This document summarizes a study that explored nurses' experiences caring for patients over 65 years old who were receiving antibiotics. The study found that nurses play a pivotal role through their nursing practice, infection prevention efforts, and teamwork. Their close relationships with patients and awareness of "little changes" allow them to identify potential infections. Preventing antibiotic use when possible is important. The nurses emphasized the importance of communication, education, and collaboration between nurses and other staff to ensure optimal antibiotic use and care for older patients. The findings suggest nurses have valuable knowledge about antibiotic use in older adult settings that could inform nursing education, practice, and policies.

1. Nurses’ Experiences of Antibiotic Use
in a
Healthcare Setting Caring for People
Over
Sixty-Five Years
Donna Mitchell
Clinical Nurse Specialist
Infection Prevention and Control,
St Mary’s Campus,
Phoenix Park,
Dublin 20
donna.mitchell@hse.ie
Telephone: 625 0427 or 0879195250

2. Antibiotics & over 65s
Background
• Antibiotics are the most prescribed medication globally
and resistance is an issue.
• The population of over 65s is increasing. Longer life
expectancy increases the chance of receiving antibiotics.
• Registered Nurses are the largest group of professionals
in the health service and work closely with people over
65.

3. Aim of the Study
To explore nurses ’ experiences of caring for patients who
are receiving antibiotics as part of their care plan, in a
healthcare setting caring for people over 65.
Research Design
Hermeneutic phenomenology was the chosen qualitative
method used:
to explore nurses’ experiences of caring for
patients receiving antibiotics
describe how they cared for and managed patients
receiving antibiotics
to inform discussions in relation to guideline
development on antibiotic use for people over 65
years of age.

4. Data Collection
Unstructured Interviews
Sample group
8 participants – registered nurses with a minimum of 6
month experience working with adults over 65 years
Data Analysis
5 step framework outlined by Cohen, Kahn &
Steeves (2000).

5. Findings
3 Themes emerged:
• Nursing Practice
• Infection Prevention
• Teamwork

6. Nursing Practice
• Registered Nursing practice in settings
caring for people over 65 was a key
theme.
• “Little changes” that was noted by staff
sometimes indicated infection. Nursing
models used for planning care.
• Data provided matches the literature for
reasons that antibiotics were prescribed.
• Varying perceptions on uses of antibiotics
– sometimes depended on the prescriber.

7. Infection Prevention
• Preventing antibiotic use in the first
instance was important.
• Quality nursing care came within this
theme.
• Registered nurses are responsible for
quality of care provided.
• Awareness of infections and how to
prevent them.
• Infection prevention measures.

8. Teamwork
• It is “everybody’s” role to work
collaboratively although nurses know
patients well to lead on care.
• Collaboration regarding infection
prevention and control via informal
networks as well as formal committees.

9. Teamwork
Communication –
•“...in my group, if someone is on an antibiotics I will
tell the person they’re on them 3 times a day or they’re
on them 4 times a day and I just say it’s important that
we give them hourly drinks and it’s important that they
have to let me know …they require small portions of
food….main meals just to give them snacks in
between. If I think they’re able…we might get them up
for an hour…it may be in the morning it may be in the
afternoon …it’s just all those things. I will discuss with
the healthcare assistant that’s with me...” participant 6,
page 9, line 244-247.

10. Subthemes
» Reasons for antibiotic use
» Monitoring patient care
» Knowing the person
» Care planning
» Effectiveness
» Education
» The team
» Communication
» Accountability

11. Summary of Findings/Implications for Practice
Highlighted that:• Nurses’ experiences in this setting has implications for
nursing education, practice and management in relation
to antibiotic use in people over 65 years of age.
• Nurses have a pivotal role to play in achieving optimal
antibiotic use in healthcare settings caring for people
over 65.
• This study identified the valuable knowledge that nurses
have in relation to antibiotic use in these settings such as
knowing the person with the 'little things' making up the
bigger picture.

12. Policy
Policy

13. HALT – matching the data
National:
• 5910 residents surveyed
ranging from 5 to 203
beds
• 5.0% had HCAI
• 9.5% prescribed
antimicrobials
• 62% had access to IPC
practitioner [76% of these
based off-site]
• GP care 43%, medical
staff employed 33%, both
in 24%.
St Mary’s:
• Larger scale bed size
• 1.6% had HCAI
• 4.3% prescribed
antimicrobials

14. Finally
• You have a role to play in antibiotic
advice, responsibility, education and
practices.
• Nurses are in an ideal position to educate
patients and the public on changing /
appropriate antibiotic use.
• Utilise national guideline on antibiotic use
for reference – www.hpsc.ie

15. Thank you