| Objective:Nurses’ participation in antimicrobial stewardship is considered to play a positive role in curbing the progress of antimicrobial resistance and promoting drug safety in patients.Clinical nurses have been included in their multidisciplinary working group on antimicrobial stewardship in developed countries,and Chinese scholars have begun to pay attention to the role of nurses in antimicrobial stewardship.The purpose of this study is to understand the knowledge,willingness and practice of participating in antimicrobial stewardship from the perspective of clinical nurses in China.To explore whether the role and work content of nurses’ participation in antimicrobial management can be accepted and promoted in the group of nurses in our country.At the same time,the study tried to use educational intervention as a promotion strategy,and through quasi-experimental research methods,to explore the effect of educational intervention and the direction of improvement in the future,in order to provide some reference for nursing managers and other members of the antimicrobial management working group to carry out the research on nurses’ participation in antimicrobial management in the future.Methods:(1)Relying on the theory of KAP,literature review,Delphi method,the “Clinical Nurses Participate in Antimicrobial stewardship’s Knowledge,Attitude and Practice Questionnaire” was formed;the convenience sampling method was adopted to select226 nurses from a tertiary A hospital in Taiyuan for pre-survey.A formal questionnaire is formed after the reliability and validity of the questionnaire is tested.(2)In August 2020,after calculating the sample size according to the Kendall principle,the convenience sampling method was used to select three tertiary general hospitals with antibacterial drug management groups in Taiyuan City.The general surgery,respiratory department and other antibacterial drugs used more A total of 463 nurses in the clinical department used self-made questionnaires to investigate their stock of existing knowledge,willingness to participate and behavioral status of participating in antibacterial drug management,and to analyze influencing factors.(3)Guided by phenomenological methods in qualitative research,16 clinical nurses from 10 departments of a tertiary hospital were selected for semi-structured interviews by purpose sampling method,data were analyzed and themes were extracted.(4)Consult and analyze relevant domestic and foreign literatures,combined with the results of preliminary qualitative interviews,and form a preliminary knowledge training program for nurses on antimicrobial management.After the training plan is determined,2clinical pharmacy experts,3 hospital infection management experts,and 1 nursing management expert are invited to evaluate the specific content,class setting,and training objectives of the training plan,and modify the plan based on expert opinions until the plan Unanimously recognized by the tripartite experts.(5)Experimental intervention: 31 nurses from the Department of General surgery of a Grade 3A general hospital in Taiyuan were selected as the object of study.Carry out educational intervention according to the self-designed knowledge training program.Using the way of self-control,the general data sheet and clinical nurses’ participation in antimicrobial management knowledge,belief and practice questionnaire were used as evaluation tools to evaluate the effect of training.Results:(1)Expert consultation results: The recovery rates of the two rounds of expert consultation were 88% and 100% respectively,indicating that the experts are highly active.The authority coefficient(Cr)was 0.86 and 0.88,the coefficient of variation of each item was 0.06～0.24,and the Kendall’s W coefficients of the two rounds were 0.169 and 0.192 respectively.(2)Reliability and validity test results: The questionnaire of clinical nurses’ participation in antimicrobial drug management knowledge,belief and behavior finally covers 3dimensions,with a total of 41 entries.This questionnaire extracts 5 common factors after exploratory factor analysis,and the cumulative variance contribution rate is 72.058%.The confirmatory factor is: c~2/df=2.883,RMSEA=0.093,GFI=0.649.The overall content validity(S-CVI)of the questionnaire is 0.90,and the content validity(I-CVI)of each item is 0.80～1.00.The overall Cronbach’s α coefficient is 0.964,and the overall split-half reliability of the questionnaire is 0.783.(3)Questionnaire survey results: Clinical nurses’ knowledge of participating in antimicrobial management needs to be improved,their willingness to participate is relatively active,and their self-evaluation behaviors in common clinical antimicrobial-related nursing practices are better.The clinical nurses’ antimicrobial management knowledge score was (56.24±9.79)points,and the score rate was 75.00%;the attitude score was(57.94±8.81)points,and the score rate was 82.80%;the behavior score was(50.44±7.51),and the score rate was 84.00 %.The results of multiple linear regression analysis showed that the main factors influencing the score of nurses’ participation in antimicrobial management knowledge were the number of training sessions and whether they knew the ASP organization setting of the hospital.The main influencing factors of nurses’ participation in antimicrobial management attitude scores are the need for training and the number of trainings.(4)Qualitative research results: four themes were extracted:(1)nurses play a marginal role in hospital antimicrobial management,and their existing clinical responsibilities are consistent with some AMS roles;(2)nurses are unwilling to accept AMS roles and work contents that go beyond their existing working scope;(3)nurses are faced with many obstacles in participating in AMS: lack of knowledge about the use of antibiotics and knowledge forgetting.Faced with the lack of policy guidance,challenges to the traditional role and other negative factors that affect the motivation of nurses to participate;lack of information system and organizational support;4 the dynamic factors of nurses’ willingness to participate: the sense of responsibility to maintain the safety of patients;the actual need to improve work efficiency.(5)Through literature analysis and preliminary investigation results,an educational intervention plan for nurses to participate in antimicrobial stewardship is initially formed.After the evaluation and guidance of the education and training plan by experts in the research group,a knowledge training plan for nurses on antimicrobial stewardship is finally formed.After applying this training program in the general surgical gastrointestinal ward of a tertiary hospital,the knowledge,attitude and behavior scores of nurses on the management of antibacterial drugs have been significantly improved.Conclusion:(1)The Knowledge,attitudes and Practice of Clinical Nurses Participation in Antimicrobial stewardship Questionnaire has good reliability and validity,and can be used as a tool to evaluate clinical nurses’ knowledge,attitudes and behaviors in antimicrobial stewardship.(2)Through a survey of clinical nurses in 3 tertiary general hospitals in Taiyuan City,clinical nurses have insufficient knowledge about the rational use of antimicrobial drugs and the prevention and control of bacterial resistance,but the willingness of nurses to participate in AMS is relatively positive,and the self-evaluated antibiotic nursing practice is good.(3)Nurses have a relatively negative attitude towards some AMS practice beyond the current working scope.Part of nurses’ work content in AMS defined by the ANA’s white paper is difficult to promote in my country,but the formulation and implementation are suitable for my country’s national conditions and The work content of nurse AMS in the status quo of the nursing industry should be put on the agenda as soon as possible.(4)Based on the theory of knowledge,attitude and practice,this study sets up a systematic antimicrobial continuing education curriculum for nurses,which can improve clinical nurses’ knowledge of the rational application of antimicrobials,increase their willingness to participate in AMS,and encourage nurses to focus on more standardized nursing behaviors and optimize antibiotic use.process. |
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