Nurses as antimicrobial stewards: Recognition, confidence, and organizational factors across nine hospitals

Monsees, Elizabeth; Goldman, Jennifer L.; Vogelsmeier, Amy; Popejoy, Lori L

doi:10.1016/j.ajic.2019.12.002

Cited by 15 publications

(15 citation statements)

References 26 publications

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“… Improving the awareness of and education on AMS and AMR among nurses is an essential element in infection and prevention control. Nurses’ role can be further strengthened by integrating fundamental training on AMS in the undergraduate nursing curriculum and providing continuing education in the clinical setting, as well as promoting the role of nurses in advocating for patients and AMS Monsees et al [ 23 ] Missouri (USA) Cross-sectional survey Nine hospitals ranged in size from 42 to 562 beds serving pediatric and adult populations in 2 different metropolitan areas Determine bedside nurses’ recognition and performance confidence in AMS RNs. A total of 4,282 direct care RN and licensed practical nurses were asked to participate but only 558 study subjects completed the survey.…”

Section: Data Extractionmentioning

confidence: 99%

“… Is the statistical analysis appropriate to answer the research question? Akbar et al [ 29 ] Survey Y Y Y N Y Ashiru-Oredope et al [ 33 ] Survey Y Y Y Y Y Barchitta et al [ 34 ] Survey Y Y Y Y Y Bouchoucha et al [ 25 ] Survey Y Y Y U Y Carter et al [ 21 ] Survey Y U Y N Y Hamilton et al [ 22 ] Survey Y U Y N Y Herawati et al [ 30 ] Survey Y U Y N Y Lim et al [ 31 ] Survey Y U Y N Y Monsees et al [ …”

Section: Risk-of-bias Assessmentunclassified

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What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

Danielis

Regano

Castaldo

et al. 2022

Antimicrob Resist Infect Control

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Background Antimicrobial resistance issues, and the consequent demand for antimicrobial stewardship (AMS) programs, need to be investigated urgently and clearly. Considering the large amount of time nurses spend at patients’ bedside, the aim of the present study was to examine recent literature on nursing competency in AMS. Methods Drawing from Tricco and colleagues’ seven-stage process, a rapid review was performed. MEDLINE, CINAHL and EMBASE databased were searched from December 1st, 2019 until December 31st, 2021. Article screening and study selection were conducted independently by three reviewers. Data were analyzed narratively and categorized adopting an inductive thematic coding. Results Sixteen studies met the inclusion criteria and were included. Publications were mainly authored in USA (n = 4), Australia and New Zealand (n = 4) and Asia (n = 4), followed by Europe (n = 2) and Africa (n = 2). Ten studies were quantitative in design, followed by qualitative (n = 4) and mixed-methods studies (n = 2). Nursing competency in AMS seems to be influenced by a two-dimensional model: on the one hand, internal factors which consisted in knowledge, attitudes and practices and, on the other hand, external aspects which are at environmental level in terms of structures and processes. Conclusion This study provided a map of dimensions for researchers and practitioners to consider when planning clinical governance, educational activities, and research programs. Significant opportunities exist for nurses to contribute to practice, education, research, and policy efforts aimed at reducing antimicrobial resistance.

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Section: Data Extractionmentioning

confidence: 99%

Section: Risk-of-bias Assessmentunclassified

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

Danielis

Regano

Castaldo

et al. 2022

Antimicrob Resist Infect Control

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“…It is of concern that in general, nursing leaders and prescribers do not support nurses' involvement in AMS. [85] Nurses collate clinical and microbiological information about the patients in their care and follow the trends of antimicrobial usage, ideally positioning them to influence decision-making regarding antibiotic use and supporting AMS. [86] Questioning the need for antimicrobial treatment therefore falls within nurse patient advocacy, [9,10,16,17,22,73,[87][88][89][90] but may be difficult within the hierarchical construct of healthcare dynamics.…”

Section: Ams Nurse Education In the Clinical Environmentmentioning

confidence: 99%

Guideline recommendations for antimicrobial stewardship education for clinical nursing practice in hospitals: A scoping review

Rout

Essack

Brysiewicz

2021

SAJCC

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Background. Antimicrobial stewardship (AMS) is a proactive healthcare intervention to improve patient outcomes by optimising antimicrobial use. Although nursing involvement is a recognised necessity, bedside nurses may not yet possess competencies to fulfil this role. Objectives. To identify recommendations for AMS education for the bedside nurse in key global AMS guidelines. Methods. Scoping review methodology was used to systematically search published and ‘grey’ literature in PubMed, EBSCOhost, Google Scholar, government websites and websites of professional societies and organisations. Search dates were from 1990 to 2020. Inclusion criteria were English language AMS guidelines for hospitals. Results. Literature searches retrieved 1 824 articles, with 43 meeting the review inclusion criteria. Reference was made to AMS nursing education in 23 (53.4%) of the articles. Educational opportunities for nurses were recommended: inclusion of AMS concepts/content into undergraduate and postgraduate nursing curricula (n=12; 27.9%), in-hospital training (n=14; 32.5%) and continuing professional development (n=6; 13.9%). Recommendations for nursing education were as follows: role of AMS in preventing antimicrobial resistance (n=7; 16.2%), infection prevention and control (n=3; 6.9%), diagnostics in AMS (n=5; 11.6%), pharmacology (n=11; 25.5%) and collaboration (n=2; 4.6%). Identified nursing educational gaps were: nurses not recognising their role within AMS (n=5; 11.6%), inadequate nursing resources and expertise for dosing, pharmacokinetic/pharmacodynamic strategies and managing possible drug incompatibilities with extended/prolonged infusions (n=3; 6.9%), and inappropriate nurse disposal of antibiotic waste (n=1; 2.3%). Conclusions. Although recommendations for nursing education were found in many key AMS guidelines, few guidelines provided detailed descriptions of the nursing competencies that were required for this role.

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“…Nurses' contributions to activities related to stewardship have been recognized by the American Nurses Association, the CDC, 1 and the World Health Organization. Although nurses have been recognized as integral to the advancement of stewardship programs, most literature has focused on the identification of barriers [5][6][7][8] and less on how to incorporate existing staff into the program. 3,9,10 The literature summarizing surveys of nurses' attitudes and beliefs has identified perceived barriers to inclusion of this group in stewardship activities.…”

mentioning

confidence: 99%

“…3,9,10 The literature summarizing surveys of nurses' attitudes and beliefs has identified perceived barriers to inclusion of this group in stewardship activities. [5][6][7][8] It has also demonstrated how nurses' everyday work already embodies stewardship activities such as collecting cultures prior to antibiotic initiation, obtaining an adverse drug reaction history, administering and monitoring antibiotic therapy, and conducting patient and family education. 1 Although nurses claim these areas as being within their purview, many other areas are within their scope of their work.…”

mentioning

confidence: 99%

Antibiotic stewardship for nurses: Using e-learning modules to bridge the education gap

Catanzaro¹

2022

ASHE

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Objective: The Centers for Disease Control and Prevention has called for an interdisciplinary approach to antibiotic stewardship implementation that includes front-line nurses. The literature to date has identified key factors preventing uptake by nurses: lack of education, poor communication among providers, and unit culture. Three e-learning modules were developed to address the nurses’ education regarding the roles nurses play in antibiotic stewardship, antibiotic resistance, allergy assessment, medication side effects and interactions, pharmacokinetics–pharmacodynamics, culture interpretation, specimen collection, and the antibiogram. A survey was used to assess whether nurses felt more prepared to participate after finishing the modules. Setting: Front-line staff nurses in acute care were assigned e-learning modules as part of their pharmacy’s introduction of an antibiotic stewardship program for nurses. Methods: Nurses viewed the modules and completed a survey designed to rank their usefulness and to assess their attitudes. Results: Overall, 81% of nurses felt that they should be part of the antibiotic stewardship team. After completing the modules, 72% felt more empowered to participate in stewardship discussions and an additional 23% requested more education. Also, 97% felt that the information they learned could be utilized in everyday work regardless of the new program. The most cited barriers to stewardship activities were lack of education (45%) and hospital and/or unit culture (13%). Conclusion: Education and culture need to be addressed to overcome the barriers to nurses’ involvement in antimicrobial stewardship. E-learning can provide a simple and effective first step to educate nurses, with minimal time investment.

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Nurses as antimicrobial stewards: Recognition, confidence, and organizational factors across nine hospitals

Cited by 15 publications

References 26 publications

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

Guideline recommendations for antimicrobial stewardship education for clinical nursing practice in hospitals: A scoping review

Antibiotic stewardship for nurses: Using e-learning modules to bridge the education gap

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