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 Role of Self-involvement in the History of Caring in Mental Health

International audienc

Le care, le caring, le cure et le soignant

En raison de la polysémie du concept de care et de ses significations culturelles variées, le but de cet article estd’aborder ce concept en débutant par une clarification de ses origines étymologiques. Outre cette clarification,les objectifs de cet article consistent à faire ressortir les rapports du care avec ceux du cure, les implicationsdu « care » dans le management des équipes de soins. L’analyse étymologique est réalisée à partir d’écritsencyclopédiques, permettant de discuter le sens originel du concept. Les résultats de cette analyse montrentque le sens d’origine du care s’ancre sur les affects et le ressenti, qui amènent au caring. Par conséquent, unedimension personnelle lui est inhérente. Cette réflexion tente de montrer que le care ne s’oppose pas au cure,mais qu’il est impératif de sensibiliser les infirmier(e)s à la dimension personnelle du care pour devenir le caringavec l’appui du management. La conclusion dévoile qu’une dimension personnelle du caring, soutenue pardes valeurs humanistes, participe de la dimension professionnelle du rôle infirmier. Ainsi, ces deux dimensions,qui doivent croître ensemble, sont incontournables pour l’exercice infirmier

A qualitative evaluation of patient’s perceptions of therapeutic alliance on mental health acute inpatient wards

Background: Since the research of H. Peplau, the question of relational psychiatry has been defined as the heart of the profession of mental health nursing. The therapeutic relationship has evolved in its design to become Therapeutic Alliance (Zetzel), or Helping Alliance (Luborsky) or Working Alliance (Bordin). Recent articles show that these concepts are still very powerful despite the appearance of computer tools and that they are still today major determinants in the management of people suffering from mental disorders.Objective: To gain insights into the construction of TA from the patients’ perspective. How do patients see the development of the Therapeutic Alliance with nursing staff? And, for example, does the way patients are admitted to hospital (if detained under the mental health act) impact on the formation of TA?Methods: Qualitative, semi-structured interviews were carried out with patients on acute wards in four inpatients sites, EPS Maison Blanche Paris, between 2014/07 and 2018/07. All interviews were recorded and transcribed, and data were analysed using Nvivo software.Results: Thirty-one participants were recruited to the study. Reporting of good quality TA did not appear to be linked to whether participants were detained in hospital, nor to their diagnosis. Close proximity is the first value described by patients as a creator of TA and refers to the concept of attachment. We will develop the Proximal Zone of TA (PZTA) concept further in this paper presentation, in addition to our data which indicated that nurses may be sought by inpatients’ as attachment figures as recalled by Gwen Adshead or Kenneth Ma. Three themes were extracted in relation to close proximity: i) during the somatic care (“I am alone with the nurse”); ii) during therapeutic communication face to face “(nurse give me advice”; “they explained me things”; “they listen to me)”; iii) the continued presence (“I was accompanied”; “they know how to manage me”; “they are present; reactive; respectful”)

Living with chronic obstructive pulmonary disease in Lebanon: a phenomenological study

International audienceBackground: Lebanon has the fastest growing older adult population in the Arab region but few social resources to address their needs. No studies have explored the experience of patients with chronic obstructive pulmonary disease (COPD) in Lebanon. Aims: Exploring the experiences of individuals living with COPD in Lebanon. Method: Using a descriptive phenomenological research design, qualitative individual semi-structured interviews were conducted with COPD patients living in Lebanon, between May 2019 and September 2019. Results: Fifty participants agreed to be interviewed. The majority were men (56%) and had moderate COPD (40%). Mean age was 71.5 (standard deviation 9.0) years. We found that COPD affects three dimensions of patients’ lives: educational, organizational and psychosocial. Conclusion: The results highlight the need for multidisciplinary strategies to address the needs of people with COPD in Lebanon, including their caregivers. Strategies include patient education and the development of new methods to facilitate and promote partnership between health care professionals, COPD patients and their caregivers

Freins à l’observance au traitement antirétroviral en milieu rural de la République Démocratique du Congo et regard sur l’Alliance thérapeutique dans le circuit de soins

Cette étude vise à comprendre les freins à l’observance au traitement antirétroviral et à porter un regard critique sur la qualité d’alliance thérapeutique Infirmier-patient. Il s’agit d’une étude qualitative phénoménologique réalisée dans deux hôpitaux ruraux de la province du Kongo-central en République Démocratique du Congo (RDC). Des entretiens semi-directifs ont été réalisés auprès de patients. Deux grands groupes de freins ont été relevés : L’un lié au patient (manque de nourriture, le ressenti (peur, doute)) et l’autre en rapport avec son environnement (rupture des antirétroviraux, influence des médias, des religieux et autres croyances traditionnelles…). Ces freins généraient des forces antagonistes influençant négativement l’observance au traitement antirétroviral. Cette étude met en évidence l’existence des écarts sur la qualité d’alliance thérapeutique dans le circuit de soins. Ainsi, surmonter les forces négatives, renforcer les capacités infirmières et revisiter les programmes de formation Infirmière sur les questions du VIH semblent une nécessité