Diagnostic stewardship: establishing the role of the hospital nurse to inform local engagement strategies

Abstract

Background: Diagnostic stewardship is 'coordinated guidance and interventions to improve appropriate use of microbiological diagnostics to guide therapeutic decisions' and a fundamental part of antimicrobial stewardship and the nursing role. The role of the nurse in diagnostic stewardship is relatively unknown and an underused resource. Lack of involvement and training in diagnostic stewardship can lead to inaction or incorrect actions, either of which may be detrimental to patient management, outcomes and care.

Aim: To determine the role of the hospital adult nurse in diagnostic stewardship to inform local engagement strategies.

Methods: The methodology was informed by Whiffin's (2020) systematic search approach. Electronic databases were searched from 2016 to 2022. The studies included were primary research papers involving adult nurses working in a hospital setting, with findings relevant to a diagnostic stewardship role. Thematic analysis was chosen to understand and compare the results, findings and recommendations of the studies.

Findings: Seven studies were included in the review. The identified themes were: (i) nursing role - to recognize infection, aid diagnosis and review results; (ii) nurse challenges - lack of knowledge and confidence to implement diagnostic stewardship; and (iii) Nurse education, empowerment and use of clinical tools.

Conclusion: Research studies do not consistently recognize the full scope of the diagnostic stewardship nursing role, signifying that nurses remain an underused resource in promoting diagnostic stewardship. Research-based clarification of the role of the nurse in diagnostic stewardship, outlined in this review, is therefore vital. Further UK-based, nurse-led research is needed to capture the impact of nurse-driven diagnostic stewardship interventions.

Keywords: Antimicrobial stewardship; Diagnostic stewardship; Nurse education; Nurse empowerment; Nursing challenges; Nursing role.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart of the process to identify studies for inclusion, adapted from [20].