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Community nursing and antibiotic stewardship: the importance of communication and training

02 July 2019
Volume 24 · Issue 7

Abstract

Antimicrobial stewardship (using antimicrobials responsibly) can reduce the risk of antimicrobial resistance (AMR). Many health professionals identify themselves as ‘antibiotic guardians’, but patient expectations, time constraints, and a lack of confidence or underdeveloped communication skills can influence decisions to prescribe. Nurse prescribers have an important role to play in antibiotic stewardship, and their numbers continue to grow. While nurse prescribers welcome this extension to their traditional role, they are often faced with barriers to antibiotic stewardship activities. These barriers may relate to their Capability (knowledge/skill), Opportunity (norms of practice, influence of patients, environmental factors), and Motivation (attitudes and beliefs, concern over outcome, emotion and habit) [COM-B]. Education, training and enablement can help to overcome these barriers, and the development of knowledge, confidence and effective communication skills should be of priority. Further, communication skills can help nurse prescribers understand patient expectations, with the use of open-ended questions, active listening and creation of a patient-centred consultation that leads to a mutually agreed end goal and way forward.

When people fall ill, it is common for them to request antibiotics (Davis et al, 2017), but it has been reported that there is a lack of understanding among patients of how antibiotics work (Gualano et al, 2015). Lay persons make false assumptions about what antibiotics can treat (e.g. viral infections) and often misuse them when they are prescribed (i.e. not completing the full course once the patients feel better). Patient expectations of antibiotics and time constraints can influence health professionals' decisions to prescribe (Fletcher-Lartey et al, 2016; Lum et al, 2018). Yet, antibiotic stewardship, and nurses' role within this, is deemed important to reduce the risk of antibiotic resistance (Edwards et al, 2011). Many health professionals, including nurses, identify themselves as ‘antibiotic guardians’ (Bhattacharya et al, 2016; Kesten et al, 2018), recognising the importance of not prescribing them in certain situations. However, this needs to be balanced against the fear that not meeting patient expectations will lead to low patient satisfaction (Rowbotham et al, 2012; Lum et al, 2018). Therefore, it has been argued that health professionals should aim to educate their patients on the need and appropriate use of antibiotics (Gualano et al, 2015).

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