ANTIMICROBIAL STEWARDSHIP: A CONCEPT ANALYSIS

Background: Antimicrobial resistance is one of the most serious threats to global health, and antimicrobial stewardship is the main strategy used to address it. However, there is no globally agreed definition of antimicrobial stewardship, and the term is used differently across disciplines, health sectors and cultures, while the contribution of nurses remains under-recognized. Objective: To clarify the concept of antimicrobial stewardship for nursing and health care practice. Methods: Walker and Avant's eight-step method of concept analysis was used. Dictionaries, international guidelines, and English-language literature were searched using the keywords stewardship, antimicrobial stewardship, antimicrobial resistance, antimicrobial stewardship programs, and nurses. Relevant sources were analyzed. Results: Six defining attributes were identified: optimization of antimicrobial use, multidisciplinary collaboration, evidence-based practice, education and training, monitoring and feedback, and contextual responsiveness. Antecedents included rising antimicrobial resistance, overuse and misuse of antibiotics, health care-associated infections caused by resistant organisms, gaps in infection prevention, institutional leadership commitment, and policy and public awareness. Consequences included more appropriate prescribing, slower emergence of resistance, better patient outcomes, lower costs and preservation of antimicrobials for future generations; possible unintended consequences included under-treatment. Empirical referents included antimicrobial consumption and quality-of-prescribing indicators, program checklists and knowledge, attitude and practice surveys. Conclusion: Antimicrobial stewardship is a coordinated, context-sensitive and shared professional responsibility, rather than a purely prescriber-led activity. Clarifying its attributes can help nurses, educators, managers and policymakers design, implement and evaluate stewardship programs, particularly in low- and middle-income countries such as Pakistan.