Bowler Sue, Brown Jo
Antimicrobial Stewardship Team, Nottingham University Hospitals NHS Trust, Nottingham, UK.
School of Social Sciences, Nottingham Trent University, Nottingham, UK.
Infect Prev Pract. 2024 Jul 24;6(3):100381. doi: 10.1016/j.infpip.2024.100381. eCollection 2024 Sep.
Diagnostic stewardship is 'coordinated guidance and interventions to improve appropriate use of microbiological diagnostics to guide therapeutic decisions' and a fundamental part of antimicrobial stewardship and the nursing role. The role of the nurse in diagnostic stewardship is relatively unknown and an underused resource. Lack of involvement and training in diagnostic stewardship can lead to inaction or incorrect actions, either of which may be detrimental to patient management, outcomes and care.
To determine the role of the hospital adult nurse in diagnostic stewardship to inform local engagement strategies.
The methodology was informed by Whiffin's (2020) systematic search approach. Electronic databases were searched from 2016 to 2022. The studies included were primary research papers involving adult nurses working in a hospital setting, with findings relevant to a diagnostic stewardship role. Thematic analysis was chosen to understand and compare the results, findings and recommendations of the studies.
Seven studies were included in the review. The identified themes were: (i) nursing role - to recognize infection, aid diagnosis and review results; (ii) nurse challenges - lack of knowledge and confidence to implement diagnostic stewardship; and (iii) Nurse education, empowerment and use of clinical tools.
Research studies do not consistently recognize the full scope of the diagnostic stewardship nursing role, signifying that nurses remain an underused resource in promoting diagnostic stewardship. Research-based clarification of the role of the nurse in diagnostic stewardship, outlined in this review, is therefore vital. Further UK-based, nurse-led research is needed to capture the impact of nurse-driven diagnostic stewardship interventions.
诊断管理是“为改善微生物诊断的合理使用以指导治疗决策而进行的协调指导和干预”，是抗菌药物管理和护理工作的重要组成部分。护士在诊断管理中的作用相对不为人知，是一种未得到充分利用的资源。在诊断管理方面缺乏参与和培训可能导致不作为或采取错误行动，这两者都可能对患者管理、治疗结果和护理产生不利影响。
确定医院成年护士在诊断管理中的作用，为当地的参与策略提供信息。
该方法借鉴了惠芬（2020年）的系统检索方法。检索了2016年至2022年的电子数据库。纳入的研究为涉及在医院环境中工作的成年护士的原创研究论文，其研究结果与诊断管理角色相关。选择主题分析来理解和比较这些研究的结果、发现和建议。
该综述纳入了七项研究。确定的主题为：（i）护理角色——识别感染、协助诊断和审查结果；（ii）护士面临的挑战——缺乏实施诊断管理的知识和信心；以及（iii）护士教育、赋权和临床工具的使用。
研究并未始终充分认识到诊断管理护理角色的全部范围，这表明护士在促进诊断管理方面仍是未得到充分利用的资源。因此，本综述中基于研究对护士在诊断管理中的作用进行的澄清至关重要。需要进一步开展以英国为基础、由护士主导的研究，以了解护士驱动的诊断管理干预措施的影响。
