key: cord-0881555-2401425f
authors: Topping, Annie
title: Commentary: Fostering nursing innovation to prevent and control antimicrobial resistance using approaches from the arts and humanities
date: 2020-05-03
journal: J Res Nurs
DOI: 10.1177/1744987120914761
sha: 9be813504098b478a71cbd56b87f391bbd0b8c6c
doc_id: 881555
cord_uid: 2401425f

nan

that is invisible (pathogenic microorganisms) until harm is present and where the evidence of effective prevention is absent. I was minded of her words in Notes on Nursing when writing this commentary and reviewing the paper: It cannot be necessary to tell a nurse that she should be clean, or that she should keep her patient clean, -seeing that the greater part of nursing consists in preserving cleanliness. (Nightingale, 1860: 87). So to this interesting paper which outlines an approach designed specifically to foster the imagination and creativity of participants. This article only represents initial findings, and focusses on the discovery phase with data relating to practice 'as is' and the meaning of AMR to those involved. The researchers drew on methods of visualisation and co-design underpinned by the Double Diamond model developed by the UK Design Council (2015) to act as a way of conceptualising the process framing imagination and innovation in design. In the paper the authors focused on the discovery phase of the Double Diamond (discover, define, develop and deliver) model. The authors position the study theoretically within Sullivan's (2005) dimensions of visualisation and normalisation process theory (May and Finch, 2009 ). They should be applauded for grappling with theory, particularly as it may serve to make any sensemaking they employ more transparent, and ultimately findings more transferable. This is particularly significant as they entered the field with the objective to comprehend how nurses understood AMR and 'AMR work' and how nurses differentiated between AMR and IPC. They also sought to recruit a heterogeneous group of nurses to the two workshops that represented different settings, experience and level of specialisation, and had to limit the recruitment of IPC specialists who volunteered. This is significant at two levels: first if nurses are truly to contribute to antibiotic stewardship (Castro-Sanchez et al., 2019) it will be universally irrespective of role and context. Second, the researchers found that IPC specialists connected AMR, hygiene and IPC most clearly evident through the story-boarding activity they used. It is clear from the evidence that a policy driven top-down approach may not have the greatest influence in terms of mobilising the agency of nurses in addressing AMR. Yet most learning, as described in this paper, seemed to come from IPC specialist to 'generalist' nurse participants and not vice versa. This may as be my reading but begs questions about onward transfer of accepted reality (Collins and Stockton, 2018) , the ownership of knowledge and work (whose role is AMR and/or IPC) and the problematic tension with specialisation within nursing and healthcare. I hope that this does not threaten any important contribution nurses can make to global health through antimicrobial stewardship.

Annie Topping is a nurse, health-services researcher and educator whose primary research focus is on improving patient outcomes and experience of care delivery, particularly in cancer, chronic illness and women's health. She is Professor of Nursing at the University of Birmingham in partnership with University Hospital Birmingham NHS Foundation Trust where she is also actively involved in nursing, midwifery and AHP research capacity and capability building across Birmingham and the wider West Midlands health community.

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Global action plan on antimicrobial resistance