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Influences on nurses’ engagement in antimicrobial stewardship behaviours: a multi-country survey using the Theoretical Domains FrameworkBackground Antimicrobial resistance (AMR) is significantly affected by inappropriate antibiotic use, and is one of the greatest threats to human health. Antimicrobial stewardship (AMS) is a programme of actions promoting responsible antimicrobial use, and is essential for limiting AMR. Nurses have an important role to play in this context. Aim: This study investigated the determinants of nurse AMS behaviours and the impact of past training. Method A cross-sectional multi-country survey design with mixed methods was employed. Participants were 262 nurses (223 female; mean age = 44.45; SD = 10.77 years) from ten nationalities, with individual survey links sent via professional networks in 5 countries, alongside Twitter. Nine AMS behaviours and 14 behavioural determinants were quantitatively assessed using the Theoretical Domains Framework (TDF), and mapped to the COM-B (Capability, Opportunity, Motivation – Behaviour) model. Analysis identified differences between nurses with and without AMS training. The influence of COVID-19 on AMS behaviour was qualitatively investigated using free text data. Findings Nurses performed all nine AMS behaviours, which were significantly higher (t(238) = -4.14, p < .001), by those who had training (M = 53.15; SD = 7.40) compared to those who had not (M = 48.30; SD = 10.75). Those with AMS training scored significantly higher in all of the TDF domains. The TDF was able to explain 27% of the variance in behaviour, with ‘Skills’ and ‘Behavioural Regulation’ (e.g. ability to self-monitor and plan), shown to be the most predictive of AMS actions. Both of these domains are situated in the Capability construct of COM-B, which can be enhanced with the intervention strategies of education and training. An increase in AMS behaviours was reported since COVID-19, regardless of previous training. Six core themes were linked to AMS: 1) Infection prevention and control, 2) Antimicrobials and antimicrobial resistance, 3) The diagnosis of infection and the use of antibiotics, 4) Antimicrobial prescribing practice, 5) Person-centred care, and 6) Interprofessional collaborative practice. Conclusion This research, has identified the significant benefit of nurse training on AMS behaviour, and its determinants. Those who had training, scored higher in all TDF determinants of behaviour, compared to those who had had no training, resulting in higher Capability, Opportunity and Motivation to perform AMS behaviours. AMS education and training should be offered to nurses to enhance these factors. Future research should consider the optimal level of training to optimise AMS behaviour, with a focus on developing skills and behavioural regulation.
National survey of commissioners' and service planners' views of public health nursing in the UKImproving public health is a key policy area both in the United Kingdom (UK) and internationally. The governments across the four UK countries each have specific strategies to guide improvements in public health services, promote greater emphasis on how people can best be helped to live healthier lives and to help address the unprecedented challenges of both an increasing population and financial austerity. Nurses are often ideally suited and uniquely placed to respond to public health challenges as they understand the particular risks of individuals but also know the population and the communities they work in. Traditionally in the UK public health nurses have been seen as those in specialist community roles such as health visitors, school nurses and occupational health nurses and in some cases specialist practitioners. However, there is an increasing need for all nurses to embrace the contribution they can have to make every contact count. During 2015 the Royal College of Nursing in the UK (RCN) undertook a programme of work building on a previous project2 to showcase public health nursing (see www.nurses4PH.org.uk). As part of this wider RCN programme, a survey was conducted to explore the views of commissioners and others involved in designing and planning public health services about the nursing and midwifery contribution to public health. The aims were to explore the perceived value of nursing in public health, to better understand the roles of nurses and midwives in public health, how these roles were valued, and what and where the gaps were in public health nursing knowledge and education.