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Abstract
Background Antibiotic overprescribing remains a problem in residential aged-care facilities (RACFs). Uncertainty, risk perception and pressure from staff and residents’ family members have been identified as significant barriers to reducing prescribing. Recent stewardship efforts have targeted antibiotic initiation by nurses to address some of these barriers.
Aim The current study investigated the relationship between nurses’ situational anxiety, clinical tolerance of uncertainty, and the nurses’ decisions that favour antimicrobial prescribing.
Methods A cross-sectional online survey using a clinical vignette was used to measure situational anxiety and nursing behaviour using the Immediate Assessment and Antibiotics scale. Nurses’ tolerance to uncertainty in clinical settings was measured using the Physicians Reactions to Uncertainty Scale adapted for nurses. The vignette described a hypothetical resident with a potential upper respiratory tract infection. Incremental information was provided with varying levels of symptoms, input from aged-care staff and availability of test results.
Results 157 registered and enrolled nurses completed the survey. There was a significant mediating effect of nurses’ anxiety on the relationship between nurses’ clinical tolerance of uncertainty and antibiotic initiation. There was no significant direct effect between clinical tolerance of uncertainty and behaviours that lead to antibiotic initiation.
Conclusions This is the first study that quantitatively links antibiotic initiation to nurses’ anxiety and clinical tolerance of uncertainty. It lends support to previous qualitative findings citing pressure from families, residents and interprofessional tensions as a source of anxiety in residential aged-care facilities and the use of antibiotics to ameliorate the effects of this anxiety. These findings support the need to expand current stewardship strategies beyond education to include strategies that target management of anxiety and uncertainty tolerance.
Keywords: Antimicrobial resistance; prescribing; stewardship; residential aged care; tolerance of uncertainty; uncertainty; anxiety
Objectives Antibiotic overprescribing remains a problem in residential aged-care facilities (RACFs). Uncertainty, risk perception and pressure from staff and residents’ family members have been identified as significant barriers to reducing prescribing. Recent stewardship efforts have targeted antibiotic initiation by nurses to address some of these barriers. The aim of the current study was to investigate the relationship between nurses’ situational anxiety, clinical tolerance of uncertainty, and the nurses’ decisions that favour antimicrobial prescribing.
Method A cross-sectional online survey using a clinical vignette was used to measure situational anxiety and nursing behaviour using the Immediate Assessment and Antibiotics scale. Nurses’ tolerance to uncertainty in clinical settings was measured using the Physicians Reactions to Uncertainty Scale adapted for nurses. The vignette described a hypothetical resident with a potential upper respiratory tract infection. Incremental information was provided with varying levels of symptoms, input from aged-care staff and availability of test results.
Results One hundred and fifty seven registered and enrolled nurses completed the survey. There was a significant mediating effect of nurses’ anxiety on the relationship between nurses’ clinical tolerance of uncertainty and antibiotic initiation. There was no significant direct effect between clinical tolerance of uncertainty and behaviours that lead to antibiotic initiation.
Conclusions This is the first study that quantitatively links antibiotic initiation to nurses’ anxiety and clinical tolerance of uncertainty. It lends support to previous qualitative findings citing pressure from families, residents and interprofessional tensions as a source of anxiety in residential aged-care facilities and the use of antibiotics to ameliorate the effects of this anxiety. These findings support the need to expand current stewardship strategies beyond education to include strategies that target management of anxiety and uncertainty tolerance.