School of Psychology, University of Wollongong, Wollongong, NSW, Australia.
Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, Early Start Building 21.110, Wollongong, NSW, 2500, Australia.
Antimicrob Resist Infect Control. 2022 Jun 28;11(1):92. doi: 10.1186/s13756-022-01128-5.
Antimicrobial resistance (AMR) is a problem in residential aged care facilities (RACF). There is a gap in our understanding of how psychosocial barriers such as risk perceptions shape staff attitudes towards antimicrobial stewardship (AMS). We sought to ascertain the attitudinal domains that have been identified to be of importance to AMS in RACF and comment on how they have been measured empirically. Our aim was to consolidate what is known regarding staff attitudes and perceptions in order to inform future stewardship.
We searched PsycINFO, PsycARTICLES, CINAHL Plus, MEDLINE, PubMed, Web of Science, Cochrane, and Scopus databases for primary studies of healthcare workers attitudes to AMS in RACF (1990-February 2021).
14 Studies were included in the review, within which 10 domains were identified: attitudes towards antimicrobial prescribing; guidelines; educational interventions; self-confidence regarding clinical assessment and prescribing; awareness of AMR as a problem and stewardship as a priority; self-efficacy; perception of role; perception of risk; team culture and resident/family members expectations. 46 measures were developed across the 14 studies to measure the 10 domains. The variability in the attitudinal domains and how these domains were measured was large. Only 13% included psychometric data regarding reliability and/or internal consistency.
Attitudes are generally defined as having three evaluative bases: cognitive, behavioural, and affective. Findings from the current review suggest that the measures commonly used to capture healthcare staff attitudes to AMS do not sufficiently capture affect; particularly with respect to staff's risk perceptions, perceptions of their role, and family members' expectations. Given that affective processes have been postulated to influence medical decision making, these findings highlight the importance of understanding how staff, especially nurses feel about implementing AMS strategies and other peoples' (e.g. residents and their families) perceptions of stewardship. It is expected that a more nuanced understanding of RACF nurses affective experiences when applying AMS, and their perceptions of the risks entailed, will help in reducing barriers to overprescribing antibiotics.
抗微生物药物耐药性（AMR）是住宅养老机构（RACF）中的一个问题。我们对抗微生物药物管理（AMS）中风险认知等心理社会障碍如何影响员工态度的理解存在差距。我们试图确定对 RACF 中的 AMS 重要的态度领域，并评论它们如何在经验上进行衡量。我们的目的是整合关于员工态度和看法的已知信息，以便为未来的管理提供信息。
我们在 PsycINFO、PsycARTICLES、CINAHL Plus、MEDLINE、PubMed、Web of Science、Cochrane 和 Scopus 数据库中搜索了医疗保健工作者对 RACF 中 AMS 的态度的主要研究（1990 年-2021 年 2 月）。
共有 14 项研究纳入了综述，其中确定了 10 个领域：对抗微生物药物处方的态度；指南；教育干预；对临床评估和处方的自我信心；对 AMR 作为问题和管理作为优先事项的认识；自我效能；角色感知；风险感知；团队文化和居民/家属的期望。在 14 项研究中开发了 46 项措施来衡量 10 个领域。态度领域的可变性和这些领域的测量方法差异很大。只有 13%的研究包括关于可靠性和/或内部一致性的心理测量数据。
态度通常被定义为具有三个评价基础：认知、行为和情感。本综述的结果表明，用于捕捉医疗保健工作者对抗微生物药物管理态度的常用措施不能充分捕捉情感；特别是在员工的风险认知、对自身角色的认知以及家庭成员的期望方面。鉴于情感过程被推测会影响医疗决策，这些发现强调了理解员工（特别是护士）对抗微生物药物管理策略实施的感受以及其他人（例如居民及其家属）对管理的看法的重要性。预计，更细致地了解 RACF 护士在应用 AMS 时的情感体验，以及他们对所涉及风险的看法，将有助于减少对抗生素过度处方的障碍。
