Select two theoretical perspectives from which to explain psychosocial development throughout the lifespan (i.e. Freud and Erikson, etc.). Describe the major tenets of each theory. Compare and contrast the two approaches to explaining development.
At this stage, 25 papers were excluded, leaving
nine relevant studies, which were appraised for quality,
using the CASP tool (see ESM Online Resources 1 and 3).
One study was excluded on the basis of this assessment;
therefore, eight studies were included in the analysis.
296 A. Fleming et al.
3.2 Study Characteristics
The details of the included studies are displayed in Table 1.
All studies were conducted in LTCFs. Most studies in-
cluded a mixed health care professional sample of nurses
and doctors. One study included medical directors and
administrators in the sample [14]. The most recently pub-
lished study included nurses, doctors and pharmacists [15].
The focus of the studies was respiratory tract infection
[RTI] (n = 3), urinary tract infection [UTI] (n = 2),
asymptomatic bacteriuria (n = 1) or pneumonia (n = 1),
and another study investigated antibiotic prescribing in
LTCFs in general.
The studies that were included collected their data by
interviews (n = 3) or focus group discussions (n = 2), and
three studies used interviews and focus group discussions.
Three studies were conducted to review the implementa-
tion of an infection management intervention: two re-
viewed an RTI care pathway and one reviewed a UTI care
pathway, implemented during randomized controlled trials
[14, 16, 17].
The quality appraisal of the studies found that all studies
clearly stated their research aims and used qualitative
methods appropriately (see ESM Online Resource 1). The
research design was discussed in detail, and in all studies,
the recruitment of participants was explained and justified.
The method of data collection was presented in sufficient
detail in all studies. One area where nearly all studies were
lacking was that of researcher reflexivity. Two studies did
not state whether they had obtained ethical approval or not
Fig. 1 Flow diagram outlining the identification of papers from
searches. LTCF Long-term care
facility
Antibiotic Prescribing in Long-Term Care Facilities 297
T a
b le
1 C
h ar
ac te
ri st
ic s
o f
th e
ei g
h t
st u
d ie
s in
cl u
d ed
in th
e sy
n th
es is
R ef
er en
ce s
G eo
g ra
p h
ic al
lo ca
ti o
n P
ar ti
ci p
an ts
D at
a co
ll ec
ti o
n A
n al
y si
s A
im
C ar
u so
n e
et al
.,
p ar
t I
[1 6 ]
O n
ta ri
o ,
C an
ad a
2 4
N u
rs es
7 F
o cu
s g
ro u
p s,
1
in te
rv ie
w
T h
em at
ic an
al y
si s
(t em
p la
te 5
p h
as e)
a T
o d
et er
m in
e n
u rs
es ’
p er
sp ec
ti v
es o
n th
e u
ti li
ty an
d
su st
ai n
ab il
it y
o f
an R
T I
p at
h w
ay
C ar
u so
n e
et al
.,
p ar
t II
[1 4 ]
O n
ta ri
o ,
C an
ad a
6 A
d m
in is
tr at
o rs
, 2
m ed
ic al
d ir
ec to
rs
In te
rv ie
w s
T h
em at
ic an
al y
si s
(t em
p la
te 5
p h
as e)
T o
d et
er m
in e
ad m
in is
tr at
o rs
’ v
ie w
s o
f an
R T
I
p at
h w
ay an
d co
m p
ar e
th em
w it
h n
u rs
es ’
v ie
w s
(f ro
m C
ar u
so n
e et
al .,
p ar
t I
[1 6 ])
H el
to n
et al
. [2
1 ]
N et
h er
la n
d s;
N o
rt h
C ar
o li
n a,
U S
A
P h
y si
ci an
s (N
et h
er la
n d
s: 1
2 ;
N o
rt h
C ar
o li
n a:
1 2
)
S em
i- st
ru ct
u re
d in
te rv
ie w
s E
d it
in g
an al
y si
sb T
o ex
p lo
re th
e fa
ct o
rs in
fl u
en ci
n g
tr ea
tm en
t
d ec
is io
n s
w h
en n
u rs
in g
h o
m e
p at
ie n
ts w
it h
d em
en ti
a b
ec o
m e
ac u
te ly
il l
w it
h p
n eu
m o
n ia
L im
et al
. [1
5 ]
V ic
to ri
a, A
u st
ra li
a 4
0 N
u rs
es ,
1 5
G P
s, 6
p h
ar m
ac is
ts
F o
cu s
g ro
u p
s, se
m i-
st ru
ct u
re d
in te
rv ie
w s
F ra
m ew
o rk
an al
y si
s T
o ex
p lo
re p
er ce
p ti
o n
s an
d at
ti tu
d es
o f
k ey
h ea
lt h
ca re
p ro
v id
er s
to w
ar d
s an
ti b
io ti
c p
re sc
ri b
in g
L o
h fi
el d
et al
.
[1 7
]
O n
ta ri
o ,
C an
ad a;
Io w
a, U
S A
5 2
N u
rs es
, 1
9 ad
m in
is tr
at o
rs 1
9 In
te rv
ie w
s, 1
0 fo
cu s
g ro
u p
s
E d
it in
g st
y le
o f
an al
y si
s T
o ex
am in
e th
e v
ie w
s o
f n
u rs
es an
d ad
m in
is tr
at o
rs
re g
ar d
in g
a cl
in ic
al p
at h
w ay
fo r
m an
ag in
g U
T Is
R u
ss el
l an
d
G al
le n
[2 2 ]
E n
g la
n d
8 N
u rs
es ,
5 d
o ct
o rs
2 F
o cu
s g
ro u
p s
T h
em at
ic an
al y
si s
T o
d et
er m
in e
th e
fa ct
o rs
in fl
u en
ci n
g an
ti b
io ti
c
p re
sc ri
b in
g in
n u
rs in
g h
o m
es
S ch
w ei
ze r
et al
.
[1 8
]
B el
fa st
, N
o rt
h er
n
Ir el
an d
1 0
G P
s, 1
0 n
u rs
es S
em i-
st ru
ct u
re d
in te
rv ie
w s
T h
em at
ic an
al y
si s
T o
es ta
b li
sh th
e d
ec is
io n
m ak
in g
p ro
ce ss
fo r
U T
Is
b y
q u
al it
at iv
e m
ea n
s to
id en
ti fy
st ep
s in
th e
p ro
ce ss
W al
k er
et al
. [2
0 ]
O n
ta ri
o ,
C an
ad a
8 N
u rs
es ,
8 d
o ct
o rs
F o
cu s
g ro
u p
T h
em at
ic an
al y
si s
T o
ex p
lo re
p er
ce p
ti o
n s,
at ti
tu d
es an
d o
p in
io n
s o
f
d o
ct o
rs an
d n
u rs
es ab
o u
t as
y m
p to
m at
ic b
ac te
ri u
ri a
G P
g en
er al
p ra
ct it
io n
er ,
R T
I re
sp ir
at o
ry tr
ac t
in fe
ct io
n ,
U T
I u
ri n
ar y
tr ac
t in
fe ct
io n
a T
em p
la te
an al
y si
s: th
e te
x t
is o
rg an
iz ed
ac co
rd in
g to
p re
-e x
is ti
n g
th eo
re ti
ca l
o r
lo g
ic al
ca te
g o
ri es
, to
p ro
v id
e n
ew d
es cr
ip ti
o n
s o
f p
re v
io u
sl y
k n o
w n
p h
en o
m en
a [3
0 ]
b E
d it
in g
an al
y si
s: u
n it
s in
th e
te x
t ar
e id
en ti
fi ed
th at
fo rm
th e
b as
is fo
r d
at a-
d ev
el o
p ed
ca te
g o
ri es
; th
es e
ar e
u se
d to
re o
rg an
iz e
th e
te x
t so
th at
th e
m ea
n in
g ca
n b
e cl
ea rl
y se
en [3
0 ]
298 A. Fleming et al.
[17, 18]. One study was excluded on the basis of the quality
assessment, as it was reported as a preliminary qualitative
study, which had a small sample size and did not reach data
saturation [19]. There was no loss of relevant findings on
exclusion of that study. Themes and sub-themes that were
derived from the thematic analysis, with supportive quo-
tations from the studies, are presented in ESM Online
Resource 4. A summary of the presence of the main themes
within each included study is provided in ESM Online
Resource 5.
3.3 Themes
3.3.1 The Long-Term Care Facility Context
The influence of the context of health care delivery in
LTCFs was reported by nurses and doctors in most of
the included studies. In two studies, it was noted that
care of patients in the LTCF setting, rather than in the
acute hospital setting, is better [14, 16]. This is linked to
the relationship between the patient and the nurses and
doctors. When the doctor, nurse or care assistant in the
LTCF knows the patient for many years, it is likely that
they will detect subtle changes in clinical signs and
symptoms that could suggest infection [16, 20, 21].
Doctors providing on-call duty reported difficulty when
managing patients that they did not know well, and they
often prescribed an antibiotic to ‘‘cover themselves’’
[20]. There were many challenges reported by nurses and
doctors in diagnosing patients with infection in LTCFs.
The delay in obtaining microbiology results for urine
samples was perceived as leading to increased empirical
prescribing of antibiotics [15, 17, 18, 22]. Participants
often depend on dipstick test results, interpreting a pa-
tient’s change in behaviour or changes in the urine as a
UTI [18, 20]. The difficulty in collecting urine samples
from these patients was highlighted, as residents are
often bed bound and incontinent [18]. Co-morbidities,
such as cognitive impairment and incontinence, chal-
lenged the nurses’ and doctors’ ability to diagnose in-
fection and conduct the necessary investigations. Not
having a doctor on-site to assess patients as quickly as
possible was also identified as a challenge to fast diag-
nosis and care [16–18, 22]. Prescribing of antibiotics
without assessment by the doctor was referred to in
several studies [17, 18]. The reasons that may have
contributed to this included lack of time on the doctors’
part to visit the LTCF and poor reimbursement for LTCF
patient care, which resulted in reduced visits. Russell and
Gallen [22] reported that many prescriptions were
ordered over the telephone and that nurses were worried
that antibiotic prescribing was conducted as a substitute
for coming to see the patient.
3.3.2 Social Factors Influencing Prescribing
The central role of the LTCF nurse emerged as a very
strong influence on antibiotic prescribing and infection
management, as reported by nurses, doctors, administrators
or pharmacists. It was evident that patient care in the LTCF
is led by nurses, who are primarily responsible for detect-
ing infection, assessing patients, taking microbiology
samples where possible and communicating this informa-
tion to the doctors [15, 20, 22]. Doctors reported that they
depend on and trust the nurses’ judgment in many cases
[15, 20, 22]. In most studies, the doctors reported that nurse
pressure can sometimes lead to increased use of antibiotics
[15].
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
Our Services
Ace Writing Center has stood as the world’s leading custom essay writing services providers. Once you enter all the details in the order form under the place order button, the rest is up to us.
Essays
At Ace Writing Center, Nowadays, students normally have extremely busy schedules. You will note that some of them have to take on some evening or weekend jobs in order to get some income that can help them to sustain in college or in the university. This can deny them a chance to write all the essays given. Others usually get bombarded with a lot of work by their lecturers. This can still delay such students from working on all their essays. However, some of them usually try to work on all these essays but end up delivering their work late. This can prevent them from graduating since most lecturers are strict on deadlines. If you want to write a business essay, the wise way is to hire an outstanding essay writing service like us, so that you can get the best results. If you are keen, you will note that many companies usually overcharge their customers. Some of them are there only to make money. And in reality, they really don’t care to build a long term commitment with students. You should not choose such companies. You should take your time and choose a reliable company to work with. Ace Writing Center is the ultimate solution for you. We have been offering our writing service for more than 7 years. This is a clear indication that you will get quality essay writing service. We have a wide range of writers who can work on any business essay that you might have. We believe in doing extensive research so that we can provide quality work to all our clients. .
Admissions
Admission and Business Papers
Have you ever had to write an admission essay for college? The majority of students face the same issues when applying to a university or college and many in such situations decide they need professional help to cope with this matter. They get in a situation when the deadline keeps coming closer but lack motivation to start because they are just not sure if their writing skills are strong enough. We have a solution for you! Ace Writing Center is the best admission essay writing service with a large professional team and years of experience in providing high-quality papers to students of all levels and faculties. The mission of our team is to help students make their dreams of entering a good college come true and that’s what we offer!.
Editing
Editing and Proofreading
Sometimes all the words for your paper just flow out of your mind and into your fingers. You type quickly at your keyboard and there they are, your beautiful words right there on the screen. But you have no idea how to polish it up. You may be wishing there was a paper writing service that offered this type of writing service. Look no more! Here at Ace Writing Center, we offer you an editing and proofreading option that you can't find anywhere else..
Coursework
College Essay Writing
In case you are familiar Ace Writing Center, you know the way to distinguish a better company from a cheap one exactly. First of all, poor service website does not have a sufficient support. We think support team is an essential part of success; it has to answer all clients’ questions and be a connecting link between clients and their writers. On our web-service you will get answers about anything you need and your writer will receive all your instructions, assignments and requirements exactly and swiftly. A writing service that we run has got a flexible pricing system that will save you from senseless wastes and many bonus systems that let you sparing money for something important for you.
