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.