Assignment: Early And Middle Adulthood Paper

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Prepare a 1,050- to 1,400-word paper in which you examine the psychological adjustments to aging and lifestyle that occur within individuals during early and middle adulthood. Be sure to include the following:

  • Discuss how social and intimate relationships evolve and change during early and middle adulthood.
  • Identify various role changes that occur during early and middle adulthood.
  • Examine the immediate and future impact of healthy and unhealthy habits practiced during early and middle adulthood.

Use a minimum of two peer-reviewed sources.

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Format your paper consistent with APA guidelines.

In general, however, they trust the nurses’ judgment

and recommendations. In two studies, doctors were

sometimes critical of nurses in terms of the quality of

communication and the accuracy of clinical information

conveyed to them [20, 22]. The nurses in the study by

Russell and Gallen [22] expressed frustration when doctors

did not trust their knowledge or judgment. Poor commu-

nication between nurses and doctors was discussed by

Carusone et al. [16] as having an impact on managing

infection; distrust between doctors and nurses may lead to

poor communication, which may compromise the quality

of patient care.

Family pressure on nurses and doctors was a theme that

emerged in seven studies [14, 15, 17, 18, 20–22]. The in-

fluence of residents’ families can result in increased pres-

sure to hospitalize a resident, to have a doctor assess a

resident or to prescribe an antibiotic [15, 20]. The fear of ill

consequences for residents or litigation from the family

was reported as impacting on decision making by doctors

[18, 22]. Some cultural differences within this theme were

found, as participants reported that family wishes had more

influence on doctors’ treatment decisions in the USA than

in the Netherlands [21].

3.3.3 Antimicrobial Resistance

The influence of AMR on antibiotic prescribing was raised

in only three studies [15, 20, 22]. Walker et al. [20] re-

ported that many nurses and doctors appreciate the need for

information to reduce AMR, but there was no further

elaboration around this in relation to antibiotic prescribing.

In the study conducted by Russell and Gallen [22], the

issue of AMR centred on methicillin-resistant Staphylo-

coccus aureus (MRSA), primarily in relation to the

knowledge of testing and treating MRSA. The doctors in

this study felt that their prescribing patterns had changed in

recent years but not as a result of MRSA or public health

concerns. The most recent study, by Lim et al. [15], pre-

sented mixed views in relation to AMR. Some doctors

reported little experience with multidrug resistance (MDR)

Antibiotic Prescribing in Long-Term Care Facilities 299

in their practice [15]. Other doctors reported increased

incidence rates of recurrent UTIs, catheter usage, antibiotic

prophylaxis and chronic wound colonization [15]. Only a

small proportion of nurses in this study were concerned

with AMR, with the main concern being ‘‘infection control

efforts in preventing MDR organism transmission’’ [15].

This study found that only a minority of doctors were

concerned that AMR would impact on their choice of

empirical antibiotics [15]. The views of pharmacists in-

cluded in the study regarding AMR were not presented.

3.3.4 Knowledge and Prescribing Practices

In all studies, the level of knowledge about infections and

antibiotics was reported as varying between health care

professionals [14–18, 20–22]. Walker et al. [20]

specifically investigated why antibiotics are prescribed for

asymptomatic bacteriuria. They noted that many miscon-

ceptions exist in practice about the symptoms of UTI and

that doctors’ and nurses’ views regarding positive dipstick

test results vary [20]. The ambiguity around interpretation

of urine sample results was reiterated in other studies [14,

17, 18, 20, 22]. In many cases, it was suggested that a UTI

was presumed to be present if a patient’s behaviour had

changed or if the urine had a strong smell or concentration

[17, 18, 20, 22]. Walker et al. [20] found that some doctors

would prescribe an antibiotic for an asymptomatic patient

if the urine culture was positive. Nurses in one study re-

ported different prescribing practices between doctors, with

some doctors being more reluctant to prescribe than others,

regardless of the patients’ clinical presentation [20].

The studies by Carusone et al. and Lohfield et al. [14,

16, 17] evaluated the implementation of pathways for

pneumonia and UTI, respectively. The aims of the trials

included reducing antibiotic prescribing. This suggested

existing knowledge on the part of the researchers that an-

tibiotic prescribing was not performed optimally in the

LTCF setting. The lack of implementation of guidelines for

treating UTI or MRSA was explained by a lack of

awareness of the guidelines by doctors [22]. Across all

health care professional groups, the main focus of decision

making was on accurately diagnosing an infection and then

deciding whether or not to prescribe an antibiotic.

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