Nurses’ role in antibiotic stewardship at medical wards of a referral hospital in Malawi: Understanding reality and identifying barriers

Mula, Chimwemwe; Middleton, Lyn; Muula, Adamson S; Solomon, Vernon P.; Varga, Christine

doi:10.1016/j.ijans.2021.100311

Cited by 4 publications

(13 citation statements)

References 17 publications

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“…The specific characteristics of each study that met the inclusion criteria are presented in Table 1 . Publications were mainly authored in the USA (n = 4, 25.0%; Missouri, Pennsylvania [multiple regions of the States], Utah, Wisconsin) [ 21 – 24 ], Australia and New Zealand (n = 4, 25.0%; Auckland, New South Wales, Victoria [two studies]) [ 25 – 28 ], and Asia (n = 4, 25.0%; Indonesia, Saudi Arabia, Singapore, Thailand) [ 29 – 32 ], followed by Europe (n = 2, 12.5%; Italy, UK [multiple European countries] [ 33 , 34 ] and Africa (n = 2, 12.5%; Malawi, South Africa) [ 35 , 36 ]. With regard to the research method, ten studies (62.5%) were quantitative in design, using surveys in all cases [ 21 – 23 , 25 , 26 , 29 – 31 , 33 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Qualitative research included interviews (n = 3, 18.8%) [ 27 , 28 , 35 ] and focus groups (n = 1, 6.2%) [ 32 ]. The remaining two studies (12.5%) were mixed-methods in design, including multiple data sources (e.g., interviews, direct observations) [ 24 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…The existence of such a large number of studies to our review reinforces the notion of an up-and-coming and meaningful interest on this particular research field. It is interesting to notice that these articles are spread across both low-income countries, such as Indonesia [ 30 ] and Malawi [ 36 ], and high-income states, such as Italy [ 34 ] and Missouri [ 23 ], which indicates that AMR is a contemporary global health threat. Moreover, it should be noted that qualitative research, which is more demanding than survey research, is limited; however qualitative studies is better methods to reveal facilitators and barriers to AMS implementation as they explore nurses’ perceptions of their experiences and roles within clinical settings in-depth [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…Veterans indicated the need to better understand differences between viral and bacterial infections. NP prescribing patterns revealed a decline in antibiotics prescribed for upper respiratory illnesses over a 3-year period Mula et al [ 36 ] Malawi (Africa) Descriptive qualitative study A referral hospital which is the largest teaching hospital, with a bed capacity of 1,200 serving a population of approximately 5.5 million. It provides tertiary care to the population in the south west districts of the country and serves an urban population of 920,000 Explore nurses’ role in antibiotic stewardship and the challenges they face in order to provide empirical evidence in support of ways to involve nurses HCPs.…”

Section: Data Extractionmentioning

confidence: 99%

“… Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? Knobloch et al [ 24 ] Interviews, prescribing data analysis Y Y Y Y Y Mula et al [ 36 ] Multiple data source including focus groups, interviews, participants observations Y Y Y Y Y Y yes, addressed, N no, not satisfied, U unknown, cannot be determined …”

Section: Risk-of-bias Assessmentmentioning

confidence: 99%

See 4 more Smart Citations

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

Danielis

Regano

Castaldo

et al. 2022

Antimicrob Resist Infect Control

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Background Antimicrobial resistance issues, and the consequent demand for antimicrobial stewardship (AMS) programs, need to be investigated urgently and clearly. Considering the large amount of time nurses spend at patients’ bedside, the aim of the present study was to examine recent literature on nursing competency in AMS. Methods Drawing from Tricco and colleagues’ seven-stage process, a rapid review was performed. MEDLINE, CINAHL and EMBASE databased were searched from December 1st, 2019 until December 31st, 2021. Article screening and study selection were conducted independently by three reviewers. Data were analyzed narratively and categorized adopting an inductive thematic coding. Results Sixteen studies met the inclusion criteria and were included. Publications were mainly authored in USA (n = 4), Australia and New Zealand (n = 4) and Asia (n = 4), followed by Europe (n = 2) and Africa (n = 2). Ten studies were quantitative in design, followed by qualitative (n = 4) and mixed-methods studies (n = 2). Nursing competency in AMS seems to be influenced by a two-dimensional model: on the one hand, internal factors which consisted in knowledge, attitudes and practices and, on the other hand, external aspects which are at environmental level in terms of structures and processes. Conclusion This study provided a map of dimensions for researchers and practitioners to consider when planning clinical governance, educational activities, and research programs. Significant opportunities exist for nurses to contribute to practice, education, research, and policy efforts aimed at reducing antimicrobial resistance.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data Extractionmentioning

confidence: 99%

Section: Risk-of-bias Assessmentmentioning

confidence: 99%

See 3 more Smart Citations

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

Danielis

Regano

Castaldo

et al. 2022

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

show abstract

An educational program on antimicrobial resistance and stewardship for staff nurses in a public tertiary care hospital in India

Mittal¹,

Deswal²,

Mittal³

et al. 2023

Infection, Disease & Health

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Knowledge and perceptions of antimicrobial resistance and antimicrobial stewardship among staff at a national cancer referral center in Uganda

Gulleen

Lubwama

Komakech

et al. 2022

ASHE

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Objectives: As access to cancer care has improved throughout sub-Saharan Africa, treatment-associated infections have increased. Assessing healthcare worker knowledge of antimicrobial stewardship and identifying the barriers to infection management will inform the development of contextually appropriate antimicrobial stewardship programs, improving cancer outcomes in sub-Saharan Africa. Design: Cross-sectional survey. Setting: The Uganda Cancer Institute (UCI), a national cancer referral center in Kampala, Uganda. Participants: We surveyed 61 UCI staff: 29 nurses, 7 pharmacists, and 25 physicians. Methods: The survey contained 25 questions and 1 ranking exercise. We examined differences in responses by staff role. Results: All 60 respondents who answered the question had heard the term “antimicrobial resistance.” Only 44 (73%) had heard the term “antimicrobial stewardship.” Nurses were less likely than pharmacists or physicians to be familiar with either term. Also, 41 respondents (68%) felt that loss of antibiotic susceptibility is a major issue at UCI. Regarding barriers to diagnosing infections, 54 (93%) of 58 thought that it was difficult to obtain blood cultures and 48 (86%) of 56 thought that it was difficult to regularly measure temperatures. Conclusions: Although most recognized the term “antimicrobial resistance,” fewer were familiar with the term “antimicrobial stewardship.” Inappropriate antibiotic use was recognized as a contributor to antimicrobial resistance, but hand hygiene was underrecognized as a contributing factor. We identified numerous barriers to diagnosing infections, including the ability to obtain blood cultures and consistently monitor temperatures. Educating staff regarding antimicrobial selection, allocating resources for blood cultures, and implementing strategies to enhance fever detection will improve infection management.

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Nurses’ role in antibiotic stewardship at medical wards of a referral hospital in Malawi: Understanding reality and identifying barriers

Cited by 4 publications

References 17 publications

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review

An educational program on antimicrobial resistance and stewardship for staff nurses in a public tertiary care hospital in India

Knowledge and perceptions of antimicrobial resistance and antimicrobial stewardship among staff at a national cancer referral center in Uganda

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