title: Participatory eHealth development to support nurses in antimicrobial stewardship.
abstract: BACKGROUND
  Antimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put antimicrobial treatment into effect. To optimally support nurses in ASPs, they should have access to information that supports them in their preparation, administration and monitoring tasks. In addition, it should help them to detect possible risks or adverse events associated with antimicrobial therapy. In this formative study, we investigate how nurses' can be supported in ASPs by means of an eHealth intervention that targets their information needs.
  
  
  METHODS
  We applied a participatory development approach that involves iterative cycles in which health care workers, mostly nurses, participate. Focus groups, observations, prototype evaluations (via a card sort task and a scenario-based information searching task) and interviews are done with stakeholders (nurses, managers, pharmacist, and microbiologist) on two pulmonary wards of a 1000-bed teaching hospital.
  
  
  RESULTS
  To perform the complex antimicrobial-related tasks well, nurses need to consult various information sources on a myriad of occasions. In addition, the current information infrastructure is unsupportive of ASP-related tasks, mainly because information is not structured to match nurse tasks, is hard to find, out of date, and insufficiently supportive of awareness. Based our findings, we created a concept for a nurse information application. We attuned the application's functionality, content, and structure to nurse work practice and tasks.
  
  
  CONCLUSIONS
  By applying a participatory development approach, we showed that task support is a basic need for nurses. Participatory development proved useful regarding several aspects. First, it allows for combining bottom-up needs (nurses') and top-down legislations (medical protocols). Second, it enabled us to fragmentise and analyse tasks and to reduce and translate extensive information into task-oriented content. Third, this facilitated a tailored application to support awareness and enhance patient safety. Finally, the involvement of stakeholders created commitment and ownership, and helped to weigh needs from multiple perspectives.
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, Enschede, the Netherlands. m.j.wentzel@utwente.nl.
authors.forename: Jobke
authors.initials: J
authors.lastname: Wentzel
authors.forename: Lex
authors.initials: L
authors.lastname: van Velsen
authors.forename: Maarten
authors.initials: M
authors.lastname: van Limburg
authors.forename: Nienke
authors.initials: N
authors.lastname: de Jong
authors.forename: Joyce
authors.initials: J
authors.lastname: Karreman
authors.forename: Ron
authors.initials: R
authors.lastname: Hendrix
authors.forename: Julia Elisabeth Wilhelmina Cornelia
authors.initials: JE
authors.lastname: van Gemert-Pijnen
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009729:Nursing / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D016730:Program Development / Q000379:methods*; D017216:Telemedicine / Q000379:methods*
chemical_list: D000890:Anti-Infective Agents