Observation of urinary tract infection signs and symptoms in nursing home residents with impaired awareness or ability to communicate signs and symptoms: The development of supportive tools

IF 1.6 4区医学 Q4 GERIATRICS & GERONTOLOGY

International Journal of Older People Nursing Pub Date : 2023-08-10 DOI:10.1111/opn.12560

Jorna van Eijk RN MSc, Jeanine J. S. Rutten MD, Cees M. P. M. Hertogh MD PhD, Martin Smalbrugge MD PhD, Laura W. van Buul PhD

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引用次数: 0

Abstract

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.

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意识或沟通能力受损的养老院居民尿路感染体征和症状的观察:支持性工具的开发

背景:在养老院(NH)的居民中，抗生素经常被不恰当地用于尿路感染(uti)。研究强调只有在出现尿路相关体征和症状时才开抗生素处方的重要性。然而，对于许多NH居民来说，发现是否存在这样的S&S是具有挑战性的，例如由于认知障碍。目的:了解在意识或沟通能力受损的NH居民中与尿路相关的S&S的评估，并开发支持性工具，由护理人员在NH居民的这个亚组中观察与尿路相关的S&S。方法采用混合方法进行以实践为基础的研究。分析了295例疑似尿路感染病例的数据，以确定在患有和不患有痴呆症的居民中，与尿路相关的S&S“未评估/不可评估”的频率。在与护理人员的访谈和焦点小组中，发现了在意识或沟通能力受损的NH居民中观察尿路相关s&s&s的障碍和促进因素。文献回顾、焦点小组数据、额外的电话访谈和对护理人员的问卷调查是一个循序渐进的过程，包括试点测试，以开发支持性工具来观察尿路相关的s&p;S。结果尿路相关的S&S在大多数NH居民痴呆中是可评估的。痴呆患者中“未评估/不可评估”的S&S比例随着痴呆严重程度的增加而增加。在患有非常严重痴呆症的居民中，高达58%的S&S“未被评估/不可评估”。了解住院医师，工作方法，并有足够的技能来解释住院医师的观察结果，有助于评估尿路相关的s&p;S。在不同的研究要素中获得的见解导致了观察清单和24小时观察工具的发展。结论:NH居民对s&s&s沟通能力的认知受损程度越高，就越难以评估与尿路相关的s&s&s。本研究开发的观察表和24小时观察工具可以帮助护理人员对该组NH住院患者的尿路相关s&s&s进行观察。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Older People Nursing Nursing-Gerontology

CiteScore

3.60

自引率

9.10%

发文量

期刊介绍： International Journal of Older People Nursing welcomes scholarly papers on all aspects of older people nursing including research, practice, education, management, and policy. We publish manuscripts that further scholarly inquiry and improve practice through innovation and creativity in all aspects of gerontological nursing. We encourage submission of integrative and systematic reviews; original quantitative, qualitative, and mixed methods research; secondary analyses of existing data; historical works; theoretical and conceptual analyses; evidence based practice projects and other practice improvement reports; and policy analyses. All submissions must reflect consideration of IJOPN''s international readership and include explicit perspective on gerontological nursing. We particularly welcome submissions from regions of the world underrepresented in the gerontological nursing literature and from settings and situations not typically addressed in that literature. Editorial perspectives are published in each issue. Editorial perspectives are submitted by invitation only.