Re-envisaging Infection Practice Ecologies in Nursing (RIPEN) through Arts and Humanities Approaches

Antimicrobial resistance (AMR) and its consequences pose serious threats to health and welfare globally. Across the world nurses constitute the largest professional healthcare workforce and typically nurses have numerous daily interactions with healthy and ill individuals, family members, community groups and other care professionals. As such nurses have huge potential to make every contact count to reduce inappropriate prescribing and demand for antibiotics, and to enhance the effectiveness of those prescribed. However evidence on nursing's engagement with AMR indicates that the profession has not yet leveraged its potential to prevent AMR advancing or to countenance the consequences of failure.

Within this context the invisibility of pathogens and related AMR processes in everyday practice make AMR a relatively abstract issue. Based on our cross disciplinary research work involving contemporary visualisations of the pathogens, people and places that constitute practice ecologies, and on our historical research detailing eras of infection control practice in hospital settings, we believe that there is significant opportunity to enhance the meaningfulness of AMR for practicing nurses through expanded application of arts and humanities approaches. Thus we will address the main question:

How can relevant arts and humanities based approaches help nurses to re-envisage their infection control practice ecologies in response to antimicrobial resistance?

In doing so we will investigate four subsidiary questions:

1) How do groups of hospital and community based nurses understand and respond to the priorities and consequences of AMR within the context of their everyday working lives?
2) How can co-design and visualisation based approaches help these nurses to identify and construct sets of meaningful practices that optimise present prevention of AMR?
3) How can co-design, visualisation, history and other relevant arts and humanities approaches help nurses to re-imagine and re-envisage their infection control practice ecologies in a future with minimal or no effective antibiotics?
4) What priority issues and other questions does this initial enquiry raise, and how can these best inform policy and planning, education and further research?

Following a preparatory phase the main qualitative research will engage a group of hospital based nurses in Glasgow and a group of community based nurses in London. Structured around four sequential workshops with interim activities, these respective "Labs" will each address questions 1-3 using and evaluating different combinations of methods. The final phase of the research will involve a "Policy Lab" where the research team, advisory group and an invited range of policy experts and art and humanities academics will address question 4.

Through these means this novel study will produce the following deliverables:

a. Project outputs (e.g. journal publications) that demonstrate enhanced understanding of the nature and scope of nurses' engagement with AMR in a range of built environments including hospitals, GP surgeries and people's homes
b. Sets of prototyped AMR-related prevention practices that nurses believe they can meaningfully enact within these practice contexts
c. Project outputs in a variety of possible formats (written, visual, web-based) that demonstrate how nurses can re-envisage their infection practice ecologies in a future with minimal or no effective antibiotics
d. Identification of a set of priority issues and other key questions that arise from the enquiry and will inform a policy brief
e. An overarching analysis of the challenges, strengths and added value of deploying particular arts and humanities approaches within a health services research context

These will be of value to clinicians, the public as health service users, managers, planners and academics, and will yield potential for further practice, policy, research and educational developments.

In addition to the benefits for academics detailed elsewhere in this application, the RIPEN study has been designed to generate five deliverables of potential direct benefit to a range of important stakeholder groups. These are now summarised:

Demonstration of enhanced understanding of the nature and scope of nurses' engagement with AMR in a range of built environments (including hospitals, GP surgeries and people's homes) will be of particular benefit to nursing and allied healthcare professions and health and social services managers. Few in-depth studies of this engagement exist and the application of arts and humanities approaches can illuminate this from a different angle, enabling more informed and nuanced planning and delivery of services. The production of sets of prototyped AMR-related prevention practices that nurses believe meaningful for practice contexts can bring added value for these clinical stakeholders.

Looking further ahead, project outputs in a variety of possible formats (written, visual, web-based) will demonstrate how nurses can re-envisage their infection practice ecologies in a future with minimal or no effective antibiotic therapies. There is a dearth of such thinking within nursing and other health services at present so this study can provide an exemplar to stimulate engagement. This will be of particular relevance to health and social policy planners and the general public as participants in health and social care. Impact will be enhanced through the fourth deliverable: identification of a set of priority issues and other key questions that arise from the enquiry. In drawing together the main findings and related questions there is the potential to inform these key stakeholders, and the relevant professional practitioner groups, in a compelling way that enables preventative actions to be identified and progressed.

The final deliverable entails producing an overarching analysis of the challenges, strengths and added value of deploying particular arts and humanities approaches within a health services research context. This will yield particular insights into processes involving models, methods and materials. This may be of interest to all stakeholder groups but will be of specific relevance to practitioners, especially those with integral research and education remits. In this way practice, education and research can be enriched to enable further methodological developments and learning gains.

These stakeholders will be reached through: direct involvement in the study (nurses, allied health professionals, lay members, and invited arts and humanities experts) and in the creation and dissemination of its associated outputs; the involvement, advocacy and networks of the six Advisory Group members who are ideally placed to engage key members of the practice, managerial, policy, education, and service user group/lay communities; the "designing-in" of a Policy Lab facilitated by King's College Policy Institute in order to harness the main findings and leverage further influence with key policy groups; the planned dissemination programme involving journal publications, conference presentations and public outreach events; the extensive professional activities and networks of the cross-disciplinary research team; and the easy accessibility of the project's website which will serve as a window on the progress, processes and key outputs of the study.