Journal of Multidisciplinary Healthcare (Nov 2022)
Nurses’ Perceptions, Involvement, Confidence and Perceived Barriers Towards Antimicrobial Stewardship Program in Pakistan: Findings from a Multi-Center, Cross-Sectional Study
Abstract
Zia Ul Mustafa,1,2 Muhammad Nouman Manzoor,3 Arfah Shahid,4 Muhammad Salman,5 Khezar Hayat,6 Khalida Yasmin,7 Mohamed A Baraka,8,9 Smitha Mathew,10 Mahpara Kanwal,11 Samina Parveen,12 Irsa Jamal,13 Amer Hayat Khan,1 Brian Godman,14– 16 Fahad Saleem,17 Mohammad Bashaar18 1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 2Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 54700, Pakistan; 3Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Pakistan; 4Department of Medicine, Rawalpindi Medical University, Rawalpindi 46000, Pakistan; 5Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan; 6Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan; 7Lahore School of Nursing, The University of Lahore, Lahore, Pakistan; 8Clinical Pharmacy Program, College of Pharmacy, Al Ain Campus, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates; 9Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Nasr city, Cairo, Egypt; 10Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 11Department of Pharmacy Services, District Headquarter Hospital, Okara South City, Pakistan; 12Department of Pharmacy Services, District Headquarter Hospital, Chakwal, Pakistan; 13Department of Pharmacy Services, District Headquarter Hospital, Kasur, Pakistan; 14School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa; 15Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates; 16Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; 17Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan; 18SMART Afghan International Trainings and Consultancy, Kabul, AfghanistanCorrespondence: Mohammad Bashaar, SMART Afghan International Trainings and Consultancy, Shahri Naw, Hospital Street No. 1, Kabul, Afghanistan, Tel +93788233865, Email [email protected]: Antimicrobial resistance (AMR) is leading to greater therapeutic cost, length of hospital stays, adverse events, morbidity and mortality. Hospital-based antimicrobial stewardship programs (ASPs) engaging physicians, pharmacists, microbiologists and nurses are considered as effective way to ensure appropriate use of antimicrobial agents. The aims of our study were to assess nurses’ perception, involvement, confidence and barriers towards hospital-based ASPs, and use the findings to provide future guidance.Methods: A web-based, cross-sectional study was conducted among the nurses serving at eleven hospitals of Punjab province of Pakistan during a period of two months (December 2021-January 2022). Data were collected using a validated self-administered questionnaire. All data were analyzed using SPSS version 22.Results: A total of 583 nurses participated in the study (response rate = 77.7%). All the participants were female staff nurses and 86% had a minimum of 3 years of working experience. The overall median score on the perception towards ASPs among the nurses was 18 (IQR: 16, 19) on a 0 to 20 scale whereas median score on the involvement in ASPs was 18 (IQR: 15, 37) on a 0 to 64 scale. Median perception and involvement score were statistically significantly differed by age (p < 0.001) and years of experience (p < 0.001). The overall median score on the confidence to perform ASP activities was 22 (IQR: 14, 24) on a 0 to 28 scale. Lack of knowledge, insufficient support from administration, and heavy workload were found to be the common barriers to perform ASP.Conclusion: Our study concluded that Pakistani nurses have positive perception but limited involvement in ASPs. Moreover, they are confident to perform ASP besides many barriers.Keywords: involvement, confidence, nurses, antimicrobial resistance, antimicrobial stewardship programs, Pakistan
