{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T01:47:39Z","timestamp":1780537659537,"version":"3.54.1"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Older People Nursing"],"published-print":{"date-parts":[[2023,9]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Antibiotics are often inappropriately prescribed for urinary tract infections (UTIs) in nursing home (NH) residents. Research emphasises the importance of prescribing antibiotics only if there are UTI\u2010related signs and symptoms (S&S). However, for many NH residents it is challenging to find out whether such S&S are present, for example due to cognitive disorders.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To provide insight into the assessment of UTI\u2010related S&S in NH residents with impaired awareness or ability to communicate S&S, and to develop supportive tools for the observation of UTI\u2010related S&S in this subgroup of NH residents, by nursing staff.<\/jats:p><\/jats:sec>Methods<\/jats:title>We performed a practice\u2010based study using mixed methods. Data of 295 cases of suspected UTI were analysed to determine how often UTI\u2010related S&S were \u2018not assessed\/non\u2010assessable\u2019 in residents with and without dementia. Barriers and facilitators in observing UTI\u2010related S&S in NH residents with impaired awareness or ability to communicate S&S were derived from interviews and focus groups with nursing staff. Literature review, focus group data, additional telephone interviews and questionnaires with nursing staff were used in a step\u2010by\u2010step process, including pilot testing, to develop supportive tools for the observation of UTI\u2010related S&S.<\/jats:p><\/jats:sec>Results<\/jats:title>UTI\u2010related S&S were assessable in the majority of NH residents with dementia. The proportion \u2018not assessed\/non\u2010assessable\u2019 S&S in residents with dementia increased with increasing severity of dementia. In residents with very severe dementia, up to 58% of the S&S were \u2018not assessed\/non\u2010assessable\u2019. Knowing the resident, working methodologically, and being sufficiently skilled to interpret observations in residents facilitate the assessment of UTI\u2010related S&S. Insights acquired during the different study elements resulted in the development of an observation checklist and a 24\u2010h observation tool.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The more NH residents have impaired awareness of ability to communicate S&S, the more difficult it seems to be to assess UTI\u2010related S&S. The observation checklist and 24\u2010h observation tool developed in the current study may support nursing staff in their observation of UTI\u2010related S&S in this group of NH residents.<\/jats:p><\/jats:sec>","DOI":"10.1111\/opn.12560","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T04:54:14Z","timestamp":1691729654000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Observation of urinary tract infection signs and symptoms in nursing home residents with impaired awareness or ability to communicate signs and symptoms: The development of supportive tools"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1251-6736","authenticated-orcid":false,"given":"Jorna","family":"van Eijk","sequence":"first","affiliation":[{"name":"Department of Medicine for Older People Amsterdam Public Health Research Institute, Amsterdam University Medical Centers Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9148-8694","authenticated-orcid":false,"given":"Jeanine J. 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