Date of Award

2026

Document Type

Dissertation

Degree Name

Doctor of Nursing (ND)

First Advisor

Dr. Alena Groves

Abstract

In primary care settings, systemic corticosteroids continue to be excessively prescribed for conditions such as viral upper respiratory infections, allergic rhinitis, and other self-resolving illnesses. Corticosteroids are commonly prescribed inappropriately, despite lack of benefit and significant potential harm with their use; this includes immunosuppression, hyperglycemia, adrenal suppression, and other serious side effects. Recommendations for appropriate use and guideline-directed care have been published including withholding corticosteroid treatments in patients who are unlikely to benefit while reserving therapy for those with established clinical indications (Global Initiative for Chronic Obstructive Lung Disease, 2023 GOLD). Steroid stewardship interventions were utilized in this Doctor of Nursing Practice quality improvement project to address knowledge deficits and impact provider behavior change utilizing the Health Belief Model (HBM) and Theory of Planned Behavior (TPB) theories. The goal was to increase knowledge and appropriate prescribing practices among nurse practitioners in primary care. Provider knowledge, perceived risks of steroid prescribing, attitudes about guideline implementation, and self-efficacy to change practice were the primary focus of this educational intervention. Pre- and post-intervention surveys were utilized to measure knowledge and behavior change. Results indicated a significant 25% increase in knowledge score post-intervention. Self-reported provider behaviors also improved post intervention, as it was more closely aligned with evidence-based practices. Nurse practitioners can take leadership role in decreasing unnecessary steroid use in primary care and improve patient safety by incorporating steroid stewardship education.

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