Table 2.

Changes in Attitudes and Beliefs Before and After the Online Course.

Attitude and Beliefs	Pre-Course Survey*	Post-Course Survey*	P-values†
Confidence related to learning objective for each module‡
Module 1: To recognize signs and symptoms of infection in older adults.	4.2	4.5	0.05
Module 2: To decide if a resident with a positive urine culture has a    urinary tract infection or asymptomatic bacteriuria.	3.9	4.4	0.01
Module 3: To determine if resident has a cough from an upper respiratory    infection (a cold), pneumonia or some other cause.	3.9	4.4	0.01
Module 4: Implement isolation precautions as a means to improve    resident safety.	4.1	4.5	0.04
Module 5: To collect samples for microbiological cultures that will    inform decisions about patient care	4.1	4.4	0.04
Module 6: To gather information about a resident’s change in status and    communicate it to the provider.	4.1	4.5	0.03
Attitudes towards their clinical assessment of residents
I can usually tell when one of my patients has a change in their clinical    status.	4.6	4.8	0.11
When my patients have a change in their clinical status, I can usually tell    whether that change is due to an infection or not.	4.0	4.5	<0.01
When I think one of my patients has an infection, I can usually tell if they    need an antibiotic to feel better.	4.0	4.2	0.16
When I think one of my patients has an infection, I can offer supportive    care to help them feel better.	4.5	4.7	0.04
Attitudes regarding role in antimicrobial stewardship
My knowledge of a patient's baseline influences whether or not the patient    receives antibiotics.	3.8	4.5	<0.01
My assessment influences whether or not a patient receives antibiotics.	3.8	4.5	<0.01
My communication with patients and their families influences whether or    not a patient receives antibiotics.	3.8	4.2	<0.01
My communication with providers influences whether or not a patient    receives antibiotics.	4.1	4.5	<0.01
Attitudes about antimicrobial stewardship in setting
Where I work, physicians routinely practice antimicrobial stewardship.	3.4	3.7	<0.01
Where I work, nurse practitioners and physician assistants routinely    practice antimicrobial stewardship.	3.5	3.8	<0.01
Where I work, pharmacists routinely practice antimicrobial stewardship.	3.3	3.7	<0.01
Where I work, patients and their families often insist on antibiotics.	3.9	3.8	0.09
Where I work, the administration supports our staff's efforts to practice    antimicrobial stewardship.	4.0	4.2	0.04
Beliefs about antimicrobial stewardship and infection control and prevention
If it is unclear if a resident has an infection, it is reasonable to monitor    them more frequently and offer supportive care for 1-2 days to see if they    get better without an antibiotic.	4.1	4.3	0.07
If our current antibiotics lose their effectiveness, the pharmaceutical    companies can make new, equally effective agents.	2.8	2.6	0.01
Only very vulnerable people acquire multi-drug resistant pathogens.	2.0	1.9	0.63
Nurses and aides at long-term care facilities have little control as to    whether residents acquire multi-drug resistant pathogens	2.1	2.0	0.59
Where I work, I have at least one patient on isolation precautions every    day or nearly every day.	2.5	2.7	0.05
Infection control practices are more important than antimicrobial    stewardship in preventing patients from acquiring multi-drug resistant    pathogens and Clostridium difficile.	3.6	3.8	0.03

^*Mean score for N = 103 RNs and LPNs who completed the pre- and post-course survey. Scores are based on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5) unless otherwise noted.

^†Bold type indicates P-values that are statistically significant following a Bonferroni adjustment to account for multiple comparisons (25 survey questions and the total knowledge score).

^‡Responses range from very unconfident (1) to very confident (5).