How do aged-care staff feel about antimicrobial stewardship? A systematic review of staff attitudes in long-term residential aged-care.
Antimicrobial resistance
Attitudes of health personnel
Education
Healthcare workers
Perception of risk
Prescribing
Residential aged-care
Risk feelings
Stewardship
Journal
Antimicrobial resistance and infection control
ISSN: 2047-2994
Titre abrégé: Antimicrob Resist Infect Control
Pays: England
ID NLM: 101585411
Informations de publication
Date de publication:
28 06 2022
28 06 2022
Historique:
received:
04
02
2022
accepted:
11
06
2022
entrez:
28
6
2022
pubmed:
29
6
2022
medline:
1
7
2022
Statut:
epublish
Résumé
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.
Sections du résumé
BACKGROUND
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.
METHOD
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).
RESULTS
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.
CONCLUSIONS
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.
Identifiants
pubmed: 35765093
doi: 10.1186/s13756-022-01128-5
pii: 10.1186/s13756-022-01128-5
pmc: PMC9238058
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Review
Systematic Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
92Informations de copyright
© 2022. The Author(s).
Références
J Am Med Dir Assoc. 2021 Jan;22(1):156-163
pubmed: 32839125
Infect Dis Clin North Am. 2017 Dec;31(4):619-638
pubmed: 29079152
Am J Infect Control. 2015 Mar 1;43(3):298-300
pubmed: 25728158
J Am Geriatr Soc. 2019 Feb;67(2):392-399
pubmed: 30517765
Am J Surg. 2011 Jan;201(1):76-83
pubmed: 20573335
Clin Microbiol Infect. 2019 May;25(5):562-569
pubmed: 30076978
Front Psychol. 2016 Jun 24;7:932
pubmed: 27445901
Infect Control Hosp Epidemiol. 1996 Feb;17(2):119-28
pubmed: 8835449
J Am Med Dir Assoc. 2009 Sep;10(7):498-504
pubmed: 19716067
Am J Alzheimers Dis Other Demen. 2005 Jul-Aug;20(4):211-9
pubmed: 16136844
BMC Med Inform Decis Mak. 2012 Sep 03;12:94
pubmed: 22943520
Psychol Bull. 2001 Mar;127(2):267-86
pubmed: 11316014
BMC Health Serv Res. 2006 Apr 03;6:44
pubmed: 16584553
Am J Infect Control. 2017 May 1;45(5):466-470
pubmed: 28189411
J Public Health Res. 2019 Nov 04;8(2):1533
pubmed: 31819866
Pharm World Sci. 2005 Jun;27(3):159-65
pubmed: 16096881
Infect Control Hosp Epidemiol. 2015 Aug;36(8):949-56
pubmed: 25998898
Am J Infect Control. 2020 Jan;48(1):13-18
pubmed: 31447117
Infect Control Hosp Epidemiol. 2019 Sep;40(9):963-967
pubmed: 31339085
PLoS One. 2015 Aug 05;10(8):e0134800
pubmed: 26244571
Am J Infect Control. 2014 Jun;42(6):653-8
pubmed: 24713596
Antibiotics (Basel). 2019 May 27;8(2):
pubmed: 31137842
J Am Geriatr Soc. 2014 May;62(5):907-12
pubmed: 24697789
BMC Med Inform Decis Mak. 2014 Jun 05;14:47
pubmed: 24903517
Clin Infect Dis. 2017 Nov 13;65(11):1943-1951
pubmed: 29020290
Implement Sci. 2014 Jan 10;9:7
pubmed: 24410955
J Antimicrob Chemother. 2020 Jun 1;75(6):1390-1397
pubmed: 32108883
J Am Geriatr Soc. 2007 Mar;55(3):473-4
pubmed: 17341259
Antimicrob Resist Infect Control. 2016 Mar 08;5:7
pubmed: 26962446
Scand J Prim Health Care. 2018 Sep;36(3):225-226
pubmed: 30088431
BMC Fam Pract. 2016 Nov 5;17(1):152
pubmed: 27814691
J Am Geriatr Soc. 2020 Jan;68(1):46-54
pubmed: 31317534
Int J Nurs Stud. 2021 May;117:103787
pubmed: 33647845
Drugs Aging. 2013 Jun;30(6):401-8
pubmed: 23444263
J Am Med Dir Assoc. 2020 May;21(5):675-682.e1
pubmed: 31974065
BMC Nurs. 2017 Mar 11;16:12
pubmed: 28293145
J Am Geriatr Soc. 2017 Jan;65(1):165-171
pubmed: 28111755
Drugs Aging. 2019 Apr;36(4):355-369
pubmed: 30675682
Infect Control Hosp Epidemiol. 2012 Dec;33(12):1185-92
pubmed: 23143354
Am J Infect Control. 2021 Feb;49(2):198-205
pubmed: 32653562
J Hosp Infect. 2018 Nov;100(3):265-269
pubmed: 29890182
J Am Geriatr Soc. 2017 May;65(5):1073-1078
pubmed: 28152171
Emerg Infect Dis. 2003 Sep;9(9):1128-35
pubmed: 14519251
Drugs Aging. 2015 Apr;32(4):295-303
pubmed: 25832969
Behav Med. 2001 Summer;27(2):52-60
pubmed: 11763825
Consult Pharm. 2017 Nov 1;32(11):700-706
pubmed: 29113637
J Am Geriatr Soc. 2013 Apr;61(4):565-70
pubmed: 23452167