working grasp of sepsis, but the aggregate figure conceals what the researchers describe as notable knowledge gaps across several recognition and management items. In sepsis care, such gaps are not academic. The condition progresses from infection to systemic inflammation, tissue hypoperfusion, and multi-organ dysfunction along a timeline measured in hours, and international survival campaigns have repeatedly emphasized that every hour of delayed recognition and treatment increases mortality. A nurse who misidentifies early warning signs, or who misunderstands fluid resuscitation targets or the significance of falling mean arterial pressure, may inadvertently contribute to that delay.

One of the most intriguing findings concerns the relationship between knowledge and decision-making style. Sepsis knowledge showed a weak but statistically significant positive correlation with the total score on the Nursing Decision-Making Instrument, with a Spearman’s rank correlation coefficient of 0.239 and a p-value of 0.007. The direction of that instrument matters: higher scores indicate a greater tendency toward intuitive rather than analytical decision-making. In other words, nurses with stronger sepsis knowledge in this sample leaned more heavily on intuition, a pattern the authors’ data link to expertise, since intuitive judgment in clinical settings is generally understood to be built on a foundation of accumulated knowledge and pattern recognition rather than on guesswork.

The study also found a weak positive correlation between sepsis knowledge and work-related independence, one of the dimensions of professional autonomy, with a coefficient of 0.220 and a p-value of 0.013. Critically, both of these associations survived the researchers’ correction for false discovery rate, with adjusted p-values of 0.034 for each. This statistical rigor matters in a field where small correlation coefficients can easily evaporate under multiple-comparison corrections. The persistence of these relationships suggests, cautiously, that knowledge, confident judgment, and a sense of professional independence travel together in the intensive care setting, forming a cluster of attributes that may reinforce one another in daily practice.

The multivariable regression analysis sharpened the picture of what actually drives sepsis knowledge. After adjusting for other factors, previous sepsis training was independently associated with higher knowledge scores, adding 1.799 points on the 30-point scale with a p-value of 0.025. Even more striking was the effect of clinical exposure: nurses who had never cared for patients with sepsis scored 3.473 points lower than those who cared for septic patients frequently, a difference with a p-value of 0.037. The magnitude of that exposure effect, nearly double that of formal training, underscores a point that educators and hospital administrators would do well to internalize. Classroom instruction builds knowledge, but the bedside encounter with a deteriorating septic patient appears to cement it.

These results arrive at a moment when sepsis continues to burden health systems worldwide. The World Health Organization has identified sepsis as a global health priority, and the condition’s dependence on rapid, coordinated frontline response makes nursing staff pivotal to any improvement strategy. In the intensive care unit, nurses continuously monitor vital signs, interpret trends in systolic blood pressure and mean arterial pressure, administer antibiotics and fluids, and escalate concerns to physicians. When their knowledge base is solid, they function as an early warning system; when it is not, the safety net develops holes precisely where patients are most vulnerable.

The authors are careful about the limits of their work, and those limits deserve emphasis. The study was conducted at a single university hospital, which means the findings may not generalize to community hospitals, rural facilities, or different national health systems. The cross-sectional design captures a single moment in time, so it can demonstrate association but not causation: the data cannot tell us whether sepsis training causes higher knowledge, whether more knowledgeable nurses seek out training, or whether unmeasured factors such as motivation drive both. The modest correlation coefficients, while statistically robust, also indicate that knowledge explains only a small share of the variation in decision-making style and autonomy. The researchers explicitly recommend interpreting the findings in light of these design constraints.

Even with those caveats, the practical implications are clear and actionable. The independent associations between structured sepsis education and higher knowledge, and between clinical exposure and higher knowledge, point toward a two-pronged strategy: evidence-based sepsis training programs paired with practice-oriented learning opportunities that guarantee nurses genuine exposure to septic patients, whether through rotations, simulation, or deliberate case-based education. For a condition in which the first hours decide outcomes, investing in the knowledge, judgment, and autonomy of the nurses who watch over critically ill patients around the clock may be among the most cost-effective interventions available. The study, published open access with a permanent DOI, invites hospital leaders and nursing educators alike to look hard at their own units and ask whether their frontline staff are being given both the training and the bedside experience that sepsis care demands.

Subject of Research: Sepsis knowledge, clinical decision-making, and professional autonomy among intensive care nurses

Article Title: Factors associated with sepsis knowledge and its relationship with clinical decision-making and professional autonomy among intensive care nurses: a cross-sectional study

Article References: Kılıç, B., Tosun, M. H., Yardımcı Gürel, T., & Candan Yamak, Z. (2026). Factors associated with sepsis knowledge and its relationship with clinical decision-making and professional autonomy among intensive care nurses: a cross-sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05384-3

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05384-3

Keywords: sepsis, intensive care nursing, clinical decision-making, professional autonomy, nursing education, cross-sectional study, critical care, knowledge gaps, Sepsis Knowledge Questionnaire, early recognition, BMC Nursing, STROBE