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

The Nurse’s Role in the Right Prescription of Antibiotics in Geriatric Facilities

La réduction de la consommation globale d’antibiotique s’impose comme un enjeu fort de santé publique afin d’éviter l’apparition de souches bactériennes résistantes. Parmi les personnes les plus exposées aux antibiotiques, on compte les personnes âgées dont certains résidents en Etablissements d’Hébergement des Personnes Âgées Dépendantes (EHPAD). L’infirmière est la première intervenante en cas de suspicion d’infections dans les EHPAD. Dès lors pourrait-elle donc avoir une place dans la prescription des antibiotiques et soutenir la réduction de la consommation ? Quel pourrait être le rôle des résidents et /ou de leurs familles dans le moindre recours aux antibiotiques ? Le programme ATOUM, qui compte six études, se veut un programme d'intervention multimodal axé sur la formation des soignants en EHPAD. Il ambitionne d’une part de comprendre la place de l’infirmière dans la prescription, de décrire le rôle des résidents et de leurs familles ; et de contribuer d’autre part au développement des compétences des infirmières, pour qu’elle soit capable de jouer un rôle essentiel dans la diminution de la prescription inappropriée d'antibiotique. Les études réalisées dans le cadre de ce programme montrent que l’infirmière a un rôle essentiel dans la prise en charge de la personne âgée en cas de suspicion d’une infection. Cependant, la place de l’infirmière dans la gestion efficace des traitements et de l’antibiothérapie requiert des compétences théoriques et professionnelles bien définies, permettant à l’infirmière d’établir une collaboration interprofessionnelle dans le but d’une meilleure prescription.Reducing overall antibiotic consumption is a major public health issue in order to avoid the emergence of resistant bacterial strains. Among the people most exposed to antibiotics are the elderly, some of whom live in long term care facilities for dependent elderly people (LTCF). The nurse is the first responder in case of suspected infections in the LTCF. Could it therefore have a place in the prescription of antibiotics and support the reduction of consumption? What could be the role of residents and/or their families in any use of antibiotics?The ATOUM program, which includes six studies, is a multimodal intervention program focused on training caregivers in LTCF. It aims at the one hand to understand the place of the nurse in prescribing, describe the role of residents and their families; and on the other hand to contribute to the development of nurses' skills, to be able to play an essential role in reducing inappropriate prescribing of antibiotic.The studies carried out show that the nurse has an essential role in the care of the elderly person in the event of suspicion of an infection. The competent nurse could have different roles in antibiotic prescribing. In addition, it appears that inter-professional collaboration requires both theoretical and professional skills on the part of the nurse. However, the nurse's participation in the prescribing decision, for a better prescription based on inter-professional collaboration, is influenced by different determinants.The different competencies for the nurse are essential to further enhance her role in the effective management of treatment and antibiotic therapy

La Place de l’Infirmière dans la Juste Prescription des Antibiotiques en Etablissements d’Hébergement des Personnes Agées Dépendantes (EHPAD)

Reducing overall antibiotic consumption is a major public health issue in order to avoid the emergence of resistant bacterial strains. Among the people most exposed to antibiotics are the elderly, some of whom live in long term care facilities for dependent elderly people (LTCF). The nurse is the first responder in case of suspected infections in the LTCF. Could it therefore have a place in the prescription of antibiotics and support the reduction of consumption? What could be the role of residents and/or their families in any use of antibiotics?The ATOUM program, which includes six studies, is a multimodal intervention program focused on training caregivers in LTCF. It aims at the one hand to understand the place of the nurse in prescribing, describe the role of residents and their families; and on the other hand to contribute to the development of nurses' skills, to be able to play an essential role in reducing inappropriate prescribing of antibiotic.The studies carried out show that the nurse has an essential role in the care of the elderly person in the event of suspicion of an infection. The competent nurse could have different roles in antibiotic prescribing. In addition, it appears that inter-professional collaboration requires both theoretical and professional skills on the part of the nurse. However, the nurse's participation in the prescribing decision, for a better prescription based on inter-professional collaboration, is influenced by different determinants.The different competencies for the nurse are essential to further enhance her role in the effective management of treatment and antibiotic therapy.La réduction de la consommation globale d’antibiotique s’impose comme un enjeu fort de santé publique afin d’éviter l’apparition de souches bactériennes résistantes. Parmi les personnes les plus exposées aux antibiotiques, on compte les personnes âgées dont certains résidents en Etablissements d’Hébergement des Personnes Âgées Dépendantes (EHPAD). L’infirmière est la première intervenante en cas de suspicion d’infections dans les EHPAD. Dès lors pourrait-elle donc avoir une place dans la prescription des antibiotiques et soutenir la réduction de la consommation ? Quel pourrait être le rôle des résidents et /ou de leurs familles dans le moindre recours aux antibiotiques ? Le programme ATOUM, qui compte six études, se veut un programme d'intervention multimodal axé sur la formation des soignants en EHPAD. Il ambitionne d’une part de comprendre la place de l’infirmière dans la prescription, de décrire le rôle des résidents et de leurs familles ; et de contribuer d’autre part au développement des compétences des infirmières, pour qu’elle soit capable de jouer un rôle essentiel dans la diminution de la prescription inappropriée d'antibiotique. Les études réalisées dans le cadre de ce programme montrent que l’infirmière a un rôle essentiel dans la prise en charge de la personne âgée en cas de suspicion d’une infection. Cependant, la place de l’infirmière dans la gestion efficace des traitements et de l’antibiothérapie requiert des compétences théoriques et professionnelles bien définies, permettant à l’infirmière d’établir une collaboration interprofessionnelle dans le but d’une meilleure prescription

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

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Overview of <i>Yersinia pestis</i> Metallophores: Yersiniabactin and Yersinopine

The pathogenic anaerobic bacteria Yersinia pestis (Y. pestis), which is well known as the plague causative agent, has the ability to escape or inhibit innate immune system responses, which can result in host death even before the activation of adaptive responses. Bites from infected fleas in nature transmit Y. pestis between mammalian hosts causing bubonic plague. It was recognized that a host’s ability to retain iron is essential in fighting invading pathogens. To proliferate during infection, Y. pestis, like most bacteria, has various iron transporters that enable it to acquire iron from its hosts. The siderophore-dependent iron transport system was found to be crucial for the pathogenesis of this bacterium. Siderophores are low-molecular-weight metabolites with a high affinity for Fe3+. These compounds are produced in the surrounding environment to chelate iron. The siderophore secreted by Y. pestis is yersiniabactin (Ybt). Another metallophore produced by this bacterium, yersinopine, is of the opine type and shows similarities with both staphylopine and pseudopaline produced by Staphylococcus aureus and Pseudomonas aeruginosa, respectively. This paper sheds light on the most important aspects of the two Y. pestis metallophores as well as aerobactin a siderophore no longer secreted by this bacterium due to frameshift mutation in its genome

Cybernetic Communications: Focusing Interactions on Goal-Centered Care

In nursing homes, due to time constraints, lack of communication can influence the quality of information exchanged, which influences the outcomes of healthcare for residents. Nurses’ proximity to the nursing home resident, their knowledge, and skill serve as an opportunity to communicate and facilitate patient-centered goals and improve treatment decision-making. Concepts within the cybernetic communication literature entail systemic interactive relationships that enable the sharing of knowledge and expertise. These interactions are based on nursing’s theoretical knowledge, clinical judgment, and empowerment and are based on patient-centered goals

Nurses’ eating habits in Lebanon during the economic and health crises: a cross-sectional study

International audienceAbstract Background Nurses face multiple stressors that can influence their lifestyle, thus affecting their health status. Scarce are the scientific data on the nutritional status of nurses, especially during health crises. The aim of this study was to assess the impact of the COVID-19 pandemic on the eating habits of hospital nurses in the context of an exceptional economic situation in Lebanon. Methods A cross-sectional study was conducted using a web-based questionnaire, targeting a non-random sampling of frontline nurses using the snowball technique. Descriptive and bivariate analyses were carried out. The population of the study included all registered nurses working in the Lebanese hospitals. A total of 533 nurses completed the questionnaire; 500 surveys were selected after excluding the ones presenting conditions that may affect their eating behavior. Results The majority of the respondents were women (78.6%) with a mean age of 33 years [18-60] [SD,7.44 years]. Most of them (57.6%) had a crowding index ≥1. The consumption of different food groups decreased during these crises. There was a significant correlation between stress and deterioration of healthy food consumption, which provides beneficial nutrients and minimizes potentially harmful elements, especially for meat (OR 2.388, CI 1.463 to 3.898, P < 0.001). The decrease in monthly income showed a real impact on the consumption of healthy food such as meat (OR 2.181, CI 1.504 to 3.161, P < 001), fruits (OR 1.930, CI 1.289 to 2.888, P = 0.001), and milk and dairy products (OR 1.544, CI 1.039 to 2.295, P = 0.031). Conclusions The pandemic and in particular the economic crisis has changed the consumption of healthy food among hospital nurses in Lebanon. Similar research and support may be extended to include other frontline health care workers

Nursing Role for Medication Stewardship Within Long-Term Care Facilities

Elderly residents in long-term care facilities (LTCFs) constitute a population noted to have a large number of medications prescribed and administered. The aim of this article is to explore the nursing role for medication management, with an emphasis on antimicrobial stewardship, guided by disciplinary knowledge of King’s theory of goal attainment and skill-based medication knowledge. The outcome is a nursing workforce truly engaged in working with interdisciplinary colleagues and focusing on care planning that includes medication management to improve the health status of residents in long-term care facilities

Nurses prescribing medications in geriatric centers: international mapping

International audienceObjective:the aim of this study was to identify the perceptions of nurses and physicians and describe the involvement of nurses in medical prescription in general and that of antibiotics in particular, in geriatric institutions.Methods:a cross-sectional multinational study was conducted among nurses and physicians in geriatric institutions between April and October 2017. Data was collected using three online questionnaires in both French and English.Results:in total, 78.7% of doctors discussed the relevance of the prescription with competent nurses. A map shows the relationship between the evidence level of nursing role in medical prescription, and prescriptive authorization nurses in the 51 participating countries.Conclusions:interpersonal physician-nurse relationships are essential in facilitating the nursing role of effective treatment management