Abstract
Background
Antimicrobial resistance (AMR) is affected significantly by inappropriate antibiotic use and is one of the greatest threats to human health. Antimicrobial stewardship (AMS) is a programme of actions promoting responsible use of antimicrobials and is essential for limiting AMR. Nurses have an important role to play in this context.
Aim
To investigate the determinants of nurse AMS behaviours and the impact of past training.
Methods
A cross-sectional multi-country survey design with mixed methods was employed. Participants were 262 nurses {223 female; mean age 44.45 [standard deviation (SD) 10.77] years} of 10 nationalities, with individual survey links sent via professional networks in five countries, alongside Twitter. Nine AMS behaviours and 14 behavioural determinants were assessed quantitatively using the Theoretical Domains Framework (TDF), and mapped to the Capability, Opportunity, Motivation – Behaviour (COM-B) model. Analysis identified differences between nurses with and without AMS training. The influence of coronavirus disease 2019 (COVID-19) on AMS behaviour was investigated qualitatively using free-text data.
Findings
Nurses performed all nine AMS behaviours, which were significantly higher [t (238) -4.14, P
Conclusion
Nurse training has a significant beneficial effect on AMS behaviour and its determinants. Nurses who had received AMS training scored higher in all TDF determinants of behaviour compared with those who had not received AMS training, resulting in higher capability, opportunity and motivation to perform AMS behaviour. AMS education and training should be offered to nurses to enhance these factors. Future research should consider the optimal level of training to optimize AMS behaviour, with a focus on developing skills and behavioural regulation.
Antimicrobial resistance (AMR) is affected significantly by inappropriate antibiotic use and is one of the greatest threats to human health. Antimicrobial stewardship (AMS) is a programme of actions promoting responsible use of antimicrobials and is essential for limiting AMR. Nurses have an important role to play in this context.
Aim
To investigate the determinants of nurse AMS behaviours and the impact of past training.
Methods
A cross-sectional multi-country survey design with mixed methods was employed. Participants were 262 nurses {223 female; mean age 44.45 [standard deviation (SD) 10.77] years} of 10 nationalities, with individual survey links sent via professional networks in five countries, alongside Twitter. Nine AMS behaviours and 14 behavioural determinants were assessed quantitatively using the Theoretical Domains Framework (TDF), and mapped to the Capability, Opportunity, Motivation – Behaviour (COM-B) model. Analysis identified differences between nurses with and without AMS training. The influence of coronavirus disease 2019 (COVID-19) on AMS behaviour was investigated qualitatively using free-text data.
Findings
Nurses performed all nine AMS behaviours, which were significantly higher [t (238) -4.14, P
Conclusion
Nurse training has a significant beneficial effect on AMS behaviour and its determinants. Nurses who had received AMS training scored higher in all TDF determinants of behaviour compared with those who had not received AMS training, resulting in higher capability, opportunity and motivation to perform AMS behaviour. AMS education and training should be offered to nurses to enhance these factors. Future research should consider the optimal level of training to optimize AMS behaviour, with a focus on developing skills and behavioural regulation.
| Original language | English |
|---|---|
| Pages (from-to) | 171-180 |
| Number of pages | 10 |
| Journal | Journal of Hospital Infection |
| Volume | 129 |
| Early online date | 16 Jul 2022 |
| DOIs | |
| Publication status | Published - 21 Oct 2022 |
Bibliographical note
Funding Information:Internationally, interprofessional collaboration and teamwork are recognized as key features of the nurses' role, and essential for safe patient care [6]. Collaboration between healthcare professionals is also a key feature of AMS, with many daily nursing activities intrinsically interwoven into the fabric of AMS [7] and integral to its success [8–10]. The emergence and transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) highlighted multiple areas in which competencies in AMS by nurses can support response efforts [11]. However, although there are calls for a nursing role in AMS [12], this role, unlike the roles of pharmacists or doctors, has not been described clearly [13].The education of undergraduate nurses has been identified as a key activity for the containment of AMR [34], with the inclusion of AMS recommended in undergraduate nurse education programmes [6,35]. The current study provides new evidence in support of these recommendations, and highlights that the TDF determinants of AMS behaviour, and AMS behaviour itself are more favourable in those who had received AMS training. Moreover, the most predictive domains of the TDF to AMS behaviour were ‘Behavioural regulation’ and ‘Skills’, both of which fall into the ‘Capability’ construct of the COM-B model. Intervention functions used most often to address these constructs are education, training and enablement. AMS taught in UK pre-registration nurse education programmes is, however, inconsistent [24]. Educators, commissioners, regulators and healthcare leads should, therefore, consider widening and providing nurse training in AMS. Environmental and social structures (e.g. local and national guidelines and point-of-care testing [23] to support AMS) should also be considered in this context.
Publisher Copyright:
© 2022 The Healthcare Infection Society