Knowledge, attitudes, and practices of bedside nursing staff regarding antibiotic stewardship: A cross-sectional study

Abbas, Salma; Lee, Kimberly; Pakyz, Amy; Markley, Daniel; Cooper, Kaila; Vanhoozer, Ginger; Doll, Michelle; Bearman, Gonzalo; Stevens, Michael P.

doi:10.1016/j.ajic.2018.09.008

Cited by 28 publications

(33 citation statements)

References 11 publications

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“… 43 Our findings reveal several barriers to nursing inclusion in AMS, including: a lack of input into AMS strategies/ASPs, limited authority to enact formal change, a lack of empowerment in terms of interprofessional roles and teamwork and a lack of clarity around the roles and responsibilities of nursing within new AMS-driven procedures. 19 It was clear from the interviews that participating nurses wanted to know more, to learn more and to be more involved and included in AMS. Yet, the majority of nurses felt peripheral to AMS practice, as well as (and relatedly) inconvenienced and burdened by the additional work it represented.…”

Section: Discussionmentioning

confidence: 99%

“…Although the potential for nursing to inform and advance AMS activities seems clear, recent research has identified numerous barriers that impede such involvement, including limited integration in training regarding AMS, interprofessional jurisdictional issues and enduring hierarchical power relations within the hospital. 19 29 A lack of full integration of AMS into formal nursing education has also been cited as one factor that can limit nurses’ knowledge of AMR and engagement in AMS implementation. 19 30 31 In a recent survey of Australian hospital nurses, more than half rated their antimicrobial-related knowledge as limited or minimal.…”

Section: Introductionmentioning

confidence: 99%

“… 19 29 A lack of full integration of AMS into formal nursing education has also been cited as one factor that can limit nurses’ knowledge of AMR and engagement in AMS implementation. 19 30 31 In a recent survey of Australian hospital nurses, more than half rated their antimicrobial-related knowledge as limited or minimal. 23 Another factor is the lack of clarity around the role of nursing in antimicrobial decision-making and ‘medical prescribing’, with nurses often situated as ancillary to medical and pharmacy expertise and authority.…”

Section: Introductionmentioning

confidence: 99%

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Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study

et al. 2020

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ObjectivesThis study responds to calls for greater focus on nursing roles, and the need for nursing integration within the antimicrobial optimisation agenda. The objective of this study was to explore Australian hospital nurses’ views on antimicrobial resistance and antimicrobial stewardship (AMS) in a hospital setting, in order to better understand the opportunities for and challenges to integration of nursing staff in antimicrobial optimisation within hospital settings.DesignQualitative one-on-one, semistructured interviews. Interview transcripts were digitally audio-recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory.SettingFour hospitals (three public and one private), across metropolitan, regional and remote areas, in two Australian states.Participants86 nurses (77 females, 9 males), from a range of hospital departments, at a range of career stages.ResultsFindings were organised into three thematic domains: (1) the current peripheral role of nurses in AMS; (2) the importance of AMS as a collaborative effort, and current tensions around interprofessional roles and (3) how nurses can bolster antimicrobial optimisation within AMS and beyond.ConclusionNursing staff are central to infection management within the hospital and are thus ideally located to enhance antibiotic optimisation and contribute to AMS governance. However, without increased interprofessional cooperation, education and integration in the AMS agenda, as well as addressing organisational/resource constraints in the hospital, the nursing role in stewardship will remain limited.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study

et al. 2020

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“…The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) identified the development and spread of antimicrobial resistance as a global health crisis and a major public health concern (Abbas et al, 2019;Ha et al, 2019;Manning et al, 2016;R.N. Olans et al, 2016).…”

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Nursing and Antimicrobial Stewardship: An Unacknowledged and Underutilized Focal Point

2021

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Background: Nurses have the ability to play an important role in patient safety related to antibiotic use and overuse but are often not involved in antimicrobial stewardship programs (ASP). Therefore, nurses need to be educated and trained in antimicrobial stewardship (AS) so that they can more competently contribute to safe patient care. Lewin’s change theory may be utilized as a framework for understanding the integration of nurses into these efforts. Objective of the Study: This integrative review is intended to explore the role of nurses in AS and discuss the importance of nurses needing to be educated, trained, and competent in this so that they can become more actively involved in such programs. Methodology: Articles were gathered from the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Google Scholar from June 2015 to December 2019. A five-year time frame was implemented to ensure that the most current information was included. Seventeen peer reviewed, written in English, original research studies that met the inclusion criteria (from the original 107 studies) and conducted in Australia, Canada, Scotland, South Africa, and the United States were included in this review. Results: The identified 17 recent studies focused on nursing and AS. Six major themes emerged, including nurses’ competency requirements and training related to AS, antimicrobial knowledge and educational gaps, perceived role of the nurse, nurses’ attitudes toward antimicrobial use, nurse and provider perspectives on ASPs, and nurses’ valuable contributions to AS. Discussion: This integrative review found that including nurses in AS would benefit ASPs and that finding ways for facilities to organize and implement such efforts is vital. This ties into the first stage of Lewin’s change theory of “unfreezing” and recognizing that the current (or old) way of practicing is in need of change. The literature reviewed provides evidence that nurses have the capacity to be an integral part of any ASPs and that they can help combat antimicrobial resistance in myriad ways when provided the necessary training and education. All studies reviewed found positive aspects to having nurse representation. However, there are gaps in antimicrobial based knowledge on the part of the nurses. Limitations: The limitations of this integrative review include the fact that the publications used were limited to a five-year timeframe and came specifically from nursing journals or have at least one nurse author contributor. Also, the current review included five international studies where the nurses’ scope and standards of practice may be different from those in the United States. A search of the grey literature reports related to AS was not conducted and could have provided additional valuable information as well. Conclusion and Recommendations: Nursing participation is needed in all ASPs. Empowering and educating nurses to feel confident and competent in this role will help to mitigate the overuse and misuse of antimicrobials. The ASPs most likely vary from institution to institution and future research should provide a framework for how to best disseminate information to nurses. Keywords: Antimicrobial Stewardship, Antibiotic Training, Nurses

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“…Knowledge, attitudes, and practices of bedside nursing staff regarding antibiotic stewardship: a crosssectional study -Abbas et al48 • Rapid respiratory panel testing: impact of active antimicrobial stewardship -Abbas et al49 • De-escalating antibiotic use in the inpatient setting: strategies, controversies, and challenges -Markleyet al 50 • Effect of carbapenem restriction on prescribing trends for immunocompromised wards at an academic medical center -Kirk et al 51 • Carbapenem-resistant Enterobacteriaceae at a low prevalence tertiary care center: patient level risk factors and implication for an infection prevention strategy -Doll et al 52 • A survey to optimize the design of an antimicrobial stewardship and infectious disease smartphone app at an academic medical center -Markley et al 53 • Surgeons do not listen: evaluation of compliance with antimicrobial stewardship program recommendations -Duane et al 54 • Guarding the goods: an introduction to antimicrobial stewardship -Wang J et al 55 • Antimicrobial stewardship practices in Virginia -Lee et al 56 • Antimicrobial stewardship program members' perspectives on program goals and national metrics -Van Parys et al 57 • Pediatric antimicrobial stewardship: state of the art -Godbout 58 • Performance of a novel antipseudomonal antibiotic consumption metric among academic medical centers in the United States -Markley et al 59 • Description of a restriction program for gram-positive antimicrobial agents at an academic medical center -Molayi et al 60 • An examination of stewardship interventions by major category in an urban, academic medical center -Pellerin et al 61 • Facilitators and barriers to implementing antimicrobial stewardship strategies: results from a qualitative study -Pakyz et al 62 • An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage -Pakyz et al 63 • Managing antibiotic resistance -Wenzel and Edmond 64 • The current state of antimicrobial stewardship: challenges, successes and future directions -Emberger et al 65 • The role of the hospital epidemiologist in antibiotic stewardship -Abbas et al 66 • Antibiotic prevention of acute exacerbations of COPD -Wenzel et al 67 • The effectiveness of formulary restriction and preauthorization at an academic medical center -Kirk et al Key barriers to nurse participation in AS-related activities include time constraints, physician pushback, and unfamiliarity with AS practices. • Challenges to ADE arise when clinicians lack confidence due to their uncertainty in culture data, thus requiring a high degree of clinical judgement.…”

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confidence: 99%

The learning hospital: From theory to practice in a hospital infection prevention program

Hess

Srivastava

Pryor

et al. 2019

Infect. Control Hosp. Epidemiol.

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The learning hospital is distinguished by ceaseless evolution of erudition, enhancement, and implementation of clinical best practices. We describe a model for the learning hospital within the framework of a hospital infection prevention program and argue that a critical assessment of safety practices is possible without significant grant funding. We reviewed 121 peer-reviewed manuscripts published by the VCU Hospital Infection Prevention Program over 16 years. Publications included quasi-experimental studies, observational studies, surveys, interrupted time series analyses, and editorials. We summarized the articles based on their infection prevention focus, and we provide a brief summary of the findings. We also summarized the involvement of nonfaculty learners in these manuscripts as well as the contributions of grant funding. Despite the absence of significant grant funding, infection prevention programs can critically assess safety strategies under the learning hospital framework by leveraging a diverse collaboration of motivated nonfaculty learners. This model is a valuable adjunct to traditional grant-funded efforts in infection prevention science and is part of a successful horizontal infection control program.

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Knowledge, attitudes, and practices of bedside nursing staff regarding antibiotic stewardship: A cross-sectional study

Cited by 28 publications

References 11 publications

Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study

Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study

Nursing and Antimicrobial Stewardship: An Unacknowledged and Underutilized Focal Point

The learning hospital: From theory to practice in a hospital infection prevention program

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