Abstract
Background
Recent evidence highlights the need for an interdisciplinary approach to antimicrobial
stewardship (AMS). Nursing involvement in optimising antimicrobials in the intensive
care unit (ICU) remains understudied.
Objective
The objective of this study was to explore nurses' perceptions and experiences of
antimicrobial optimisation or stewardship in ICUs in Australia.
Methods
An anonymous web-based survey was deployed nationally in early 2021 through two ICU
nursing networks. Associations between survey responses were analysed descriptively
and by using nonparametric tests (with statistical significance established at p ≤ 0.05). Free-text survey responses underwent qualitative thematic analysis. Interpretation
and reporting of quantitative and qualitative data were integrated.
Results
A total of 226 ICU nurses completed the survey. The majority (197/226; 87%) responded
that lack of education limits engagement in AMS. Only 13% (30/226) reported the presence
of AMS education and training for nurses in their ICUs. Only about half (108/226;
48%) of the nurses were confident to question prescribers when they considered that
the antimicrobial prescribed was unnecessary, with nurses in senior roles more likely
to do so than nurses providing bedside care (p < 0.05). Gaps in education (including unfamiliarity with AMS roles), noninclusive
antimicrobial discussions, moral distress, and potential workload burden were seen
as potential barriers/challenges to engagement.
Conclusion
The multifactorial barriers identified that inhibit nurses from performing AMS tasks
could be addressed by strengthening interprofessional education at all levels and
by applying practical AMS interventions that are inclusive for nursing participation.
A purposeful culture change that fosters psychological safety and collaborative practice
is paramount to supporting nurses in these roles.
Keywords
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Article info
Publication history
Published online: November 17, 2022
Accepted:
September 8,
2022
Received in revised form:
September 8,
2022
Received:
June 2,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
