Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia.
School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia.
Soc Sci Med. 2022 Jul;305:115094. doi: 10.1016/j.socscimed.2022.115094. Epub 2022 May 31.
Recent social science scholarship has sought to understand the visible and invisible impacts of how antibiotics are entrenched as infrastructures and put to work as a proxy for higher levels of care (clinical or otherwise) within modern healthcare. Using a qualitative research design, in this paper our aim is to draw attention to less visible aspects of antimicrobial stewardship (AMS) in residential aged care and their implications for nurse-led optimization of antibiotic use in these settings. By developing an account of the perceptions, experiences and practices of staff regarding the 'on the ground' work associated with implementing and upholding AMS objectives our study extends research on attempts to dismantle antibiotic infrastructures in Australian residential aged care facilities (RACF). Drawing on a review of relevant policies, empirical data is presented from fifty-six in-depth interviews conducted in 2021 with staff at 8 different RACFs. Interview participants included managers, nurses, and senior and junior personal care assistants. Our results suggest that registered nurses in residential aged care have been tasked with promoting antibiotic optimization and assigned with AMS responsibilities without sufficient authority and resourcing. A host of hidden care work associated with AMS strategies was evident, reinforcing some staff support for empirical antibiotic prescribing as a 'safety net' in uncertain clinical cases. We argue that this hidden work occurs where AMS strategies displace the infrastructural role previously performed by antibiotics, exposing structural gaps and pressures. The inability of organisational accounting systems and the broader AMS policy agenda to capture hidden AMS workflows in RACFs has consequences for future resourcing and organisational learning in ways that mean AMS gaps may remain unaddressed. These results support findings that AMS interventions might not be easily accepted by aged care staff in view of associated burdens which are under recognised and under supported in this domain.
最近的社会科学研究试图理解抗生素作为基础设施的可见和不可见影响，并将其作为现代医疗保健中更高水平护理（临床或其他）的代理。在本文中，我们使用定性研究设计，旨在提请人们注意在住宅老年护理中抗菌药物管理（AMS）不太明显的方面，以及它们对护士主导的这些环境中抗生素使用优化的影响。通过描述员工对与实施和维护 AMS 目标相关的“实地”工作的看法、经验和做法，我们的研究扩展了关于试图拆除澳大利亚住宅老年护理机构（RACF）中抗生素基础设施的研究。在对相关政策进行审查的基础上，本文从 2021 年在 8 个不同的 RACF 对 56 名员工进行的 56 次深入访谈中呈现了实证数据。访谈参与者包括经理、护士以及高级和初级个人护理助理。我们的研究结果表明，住宅老年护理中的注册护士被赋予了促进抗生素优化和承担 AMS 责任的任务，但没有足够的权力和资源。与 AMS 策略相关的大量隐藏护理工作显而易见，这加强了一些员工对经验性抗生素处方的支持，认为这是不确定临床情况下的“安全网”。我们认为，这种隐藏的工作发生在 AMS 策略取代抗生素以前执行的基础设施角色时，暴露出结构上的差距和压力。组织会计系统和更广泛的 AMS 政策议程无法在 RACF 中捕获隐藏的 AMS 工作流程，这对未来的资源配置和组织学习产生了影响，意味着 AMS 差距可能仍然得不到解决。这些结果支持了这样一种观点，即鉴于与年龄相关的护理人员相关的负担未得到充分认识和支持，AMS 干预措施可能不容易被老年护理人员接受。
