Factors influencing nurses' knowledge and competence in warfarin-drug and nutrient interactions and patient counseling practices.
Background: Warfarin therapy is commonly used to prevent thromboembolic events and cardiovascular disorders, but its effectiveness can be influenced by interactions with drugs and foods. Nurses play a crucial role in managing warfarin therapy and counseling patients on these interactions. This study aimed to assess the predictors of nurses' knowledge regarding warfarin-nutrient and drug interactions and their competence in counseling patients on warfarin therapy.
Methods: A cross-sectional study design was used to evaluate nurses' knowledge and counseling practices related to warfarin therapy across various healthcare institutions in Amman, Jordan. Participants included 176 registered nurses with at least one year of experience, recruited through convenience sampling from governmental, private, and educational hospitals. Data were collected through a self-administered questionnaire that assessed demographic characteristics, work-related factors, exposure to health education, and knowledge of warfarin-drug and food interactions, as well as counseling practices.
Results: The study found that most participants were female (58.6%) and held a bachelor's degree (72.7%). Nurses demonstrated moderate knowledge of warfarin-drug interactions, with a mean score of 8.76 ± 2.26 out of 26. Knowledge was better for cardiac agents like atenolol (53.4%) and gastrointestinal agents (53.4%), but gaps were observed for anti-inflammatory and CNS drugs. The mean score for knowledge of warfarin-food interactions (out of 18) was 12.27 ± 3.84, with strong knowledge of non-interfering foods, but gaps in understanding foods like leafy greens, high in vitamin K. Nurses' knowledge of counseling practices for warfarin therapy was moderate, with a mean score of 8.07 ± 2.31 out of 15. While knowledgeable about diet and adherence, gaps existed in counseling patients on missed doses and dietary restrictions. Regression analysis identified key predictors of knowledge, including education, work experience, direct patient care, self-confidence, exposure to health education, and anticoagulant training, explaining 35% of the variance in knowledge scores. A postgraduate degree, work experience, and confidence in warfarin care positively impacted knowledge, while demographic factors like age, gender, and job position had no significant effect. The findings highlight the need for educational programs and confidence-building initiatives.
Conclusions: The study highlights significant gaps in nurses' knowledge of warfarin interactions, particularly with certain drugs and foods, and underscores the need for targeted education and training. However, the study is limited by its reliance on self-reported data and a convenience sampling approach, which may impact generalizability. Strengthening nurses' understanding of warfarin management, especially regarding high-risk interactions, is essential for improving patient safety and the efficacy of anticoagulant therapy. Future initiatives should focus on structured educational programs, introducing interactive e-learning modules, regular workshops, and case-based training, as well as promoting multidisciplinary teamwork to enhance nurses' competency in warfarin counseling and patient care.