Nurses' actions in response to nursing assistants' observations of signs and symptoms of infections among nursing home residents

Abstract

AimsTo describe what nurses do during episodes of suspected infection in elderly nursing home residents and if these actions are linked to who is initiating an episode and whether the episode is considered an infection or not.DesignProspective descriptive study. Data were collected in 2008–2010.MethodsSummarized and categorized documentation by nursing assistants and nurses was used for summative content analysis.ResultsNurses' actions seem to be related to who initiated the episode and if the episodes are categorized as ‘non‐infection’, ‘possible infection’ or ‘infection’. Actions could be ‘observation’, ‘screenings’, ‘engaged in waiting’, ‘follow‐ups’, ‘nurse‐prescribed actions’, ‘diagnosing’, ‘contacting the physician’, ‘carrying out an action prescribed by the physician’, ‘contacting an ambulance or arranging an emergency visit to the hospital’ and ‘prescribing screening’. As NAs often initiate episodes of suspected infection by observing changed conditions, it seems important to include the NA in the decision‐making process as these observations could detect possible early signs and symptoms of infections.

Variation in Normal Ear Temperature

“…Difftemp is especially useful in assessing suspected infections in frail elderly individuals with lower baseline temperatures, a wellknown clinical problem. [60][61][62] Based on the present results, it is reasonable to propose further clinical studies to explore whether a difftemp of approximately 1.0-1.5 1C accompanied by malaise could be considered to indicate increased temperature defined as fever.…”

Nurse Decision-making for Suspected Urinary Tract Infections in Nursing Homes: Potential Targets to Reduce Antibiotic Overuse

“…5 As the primary workforce in NHs, certified nursing assistants (CNAs) are typically the first to recognize symptoms of potential infections and then to report them to the licensed practical nurse (LPN) or registered nurse (RN). 6 In turn, nurses are responsible for noting changes in resident status, assessing the resident, identifying signs and symptoms of potential infections, collecting and testing urine samples, and deciding when to communicate the findings to the resident's clinician. 7,8 During this communication, they also may express the need for an antimicrobial.…”

“…A qualitative chart review study of infections in NH residents suggested that a patient's characteristics (eg, age, presenting symptoms, temperature, and UTI risk) were important to nurses' subsequent actions. 6 Other research on nurse decision-making in hospitals indicates that the nurse's clinical experience, 12 the nurse's work role, 13 and whether the nurse takes time to deliberate 14e18 can influence decision-making; however, this work is limited in scope and applicability to RN decision-making about suspected UTIs for NH residents. Current observational research examining antibiotic prescribing does not examine nurse decision-making in NHs and the decision to call a prescriber about a suspected UTI for NH residents.…”

Interpretation of Body Temperature and Oxygen Saturation based on Individual Normal Ranges in Habitual Condition: A Step Forward for Applied Precision Medicine

“…In addition, in frail elderly persons, temperature assessed as fever may be lower than the traditional limit 28 , due to a lower normal body temperature 15,29 . In combination with unclear signs and symptoms, this leads to delayed, incorrect or missing diagnosis and treatment [30][31][32][33][34][35][36] with increased risk of more serious illness and death, increased need for hospital care [37][38][39] , long recovery with risk of residual functional impairment after that the infection is cured 35,38,40 and risk of antibiotic resistance related to overtreatment 41,42 .…”