ArticleJMIR research protocols2026
Nurse-Led and Nurse-Involved Antimicrobial Stewardship in Hospitals and Primary Care: Protocol for a Mixed Methods Systematic Review and Meta-Analysis With Gulf Cooperation Council and Middle East and North Africa Subgroup Analysis.
Article in JMIR research protocols, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Antimicrobial resistance poses a growing threat to patient safety worldwide. Nurses are central to antimicrobial management; however, their contribution to formal antimicrobial stewardship (AMS) programs remains poorly characterized. To our knowledge, no previous review has combined evidence on the effectiveness and implementation of nurse-led and nurse-involved AMS interventions, including Gulf Cooperation Council and Middle East and North Africa (GCC/MENA) subgroup analysis. Objective: This protocol describes a mixed methods systematic review that aims to determine (1) the effectiveness of nurse-led or nurse-involved AMS interventions on patient and antimicrobial outcomes in hospital and primary care settings and (2) the barriers and facilitators influencing this implementation using the Consolidated Framework for Implementation Research (CFIR 2.0). Methods: This review follows the Joanna Briggs Institute convergent, parallel-streams mixed methods methodology. Eligible studies report a nurse-led or nurse-involved AMS intervention among adults receiving antimicrobial therapy in hospital or primary care settings; pediatric-only and long-term care settings are excluded. Eleven databases will be searched from January 2000 to the calendar month of searching. Two reviewers will independently screen records in 2 rounds, with agreement quantified by Cohen κ (target ≥0.70). The quantitative stream will include randomized, quasi-experimental, interrupted time series, and controlled before-and-after studies, with effect measures matched to outcome type. Risk of bias will be independently assessed using design-matched tools. Random-effects meta-analysis will be the primary approach, with prediction intervals supplementing Results: Database searches, Covidence import, and deduplication were completed in March 2026. Title and abstract screening, including pilot calibration, was completed by June 2026. Full-text screening was planned for completion by August 2026, followed by parallel quantitative and qualitative data extraction from August to September 2026. Meta-analysis, CFIR thematic synthesis, and GRADE assessment are expected by November 2026, with mixed methods integration planned for November to December 2026. Manuscript writing is planned for January to February 2027, with submission targeted for March 2027. No amendments to the registered protocol have occurred. Conclusions: This review is intended to provide one of the first meta-analytic syntheses of nurse-led and nurse-involved AMS clinical effectiveness alongside a structured implementation analysis. Findings may inform stewardship program design, nursing education, and health policy, particularly in GCC/MENA settings where nursing AMS evidence is scarce.
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