SOLUTION: BIO 205 CCB Handling Specimens of Bacteria Summary Analysis

Microbiology Education in Nursing Practice †
Robert J. Durrant*, Alexa K. Doig, Rebecca L. Buxton, and JoAnn P. Fenn
University of Utah, Salt Lake City, UT 84132
Nurses must have sufficient education and training in microbiology to perform many roles within clinical
nursing practice (e.g., administering antibiotics, collecting specimens, preparing specimens for transport
and delivery, educating patients and families, communicating results to the healthcare team, and developing care plans based on results of microbiology studies and patient immunological status). It is unclear
whether the current microbiology courses required of nursing students in the United States focus on
the topics that are most relevant to nursing practice. To gauge the relevance of current microbiology
education to nursing practice, we created a confidential, web-based survey that asked nurses about their
past microbiology education, the types of microbiology specimens they collect, their duties that require
knowledge of microbiology, and how frequently they encounter infectious diseases in practice. We used
the survey responses to develop data-driven recommendations for educators who teach microbiology to
pre-nursing and nursing students.
Two hundred ninety-six Registered Nurses (RNs) completed the survey. The topics they deemed most
relevant to current practice were infection control, hospital-acquired infections, disease transmission, and
collection and handling of patient specimens. Topics deemed least relevant were the Gram stain procedure
and microscope use. In addition, RNs expressed little interest in molecular testing methods. This may reflect
a gap in their understanding of the uses of these tests, which could be bridged in a microbiology course.
We now have data in support of anecdotal evidence that nurses are most engaged when learning about
microbiology topics that have the greatest impact on patient care. Information from this survey will be
used to shift the focus of microbiology courses at our university to topics more relevant to nursing practice.
Further, these findings may also support an effort to evolve national recommendations for microbiology
education in pre-nursing and nursing curricula.
The role of biosciences in pre-nursing and nursing curricula is a well-described, international concern, as educational
institutions respond to changes in the clinical environment
(1). Key themes among studies include a shift from biosciences to humanistic sciences (sociology, psychology, etc.) in
order to provide a more comprehensive, holistic care model
(2); inadequate science content in nursing curricula (3–5);
poor alignment between curricula and nursing practice
(6–8); nurses’ lack of confidence in educating patients and
other healthcare professionals (9); and a need for curricula
*Corresponding author. Mailing address: University of Utah School
of Medicine, Department of Pathology, Medical Laboratory Science
Division, 30 N 1900 E RM 5R472A, Salt Lake City, UT 84132.
Phone: 801-585-6989. E-mail:
Received: 16 August 2016, Accepted: 22 June 2017, Published:
1 September 2017.
†Supplemental materials available at
that are responsive to a changing clinical landscape (10).
Less time devoted to curricula for bioscience, including
microbiology, has also led to concerns about possible gaps
in foundational knowledge related to patient care (11).
Several studies have attempted to identify learning
deficits and assess their potential impacts on patient
care (6, 12–15). These studies suggest that a particular
concern among nurses and nurse educators is the nurses’
lack of comfort in correlating patient symptoms with the
underlying pathophysiology and making appropriate care
interventions based on that information. Such discomfort can lead to inaction or incorrect actions, either of
which may be detrimental to patient care. At least some
of the nurses’ discomfort may result from inadequate
coverage of certain topics or knowledge applications in
a foundational microbiology course (or from nurses not
taking such a course in the first place). Without a solid
foundation in microbiology, nurses may have knowledge
shortfalls in related areas such as infection control,
pathophysiology, antimicrobial resistance, critical values,
and patient management.
©2017 Author(s). Published by the American Society for Microbiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International
license ( and, which grants the public the nonexclusive right to copy, distribute, or display the published work.
Volume 18, Number 2
Journal of Microbiology & Biology Education
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In 2012, an American Society for Microbiology (ASM)
Task Force published curriculum guidelines specific to undergraduate education in microbiology (16), based on survey
feedback from microbiology educators. These guidelines
recommended six concept areas as focal points in undergraduate microbiology courses—evolution, cell structure
and function, metabolic pathways, information flow and
genetics, microbial systems, and the impact of microorganisms. The guidelines were intentionally not specific to any
one professional program; rather, they sought to outline a
well-rounded, foundational microbiology education for a
range of undergraduate students.
Nursing programs presently devote limited time to
microbiology, and many are considering further reducing
or even eliminating microbiology instruction. Therefore, it
is vital that any microbiology topics they cover be salient
to nursing practice. Relevance is key to student success and
engagement, and to the proper application of knowledge in
the healthcare workplace (4, 10, 17). Although researchers
have assessed the microbiology curricula at various institutions and gathered faculty views on the standards for undergraduate microbiology courses (16, 18), no survey, to our
knowledge, has asked currently employed nurses for their
input on the content and quality of pre-nursing or nursing
microbiology courses.
Our objective was to assess nurses’ perceptions of the
relevance of various topics in microbiology and infectious
disease to nursing practice, in order to develop data-driven
recommendations for educators who teach microbiology to
pre-nursing and nursing students.
To identify the relevance of current microbiology education to nursing practice, we developed an
Internet-based survey in which we asked nurses about
their educational background in microbiology and related
topics, about their use of microbiology knowledge in
their current work, and about the relevance of specific
microbiology course topics in the workplace. The nurses
also answered questions about their demographic and
place of employment. The microbiology topics included
in the survey were from our university’s pre-nursing microbiology course syllabus. This syllabus is loosely based
on the American Society for Clinical Laboratory Science
Entry Level Curriculum (19) recommendations for Medical
Laboratory Science students; it has been modified based
on input from nursing and physician educators. The study
was submitted to the Institutional Review Board and
designated as exempt.
The link to the survey was distributed through the University of Utah College of Nursing alumni network in May
2015. Responses from this convenience sample were collected through November 2015. Targeted participants were
Registered Nurses (RNs) practicing in the United States or
Canada who had completed their undergraduate nursing
education in the United States or Canada. RNs practicing
in any healthcare setting were eligible to participate. Nurses
licensed as Advanced Practice Registered Nurses (i.e., nurse
practitioners or clinical nurse specialists) were directed to
another, similar survey.
Data were collected and managed using REDCap
(Research Electronic Data Capture) tools hosted at the
University of Utah (20) with the support of the CTSC
grant (1 UL1 RR024989 from NCRR/NIH). REDCap is a
secure, web-based application designed to support data
capture for research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking
data manipulation and export procedures; 3) automated
export procedures for seamless data downloads to common
statistical packages; and 4) procedures for importing data
from external sources. Data were analyzed using IBM SPSS
Statistics for Macintosh, Version 22.0. The primary analysis
focused on descriptive statistics (frequencies, means, and
measures of variance). Independent t-tests were used to
examine differences between hospital and community-based
nurses, and other demographic groups.
Two hundred ninety-six RNs completed the survey.
As expected due to dissemination of the survey through
a university alumni network, most respondents had baccalaureate or graduate degrees (Table 1). Representation
was very good across all years of work experience. The
majority of respondents work in hospital settings (81.9%);
the rest are in community settings (18.1%). Most respondents had a formal microbiology course either prior to or
during their program (77.3%), and over half (55.1%) had a
microbiology lab.
Survey respondent demographics (N = 296).
Demographic Characteristics
n (%)
Highest degree in nursing
19 (6.4)
210 (70.7)
54 (18.2)
13 (4.4)
Years of experience as a RN
15 (5.1)
87 (29.3)
71 (23.9)
24 (8.1)
14 (4.7)
16 (5.4)
20 (6.7)
35 (11.8)
14 (4.7)
RN = registered nurse.
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Volume 18, Number 2
Nurses were surveyed about duties they routinely
performed that related to microbiological topics, about
the specimens they most frequently collected for microbiological testing, and about the types of infections they
most frequently encountered. Among the more frequently
performed duties were administration of intravenous/oral
antibiotics, patient education regarding specimen collection,
and patient education regarding the nature of their infections
(Table 2). Specimens most frequently collected by nurses
included urine, stool, blood, and sputum (Table 3). Wound
and urinary tract infections were the most frequent infection
types encountered by respondents (Table 4). Almost half
of survey respondents (43.6%) indicated that they routinely
encountered fungal infections, which was almost the same
percentage as for upper respiratory tract infections (43.9%).
Duties routinely performed (N = 296).
Administer intravenous (IV) antibiotics
Educate patients about collection of sputum,
urine, or stool specimens
Administer oral (PO) antibiotics
Educate patients about the nature of their infections
Routinely interpret results from bacteriology laboratory
tests and communicate significant results to healthcare
team members
Deliver specimens from hospital unit or clinic
to laboratory
Read throat cultures inoculated to agar plates
and identify Group A Streptococcus
Perform Gram stains
Inoculate specimens to culture media and
streak the agar plates for isolation of bacteria
Specimens routinely collected for microbiology tests (N = 296).
Specimen Type
To assign relevance to different microbiological topics,
respondents were asked to rate each topic from 1 (no relevance) to 5 (extremely relevant). The highest-rated topics
were infection control, hospital-acquired infections, and
disease transmission; the lowest-rated were microscope
use and the Gram stain procedure (Fig. 1). While there
was slight variation in the mean relevance that different
age groups assigned to topics, these differences were not
statistically significant.
Nurses working in hospital settings identified several
microbiology course topics as having greater relevance to
their practice than nurses working in community settings
did. These topics included the collection and handling of
specimens (t = 2.9, p = 0.005), knowledge of medically
important microorganisms (t = 2.4, p = 0.016), and infection in the immunocompromised host (t = 2.0, p = 0.045).
As expected, hospital-based nurses gave the topic of
hospital-acquired infections a significantly higher relevance
rating than did the community-based nurses (t = 4.4, p
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