A theory-informed assessment of the barriers and facilitators to nurse-driven antimicrobial stewardship

Fisher, Christopher Chase; Cox, Victoria; Gorman, Sean K; Lesko, Natalie; Holdsworth, K; Delaney, Nicole; McKenna, Carmen

doi:10.1016/j.ajic.2018.05.020

Cited by 22 publications

(18 citation statements)

References 17 publications

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“…Being a competent prescriber requires nurses to achieve a high level of knowledge, ability, and self-efficacy (Abuzour et al, 2018; Cleary et al, 2017; Eng & Pai, 2015; Fisher et al, 2018). Self-efficacy is defined as the level of confidence that one has to perform a task effectively (Bandura, 2006; Hernández-Padilla et al, 2016).…”

Section: Nurse Prescribing and Self-efficacymentioning

confidence: 99%

Development and Validation of the Nurse Prescribing Self-Efficacy Scale

et al. 2020

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Low self-efficacy is a barrier to effective nurse prescribing. Therefore, nurses’ self-efficacy should be assessed using validated tools. We aimed to develop and psychometrically test the Nurse Prescribing Self-Efficacy Scale (NP-SES). We conducted an observational cross-sectional study with 290 nurses between January and June 2019. We studied the NP-SES’ reliability (i.e., internal consistency and temporal stability), validity (i.e., content, criterion, and construct) and legibility. The NP-SES showed good internal consistency (Cronbach’s alpha=0.958) and temporal stability (intraclass correlation coefficient=0.783). The NP-SES also showed good content validity (scale’s content validity index=0.98) and criterion validity ( r=0.75; p<0.001). Construct validity analysis revealed the NP-SES’ three-dimensional structure and showed its ability to detect significant differences between nurses with different levels of experience. Our psychometric analysis suggests that the NP-SES is a reliable and valid instrument that could be used to assess nurses’ self-efficacy in nurse prescribing.

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Section: Nurse Prescribing and Self-efficacymentioning

confidence: 99%

Development and Validation of the Nurse Prescribing Self-Efficacy Scale

et al. 2020

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“…Limited opportunities for training meant that nurses were often not aware of their potential contribution to AMS; for nurses, the AMS process lacked coherence therefore potential cognitive participation and collective action were severely constrained. There is growing discussion in the literature advocating greater nurse involvement in AMS [35][36][37], with other exploratory studies finding comparable results to ours [38][39][40]; however, intervention studies which detail approaches to strengthen the nurse's role are limited [41,42]. As nurses are the most consistently present members of the healthcare workforce, capitalising on the continuity afforded by nurses to prompt prescribers, who are more likely to be transient, would be of significant benefit in strengthening AMS.…”

Section: Discussionmentioning

confidence: 86%

Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory

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et al. 2020

Antimicrob Resist Infect Control

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Background: Antimicrobial stewardship (AMS) describes activities concerned with safeguarding antibiotics for the future, reducing drivers for the major global public health threat of antimicrobial resistance (AMR), whereby antibiotics are less effective in preventing and treating infections. Appropriate antibiotic prescribing is central to AMS. Whilst previous studies have explored the effectiveness of specific AMS interventions, largely from uniprofessional perspectives, our literature search could not find any existing evidence evaluating the processes of implementing an integrated national AMS programme from multi-professional perspectives. Methods: This study sought to explain mechanisms affecting the implementation of a national antimicrobial stewardship programme, from multi-professional perspectives. Data collection involved in-depth qualitative telephone interviews with 27 implementation lead clinicians from 14/15 Scottish Health Boards and 15 focus groups with doctors, nurses and clinical pharmacists (n = 72) from five Health Boards, purposively selected for reported prescribing variation. Data was first thematically analysed, barriers and enablers were then categorised, and Normalisation Process Theory (NPT) was used as an interpretive lens to explain mechanisms affecting the implementation process. Analysis addressed the NPT questions 'which group of actors have which problems, in which domains, and what sort of problems impact on the normalisation of AMS into everyday hospital practice'. Results: Results indicated that major barriers relate to organisational context and resource availability. AMS had coherence for implementation leads and prescribing doctors; less so for consultants and nurses who may not access training. Conflicting priorities made obtaining buy-in from some consultants difficult; limited role perceptions meant few nurses or clinical pharmacists engaged with AMS. Collective individual and team action to implement AMS could be constrained by lack of medical continuity and hierarchical relationships. Reflexive monitoring based on audit results was limited by the capacity of AMS Leads to provide direct feedback to practitioners.

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“…There is evidence that improving the knowledge base, specifically in terms of topics related to microbiology and antibiotics, along with consistently including nursing staff in the aforementioned activities, is essential. Fisher et al (2018) also found that nurses have the ability to enhance AS activities by promoting IV to PO step-down of antimicrobials. However, nurse participants mentioned insufficient knowledge as one of the main modifiable barriers.…”

Section: Knowledge and Training/educational Gaps Related To Antimicromentioning

confidence: 93%

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Description of Respondents Technique (Level 2) By Age Identity (Level 3) < 20 years old. (Level 4) 20-30 years old. (Level 4) >30 years old (Level 4). By Education (Level 3) *For further guidance on all formatting details, please refer to the Purdue Online Writing Lab (OWL).* Tables All tables must be in Microsoft Word format (.doc not .xls or .pdf), can be editable or re-sized. Tables must be textbased and contain no images or graphics. It is not permissible to use tabs or auto-formats. All tables meet the standards of the Publication Manual of the American Psychological Association (7th ed.). Table font should be Times New Roman, 10-point, and single-spaced. Number all tables consecutively throughout the manuscript and must be placed at the end of the manuscript. Identify placeholders within the text where you wish them inserted, e.g., .

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A theory-informed assessment of the barriers and facilitators to nurse-driven antimicrobial stewardship

Cited by 22 publications

References 17 publications

Development and Validation of the Nurse Prescribing Self-Efficacy Scale

Development and Validation of the Nurse Prescribing Self-Efficacy Scale

Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory

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