TY - JOUR
T1 - Observation of urinary tract infection signs and symptoms in nursing home residents with impaired awareness or ability to communicate signs and symptoms
T2 - The development of supportive tools
AU - van Eijk, Jorna
AU - Rutten, Jeanine J. S.
AU - Hertogh, Cees M. P. M.
AU - Smalbrugge, Martin
AU - van Buul, Laura W.
N1 - Funding Information: This work was supported by a grant from the Regional Cooperative Networks Antibiotic Resistance (‘ABR zorgnetwerk’) of Noord‐Holland West and Noord‐Holland Oost / Flevoland, the Netherlands. This study reused data from the ANNA study (Antibiotic prescribing and Non‐prescribing in Nursing home residents with signs and symptoms Ascribed to urinary tract infection). The ANNA study was supported by The Netherlands Organisation for Health Research and Development (ZonMw, grant number 839120008). Funding Information: We thank the nursing staff for their participation in this study. We also thank members of the ANNA study project group for their contribution to interpretation of ANNA study data that was used in the current study. The funding body (i.e. the Regional Cooperative Networks Antibiotic Resistance (‘ABR zorgnetwerk’) of Noord-Holland West and Noord-Holland Oost/Flevoland) had no role in study design, methods, subject recruitment, data collections, analysis and preparation of this paper. Publisher Copyright: © 2023 The Authors. International Journal of Older People Nursing published by John Wiley & Sons Ltd.
PY - 2023/9
Y1 - 2023/9
N2 - Background: Antibiotics are often inappropriately prescribed for urinary tract infections (UTIs) in nursing home (NH) residents. Research emphasises the importance of prescribing antibiotics only if there are UTI-related signs and symptoms (S&S). However, for many NH residents it is challenging to find out whether such S&S are present, for example due to cognitive disorders. Objectives: To provide insight into the assessment of UTI-related S&S in NH residents with impaired awareness or ability to communicate S&S, and to develop supportive tools for the observation of UTI-related S&S in this subgroup of NH residents, by nursing staff. Methods: We performed a practice-based study using mixed methods. Data of 295 cases of suspected UTI were analysed to determine how often UTI-related S&S were ‘not assessed/non-assessable’ in residents with and without dementia. Barriers and facilitators in observing UTI-related S&S in NH residents with impaired awareness or ability to communicate S&S were derived from interviews and focus groups with nursing staff. Literature review, focus group data, additional telephone interviews and questionnaires with nursing staff were used in a step-by-step process, including pilot testing, to develop supportive tools for the observation of UTI-related S&S. Results: UTI-related S&S were assessable in the majority of NH residents with dementia. The proportion ‘not assessed/non-assessable’ S&S in residents with dementia increased with increasing severity of dementia. In residents with very severe dementia, up to 58% of the S&S were ‘not assessed/non-assessable’. Knowing the resident, working methodologically, and being sufficiently skilled to interpret observations in residents facilitate the assessment of UTI-related S&S. Insights acquired during the different study elements resulted in the development of an observation checklist and a 24-h observation tool. Conclusions: The more NH residents have impaired awareness of ability to communicate S&S, the more difficult it seems to be to assess UTI-related S&S. The observation checklist and 24-h observation tool developed in the current study may support nursing staff in their observation of UTI-related S&S in this group of NH residents.
AB - Background: Antibiotics are often inappropriately prescribed for urinary tract infections (UTIs) in nursing home (NH) residents. Research emphasises the importance of prescribing antibiotics only if there are UTI-related signs and symptoms (S&S). However, for many NH residents it is challenging to find out whether such S&S are present, for example due to cognitive disorders. Objectives: To provide insight into the assessment of UTI-related S&S in NH residents with impaired awareness or ability to communicate S&S, and to develop supportive tools for the observation of UTI-related S&S in this subgroup of NH residents, by nursing staff. Methods: We performed a practice-based study using mixed methods. Data of 295 cases of suspected UTI were analysed to determine how often UTI-related S&S were ‘not assessed/non-assessable’ in residents with and without dementia. Barriers and facilitators in observing UTI-related S&S in NH residents with impaired awareness or ability to communicate S&S were derived from interviews and focus groups with nursing staff. Literature review, focus group data, additional telephone interviews and questionnaires with nursing staff were used in a step-by-step process, including pilot testing, to develop supportive tools for the observation of UTI-related S&S. Results: UTI-related S&S were assessable in the majority of NH residents with dementia. The proportion ‘not assessed/non-assessable’ S&S in residents with dementia increased with increasing severity of dementia. In residents with very severe dementia, up to 58% of the S&S were ‘not assessed/non-assessable’. Knowing the resident, working methodologically, and being sufficiently skilled to interpret observations in residents facilitate the assessment of UTI-related S&S. Insights acquired during the different study elements resulted in the development of an observation checklist and a 24-h observation tool. Conclusions: The more NH residents have impaired awareness of ability to communicate S&S, the more difficult it seems to be to assess UTI-related S&S. The observation checklist and 24-h observation tool developed in the current study may support nursing staff in their observation of UTI-related S&S in this group of NH residents.
KW - dementia
KW - long-term care facilities
KW - nursing staff
KW - observation tools
KW - signs and symptoms
KW - urinary tract infection
UR - http://www.scopus.com/inward/record.url?scp=85167622718&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/opn.12560
DO - https://doi.org/10.1111/opn.12560
M3 - Article
C2 - 37563799
SN - 1748-3743
VL - 18
JO - International Journal of Older People Nursing
JF - International Journal of Older People Nursing
IS - 5
M1 - e12560
ER -