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

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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

Représentations croisées de la fonction d’infirmière coordinatricedans un service d’hépatologie : une recherche ethnosociologique

International audienceL’étude présentée ici est une ethnosociologie d’une unité de soin hospitalier reposant principalement sur des entretiens semi-directifs avec des professionnels de santé, mais aussi des patients (N=26), ainsi qu’une observation du terrain. Le but de cette recherche était de comprendre l’intérêt de la mise en place d’une nouvelle fonction infirmière : celle d’infirmière « coordinatrice » (IC) en hépatologie, d’en analyser le cœur d’exercice et l’impact sur les patients et les soignants. Les résultats montrent que les facteurs clefs de la réussite d’un telprojet sont 1) une organisation des soins qui a dû aménager un nouveau paradigme, puisque les IC ne sont plus dédiées au lit du malade, mais à un suivi ambulatoire 2) une implication forte de ces IC dans le projet médical et auprès des patients et 3) une grande autonomie dont doivent faire preuve ces IC. Celle-ci est en lien direct avec un niveau d’expertise requis

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”)

Characteristics of the skills of caregivers of people with dementia: observational study

Abstract Background Due to demographic change within an aging population as announced by the WHO, the involvement of caregivers is essential. Caregivers are required to change their roles within the family unit. Such life transitions experienced by caregivers to people confronted with dementia-type pathologies are sometimes difficult, necessitating the acquisition and development of certain skills. Few studies have shown that caregivers develop specific and essential skills to promote quality care and safety. To characterize their skills, there is a need to identify the abilities, knowledge, resources, obstacles and constraints that contribute to caregivers’ transitions. The research question for this study was: What skills do caregivers use to care for their loved one with dementia? Methods Qualitative observational research based on the epistemological paradigm of socioconstructivist knowledge was conducted. The study was carried out in the canton of Geneva and recruitment was carried out through the participation of the Alzheimer’s association and the association for the support and assistance of elderly people in medical and social institutions and their families (APAF). Observations and semi-structured interviews were conducted in the homes of 14 family carers caring for their loved one with dementia. The observations were transcribed on observation grids and the interviews were recorded. Subsequently, according to the classic distinction of Denzin (Interpretive interractionism, 2001), we analysed the observation notes and verbatims, then as recommended by Miles et al. (Qualitative data analysis: a methods sourcebook, 2014), two researchers triangulated the results. Results The results identified five types of situations regularly experienced by caregivers. The study characterized 11 skills that caregivers use to cope with their daily lives. The learning process and maladaptive behaviours in caring for their loved ones with dementia were also highlighted. Conclusion This study was able to point out that today’s caregivers have developed more competency than their predecessors. This evolution can be explained by new paradigms of care requiring caregivers to be more involved. Although some caregivers need training, others through their experiences can act upon and provide knowledge. To improve the quality and safety of care for people with dementia, this expertise can be the subject of partnerships between caregivers and health care staff

Defining an enabling environment for those with chronic disease: an integrative review

Abstract Background Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual’s capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management. Methods An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used. Results A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting “take care”, involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment. Conclusion This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised

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

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