Professional learning in healthcare settings in resource-limited environments: what are the tensions for professionals’ knowing and learning about antimicrobial resistance?

Abstract

This article examines tensions that professionals in healthcare settings in low-to-middle income countries (LMICs) face in the evolving field around surveillance of antimicrobial resistance (AMR). Few public health problems are of greater global importance today than AMR, that poses a threat to our ability to treat infections. In this context, the microbiology laboratory occupies a prominent place and the knowledge field of microbiology is expanding. In this study, we interviewed twentythree (n = 23) professionals with expertise on AMR and public health systems to synthesise knowledge on strengthening AMR surveillance in LMICs. By drawing on a practice approach [Schatzki, T. R. 2001. "Practice Ttheory." In The Practice Turn in Contemporary Theory (1-14), edited by T. R. Schatzki, K. Knorr-Cetima, and E. von Savigny. New York: Routledge.] combined with socio-cultural and cultural-historical theories (CHAT) [Engeström, Y. 1987. Learning by Expanding: An Activity-Theoretical Approach to Developmental Research. Helsinki: Orienta-Konsultit] the analysis reveals seven tensions between elements of the systems and discusses how such tensions serve to frame implications for implementing a capacity strengthening programme. The analysis shows that the novelty of the AMR as well as being a multi-disease and multisectoral by nature challenges existing forms of professional practice in healthcare settings. It also suggests that AMR requires to be dealt with through inter-professional and inter-sectoral approaches, while maintaining a focus across the local, national, and global systems, which is essential for initiatives that are set to address challenges to global health.

Gaps and barriers in the implementation and functioning of antimicrobial stewardship programmes: results from an educational and behavioural mixed methods needs assessment in France, the United States, Mexico and India

“…lack of consideration of long-term outcomes) and influences of capitalism that promote ‘perverse antimicrobial prescription’ without thorough assessment of need. 35 , 36 Additionally, a 2014 situational analysis of India by Madhok et al . 6 found that ‘reporting of incidents related to patient safety is seen as an act of complaining’, which ‘discourages reporting or owning mistakes’.…”

Antimicrobial resistance challenging professional learning in three LMICs

“…At the local level, there are insufficient protocols to enable cross-sectoral collaboration and information sharing across different professions. This was raised as a significant challenge, fundamental to the reduction of AMR (Sayed et al, 2018;Charitonos and Littlejohn, 2021). Similar concerns were raised in connection with national-level collaboration.…”

“…Recent work by Singh and Manchada (2017) identified following challenges: limited diagnostic capability of laboratories; low numbers of trained professionals trained; poor collaboration across different parts of the health system; and insufficient policy legislation to ensure high-quality surveillance data. Other studies have identified challenges around actions of raising the awareness of AMR, and emphasizing the importance of improved infrastructure, information and regulation (Pearson and Chandler, 2019); limited levels of communication between local clinics and central or national laboratories (Sayed et al, 2018); rigid structures and rules in workplace settings that hinder new AMR surveillance practice (Charitonos and Littlejohn, 2021); issues associated with hierarchies in health care (Gebretekle et al, 2018) leading to issues of trust among clinicians and lab workers (Charitonos and Littlejohn, 2021); and problems caused by the practices of clinicians who do not draw on the expertise of other specialists, such as nurses or pharmacists (Charani et al, 2019).…”

A Tasty Encounter with Routine Dynamics Ideas

“…in primary care (NHS, 2019)? A related question then, might be in how the expansive facets of learning are born: from changes in the range of professionals involved, in their divisions of labour/job descriptions, repertoires of actions/action sequences, and sites of work established in the unfolding of larger projects of change (Charitonos & Littlejohn, 2021); which empirical data are reflective of key ideas in these 'master conceptual schemes' (Merton, 1968) on offer for example, in considering the routine, dynamic, or expansive ingredients of change?…”