The role of nurses in antimicrobial stewardship near the end of life in aged-care homes: A qualitative study
Section snippets
What is already known about the topic?
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Nurses are important participants in antimicrobial use in aged-care homes.
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Antimicrobials are frequently prescribed for residents of aged-care homes who are near the end of life, commonly without residents having signs or symptoms of infection to support such use.
What this paper adds
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Aged-care home nurses are influential in antimicrobial decisions near the end of life in routine care.
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Nurse leadership in advance care planning, care co-ordination and care provision in an environment with stopgap and visiting medical resources are opportunities for nurses to lead antimicrobial stewardship near the end of life in aged-care homes.
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Past negative social interactions within the aged-care home environment between nurses and families can result in ‘fear-based’ social influences on
Background
Internationally, the inappropriate use of antimicrobials in aged-care homes is a widely recognised phenomenon (Loeb et al., 2001; National Centre for Antimicrobial Stewardship and Australian Commission on Safety and Quality in Health Care, 2018; Pettersson et al., 2008). This is problematic because it can harm residents (Daneman et al., 2015), and is detrimental to public health (Medew, 2015; O'Fallon et al., 2009; Tenover, 2006). There is compelling evidence that antimicrobial resistance
Methods
One-on-one semi-structured qualitative interviews were conducted with health professionals (i.e., nurses, general practitioners and pharmacists) working in aged-care homes in Victoria, Australia.
Results
No interview participants withdrew from the study after participating, and three people declined to participate at the time of interview without offering specific reasons. The demographics of the 20 participants are listed in Table 1. The mean interview duration was 29 min and 07 s (Range: 16 min and 29 s to 59 min and 35 s). Two participants (General Practitioner 3 and Pharmacist 2) were not audio recorded.
There was a high degree of concordance between AR and LD's descriptive coding and the
Discussion
To our knowledge, this is the first study to describe specific nursing opportunities to participate in antimicrobial activities near the end of life, within the environmental contexts and social influences of aged-care homes. In aged-care homes, nurses take on required leadership roles and have substantial social influence within a context of stopgap and visiting medical resources. This includes facilitating advance care planning and having critical conversations with families about decisions
Conclusions
Nurses have important roles in facilitating advance care planning, care coordination, care delivery and communication with families and medical professionals, and these activities present important opportunities for nurses to lead antimicrobial stewardship activities appropriate for care near the end of life in aged-care homes.
Acknowledgments
This research is funded by the National Health and Medical Research Council (NHMRC) of Australia, Grant Number: APP1079625.
Leslie Dowson receives an Australian Government Research Training Program Scholarship.
The authors would like to acknowledge all those who participated in, and supported, this project.
CRediT authorship contribution statement
Leslie Dowson: Conceptualization, Methodology, Investigation, Data curation, Writing - original draft, Writing - review & editing, Project administration. N. Deborah Friedman: Conceptualization, Methodology, Resources, Writing - review & editing, Supervision. Caroline Marshall: Conceptualization, Methodology, Resources, Writing - review & editing, Supervision. Rhonda L. Stuart: Conceptualization, Methodology, Resources, Writing - review & editing, Supervision. Kirsty Buising: Conceptualization,
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