| Objectives1.To develop and evaluate a questionnaire on the status of nurses’ engagement in antimicrobial stewardship(AMS).2.To measure the status quo of nurses’ engagement in AMS in tertiary hospitals in Hunan province and analyze the influencing factors.Methods1.Based on the COM-B theory,an initial questionnaire was formed through literature review,semi-structured interviews and expert consultation.A pre-investigation was conducted on a tertiary hospital in Changsha.The modeling group was used for item analysis and exploratory factor analysis,and the validation group for confirmatory factor analysis and reliability and validity tests to form and evaluate the final questionnaire.2.Using general information form and the developed questionnaire,through multi-stage sampling,the responsible nurses who used antibiotics and worked for at least one year in tertiary hospitals in Hunan Province were investigated.The score rates below 80% were defined as weak capability,insufficient opportunity,weak motivation and poor behavior.SPSS 26.0 was used for descriptive statistical analysis and binary logistic regression for univariate and multivariate analysis.Using AMOS26.0,the Bootstrapping confidence interval method was used for path analysis.Results1.The questionnaire had 39 items with 4 dimensions,including capability,opportunity,motivation and behavior.The Cronbach’s α of the total questionnaire was 0.96,the test-retest reliability was 0.89,and spearman-Brown parity half reliability was 0.95.I-CVI ranged from 0.80 to 1.00,S-CVI/AVE was 0.97 and S-CVI/UA was 0.87.2.17 tertiary hospitals were investigated and 4514 valid questionnaires were collected.53.0% of nurses had weak AMS capability,31.9% had insufficient AMS opportunity,32.4% had weak AMS motivation,and 35.0% had poor AMS behavior.3.Multivariate logistic regression analysis showed that: The longer the working years,the stronger the nurse’s AMS capability,but the fewer opportunities,the weaker the motivation and the worse the behavior;the higher the professional title,the fewer opportunities;the bachelor degree or above,and participation in clinical teaching were related to strong capability.AMS training and joint ward rounds as well as clinical pharmacist staffing led to strong capability,sufficient opportunity,strong motivation and good behavior,while a lack of AMS awareness produced the opposite results.Hospital location was a significant predictor,and nurses working in Loudi District was relatively good in AMS engagement;nurses in specialized hospitals had weaker motivation than general hospital nurses.Department type was a significant predictor.Nurses in intensive care units,infectious diseases and emergency departments were more likely to report poor AMS engagement;nurses in departments using antimicrobials mainly to treat infections had stronger capability and weaker motivation than their counterparts.4.Path analysis showed that nurses’ capability to participate in AMS was moderately correlated with opportunity(r =0.45,P<0.001).The direct effect of capability on behavior(b =0.315,P<0.001)was stronger than the indirect effect(b =0.075,P<0.001).The indirect effect of opportunity on behavior(b=0.252,P<0.001)was stronger than the direct effect(b=0.191,P<0.001).Conclusion1.This study develops a questionnaire on measuring the status of nurses’ engagement in AMS with good reliability and validity.2.The capability of nurses in tertiary hospitals in Hunan province to engage in AMS is obviously insufficient,and there is room for improvement in opportunity,motivation and behavior.3.This study reveals common influencing factors of nurses’ AMS capability,opportunity,motivation and behavior: working years,AMS training frequency,awareness of AMS working group/infectious disease teams/defined daily doses,hospital location,department type,clinical pharmacists staffing in the department,and joint ward round frequency of medical staff.4.The capability and opportunity of nurses to engage in AMS have direct effects and motivational mediating effects on behavior. |
PDF Full Text Request