Influences on nurses’ engagement in antimicrobial stewardship behaviours: a multi-country survey using the Theoretical Domains Framework
AuthorsChater, Angel M.
Abraao, Ligia Maria
Du Toit, Briëtte
de Figueiredo, Rosely Moralez
Padoveze, Maria Clara
AffiliationUniversity of Bedfordshire
University College London
Americas Medical Serviçes
Fatima College of Health Sciences
University of West London
Infection Control Africa Network
Royal College of Nursing
University of Melbourne
Ninewells Hospital, Dundee
Universidade Federal de São Carlos
Glasgow Caledonian University
MGH Institute of Health Professions, Boston
University of São Paulo
Subjectscommunity health services
Subject Categories::B790 Nursing not elsewhere classified
MetadataShow full item record
AbstractBackground 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.
CitationChater AM, Family H, Abraao LM, Burnett E, Castro-Sanchez E, Du Toit B, Gallagher R, Gotterson F, Manias E, Mcewen J, Figueiredo RM, Nathan M, Ness V, Olans R, Padoveze MC, Courtenay M (2022) 'Influences on nurses’ engagement in antimicrobial stewardship behaviours: A multi-country survey using the Theoretical Domains Framework', Journal of Hospital Infection, (), pp.-.
PublisherHealthcare Infection Society
JournalJournal of Hospital Infection
SponsorsThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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- Creative Commons
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