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In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).
Prospective surveys during January–June 2018.
All acute and long-term care units of 4 Veterans’ Affairs facilities.
The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).
A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.
Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.
This paper examines the idea of embedding Indigenous perspectives drawing upon a metaphor for designing an environment that nurtures Indigenous cultural identity and relationships. This paper constitutes a teacher’s personal story of emerging understandings of Indigenous Standpoint Theory and pedagogy, which began with embedding Indigenous perspectives within a tertiary music and sound curriculum. These understandings were developed into “rules of thumb” that have had transferable implications for research that examines community music-making projects in urban Indigenous and cross-cultural communities. These ideas are explored through case studies that examine them in context. Furthermore, the idea of embedding Indigenous perspectives in my own value systems is explored and a growing awareness of the embodied understanding that stems from an open, continuous and critical discourse with Indigenous people. This reveals a relationship of belonging and welcoming interfaced with obligation and a growing knowledge of people, community and country and its effect on my “white understanding” of relationships. This proposal stems from several successful projects where participants have experienced both nurturing of Indigenous knowledge and a productive tension. This does not advocate an argument for positive discrimination but rather seeks to build the idea that interfaces which simultaneously develop embodied understanding alongside Indigenous pride can lead to compelling and unique learning experiences for students, teachers and communities.
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