Empowerment of nurses in antibiotic stewardship: a social ecological qualitative analysis

Wong, L.H., Bin Ibrahim, M.A., Guo, H., Kwa, A.L.H., Lum, L.H.W., Ng, T.M., Chung, J.S., Somani, J., Lye, D.C.B., and Chow, A. (2020) Empowerment of nurses in antibiotic stewardship: a social ecological qualitative analysis. Journal of Hospital Infection, 106 (3). pp. 473-482.

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Abstract

Background: Inappropriate antibiotics use and antimicrobial resistance (AMR) are increasingly becoming global health issues of great concern. Despite the established antibiotic stewardship programmes (ASPs) in many countries, limited efforts have been made to engage nurses and clearly define their roles in ASPs.

Aim: An exploratory qualitative study was conducted to understand the facilitators and barriers that impact nurses' involvement and empowerment in antibiotic stewardship.

Methods: Focus group discussions (FGDs) were conducted with purposively sampled nurses from three major public hospitals in Singapore. FGDs were audio-recorded and transcribed verbatim. Data were analysed using Applied Thematic Analysis and interpreted using the Social Ecological Model.

Findings: At the intrapersonal level, nurses felt empowered in carrying out their roles in antibiotic administration. They saw themselves as gatekeepers to ensure that the prescribed antibiotics were administered appropriately. However, nurses felt they lacked the knowledge and expertise in antibiotic use and AMR prevention. At the interpersonal level, this deficit in knowledge and expertise in antibiotic use impacted how they were perceived by patients and caregivers as well as their interactions with the primary care team when voicing outpatient safety concerns and antibiotic administration suggestions. At the organizational level, nurses relied on drug administration guidelines to ensure appropriate antibiotic administration and as a safety net when physicians questioned their clinical practice. At the community level, nurses felt there was a lack of awareness and knowledge on antibiotic use among the general population.

Conclusion: These findings provide important insights to harness the contributions of nurses, and to formally acknowledge and enlarge their roles in ASPs.

Item ID: 64526
Item Type: Article (Research - C1)
ISSN: 1532-2939
Keywords: Antibiotic stewardship, Antimicrobial resistance, Empowerment, Hospitals, Nurses
Copyright Information: © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
Funders: National Medical Research Council of Singapore (NMRC)
Projects and Grants: NMRC Grant number: NMRC/HSRG/0083/2017
Date Deposited: 05 Oct 2020 23:49
FoR Codes: 42 HEALTH SCIENCES > 4202 Epidemiology > 420209 Occupational epidemiology @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320211 Infectious diseases @ 50%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920401 Behaviour and Health @ 50%
92 HEALTH > 9202 Health and Support Services > 920210 Nursing @ 50%
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