Exploring the role of the intensive care nurse in the antimicrobial stewardship team at a private hospital, eThekwini, South Africa.

Abstract

Background: The care of the critically ill patient across the world has become progressively challenging with increasingly resistant pathogens resulting in difficult to treat infections. This is compounded by the decreasing effectiveness of many antibiotics. Severe infections increases the length of time spent in an ICU, increases morbidity and mortality, and increases healthcare costs. Antimicrobial stewardship (AS) has the aims of slowing resistance and the protection of patients and the wider community through the promotion of correct antimicrobial use by education and guidelines. Infection control measures are an essential part of AS in preventing emergent resistant pathogens and hospital-acquired infections. Research purpose: The identification of the role of the ICU nurse in an AS team in a private ICU in South Africa. Research approach: A qualitative approach was used in this study in order to obtain meaningful contributions that a questionnaire may not have been able to provide. Purposive sampling was used to identify participants from an ICU multidisciplinary AS team in a hospital in the private healthcare sector. Semi-structured interviews were conducted with fifteen participants; ICU clinical nurses, nursing management, surgeons, anaesthetists, physicians, microbiologists and pharmacists. Data were analysed and categorised using content analysis. Findings: Perspectives of the various members of the multidisciplinary AS team identified the role of the ICU nurse in an AS team as being organisational, advocatory, clinical and collaborative. Suggestions were made to further develop this nursing role by supporting proactive behaviour, teaching and learning, and teamwork. Concerns were raised about this role relating to resource barriers, knowledge deficit, poor attitude towards work, ineffective teamwork, working in isolation, and economic pressures. A limitation to this study is that it is a small study in a single setting, which may limit generalizability. Conclusion: The ICU nurse’s role in AS is essential for the successful implementation of an AS programme. Recommendations to develop this role are made for clinical practice, education, research and policy development.