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Mixed-Methods Pilot Study to Assess Perceptions of Antimicrobial Stewardship in Nursing Homes.

ABSTRACT: To identify features of community nursing home (NH) environments associated with lower rates of overall antibiotic use.This pilot study used an explanatory sequential design that incorporated comparative feedback about antibiotic use to inform a discussion about antimicrobial stewardship practices in community NHs.NHs.Clinical leadership of five NHs.For the quantitative phase, the number of antibiotic prescriptions, length of therapy, and days of therapy/1,000 days of care were measured at six NHs. For the qualitative phase, semistructured interviews were conducted with healthcare workers in leadership positions at five community NHs. Transcripts from the recorded interviews were assessed using emergent thematic analysis. For the triangulation phase, themes from the semistructured interviews were evaluated in the context of each NH's antibiotic use.The number of antibiotic prescriptions ranged from 172 to 1,244, with 50% to 83% written for 7 days or fewer. All NHs reported a similar proportion of fluoroquinolone use (27-32% of days of therapy). Triangulation yielded six themes for which the environment at each facility ranged from less- to more-supportive antimicrobial stewardship: practice patterns, external influences, infection control, leadership, communication, and facility culture. All NHs reported pressure from well-intentioned family members to prescribe antibiotics. NHs with shorter lengths of therapy and lower overall antibiotic use were consonant with an environment more supportive of antimicrobial stewardship.These findings suggest several features of NHs that are supportive of antimicrobial stewardship: practice patterns grounded in established diagnostic criteria, proactive infection control and prevention, open communication and interconnectedness among staff.

SUBMITTER: Carter RR

PROVIDER: S-EPMC5435504 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Mixed-Methods Pilot Study to Assess Perceptions of Antimicrobial Stewardship in Nursing Homes.

Carter Rebecca R RR Montpetite Michelle M MM Jump Robin L P RLP

Journal of the American Geriatrics Society 20170202 5

<h4>Objectives</h4>To identify features of community nursing home (NH) environments associated with lower rates of overall antibiotic use.<h4>Design</h4>This pilot study used an explanatory sequential design that incorporated comparative feedback about antibiotic use to inform a discussion about antimicrobial stewardship practices in community NHs.<h4>Setting</h4>NHs.<h4>Participants</h4>Clinical leadership of five NHs.<h4>Measurements</h4>For the quantitative phase, the number of antibiotic pre ...[more]

PMID: 28152171

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Project description:BACKGROUND:Society demands a university education grounded on ethical principles. Education in ethics values is responsibility of universities but will not be viable unless also adopted by directly responsible agents, the teachers who work with the students. For this reason, our primary research objective was to conduct an in-depth analysis of how Health Sciences students self-perceive the ethical dimension. METHODS:A mixed research methodology with two phases, qualitative and quantitative, allowed us to address our research question from two complementary viewpoints. Conversational interviews were conducted in an intentional and purposive sample to identify a wide range of discursive representations. A questionnaire was designed based on previous studies and the topics of qualitative research. The response format for the questionnaire followed a Likert scale and modulators such as sex, age, degree and the score of a social desirability test were examined. RESULTS:After 24 conversational interviews, three main thematic blocks (coinciding with the three subscales of the questionnaire) were identified: "attitudes for harmony in human relations", "construction of the self" and "rules and regulations". A total of 246 students completed a questionnaire with 39 items. The total scores ranged from 93 to 152 points, with an average score of 122.72?±?10.64 points. Responsibility, the basic rules of education and respect were perceived as the two most important values, whereas solidarity and social participation as the least important. Results showed a significant positive linear correlation between total score on the questionnaire and age and social desirability. Age was also a significant predictor for the total score and the subscale score "rules and regulations". The students´ responses seemed to be conditioned by the degree of social desirability that they present. CONCLUSIONS:The ad-hoc questionnaire captured the maintenance of high ethical values in our college undergraduate students, which may be directly related to enhanced social desirability. The scores obtained on the questionnaire were correlated with the students' age, which may indicate that values might tend to acquire progressively more importance as students grow older. Further research is warranted to delve deeper on the determinants of professionalism and ethical decision-making in college students.

Project description:IntroductionFrench nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.MethodsA cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.ResultsThe average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.ConclusionDespite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents' and caregivers' overall well-being and mental health.

Project description:BACKGROUND: A 'blended' (e-learning and facilitated workshops) training course for Group C staff (i.e. staff with relatively infrequent contact with end of life care) has been delivered across several English counties with the aim of improving end of life care in nursing and residential care homes. This paper evaluates the impact of the course on participants' understandings of and confidence in delivering end of life care in one nursing home, while also considering barriers to change in practice. METHODS: A mixed-methods case study approach, incorporating pre- and post-course questionnaires (SHA East of England End of Life Care Education Programme 'ABC' Project Work Force C or Non Nurse Workforce B Pre and Post Course Questionnaire; E-Learning in End of Life Care Study Pre and Post Course Questionnaire), documentary analysis, semi-structured interviews, and observation of course workshops. Participants were 20 members of staff at a nursing home in a city in the East of England, including 14 Health Care Assistants (carers) and 6 others (administrative, activities, hosting, and catering staff). The questionnaires and interviews assessed understandings of and confidence towards end of life care delivery. RESULTS: Improvements in participants' confidence in delivering end of life care were observed, particularly in the core competency areas of symptom management, communication, and advance care planning. A shift towards more detailed and more holistic understandings of end of life care was in evidence; some participants also championed end of life care in the home as a result of the course. Several barriers to changes in practice were encountered, including uneven participation, the absence of mechanisms for disseminating new insights and knowledge within the home, and a widespread perception that nurses' professional dominance in the home made sustainable change difficult to enact. CONCLUSIONS: While blended e-learning courses have the potential to generate positive change in participants' understandings of and confidence about End of Life Care, organizational and inter-professional obstacles must be overcome in order to translate these changes into improved end of life care delivery in nursing (and residential) homes.

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Mixed-Methods Pilot Study to Assess Perceptions of Antimicrobial Stewardship in Nursing Homes.

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Mixed-Methods Pilot Study to Assess Perceptions of Antimicrobial Stewardship in Nursing Homes.

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