Changing Southern African Nurses' Roles in Antibiotic Stewardship: An Innovative Pedagogical Approach

Saturday, 26 July 2014

Christine Amalia Varga, RN, MSN, MA, PhD
School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa


The purpose of this presentation is to describe the roles nurses can play in antimicrobial stewardship, lessons learned in the creation of health-related e-learning efforts in a developing country context. It will also illustrate means of encouraging inter-disciplinary strategies to antimicrobial steward through innovative pedagical approaches. Antimicrobial resistance (AMR) is an international health concern and major threat to global stability (Laxminarayan et al., 2007). While drug resistance is increasing worldwide, evidence suggests that AMR is disproportionately high in developing countries (Nweneka et al., 2009). This is certainly true for (southern) African countries, where factors such as high rates of HIV/AIDS and tuberculosis exacerbate complex political, health systems, economic and socio-cultural elements that influence antimicrobial access, use, surveillance, and ultimately rates of resistance (Gelband & Duse, 2011; Kimanga 2012). Antibiotic/antimicrobial stewardship (AS) efforts, defined here as a suite of interventions aimed at measurement, conservation, and optimal use of antimicrobials for favorable patient outcomes and reduction of resistance, are one response in attempting to reduce AMR. There is a small but growing literature on nurses’ role in antibiotic stewardship in developed country settings (Edwards et al. 2010, Ladenheim et al. 2013), especially in in-patient settings (Edwards et al. 2011). However, in the developing world the relationship between nursing and AS seems to have been largely overlooked. Such a gap stands in stark contrast to the fact that in many such environments including South Africa, Malawi and Mozambique, where this work is situated, nurses play a frontline role in antimicrobial management. This is especially true in primary health care settings, where the majority of health care provision - including medication prescription and education - takes place. Further, nurses’ ability to effect change within healthcare is often curtailed by cultural, institutional, and systems-level factors. Against this background, we present an update on the formative stages of a multi-country inter-disciplinary pilot project aimed at strengthening AS efforts among nurses and other allied health care professionals through the use of e-learning approaches. The project described aims to develop a 2-year e-learning Masters-level curriculum in Malawi and Mozambique that will provide learners with appropriate critical analytical, research, communication and practical skills relevant to antibiotic stewardship, infection prevention and control. The curriculum is based on an existing e-learning program in South Africa housed within the University of KwaZulu-Natal School of Health Sciences. One portion of the formative research stage of the project addresses the role of nursing in antibiotic stewardship efforts and infection prevention and control. In each of the three country settings (Mozambique, Malawi, and South Africa) the research describes 1) nurses’ current roles in antibiotic prescription, administration, management, and patient education; 2) socio-cultural, educational, institutional and systems-level factors that affect nurses’ ability to meaningfully engage in antibiotic stewardship efforts; 3) nurses’ knowledge related to antimicrobials in general and AS in particular; and 4) factors involved in developing an inter-disciplinary approach to antibiotic stewardship that includes nursing professionals and nursing approaches. 


Data collection takes place through qualitative (focus groups, in-depth interviews, narrative research and role mapping activities) and quantitative (questionnaires) data collection among potential learners (i.e. nurse applicants), policymakers and government officials, individuals involved in healthcare management on institutional and community levels, actively practicing nurses in a variety of healthcare environments, individuals involved in (undergraduate and post-graduate) nursing education, and nursing students. 

Results: The presentation will: 1) illustrate the role nurses in South Africa, Malawi and Mozambique currently play in antimicrobial prescription, management, administration, monitoring and patient education; 2) discuss existing barriers in nurses’ ability to engage in antibiotic stewardship efforts; 3) describe nurses’ knowledge of antimicrobials and AS, highlighting strengths and gaps; 4) suggest means to more meaningfully and actively involve nurses in stewardship efforts in developing country contexts; 5) discuss means of encouraging inter-disciplinary strategies to AS via innovative pedagical approaches; and 6) highlight lessons learned concerning health-related e-learning and the curriculum development process in developing country contexts. 


The target audience of this presentation is those interested in international health issues, strengthening nursing's role in interdisciplinary approaches to healthcare, and cross-cultural and innovative approaches to nursing research and education. It will appeal to nursing researchers, educators and practitioners.