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.
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  expressed frustration when doctors
did not trust their knowledge or judgment. Poor commu-
nication between nurses and doctors was discussed by
Carusone et al.  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 .
3.3.3 Antimicrobial Resistance
The influence of AMR on antibiotic prescribing was raised
in only three studies [15, 20, 22]. Walker et al.  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 , 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. , 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 . Other doctors reported increased
incidence rates of recurrent UTIs, catheter usage, antibiotic
prophylaxis and chronic wound colonization . 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’’ .
This study found that only a minority of doctors were
concerned that AMR would impact on their choice of
empirical antibiotics . 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. 
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 . 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.  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 .
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 . 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.