Antimicrobial Stewardship Through the Nurses’ Lens: Knowledge, Perceptions and Challenges in a Mixed-Methods Study

Abstract

Antimicrobial resistance (AMR) remains a global health threat, and nurses play a pivotal yet often under-recognized role in antimicrobial stewardship (AMS). This study examined nurse’s knowledge, perceptions, and challenges related to their role in AMS using a mixed methods explanatory sequential design. The quantitative phase involved 313 registered nurses from various clinical settings who completed a validated online questionnaire assessing their AMS knowledge, perceptions, and perceived challenges. Data were analysed using descriptive statistics, correlation, and logistic regression. The qualitative phase involved semi-structured interviews with 10 purposively selected nurses to explore and contextualize the quantitative findings.

Results indicated that most participants demonstrated high AMS knowledge (88.8%) and a generally positive perception of their role in AMS (WM = 3.97, “Agree”). However, gaps remained in application-level knowledge, particularly in areas such as intravenous-to-oral conversion and understanding environmental contributors to resistance. Linear regression analysis revealed that knowledge significantly predicted perception (B = -1.55, p < .001), suggesting that more knowledgeable nurses held more critical or realistic perspectives on AMS practice within hierarchical healthcare structures. Conversely, knowledge was not significantly associated with perceived challenges (p = .399), indicating that the barriers were primarily systemic rather than individual. The qualitative analysis identified six themes: fragmented and experience- driven knowledge, limited role perception, competing priorities and workload pressures, confidence and hierarchy, patient education limitations, and training and empowerment. The integration of findings indicated that although nurses demonstrated a strong foundational awareness of AMS, their potential contributions were constrained by institutional culture, workload demands, and the absence of structured AMS training programs.

The study concludes that empowering nurses through targeted AMS education, interprofessional collaboration, and organisational support is essential for strengthening their stewardship role and addressing antimicrobial resistance.