Decisional issues in antibiotic prescribing in French nursing homes: An ethnographic study

Background: Medication prescription is generally the responsibility of doctors. In nursing homes, the nursing staff is often the first to suspect an infection. Today, physicians are more confident with nursing assessment, relying primarily on nursing staff information. Very few studies have investigated the nurses’ influence on decision of medical prescription. This study investigates the role of nurses in antibiotic prescribing for the treatment of suspected infections in nursing home residents. Design and methods: An ethnographic study based on semi-structured interviews and participant observations was conducted. Sixteen nurses and five doctors working in five nursing homes in Paris, France participated between October 2015 and January 2016. Results: Given their proximity to elderly residents, registered nurses at the nursing homes occasionally assisted doctors in their medical diagnostic. However, nurses who are theoretically incompetent have met difficulties in their ability to participate in their decisions to prescribe antibiotics when managing residents’ infections.Conclusion: if proximity and nursing skills reinforce the relevance of the clinical judgment of nurses, the effective and collaborative communication between the nurse and the doctor may help the nurse to enhance their role in the antibiotic prescribing in nursing homes, which would enhance antimicrobial stewardship efficiency

Perceptions of Antibiotic Therapy Among Nursing Home Residents: Perspectives of Caregivers and Residents in a Mixed Exploratory Study

Antimicrobial resistance is a major public health threat worldwide. Some authors have suggested that end-users of nursing homes have an influence on antibiotic prescribing. The objective of this study is to describe the views of end-users and professionals on residents’ behavior towards antibiotic therapy in terms of knowledge, beliefs, and attitudes towards this drug class and its prescribing process. This is a concurrent mixed methodology study using questionnaires and semi-directive individual interviews with nursing homes residents, nurses, and doctors practicing in these facilities. The questionnaires analyzed were collected from 35 residents (24.3%) and 109 nurses (75.7%). The qualitative interview involved 26 of total participants that agreed to be interviewed. We noticed misconceptions being held by the residents regarding the antibiotic resistance phenomenon. Additionally, nurses were not considered as a source of information about antibiotics. Nurses and residents had conflicting opinions about residents requesting antibiotics, and the findings depict a stereotypical view of the nurse profession as a reflection of a cognitive representation. The authors conclude that, despite many campaigns, further efforts are needed to tackle antimicrobial resistance. Initiatives could include raising awareness about antimicrobial resistance, clarifying the role of nurses, and communicating well with residents about their needs in nursing homes

Promoting the proper use of antibiotics in Nursing homes : a needed convergence of actors towards the most appropriate use

En France, le nombre de personnes âgées d’au moins 65 ans augmente et une part de cettepopulation est institutionnalisée en EHPAD. Les EHPADs ont été identifiés comme foyerd’antibiorésistance ; problème majeur de santé publique. La présente thèse qui inclut laseconde partie d’un programme de recherche dénommé Atoum s’inscrit dans la stratégie delutte contre l’antibiorésistance. Le programme de recherche Atoum comporte 8 études ets’intéresse à trois dyades impliquées dans le processus de prescription en EHPAD. Il s’agitnotamment des dyades infirmières-médecins, infirmières-résidents/familles, résidentsprescripteurs.Cette thèse s’est appuyée sur les résultats d’une première partie de ceprogramme (3 premières études) pour construire les 4 études suivantes dontl’expérimentation d’une intervention en EHPAD.La première partie du programme Atoum s’est intéressée à l’infirmière et relève que le rôlede l’infirmière est essentiel dans le processus de prescription concordant avec des articles déjàpubliés. Ce rôle consiste à faire des recommandations au prescripteur en s’abstenant de touteproposition aux médecins quand l’infirmière estime qu’elle ne possède pas de connaissancessuffisantes concernant la pharmacologie d’une thérapeutique. Aussi, les interactionsinfirmières-prescripteurs sont modulées par deux concepts que sont la proxémie et lescompétences qui devraient être associées à la communication. Cependant, la communicationmédecins-infirmiers faisait défaut de façon globale tendant à réduire la portée du jugementclinique de l’infirmière sur la pertinence de la prescription médicale. En effet, le désir decollaboration dans le processus de prescription médicale serait plutôt du côté des infirmières.Quant à la seconde partie du programme, ses principaux résultats sont de deux ordres. Il s’agitd’abord de la nécessité de sensibiliser davantage sur le phénomène d’antibiorésistance. Unautre résultat fondamental de cette seconde partie est l’importance des perceptionsinterpersonnelles dans les approches de communication au sein des dyades infirmièresmédecins,résidents-prescripteurs, résidents-infirmières. Enfin, la participation des acteursimpliqués dans les trois dyades est un manque crucial souligné dans la construction voire lamise en oeuvre des interventions pour un juste recours aux antibiotiques. Cette rechercheplace ainsi le renforcement de la participation active des différents acteurs concernés au coeurdes stratégies envisagées pour le juste recours aux antibiotiques. L’ensemble de cesobservations ont contribué à construire un cadre d’action pour le juste recours auxantibiotiques qui a servi à la construction puis à l’expérimentation d’une intervention.Cependant, le contexte sanitaire du au COVID-19 a eu un impact notable sur le bondéroulement de l’interventionIn France, the number of people aged 65 and over is increasing and a part of this population lives innursing homes. Nursing homes are recognized as a source of antibiotic resistance, a major publichealth problem. The present thesis, which is part of a research program called Atoum, and is acontribution to the strategy to fight against antibiotic resistance. The Atoum program includes 8studies and focuses on three dyads involved in the prescription process in nursing homes. Theseinclude nurse-physician dyads, nurse-residents/families, resident-prescribers. This thesis was basedon the results of a first part of this program (3 first studies) to build the 4 following studies includingthe experimentation of a multimodal intervention in nursing homes.The first part of the Atoum research program focused on the nurse and notes that the nurse's role isessential in the medical prescription process, in line with previously published studies. This roleconsists of making recommendations to the prescriber while refraining from making any proposals tophysicians when they feel they do not have sufficient knowledge of the pharmacologicalcharacteristics of a therapy. Also, nurse-prescriber interactions are modulated by two concepts:proxemia and the skills that should be associated with communication. Also, physician-nursecommunication was lacking in an overall way that tends to reduce the scope of the nurse's clinicaljudgment on the appropriateness of the prescription. Indeed, the desire to collaborate in theprescribing process would rather be on the nurses' side.The main results of the second part of the program are threefold. The first is the need to increaseawareness of the phenomenon of antibiotic resistance. The second fundamental result of this secondpart is the importance of interpersonal perceptions in communication approaches within the nursephysician,resident-prescribers, nurse-resident’s dyads. Finally, the participation of the actorsinvolved in the three dyads is a crucial lack that is highlighted in the construction and evenimplementation of actions for a fair use of antibiotics. This research places the reinforcement of theactive participation of the different actors involved at the forefront of the strategies designed for thefair use of antibiotics. All these findings have contributed to the construction of a framework foraction for the fair use of antibiotics, which has been used to design and then experiment with anintervention. However, the health context at COVID-19 had a deleterious impact on the successfulimplementation of the interventio

End-Users and Caregivers’ Involvement in Health Interventional Research Carried Out in Geriatric Facilities: A Systematic Review

Public involvement (PI) is of great interest. However, little is known about this topic in the design, development, and/or implementation of health interventions in geriatric facilities. This study aimed to provide a critical overview of the involvement of caregivers and end-users in interventions in these facilities, based on Rifkin’s analytical framework. This systematic review, supplemented by a questionnaire to the corresponding authors, covered non-drug intervention reports targeting nurses, doctors, residents, and their relatives. Articles were published in Pubmed, Medline, Scopus, and Cinahl, from January 2016 to April 2018. Ninety-seven articles were included. The review shows a low level or partial PI in geriatric facilities where it exists. These results are further supported by the authors’ responses to the questionnaire. PI remains uncommon in geriatric institutions and consists of a consumerist model, suggesting the need for improved practices. More efforts are needed to experiment with recommendations to meet the challenges of PI and enhance the public ownership of interventions. The protocol was registered on Prospero under the number CRD42018098504

Perceptions of Antibiotic Therapy Among Nursing Home Residents: Perspectives of Caregivers and Residents in a Mixed Exploratory Study

Antimicrobial resistance is a major public health threat worldwide. Some authors have suggested that end-users of nursing homes have an influence on antibiotic prescribing. The objective of this study is to describe the views of end-users and professionals on residents’ behavior towards antibiotic therapy in terms of knowledge, beliefs, and attitudes towards this drug class and its prescribing process. This is a concurrent mixed methodology study using questionnaires and semi-directive individual interviews with nursing homes residents, nurses, and doctors practicing in these facilities. The questionnaires analyzed were collected from 35 residents (24.3%) and 109 nurses (75.7%). The qualitative interview involved 26 of total participants that agreed to be interviewed. We noticed misconceptions being held by the residents regarding the antibiotic resistance phenomenon. Additionally, nurses were not considered as a source of information about antibiotics. Nurses and residents had conflicting opinions about residents requesting antibiotics, and the findings depict a stereotypical view of the nurse profession as a reflection of a cognitive representation. The authors conclude that, despite many campaigns, further efforts are needed to tackle antimicrobial resistance. Initiatives could include raising awareness about antimicrobial resistance, clarifying the role of nurses, and communicating well with residents about their needs in nursing homes

Perceptions of Antibiotic Therapy Among Nursing Home Residents: Perspectives of Caregivers and Residents in a Mixed Exploratory Study

Antimicrobial resistance is a major public health threat worldwide. Some authors have suggested that end-users of nursing homes have an influence on antibiotic prescribing. The objective of this study is to describe the views of end-users and professionals on residents’ behavior towards antibiotic therapy in terms of knowledge, beliefs, and attitudes towards this drug class and its prescribing process. This is a concurrent mixed methodology study using questionnaires and semi-directive individual interviews with nursing homes residents, nurses, and doctors practicing in these facilities. The questionnaires analyzed were collected from 35 residents (24.3%) and 109 nurses (75.7%). The qualitative interview involved 26 of total participants that agreed to be interviewed. We noticed misconceptions being held by the residents regarding the antibiotic resistance phenomenon. Additionally, nurses were not considered as a source of information about antibiotics. Nurses and residents had conflicting opinions about residents requesting antibiotics, and the findings depict a stereotypical view of the nurse profession as a reflection of a cognitive representation. The authors conclude that, despite many campaigns, further efforts are needed to tackle antimicrobial resistance. Initiatives could include raising awareness about antimicrobial resistance, clarifying the role of nurses, and communicating well with residents about their needs in nursing homes

Promouvoir le bon usage des antibiotiques en Ehpad : une nécessité de convergence des acteurs vers le juste recours

International audienc

Relever le défi de l’Approche Par Compétence pour la formation doctorale : enjeux et proposition de l’expérimentation d’un curriculum au sein du Laboratoire Educations et Pratiques de santé UR 3412

L’arrêté du 22 février 2019(1) inscrit le doctorat au répertoire national de la certification (RNCP) professionnelle et définit de nouvelles compétences devant être acquises au cours de la formation doctorale. Il s’agit de replacer le doctorant dans une perspective métier, la réalisation d’une thèse s’accompagnant du développement de compétences que l’on peut attendre d’un chercheur. Au-delà d’une simple visée utilitariste de la notion de compétence(2) -dont les acceptions sont multiples- sa mise en œuvre dans les dispositifs de formation est décrite dans la littérature comme une opportunité de faire changer et d’améliorer les pratiques pédagogiques. Pour la formation doctorale, cela peut être l’occasion de discuter les enjeux de qualité(3) des processus d’accompagnement pédagogique, de la construction du projet de recherche du doctorant et de son parcours professionnel. Dans cette perspective, un comité de pilotage du LEPS UR 3412 réunissant doctorants, enseignants-chercheurs et directeurs a conçu et mis en place un dispositif de formation à l’attention des doctorants du LEPS. Ce dispositif est basé sur une Approche Par Compétence(4) articulant des ressources pédagogiques mises à disposition par le laboratoire et l’Ecole Erasme-Université Sorbonne Paris Nord. La construction du dispositif s’est opérée en plusieurs étapes itératives, de la définition d’un référentiel de compétences à partir du cadre législatif à son opérationnalisation en lien avec les valeurs et axes de recherche du laboratoire. Les activités de formation sont organisées au moyen d’une planification en spirale(5). Celle-ci permet au doctorant de complexifier ses apprentissages de manière graduelle en les reliant à ceux préexistants, dans une perspective socioconstructiviste et pragmatiste de l’apprentissage. Les doctorants sont impliqués à chaque niveau de la formation, que cela soit pour sa gouvernance, dans la planification, ou la réalisation des activités à visée d’apprentissage. Au travers cette communication, il s’agit de présenter le dispositif de formation en cours d’expérimentation, de discuter la conception curriculaire, ses avantages et ses limites pour l’amélioration de la formation des doctorants. Références : 1. Arrêté du 22 février 2019 définissant les compétences des diplômés du doctorat et inscrivant le doctorat au répertoire national de la certification professionnelle [Internet]. Disponible sur: https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000038200990&categorieLien=id 2. Tardif J. L’évaluation des compétences. Documenter le parcours de développement. Montréal (QC) : Chenelière Education. 2006. 363 p. 3. Workshop Encadrement Doctoral 2018 « La qualité du doctorat ». Organisé par Adoc Mètis, l’Association Nationale des Docteurs, le Réseau National de Collèges Doctoraux et l’Université de Lyon. [Internet]. Disponible sur: https://w-e-d.info/ 4. Poumay M, Tardif J, Georges F. Organiser la formation à partir des compétences - Un pari gagnant pour l’apprentissage dans le supérieur. De Boeck supérieur; 2017. 5. Harden RM, Stamper N. What is a spiral curriculum? Med Teach. mars 1999;21(2):141‑3