NURSES’ KNOWLEDGE, ATTITUDES, AND PRACTICES TOWARD ANTIMICROBIAL STEWARDSHIP IN TERTIARY HOSPITALS

Abstract

Background

Antimicrobial resistance (AMR) is accelerating globally and poses a critical threat to patient safety, particularly in tertiary hospitals where antibiotic utilization is high. Antimicrobial stewardship (AMS) is the primary health-system strategy to optimize antibiotic use; however, its effectiveness depends on active involvement of frontline healthcare workers. Nurses constitute the largest clinical workforce and are central to antibiotic administration, monitoring, specimen collection, documentation, infection prevention, and patient education. Despite this, evidence from low- and middle-income settings—including Pakistan—suggests that nursing roles in AMS remain underdeveloped.

Objective

To assess the level of awareness and practice adherence of nurses in antimicrobial stewardship programs. The study seeks to identify knowledge gaps and provide training frameworks for better antibiotic use in clinical practice.

Methods

A descriptive cross-sectional survey was conducted among registered nurses working across inpatient and critical care departments of a tertiary hospital in KPK. Nurses with ≥6 months of clinical experience and direct involvement in patient care were eligible. A structured questionnaire assessed socio-demographic/professional characteristics and KAP related to AMS. Scores were standardized on a 0–100 scale for each domain and categorized into levels (knowledge: poor/moderate/good; attitudes: negative/neutral/positive; practices: low/moderate/high adherence). Descriptive statistics summarized findings. Group comparisons were performed to examine differences by AMS training exposure. Correlation analysis explored relationships among KAP domains. A p-value ≤0.05 was considered statistically significant.

Study type: Descriptive cross-sectional survey Results

A total of 240 nurses participated. Overall mean scores were 67.0±11.6 for knowledge, 76.8±10.0 for attitude, and 61.5±13.5 for practice. Most nurses demonstrated moderate knowledge (55.4%), while 39.2% achieved good knowledge and 5.4% had poor knowledge. Attitudes were predominantly strong: 58.8% expressed positive attitudes and only 2.9% demonstrated negative attitudes. Practice adherence showed variability: 41.7% reported high adherence, 44.2% moderate adherence, and 14.2% low adherence. Nurses who reported receiving AMS training scored significantly higher across domains, particularly for practice (69.3±11.8 vs 56.6±12.8; p<0.001). Knowledge demonstrated a moderate positive correlation with practice (r=0.52), indicating that stronger stewardship understanding was associated with better bedside behaviors.

Conclusion

Nurses in this tertiary hospital displayed strong stewardship attitudes, but their knowledge and real-world AMS practices were inconsistent, revealing a clear attitude–practice gap. AMS training emerged as the most influential factor associated with improved practice adherence, while knowledge was moderately predictive of better stewardship behaviors. These findings support the urgent need for structured nursing AMS education, role clarification, and workflow-integrated stewardship tools—especially in high-antibiotic-use units such as ICU and emergency services. Strengthening nurse-driven stewardship capacity offers a practical pathway to improve antibiotic safety and reduce AMR pressures in tertiary hospitals across KPK and comparable healthcare settings.