Stewardship Network Research Articles

Nurses' attitudes, behaviours, and enablers of intravenous to oral switching (IVOS) of antibiotics: a mixed-methods survey of nursing staff in secondary care hospitals across the Midlands region of England

Intravenous (IV) antibiotic use in secondary care in England is widespread. Timely appropriate intravenous to oral switch (IVOS) has the potential to deliver significant clinical and operational benefits. To date, antimicrobial stewardship (AMS) efforts around IVOS have not focused on the nursing staff who administer antibiotics, which represents a significant gap in AMS programmes. To determine the involvement of bedside nurses in acute trusts in the Midlands region of England in IVOS in their organizations and describe their views regarding how to improve IVOS. An anonymous self-administered mixed-methods online survey was developed and distributed to nursing staff in acute trusts via antimicrobial stewardship networks between March and May 2023. Quantitative data was analysed to describe participant demographics and behaviours, whereas barriers and enablers to IVOS were explored through thematic content analysis of responses to open-ended questions. A total of 545 nursing staff responded to the survey. The majority (65.3%) routinely suggested IVOS to clinicians, despite only 50.6% being aware of local IVOS policies. One-third (34.7%) did not suggest IVOS, relying on doctors, believing their patients needed IV treatment, or lacked knowledge and skills to request IVOS. Content analysis of suggestions for improving the rate of IVOS proposed three major themes (People, Process, System) and identified that education and training, improved confidence and interprofessional relationships, and prompts were important drivers. Nursing staff suggest IVOS to other clinicians, but more education and resources are needed to enable and empower them in this role.

Increasing Local Productivity Through a Regional Antimicrobial Stewardship Collaborative.

Antimicrobial stewardship programs (ASPs) are vital to improving patient safety and ensuring quality of care but are often underresourced, limiting their effectiveness and reach. While barriers to ASP success have been well documented, approaches to address these barriers with limited resources are needed. Stewardship networks and collaboratives have emerged as possible solutions. In January 2020, 5 US Department of Veterans Affairs facilities created a regional ASP collaborative. In this article, we describe the impact of this collaborative on the productivity of the facilities' ASPs. ASP annual reports for each of the 5 facilities provided retrospective data. Reports from fiscal year (FY) 2019 and reports from FY 2020-2022 were reviewed. Staffing, inpatient and outpatient stewardship reporting, individual and collaborative initiatives, and publications data were collected to measure productivity. Yearly results were trended for each facility and for the region. Additionally, the COVID-19 antibiotic use dashboard and upper respiratory infection dashboard were used to review the impact of initiatives on antibiotic prescribing during the collaborative. Regular reporting of outpatient metrics increased; 27% of measures showed improvement in 2019 and increased to 60% in 2022. For all 5 facilities, ASP initiatives increased from 33 in 2019 to 41 in 2022 (24% increase) with a corresponding increase in collaborative initiatives from 0 to 6. Likewise, publications increased from 2 in 2019 to 17 in 2022 (750% increase). Rates of reporting and improvement in inpatient metrics did not change significantly. The ASP collaborative aided in efficiency and productivity within the region by sharing improvement practices, distributing workload for initiatives, and increasing publications.

Self-Reported Effects of the Covid-19 Pandemic on Stewardship Organizations and Their Activities in Southeast New England, USA

In many communities, regions, or landscapes, there are numerous environmental groups working across different sectors and creating stewardship networks that shape the environment and the benefits people derive from it. The make-up of these networks can vary, but generally include organizations of different sizes and capacities. As the Covid-19 pandemic (2020 to the present) shuts down businesses and nonprofits, catalyzes new initiatives, and generally alters the day-to-day professional and personal lives, it is logical to assume that these stewardship networks and their environmental work are impacted; exactly how, is unknown. In this study, we analyze the self-reported effects of the Covid-19 pandemic on stewardship groups working in southeast New England, USA. Stewardship organizations were surveyed from November 2020 to April 2021 and asked, among other questions, "How is Covid-19 affecting your organization?" We analyzed responses using several qualitative coding approaches. Our analysis revealed group-level impacts including changes in group capacity, challenges in managing access to public green spaces, and altered forms of volunteer engagement. These results provide insights into the varied effects of the Covid-19 pandemic and government responses such as stay-at-home orders and social distancing policies on stewardship that can inform the development of programs to reduce negative outcomes and enhance emerging capacities and innovations.

Using Peer-to-Peer Knowledge Transfer to Build Marine Oil Spill Preparedness Capacity and Foster Resilience Among Indigenous Communities

ABSTRACT Indigenous communities often bear disproportionate risks from marine oil spills because of their close connections to and reliance on marine ecosystems. The impacts of an oil spill on Indigenous people and communities can be far-reaching, even for incidents that might be considered “small” from the perspective of the response community. Building community capacity for oil spill preparedness and response is a critical component to creating resilience within Indigenous communities. While the fundamental elements of capacity are the same for Indigenous communities as for any other coastal community, the approach requires an understanding and respect for Traditional Knowledge, Indigenous governance structures, and existing stewardship networks. Oil spill preparedness and response traditionally follows a top-down approach within both government and industry, because marine oil spills are low frequency, high consequence, highly complex incidents where multiple organizations and jurisdictions must work together. While this reality applies regardless of whether an oil spill impacts Indigenous communities, a top-down approach can be experienced as a threat to self-governance and compromise the effectiveness of capacity-building efforts. There is a significant body of research in support of the concept that resilience to emergencies and disasters among Indigenous people must build upon existing social, cultural, and familial structures in order to be effective. This requires a fundamentally different approach that builds from the ground up with the goal of ultimately meshing with the existing preparedness and response framework. Peer-to-peer learning and knowledge transfer is an approach that has been used in support of a range of initiatives among Indigenous communities, such as human health initiatives. The same approach may provide a mechanism to empower Indigenous communities to enhance both capacity and resilience. This paper presents a case study from ongoing work to connect Indigenous communities from Canada's High Arctic and Pacific Coast in support of marine oil spill preparedness and response.

Increasing Voluntary Public Health Reporting to the NHSN Antimicrobial Use Option

Background: The CDC NHSN launched the Antimicrobial Use Option in 2011. The Antimicrobial Use Option allows users to implement risk-adjusted antimicrobial use benchmarking within- and between- facilities using the standardized antimicrobial administration ratio (SAAR) and to evaluate use over time. The SAAR can be used for public health surveillance and to guide an organization’s stewardship or quality improvement efforts. Methods: Antimicrobial Use Option enrollment grew through partner engagement, targeted education, and development of data benchmarking. We analyze enrollment over time and discuss key drivers of participation. Results: Initial 2011 Antimicrobial Use Option enrollment efforts awarded grant Funding: to 4 health departments. These health departments partnered with hospitals, which encouraged vendors to build infrastructure for electronic antimicrobial use reporting. CDC supported vendors through outreach and education. In 2012, with CDC support, Veterans’ Affairs (VA) Informatics, Decision-Enhancement, and Analytic Sciences Center and partners began implementation of Antimicrobial Use Option reporting and validation of submitted data. These early efforts led to enrollment of 64 facilities by 2014 (Fig. 1). As awareness of the antimicrobial use option grew, we focused on facility engagement and development of benchmark metrics. A second round of grant Funding: in 2015 supported submission to the Antimicrobial Use Option from additional facilities by Funding: a vendor, a healthcare system, and an antimicrobial stewardship network. In 2015, CMS recognized the Antimicrobial Use Option as a choice for public health registry reporting under Meaningful Use Stage 3, resulting in an increase in participating hospitals. Antimicrobial Use Option enrollment increased in 2015 (n = 120), coinciding with national prioritization of antimicrobial stewardship. In 2016, the SAAR, was released in NHSN. We leveraged the SAAR to encourage participation from additional facilities and began quarterly calls to encourage continued participation from existing users. In 2016, the Department of Defense began submitting data to the Antimicrobial Use Option, resulting in 207 facilities enrolled in 2016, which grew to 616 in 2017. As of November 2019, 12 vendors self-report submission capabilities and 1,470 facilities, of ~6,800 active NHSN participants, are enrolled in the Antimicrobial Use Option. Two states have passed requirements regulating Antimicrobial Use Option reporting with Tennessee’s requirement going into effect in 2021. Conclusions: The Antimicrobial Use Option offers evidence that collaboration with partners, and leveraging of benchmarking metrics available to a national surveillance system can lead to increased voluntary participation in surveillance of high-priority public health data. Moving forward, we will continue expanding analytic capabilities and partner engagement.Funding: NoneDisclosures: None

Shareholder Stewardship Enforcement

One of the central problems of shareholder stewardship around the world is rendering institutional investors good monitors of their investee companies and improving their accountability to both companies and their own beneficiaries and clients. The co-existence of soft norms (stewardship codes or principles) as well as semi-hard and hard law rules across the globe raises important questions about the future of shareholder stewardship frameworks and their enforcement. In this paper, we investigate this problem focusing on the availability (or not) of strategies to enforce shareholder stewardship. We adopt a broad approach to enforcement mechanisms in the area of shareholder stewardship and set out a simple conceptual taxonomy based on three dimensions. The proposed taxonomy takes into account the nature of the norm enforcer and distinguishes between self-enforcement and third-party enforcement. In the latter we consider public, quasi-public, private, market and social norm-enforcers. These actors may or not be the standard setters of the relevant norms. We then distinguish between formal – in the sense of either (quasi)judicial proceedings or membership/adherence sanctions within stewardship networks – and informal enforcement mechanisms. Finally, we take into account the temporal dimension of enforcement and distinguish between ex ante (monitoring and deterrence) and as ex post compliance. Our starting point is that, for market actors to be able to absorb bottom-up or, most importantly, top-down regulation, flexibility in adapting to best shareholder stewardship practices is needed. Indeed, examining the enforcement mode of shareholder stewardship across 25 countries we confirm that informal enforcement by market actors is the preferred option. Looking forward, we sketch the broad contours of an optimal shareholder stewardship enforcement framework based on our proposed taxonomy. We caution against administrative sanctions and support instead a facilitating role for public and quasi-public actors in two distinct ways. First, public and quasi-public actors can facilitate shareholder stewardship enforcement via membership/adherence sanctions taking place within stewardship networks (such as public tiering) or informal mechanisms (including public information diffusion through annual reports and guidelines, public reputational mechanisms, such as ‘name and shame’, and private dialogue). Secondly, where ultimate investors have suffered damages from deficient disclosure of engagement policies, we support the introduction of a facilitating system of civil claims initiated by public or quasi-public authorities that can serve both restorative-compensatory objectives and public interests. We also advance the importance of promoting and refining enforcement by market and social actors. Our proposed enforcement framework is not intended to be applied in a uniform fashion around the world. Rather its multi-actor, multi-modal and temporally continuous fashion can adjust to any national or supranational framework.

Leadership Learning Communities, Scientific Sustenance, and Adventures in Inspiration Feedback Loops in Baltimore, Maryland

In 2012, three groups of neighbors from different Baltimore, MD communities reached out individually for assistance in cleaning up, protecting, and/or improving their community forests. In response, Baltimore Green Space (BGS) launched the forest stewardship network which included both neighbors and experts in forestry. The forest stewardship program hinges on cultivating resident interest, fostering collaborations, and conducting leadership development with community members, which involves over 300 neighbors in forest environmental engagements each year in 10-12 forest patches. BGS uses the term “environmental engagement” to describe a wide range of offerings that help to either educate the community about the environment and/or engage them with the environment. Our work with forest stewards inspired original research, which concluded that 20% of Baltimore’s Tree Canopy is in forest patches outside of parks—subsequent research was conducted in 100 of those forested spaces. A partnership with University of Maryland, Baltimore County and the US Forest Service continues to grow this dataset. These patches provide distributed access to natural environments in neighborhoods and are located throughout the city, excluding the most developed area in downtown Baltimore.

UK Paediatric Antimicrobial Stewardship: a call for action

Background: Paediatric antimicrobial stewardship (PAS) networks exist in the USA and Australia but not in the UK. We sought to capture a snapshot of the current PAS landscape across UK children’s hospitals. Methods: A survey of PAS activities was conducted in tertiary children’s hospitals. Results: Infectious disease or microbiology consultants responded to the survey (n=15). All hospitals had neonatal, paediatric intensive care and surgical patients.All centres provided a PAS education programme for doctors, 7 for nurses and 9 for pharmacists as well. All centres had empirical antimicrobial prescribing guidelines. All centres with a paediatric infectious diseases (PID) team (11/15) used “audit and feedback” rounds, although their frequency and coverage varied. The PAS teams mostly included a PID consultant and/or microbiology consultants and a pharmacist. Three centres also had a nurse covering also the paediatric out-patient antibiotic treatment programme. Funding for PAS were inconsistent: Great Ormond Street Hospital had secured a dedicated full-time paediatric microbiologist, antimicrobial pharmacist and PID consultant with a ratio of 1/453 in-patient beds. 9 centres did not have dedicated funding for a paediatric antimicrobial pharmacist, 7 did not have funding for a paediatric infectious disease consultant. Only 2 hospitals had microbiology consultant time for paediatric audit and feedback. Conclusion: PAS programmes in the UK are limited, funding is inconsistent and their set up is variable, even in tertiary children’s hospitals with a strong interest in infectious diseases. We propose a national PAS network to advocate for more consistency and research into the implementation of PAS programmes.

Participatory action research for global antibiotic stewardship network in CPLP: mixed-method study

Abstract Background Antibiotic stewardship services (ABS) contribute to antibiotic resistance (AR) global monitoring. Aiming at co-implement an ABS network within the Portuguese-speaking setting (CPLP), by enabling the evidence translation and second opinion between the countries, we surveyed Cape Verdean (CV) health professionals (HP) perceptions about AR prevention and control, assessing ABS opportunities. Methods A Design Science with Participatory Action Research establishes a contextualized ABS process. This mixed-method study addressed the first 2 stages, the problem and objectives. Quantitative study considered the HP’s answers (56 HP; 2 hospitals) to a questionnaire, about their perception on AR and ABS. Qualitative study set-up 10 open-ended structured interviews, clinical shift observation in 2 pilot-services (1 hospital), and meetings with key-elements for ABS, including leadership. Results Key-stakeholders for ABS multidisciplinary teamwork were identified. Preliminary results are: 1. HP reveal some knowledge but lack of awareness on AR and ABS (eg. 34% don’t recognize the AR local threat); 2. The absence of guidelines and lack of access to key-information affect prescribing confidence (eg. only 46% HP consider microbiology results in deciding antibiotherapy); 3. Priorities for a pilot service are the lack of qualified HP, the need to optimize material resources management and stock procurement, and the need for better access to patient’s clinical and prescription information; 4. Digital resources and telemedicine system can be facilitators. Top-down communication and support are essential for the ABS process sustainability. Conclusions A Global ABS network can be important in promoting prevention and effective control of AR, reducing differences between the CPLP countries. In CV, an educational program to support the co-design of ABS service and a decision-support information system are identified priorities. Digital health, like telemedicine, can be ABS facilitators. Key messages The implementation of a Global Antibiotic Stewardship network, aiming at reducing Portuguese-speaking Countries differences, could be leveraged by a Participatory Action Research process. An educational program, a decision-support information system and the telemedicine are key for the Global Antibiotic Stewardship network implementation success.

Urban tree survival and stewardship in a state-managed planting initiative: A case study in Holyoke, Massachusetts

Stewardship is essential for the survival of trees planted in challenging urban conditions and for reaching canopy cover goals and anticipated benefits. The governance structure of the stewardship network can dictate stewardship efficacy and ultimately, tree survival. While many planting initiatives are managed locally, the stewardship network and survival rates of a state-managed initiative are not commonly addressed in scholarly literature. The Greening the Gateway Cities Program (GGCP) in Massachusetts is planting thousands of trees in post-industrial cities around the state. We carried out a mixed-methods case study of 2014 to 2016 tree planting in Holyoke, a GGCP pilot city, to assess the factors that influence survival. Specifically, we interviewed program stakeholders and coupled that data with field monitoring of trees planted along streets and on commercial and institutional landscapes. A logistic regression model shows that trees stewarded by state foresters were approximately 5.18 times more likely to survive, and trees which were not impacted by a summer 2016 drought were approximately 2.80 times more likely to survive. However, the drought impact was muted for trees stewarded by the state, and species characteristics were not significantly related to survival. Importantly, stewardship and planting site type strongly overlapped, providing insight into links between tree survival and stewardship network. At program launch, local recipients and partners agreed to water newly planted trees. But interviews revealed that tree recipients had neither the time nor staffing to adequately care for their trees. The GGCP intended for the local municipal public works department to assume stewardship responsibility, but the latter was unable and/or unwilling to do so due to a lack of funding and misalignment of goals, leaving stewardship as the state’s responsibility. Dedicated funding and staffing for maintenance is essential for strengthening stewardship networks and improving survival of large-scale urban tree plantings. Additionally, urban tree survival can be more strongly mediated by stewardship actors than some biophysical factors.

Antibiotic stewardship network in India.

Graphical Abstract.

Perspectives on East Texas Archaeology

A key to my career as an archaeologist working in East Texas has been a very successful professional-avocational collaboration on a wide range of projects with individuals and avocational organizations working in East Texas, such as the Northeast Texas Archeological Society, the East Texas Archeological Society, the Valley of the Caddo Archeological Society, the East Texas Caddo Research Group, as well as the Gregg County Historical Museum, among other museums in the region that hold ancestral Caddo archaeological collections. It has been my good fortune to work with a number of very knowledgeable and hard-working East Texas avocational archaeologists and Texas Archeological Stewardship Network members over the years, including Bo Nelson (who has gone on to establish a professional career as an archaeologist and also start his own CRM firm, Tejas Archaeology, in 1997), Mark Walters, Tom Middlebrook, Patti Haskins, Robert L. Turner, Jr., Kevin Stingley, Bryan Boyd, Mike Turner, Mark Thatcher, Gary W. Cheatwood, Clyde Amick, Lee Green, and Bill Young, among others.

Implementation and Success of a Multicenter Antimicrobial Stewardship Network

Implementation and Success of a Multicenter Antimicrobial Stewardship Network

A Social-Ecological Framework for Urban Stewardship Network Research to Promote Sustainable and Resilient Cities

To realize more sustainable and resilient urban social-ecological systems, there is great need for active engagement from diverse public agencies, non-profit organizations, businesses, natural resource managers, scientists, and other actors. Cities present unique challenges and opportunities for sustainability and resilience, as issues and organizations are frequently intertwined in networks of relations. Understanding and leveraging the range of knowledge types, motivations, skills, and goals of diverse participants and their networks is fundamental to sustainable and resilient cities. As efforts to examine and understand urban stewardship networks continue to emerge, it is increasingly clear that there are no structured or systematic frameworks to guide the integration of social and ecological phenomena. Such a framework could facilitate planning new urban stewardship network research, and provide a basis for comparisons among cities and their urban stewardship networks. In this paper, we develop and present a social-ecological framework for examining and understanding urban stewardship networks. To illustrate this framework and provide examples of its prospective and evaluative utility, we use examples from the U.S. Forest Service’s Stewardship Mapping (STEW-MAP) network in the United States from Baltimore, MD, USA, New York City, NY, USA, San Juan, Puerto Rico, USA, and Seattle, WA, USA.

Leveraging the power of place in citizen science for effective conservation decision making

Many citizen science projects are place-based - built on in-person participation and motivated by local conservation. When done thoughtfully, this approach to citizen science can transform humans and their environment. Despite such possibilities, many projects struggle to meet decision-maker needs, generate useful data to inform decisions, and improve social-ecological resilience. Here, we define leveraging the ‘power of place’ in citizen science, and posit that doing this improves conservation decision making, increases participation, and improves community resilience. First, we explore ‘place’ and identify five place dimensions: social-ecological, narrative and name-based, knowledge-based, emotional and affective, and performative. We then thematically analyze 134 case studies drawn from CitSci.org (n=39), The Stewardship Network New England (TSN-NE; n=39), and Earthwatch (n=56) regarding: (1) use of place dimensions in materials (as one indication of leveraging the power of place), (2) intent for use of data in decision-making, and (3) evidence of such use. We find that 89% of projects intend for data to be used, 46% demonstrate no evidence of use, and 54% provide some evidence of use. Moreover, projects used in decision making leverage more (t=−4.8, df=117; p<0.001) place dimensions (x̅=3.0; s=1.4) than those not used in decision making (x̅=1.8; s=1.2). Further, a Principal Components Analysis identifies three related components (aesthetic, narrative and name-based, and social-ecological). Given these findings, we present a framework for leveraging place in citizen science projects and platforms, and recommend approaches to better impart intended outcomes. We discuss place in citizen science related to relevance, participation, resilience, and scalability and conclude that effective decision making as a means towards more resilient and sustainable communities can be strengthened by leveraging the power of place in citizen science.

Broader view of stewardship to achieve conservation and sustainability goals in South Africa

Stewardship is a popular term for the principles and actions aimed at improving sustainability and resilience of social-ecological systems at various scales and in different contexts. Participation in stewardship is voluntary, and is based on values of altruism and long-term benefits. At a global scale, ‘earth stewardship’ is viewed as a successor to earlier natural resource management systems. However, in South Africa, stewardship is narrowly applied to biodiversity conservation agreements on private land. Using a broader definition of stewardship, we identify all potentially related schemes that may contribute to sustainability and conservation outcomes. Stewardship schemes and actors are represented as a social network and placed in a simple typology based on objectives, mechanisms of action and operational scales. The predominant type was biodiversity stewardship programmes. The main actors were environmental non-governmental organisations participating in prominent bioregional landscape partnerships, together acting as important ‘bridging organisations’ within local stewardship networks. This bridging enables a high degree of collaboration between non-governmental and governmental bodies, especially provincial conservation agencies via mutual projects and conservation objectives. An unintended consequence may be that management accountability is relinquished or neglected by government because of inadequate implementation capacity. Other stewardship types, such as market-based and landscape initiatives, complemented primarily biodiversity ones, as part of national spatial conservation priorities. Not all schemes related to biodiversity, especially those involving common pool resources, markets and supply chains. Despite an apparent narrow biodiversity focus, there is evidence of diversification of scope to include more civic and community-level stewardship activities, in line with the earth stewardship metaphor.

Toward an Understanding of Citywide Urban Environmental Governance: An Examination of Stewardship Networks in Baltimore and Seattle.

Efforts to create more sustainable cities are evident in the proliferation of sustainability policies in cities worldwide. It has become widely proposed that the success of these urban sustainability initiatives will require city agencies to partner with, and even cede authority to, organizations from other sectors and levels of government. Yet the resulting collaborative networks are often poorly understood, and the study of large whole networks has been a challenge for researchers. We believe that a better understanding of citywide environmental governance networks can inform evaluations of their effectiveness, thus contributing to improved environmental management. Through two citywide surveys in Baltimore and Seattle, we collected data on the attributes of environmental stewardship organizations and their network relationships. We applied missing data treatment approaches and conducted social network and comparative analyses to examine (a) the organizational composition of the network, and (b) how information and knowledge are shared throughout the network. Findings revealed similarities in the number of actors and their distribution across sectors, but considerable variation in the types and locations of environmental stewardship activities, and in the number and distribution of network ties in the networks of each city. We discuss the results and potential implications of network research for urban sustainability governance.

The governance of private residential land in cities and spatial effects on tree cover

Trees in cities supply ecosystem services, including cooling, storm water quality management, habitat, visual screening and softening of built form. There is an expanding interdisciplinary field encompassing biodiversity, ecosystem services, and stewardship networks in cities. However most of this work focuses on public greenspace. While much work has been done to demonstrate that trees on private land are an important complement to the public urban forest, and to understand the social drivers of such, less is known about the governance of private greenspace in cities. Private land contributes to a significant component of a city’s tree cover, particularly in cities characterised by low-density residential suburbs. It is important to understand the mechanisms that govern private tree cover, given the pace and scale of urbanisation globally. We combined policy and spatial analysis to examine the influence of larger and denser forms of residential development on suburban tree cover and the scope of contemporary governance measures. We interrogated tree cover patterns in the rapidly densifying and consolidating city of Brisbane, Australia, to show that private residential tree cover is explained by dwelling density, housing age, terrain slope, high school education, and household income. Results show significantly (30%) less tree cover in low-density residential suburbs developed since the early 1990s. We develop five governance principles for reversing the decline of urban trees on private residential property that may be transferable to other rapidly developing cities in around the world.

Utilization of Systemic Antifungal Therapy Among Community Hospitals in the Duke Antimicrobial Stewardship Network

Utilization of Systemic Antifungal Therapy Among Community Hospitals in the Duke Antimicrobial Stewardship Network

A boundary-spanning organization for transdisciplinary science on land stewardship: The Stewardship Network

A boundary-spanning organization for transdisciplinary science on land stewardship: The Stewardship Network