The Lived Experience of Nursing Staff in Skilled Nursing Facilities: Identification of Urinary Tract Infection in Residents

Abstract

Annually, 50-70% of skilled nursing facility (SNF) residents receive at least one antibiotic, with up to 75% of those prescribed inappropriately. One-third of the antibiotic prescriptions are ordered to treat urinary tract infections (UTI). Inappropriate antibiotic use may result in avoidable side effects and adverse outcomes, including death. The structure of the SNF and the complex medical conditions of residents present a unique challenge especially when health care providers (HCPs) are typically off-site with limited in-person visits. HCPs in SNFs frequently rely on nursing staff to make observations, recognize changes, communicate, and make recommendations, typically via telephone. The SNF nursing staff member communicating with the HCP, will likely be a licensed practical nurse (LPN). The SNF role of certified nursing assistants (CNAs) and LPNs in identification of UTI and decision-making by registered nurses (RNs), LPNs and CNAs have been vastly understudied. Ascertaining and acknowledging the lived experience of SNF nursing staffs' encounter with residents whom they suspect may have a UTI will improve our understanding of this experience. The purpose of this study was to describe the lived experience of nursing staff as they identify changes in SNF residents that may be indicative of a UTI. Chapter 4 presents a manuscript, published May 2022, of the integrative review which served as the literary foundation for this dissertation. Chapter 5 presents a manuscript, to be submitted for publication, outlining the dissertation study, and providing insight into SNF nursing staff perspectives and their contributions to UTI identification.