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dc.contributorDowson, Leslieen_US
dc.contributorFriedman, N. Deborahen_US
dc.contributorMarshall, Carolineen_US
dc.contributorStuart, Rhonda L.en_US
dc.contributorBuising, Kirstyen_US
dc.contributorRajkhowa, Arjunen_US
dc.contributorGotterson, Fionaen_US
dc.contributorKong, David C. M.en_US
dc.description.abstractBackground: The excessive use of antimicrobials in aged-care homes is a widely recognised phenomenon. This is problematic because it can harm residents, and is detrimental to public health. Residents in the final month of life are increasingly likely to be prescribed an antimicrobial, commonly without having signs and symptoms of infection that support antimicrobial use. Objectives: We aimed to describe the perspectives of health professionals on antimicrobial use near the end of life in aged-care homes and investigate the potential opportunities for nurses to undertake antimicrobial stewardship activities near the end of life in aged-care homes. Design: One-on-one, semi-structured, qualitative interviews. Settings and participants: Twelve nurses, six general practitioners and two pharmacists providing routine care to residents of aged-care homes in Victoria, Australia were interviewed. Diversity in terms of years of experience, aged-care funding type (government, private-for-profits and not-for-profits) and location (metropolitan and regional) were sought. Methods: Interviews were transcribed and open coded in a descriptive manner using validated frameworks for understanding behaviour change. The descriptive code was then used to build an interpretive code structure based on questions founded in grounded theory. Results: Thematic saturation was reached after fourteen interviews, and an additional six interviews were conducted to ensure emergent themes were consistent and definitive. There are opportunities for aged-care home nurses to undertake antimicrobial stewardship activities near the end of life in the provision of routine care. Aged-care home nurses are influential in antimicrobial decisions near the end of life in routine care because of their leadership in advance care planning, care co-ordination and care provision in an environment with stopgap and visiting medical resources. Nurses also have social influence among residents, families and medical professionals during critical conversations near the end of life. Past negative social interactions within the aged-care home environment between nurses and families can result in ‘fear-based’ social influences on antimicrobial prescribing. Conclusions: The work of facilitating advance care planning, care coordination, care delivery, and communicating with families and medical professionals provide important opportunities for aged-care home nurses to lead appropriate antimicrobial stewardship activities near the end of life.en_US
dc.description.provenanceSubmitted by Gemma Siemensma ( on 2020-06-01T04:13:54Z No. of bitstreams: 0en
dc.description.provenanceApproved for entry into archive by Gemma Siemensma ( on 2020-06-01T04:14:23Z (GMT) No. of bitstreams: 0en
dc.description.provenanceMade available in DSpace on 2020-06-01T04:14:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2020en
dc.titleThe role of nurses in antimicrobial stewardship near the end of life in aged-care homes: A qualitative study.en_US
dc.typeJournal Articleen_US
dc.bibliographicCitation.titleInternational Journal of Nursing Studiesen_US
dc.subject.healththesaurusAGED CAREen_US
dc.subject.healththesaurusANTIBACTERIAL AGENTSen_US
dc.subject.healththesaurusANTI-INFECTIVE AGENTSen_US
dc.subject.healththesaurusANTIMICROBIAL STEWARDSHIPen_US
dc.subject.healththesaurusPALLIATIVE CAREen_US
dc.subject.healththesaurusNURSING HOMESen_US
dc.subject.healththesaurusRESIDENTIAL CAREen_US
dc.subject.healththesaurusLONG-TERM CAREen_US
dc.subject.healththesaurusQUALITATIVE RESEARCHen_US
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