Nie Huiyu, Yue Liqing, Peng Huan, Zhou Jinping, Li Bingyu, Cao Ziwei
Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.
Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
Int J Nurs Sci. 2023 Dec 11;11(1):91-98. doi: 10.1016/j.ijnss.2023.12.002. eCollection 2024 Jan.
This study aimed to investigate the level and influencing factors of nurses' antimicrobial stewardship (AMS) engagement in China based on the capability, opportunity, motivation, and behavior (COM-B) theory, providing valuable insights for developing effective strategies to improve nursing quality in AMS.
This cross-sectional study was conducted in 17 tertiary hospitals in Hunan, China, from November 2021 to January 2022. A total of 4,514 nurses were selected. The Nurse AMS Engagement Questionnaire (NAEQ), developed using the COM-B theory, was used for evaluation. The questionnaire included capability (14 items), opportunity (7 items), motivation (6 items), and behavior (12 items) four dimensions, 39 items.
The total NAEQ score was 155.08 ± 27.12, indicating a moderate level. The score of the capability, opportunity, motivation, and behavior dimensions were 52.33 ± 13.48, 28.64 ± 5.76, 24.57 ± 4.57 and 49.53 ± 8.83, respectively. Significant differences in nurses' AMS engagement were based on professional titles, whether working as a part-time infection control nurse, whether knowing the AMS teams and the defined daily doses of antibiotics, department type, the deployment of clinical pharmacists, and frequency of antimicrobial training and physician-nurse joint rounds ( < 0.05). Nurses with junior titles had higher scores on the NAEQ than nurses with intermediate titles ( < 0.05). Nurses who worked as part-time infection control nurses, knew the AMS team, and the defined daily doses of antibiotics had higher NAEQ scores than those who didn't ( < 0.01). Nurses working in the ICU and infectious disease department had lower NAEQ scores than those in other departments, such as the ear, nose, and throat (ENT) department ( < 0.01). Nurses who had clinical pharmacists deployed in their department had higher NAEQ scores than those without or unclear deployment ( < 0.01). Furthermore, nurses who received more frequent antimicrobial training and participated in physician-nurse joint rounds had higher NAEQ scores ( < 0.01).
Multiple strategies, including enhanced education and training and improved multidisciplinary communication and collaboration, are expected to improve nurse AMS engagement. It is important to give more attention to nurses with intermediate professional titles, less experience, and those working in specific departments.
本研究旨在基于能力、机会、动机和行为（COM-B）理论，调查中国护士抗菌药物管理（AMS）参与度的水平及其影响因素，为制定提高AMS护理质量的有效策略提供有价值的见解。
本横断面研究于2021年11月至2022年1月在中国湖南的17家三级医院进行。共选取4514名护士。采用基于COM-B理论编制的护士AMS参与度问卷（NAEQ）进行评估。问卷包括能力（14项）、机会（7项）、动机（6项）和行为（12项）四个维度，共39项。
NAEQ总分为155.08±27.12，表明处于中等水平。能力、机会、动机和行为维度的得分分别为52.33±13.48、28.64±5.76、24.57±4.57和49.53±8.83。护士的AMS参与度在职称、是否兼任感染控制护士、是否了解AMS团队及抗生素限定日剂量、科室类型、临床药师的配备以及抗菌药物培训和医护联合查房的频率方面存在显著差异（P<0.05）。初级职称护士的NAEQ得分高于中级职称护士（P<0.05）。兼任感染控制护士、了解AMS团队及抗生素限定日剂量的护士的NAEQ得分高于不具备这些条件的护士（P<0.01）。在重症监护病房（ICU）和传染病科工作的护士的NAEQ得分低于其他科室，如耳鼻喉科（ENT）的护士（P<0.01）。科室配备临床药师的护士的NAEQ得分高于未配备或配备情况不明确的护士（P<0.01）。此外，接受抗菌药物培训更频繁且参与医护联合查房的护士的NAEQ得分更高（P<0.01）。
包括加强教育培训以及改善多学科沟通与协作在内的多种策略有望提高护士的AMS参与度。应更加关注中级职称、经验较少以及在特定科室工作的护士。
