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Challenges undertaking procedures requiring asepsis: a qualitative interview study with nurses. J Hosp Infect 2023; 133:55-61. [PMID: 36565934 DOI: 10.1016/j.jhin.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Invasive devices and breaches to skin and mucous membranes increase susceptibility to infection. Nurses frequently undertake procedures requiring asepsis (PRAs), but report challenges and unwarranted variations in practice. OBJECTIVE To explore nurses' experiences, perceived gaps in information and support needed to conduct PRAs. METHODS Qualitative interviews were undertaken with 20 nurses in the UK National Health Service between September 2021 and January 2022 employing approaches to sampling and data collection adopted in grounded theory. RESULTS Informants were employed in diverse clinical settings. They thought that outside operating theatres, attempts to maintain asepsis would inevitably be compromised, but that much could still be done to contain the risk of contaminating susceptible sites irrespective of circumstances. Suboptimal practice was reported, and informants were unclear whether asepsis was needed to perform routine procedures (e.g. dressing chronic wounds, manipulating indwelling intravascular lines). Problems were attributed to inadequacies in nursing education, poor access to continuing professional development, and carelessness of junior nurses and medical staff. Informants wanted more detailed guidelines to conduct PRAs. Senior nurses wanted procedures to be conducted in the same way regardless of circumstance. Nurses who undertook PRAs regularly suggested that guidelines should be flexible. CONCLUSION There is a need for detailed guidelines to inform PRAs, better access to clinical updating, and improvements in pre-registration nursing education. To meet contemporary standards, guideline generation should adopt recognized methodology. Student nurses should be introduced to the knowledge and skills required to undertake and adjust PRAs according to circumstance during simulated practice before contact with real patients.
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Muacevic A, Adler JR, Sidiropoulos A, Zarkali O. Perception of Nursing Staff in ICU Regarding Measures to Prevent Hospital-Acquired Infections: A Qualitative Approach. Cureus 2022; 14:e33029. [PMID: 36721605 PMCID: PMC9880497 DOI: 10.7759/cureus.33029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Background Hospital-acquired infections are a common problem in Intensive Care Units and are associated with significant morbidity, mortality, and cost of hospitalization. Despite the development of prevention and control strategies, the incidence of hospital-acquired infections remains consistently high in ICUs and is often associated with the practices of healthcare professionals in patient care. Purpose The aim of the study was to investigate the perceptions of ICU nursing staff regarding measures for the prevention of hospital-acquired infections. Methods and materials This is an ethnographic qualitative study. It was performed in the Intensive Care Unit and the Cardiac Care Unit of a General Hospital in North Greece. Seventeen nurses recounted their perceptions regarding infection prevention and control through semi-structured interviews. Thematic analysis using inductive and deductive approaches was conducted. This manuscript adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Findings The two basic themes that emerged are (1) infection prevention measures in practice, and (2) factors that affect compliance with infection prevention measures. Conclusions The results of this study demonstrate the need for training and compliance of ICU nursing staff regarding measures to prevent hospital-acquired infections. There are several barriers that need to be addressed, such as culture, working conditions, and communication problems through documented interventions in the education, working environment, and professional identity of nursing staff.
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Daker-White G, Panagioti M, Giles S, Blakeman T, Moore V, Hall A, Jones PP, Wright O, Shears B, Tyler N, Campbell S. Beyond the control of the care home: A meta-ethnography of qualitative studies of Infection Prevention and Control in residential and nursing homes for older people. Health Expect 2021; 25:2095-2106. [PMID: 34420254 PMCID: PMC9615085 DOI: 10.1111/hex.13349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. Design This study had a meta‐ethnography design. Data Sources Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. Review Methods A meta‐ethnography was performed. Results Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie ‘outside’ the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered. Conclusions Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes. Patient or Public Contribution A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings.
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Affiliation(s)
- Gavin Daker-White
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sally Giles
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Victoria Moore
- Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,The University of Manchester Law School, Manchester, UK
| | - Alex Hall
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Paul P Jones
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Oliver Wright
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Bethany Shears
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Natasha Tyler
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Stephen Campbell
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Enosh G, Freund A, Goldblatt H, Drach-Zahavy A, Guindy M, Ofer-Bialer G. Whose fault is it? Attribution of causes of patient violence among exposed and unexposed community-based family physicians. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:175-184. [PMID: 32627279 DOI: 10.1111/hsc.13080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/24/2020] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
Extensive research has dealt with violence directed at healthcare workers in hospital settings; however, few studies have examined community-based settings. Furthermore, there is also scant literature regarding the perceptions of healthcare providers who were exposed to violence, compared to those who were not. This study aims to narrow these gaps in the literature by examining community-based family physicians' (CBFPs) perceptions in a large national Health Maintenance Organisation (HMO) regarding patient-initiated violence. Using a voluntary online survey, directed at all CBFPs working at the HMO, 412 CBFPs were surveyed on the following issues: exposure to violence initiated by patients or their family members; perceptions of violent occurrences and possible safety measures. The differences between CBFPs who had been exposed to violence and those who had not were compared. The majority of CBFPs reported experiencing verbal attacks (64%), and a small percentage experienced property-related violence (11.7%) or physical violence (3.4%). Comparing CBFPs who were exposed to violence with those who were not, regarding their perceptions of the 'causes of violence', revealed three differentiating factors: 'waiting time', 'failure to meet the patient's expectations' and 'the nature of the physician-patient encounter'. Regarding the desired preventive actions, the four differentiating factors were as follows: 'reduction in the number of patients per physician', 'improved queue management processes', 'longer meetings' and 'violence prevention training'. Conducting separate analyses, according to violence type (verbal abuse, vandalism or physical violence), indicated finer differentiations. In terms of Attribution Theory, one might argue that CBFPs who were directly exposed to patients' aggression attributed internal locus to the attacker, and tended to blame the attacker's personal characteristics and cultural values. Conversely, family CBFPs who were not attacked attributed external locus to situational factors such as waiting time, not receiving service, and the nature of the interaction between the attacker and the CBFP.
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Ojo O, Adegboye ARA, Ojo OO, Wang X, Brooke J. The Microbial Quality and Safety of Blenderised Enteral Nutrition Formula: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249563. [PMID: 33371227 PMCID: PMC7766503 DOI: 10.3390/ijerph17249563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
UNLABELLED The use of blenderised enteral nutrition formula (ENF) is on the increase globally. However, concerns remain regarding the microbial quality and safety of blenderised ENF compared with standard recommendations and commercial ENF. AIM This was a systematic review which sought to compare the microbial quality of blenderised ENF and commercial ENF and to evaluate the effect of storage time on blenderised ENF. METHOD Four databases (Pubmed, EMBASE, PSYCInfo and Google scholar) were searched for relevant articles based on the Population, Intervention, Comparator, Outcomes framework. RESULTS Eleven studies which met the criteria were included in the systematic review. Two major areas were identified; Microbial Quality of Blenderised ENF versus Commercial ENF; and The Effect of Storage Time on Microbial Quality of Blenderised ENF. Overall, 72.7% of the studies showed microbial contamination in blenderised ENF compared with 57.1% of commercial ENF, and the storage time was another important factor in the rates of contamination. The extent of handling or manipulation of the enteral formula was critical in determining the level of contamination. CONCLUSION Preparation techniques for blenderised ENF need to be established and caregivers taught how to prepare and administer it appropriately in order to reduce contamination. Further, well-designed studies are required, which compare the microbial quality of blenderised ENF using adequate handling techniques and commercial ENF.
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Affiliation(s)
- Omorogieva Ojo
- Faculty of Education, Health and Human Sciences, School of Health Sciences, University of Greenwich, Avery Hill Campus, Avery Hill Road, London SE9 2UG, UK
| | - Amanda Rodrigues Amorim Adegboye
- Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health, Coventry University Priory Street, Coventry CV1 5FB, UK;
| | - Osarhumwese Osaretin Ojo
- South London and Maudsley NHS Foundation Trust, University Hospital, Lewisham High Street, London SE13 6LH, UK;
| | - Xiaohua Wang
- The School of Nursing, Soochow University, Suzhou 215006, China;
| | - Joanne Brooke
- Faculty of Health, Education and Life Sciences, Ravensbury House, Birmingham City University, City South Campus, Birmingham B15 3TN, UK;
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Tian H, Wang P. Development of the Attributional Style of Doctor Questionnaire. Psychol Res Behav Manag 2020; 13:1079-1088. [PMID: 33281460 PMCID: PMC7709868 DOI: 10.2147/prbm.s267141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background The attributional style of clinical workers will affect their emotion and behavior and affect how they deal with the relationship with patients. Current tools lack clinical events and are not suitable for measuring the attributional style of doctor. In this study, the development of the Doctor’s Attributional Style Questionnaire (DASQ) is presented. Methods In study 1, based on the previous literature and the open-ended questionnaire, the theoretical structure of DASQ was constructed. In study 2, items analysis and exploratory factor analysis (EFA) were conducted in the sample (n=559) to select the best items for the DASQ. In study 3, the internal structure of the DASQ was tested in the sample (n=740) via confirmatory factor analysis (CFA) and 218 doctors were retested four weeks later. Results There are 24 items in the scale, including positive events questionnaire and negative events questionnaire, all of which are composed of four dimensions: controllability, globality, stability, and internality. The fitting degree of each questionnaire model is good, and all indexes are above 0.9. The internal consistency coefficient and retest coefficient of both the positive events questionnaire and the negative events questionnaire were above 0.75. Conclusion The DASQ meets the requirements of measurement and can be used to measure the attributional style of doctors.
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Affiliation(s)
- Hemei Tian
- Department of Psychology, Shanghai Normal University, Shanghai 200234, People's Republic of China
| | - Pei Wang
- Faculty of Education, East China Normal University, Shanghai 200062, People's Republic of China
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Mitchell BG, Russo PL, Kiernan M, Curryer C. Nurses' and midwives' cleaning knowledge, attitudes and practices: An Australian study. Infect Dis Health 2020; 26:55-62. [PMID: 33011114 PMCID: PMC7526607 DOI: 10.1016/j.idh.2020.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 12/03/2022]
Abstract
Background As frontline providers of care, nurses and midwives play a critical role in controlling infections such as COVID-19, influenza, multi-drug resistant organisms and health care associated infections. Improved cleaning can reduce the incidence of infection and is cost effective but relies on healthcare personnel to correctly apply cleaning measures. As nurses and midwives have the most contact with patients and as an important first step in improving compliance, this study sought to explore nurses' and midwives’ knowledge on the role of the environment in infection prevention and control and identify challenges in maintaining clean patient environments. Methods Cross-sectional online survey of 96 nurses (RN/EN) and midwives (RW) employed in clinical settings (e.g. hospital, aged care, medical centre, clinic) in Australia. Results Nurses and midwives broadly stated that they understood the importance of cleaning. However, cleaning responsibilities varied and there was confusion regarding the application of different disinfectants when cleaning after patients with a suspected or diagnosed infection post-discharge. Most would not be confident being placed in a room where a previous patient had a diagnosed infection such as multi-drug resistant organism. Conclusion Greater organisational support and improving applied knowledge about infection control procedures is needed. This includes correct use of disinfectants, which disinfectant to use for various situations, and cleaning effectively following discharge of a patient with known infection. The cleanliness of shared medical equipment may also pose current risk due to lack of cleaning. Improved cleaning reduces incidence of healthcare associated infection but relies on correct application. Nurses and midwives expressed confusion regarding disinfectant use and cleaning responsibility. Most would not be confident being placed in a room where a previous patient had a diagnosed infection.
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Affiliation(s)
- Brett G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia; School of Nursing, Avondale College of Higher Education, Wahroonga, New South Wales, Australia.
| | - Philip L Russo
- Department of Nursing Research, Cabrini Institute, Malvern, VIC, Australia; Nursing and Midwifery, Monash University, Frankston, VIC, Australia
| | - Martin Kiernan
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia; Richard Wells Research Centre, University of West London, Brentford, UK
| | - Cassie Curryer
- School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia
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AKTAŞ E, ÇÖVENER ÖZÇELİK Ç, OCAKÇI AF. Reliability and Validity of Nurses’ Experiences of Infection Prevention and Control Questionnaire. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2020. [DOI: 10.33808/clinexphealthsci.646357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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Agreli H, Barry F, Burton A, Creedon S, Drennan J, Gould D, May CR, Smiddy MP, Murphy M, Murphy S, Savage E, Wills T, Hegarty J. Ethnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Ireland. BMJ Open 2019; 9:e029514. [PMID: 31462475 PMCID: PMC6720340 DOI: 10.1136/bmjopen-2019-029514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore how infection prevention and control (IPC) guidelines are used and understood by healthcare professionals, patients and families. DESIGN Ethnographic study with 59 hours of non-participant observation and 57 conversational interviews. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework. SETTING Four hospitals in Ireland. PARTICIPANTS Healthcare professionals, patient and families. RESULTS Five themes emerged through the analysis. Four themes provided evidence of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring). Our findings revealed the existence of a 'dissonance between IPC guidelines and the reality of clinical practice' (theme 1) and 'Challenges to legitimatize guidelines' recommendations in practice' (theme 3). These elements contributed to 'Symbolic implementation of IPC guidelines' (theme 2), which was also determined by a 'Lack of shared reflection upon IPC practices' (theme 4) and a clinical context of 'Workforce fragmentation, time pressure and lack of prioritization of IPC' (theme 5). CONCLUSIONS Our analysis identified themes that provide a comprehensive understanding of elements needed for the successful or unsuccessful implementation of IPC guidelines. Our findings suggest that implementation of IPC guidelines is regularly operationalised through the reproduction of IPC symbols, rather than through adherence to performance of the evidence-based recommendations. Our findings also provide insights into changes to make IPC guidelines that align with clinical work.
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Affiliation(s)
- Heloise Agreli
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Fiona Barry
- Public Health and Epidemiology, University College Cork National University of Ireland, Cork, Ireland
| | - Aileen Burton
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Sile Creedon
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Jonathan Drennan
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Dinah Gould
- Healthcare Sciences, Cardiff University School of Healthcare Studies, Cardiff, UK
| | - Carl R May
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - M P Smiddy
- Public Health and Epidemiology, University College Cork National University of Ireland, Cork, Ireland
| | - Michael Murphy
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Siobhan Murphy
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Eileen Savage
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Teresa Wills
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
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Engl E, Kretschmer S, Jain M, Sharma S, Prasad R, Ramesh BM, Shetye M, Tandon S, Kumar S, Barrios Wilson T, Sgaier SK. Categorizing and assessing comprehensive drivers of provider behavior for optimizing quality of health care. PLoS One 2019; 14:e0214922. [PMID: 30995274 PMCID: PMC6469845 DOI: 10.1371/journal.pone.0214922] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 03/23/2019] [Indexed: 11/18/2022] Open
Abstract
Inadequate quality of care in healthcare facilities is one of the primary causes of patient mortality in low- and middle-income countries, and understanding the behavior of healthcare providers is key to addressing it. Much of the existing research concentrates on improving resource-focused issues, such as staffing or training, but these interventions do not fully close the gaps in quality of care. By contrast, there is a lack of knowledge regarding the full contextual and internal drivers-such as social norms, beliefs, and emotions-that influence the clinical behaviors of healthcare providers. We aimed to provide two conceptual frameworks to identify such drivers, and investigate them in a facility setting where inadequate quality of care is pronounced. Using immersion interviews and a novel decision-making game incorporating concepts from behavioral science, we systematically and qualitatively identified an extensive set of contextual and internal behavioral drivers in staff nurses working in reproductive, maternal, newborn, and child health (RMNCH) in government public health facilities in Uttar Pradesh, India. We found that the nurses operate in an environment of stress, blame, and lack of control, which appears to influence their perception of their role as often significantly different from the RMNCH program's perspective. That context influences their perceptions of risk for themselves and for their patients, as well as self-efficacy beliefs, which could lead to avoidance of responsibility, or incorrect care. A limitation of the study is its use of only qualitative methods, which provide depth, rather than prevalence estimates of findings. This exploratory study identified previously under-researched contextual and internal drivers influencing the care-related behavior of staff nurses in public facilities in Uttar Pradesh. We recommend four types of interventions to close the gap between actual and target behaviors: structural improvements, systemic changes, community-level shifts, and interventions within healthcare facilities.
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Affiliation(s)
- Elisabeth Engl
- Surgo Foundation, Seattle, Washington, United States of America
| | | | - Mokshada Jain
- Surgo Foundation, Seattle, Washington, United States of America
| | | | - Ram Prasad
- Final Mile Consulting, Chicago, Illinois, United States of America
| | - B. M. Ramesh
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Seema Tandon
- India Health Action Trust (IHAT), Uttar Pradesh Technical Support Unit (TSU), Lucknow, India
| | - Sanjiv Kumar
- India Health Action Trust (IHAT), Uttar Pradesh Technical Support Unit (TSU), Lucknow, India
| | | | - Sema K. Sgaier
- Surgo Foundation, Seattle, Washington, United States of America
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Gould DJ, Navaie D, Purssell E, Drey NS, Creedon S. Changing the paradigm: messages for hand hygiene education and audit from cluster analysis. J Hosp Infect 2017; 98:345-351. [PMID: 28760636 DOI: 10.1016/j.jhin.2017.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hand hygiene is considered to be the foremost infection prevention measure. How healthcare workers accept and make sense of the hand hygiene message is likely to contribute to the success and sustainability of initiatives to improve performance, which is often poor. METHODS A survey of nurses in critical care units in three National Health Service trusts in England was undertaken to explore opinions about hand hygiene, use of alcohol hand rubs, audit with performance feedback, and other key hand-hygiene-related issues. Data were analysed descriptively and subjected to cluster analysis. RESULTS Three main clusters of opinion were visualized, each forming a significant group: positive attitudes, pragmatism and scepticism. A smaller cluster suggested possible guilt about ability to perform hand hygiene. CONCLUSION Cluster analysis identified previously unsuspected constellations of beliefs about hand hygiene that offer a plausible explanation for behaviour. Healthcare workers might respond to education and audit differently according to these beliefs. Those holding predominantly positive opinions might comply with hand hygiene policy and perform well as infection prevention link nurses and champions. Those holding pragmatic attitudes are likely to respond favourably to the need for professional behaviour and need to protect themselves from infection. Greater persuasion may be needed to encourage those who are sceptical about the importance of hand hygiene to comply with guidelines. Interventions to increase compliance should be sufficiently broad in scope to tackle different beliefs. Alternatively, cluster analysis of hand hygiene beliefs could be used to identify the most effective educational and monitoring strategies for a particular clinical setting.
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Affiliation(s)
- D J Gould
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - D Navaie
- University Hospital Lewisham, London, UK
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Taffurelli C, Sollami A, Camera C, Federa F, Grandi A, Marino M, Marrosu T, Sarli L. Healthcare associated infection: good practices, knowledge and the locus of control in heatlhcare professionals. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:31-36. [PMID: 28752830 DOI: 10.23750/abm.v88i3 -s.6611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM The incidence of Healthcare Associated Infections (HAI) is an important indicator of the quality of care. The behaviors associated with the prevention of infections are not only supported by rational knowledge or motivation, but are mediated by social, emotional and often stereotyped behaviors. The awarness of the good practices related to HAI, may be a factor. Other studies, identify how the perception of the problem in healthcare professionals is often influenced by a tendency towards an external Locus of Control: the patient, the family, the other wards, other care settings. The aim of this study is to investigate the perception of healthcare professionals. In particular they have been measured their awarness of the good practices, perceptions of the potential contamination level of some commonly used objects, knowledge about the management of invasive devices, Locus of Control. METHOD A cross-sectional correlational design was utilized. An ad hoc questionnaire was interviewed by 222 health professionals nurses and physicians in a northern hospital of Italy. RESULTS The percentage of professionals who have attended training courses over the last 5 years was quite high, both for upgrades on HAI (78.7%) and Vascular Catheters (78.8%), while the percentage of professionals who updated on bladder catheterization (59.46%) was lower. The mean score of good practice awareness towards HAI (5.06), is high. The perception of the potential level of contamination of some devices had a mean ranging from 4.62 (for the drip) to 5.26 (for the door handle). The average value of the Locus of Control (43.54) indicates that participants demonstrated a value that is midway between External and Internal. The correlation test analysis revealed no significant relationships among professionals'age, knowledge about HAI, or infection related venus catheter. Also, results revealed that there were statistically significant positive relationships between professionals' Good Practices awareness about HAI , Knowledge, and Locus of Control. CONCLUSION The study findings demonstrated that good practice awareness towards HAI among nurse and physician was good but not completely optimal. Findings revealed that knowledge toward HAI prevention and HAI related device prevention were not completely adequate. The educational courses, according to our correlational findings, should definitely take into account the psycho-social aspects of this phenomenon.
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Affiliation(s)
- Hardip Malhi
- Nutrition Nurse Specialist, University Hospitals Birmingham NHS Foundation Trust
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14
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Promoting health workers' ownership of infection prevention and control: using Normalization Process Theory as an interpretive framework. J Hosp Infect 2016; 94:373-380. [DOI: 10.1016/j.jhin.2016.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/16/2016] [Indexed: 11/18/2022]
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Jackson C. Nurses’ perceptions of dirt and contagion: Does the work environment pose a greater threat than one’s own home? J Res Nurs 2016. [DOI: 10.1177/1744987116628921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to understand nurses’ infection prevention behaviours in the acute hospital setting by eliciting their explanations of observed behaviour. It sought to identify perceptions of risk from infection within their work environment and their homes, the practices carried out to avoid these risks, and the factors that influence behaviour. Twenty semi-structured interviews, using a topic guide and vignettes, were conducted with Registered Nurses. Interviews were audio recorded and transcribed verbatim. Three main themes of ‘Rationalising dirt related behaviour’, ‘Protection from dirt’ and ‘Transitions and journeys: no place like home’ emerged following data analysis using a framework method. This paper presents the theme ‘Transitions and journeys: no place like home’, which has two components: ‘Where is the dirt?’ and ‘Practice and rituals’. The findings demonstrate that dirt and germs present in hospitals represent a higher risk than those in the home. Healthcare workers can take measures to mitigate this risk; however, on leaving the workplace perception of self does not change significantly until they arrive home. At this point a transition occurs; they now recognise the risk they may pose and practices and rituals are required in order to protect the home . The findings demonstrate the multifaceted nature of infection prevention beliefs and behaviours. Behaviour is influenced by knowledge, belief systems and the circumstances of the situation. People see themselves positioned differently within the environment depending on the context of the risk; they can either be at risk or be the cause of the risk.
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Affiliation(s)
- Carole Jackson
- Lecturer, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, UK
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Maben J, Griffiths P, Penfold C, Simon M, Pizzo E, Anderson J, Robert G, Hughes J, Murrells T, Brearley S, Barlow J. Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jill Maben
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Peter Griffiths
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Clarissa Penfold
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Michael Simon
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Elena Pizzo
- Imperial College Business School, London, UK
| | - Janet Anderson
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Glenn Robert
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Jane Hughes
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Trevor Murrells
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
| | - Sally Brearley
- National Nursing Research Unit, Florence Nightingale Faculty of Nursing and Midwifery (formerly Florence Nightingale School of Nursing and Midwifery), King’s College London, London, UK
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Golfenshtein N, Drach-Zahavy A. An attribution theory perspective on emotional labour in nurse-patient encounters: a nested cross-sectional study in paediatric settings. J Adv Nurs 2015; 71:1123-34. [DOI: 10.1111/jan.12612] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Nadya Golfenshtein
- School of Nursing; University of Pennsylvania; Philadelphia Pennsylvania USA
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Santiano N, Caldwell J, Ryan E, Smuts A, Schmidt HM. Knowledge and understanding of patients and health care workers about multi-resistant organisms. ACTA ACUST UNITED AC 2014. [DOI: 10.1071/hi13027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jackson C, Griffiths P. Dirt and disgust as key drivers in nurses' infection control behaviours: an interpretative, qualitative study. J Hosp Infect 2014; 87:71-6. [DOI: 10.1016/j.jhin.2014.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 04/07/2014] [Indexed: 11/15/2022]
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Seibert DJ, Speroni KG, Oh KM, DeVoe MC, Jacobsen KH. Preventing transmission of MRSA: a qualitative study of health care workers' attitudes and suggestions. Am J Infect Control 2014; 42:405-11. [PMID: 24559596 DOI: 10.1016/j.ajic.2013.10.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/09/2013] [Accepted: 10/09/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Health care workers' (HCWs) perceptions and attitudes affect implementation of precautions to prevent transmission of drug-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). Identification of challenges and barriers to recommended practices is a critical component of promoting a safe clinical environment of care. METHODS Semistructured interviews addressed how MRSA affects HCWs, prevention of transmission, and challenges and barriers HCWs experience when entering a MRSA isolation room and performing appropriate hand hygiene. RESULTS The purposive sample of 26 acute care HCWs (16 registered nurses; 1 physician; 6 allied health professionals; and 3 support staff) self-selected from 276 responding to a questionnaire on MRSA. Analysis identified 18 themes across seven categories. Most participants reported feeling responsible for preventing transmission, and having the knowledge and desire to do so. However, many also reported challenges to following consistent hand hygiene and use of contact precautions. Barriers included patient care demands, equipment and environmental issues such as availability of sinks, time pressures, the practices of other HCWs, and the need for additional signs indicating which patients require contact precautions. CONCLUSIONS The HCWs reported a need for improved clarity of isolation protocols throughout patients' hospital journey, additional rooms and staff for isolation patients, improved education and communication (including timely and appropriate signage), and an emphasis on involving all HCWs in reducing contamination.
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Hughes C, Tunney M, Bradley MC. Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database Syst Rev 2013; 2013:CD006354. [PMID: 24254890 PMCID: PMC7000924 DOI: 10.1002/14651858.cd006354.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Nursing homes for older people provide an environment likely to promote the acquisition and spread of meticillin-resistant Staphylococcus aureus (MRSA), putting residents at increased risk of colonisation and infection. It is recognised that infection prevention and control strategies are important in preventing and controlling MRSA transmission. OBJECTIVES To determine the effects of infection prevention and control strategies for preventing the transmission of MRSA in nursing homes for older people. SEARCH METHODS In August 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Database of Abstracts of Reviews of Effects (DARE, The Cochrane Library), Ovid MEDLINE, OVID MEDLINE (In-process and Other Non-Indexed Citations), Ovid EMBASE, EBSCO CINAHL, Web of Science and the Health Technology Assessment (HTA) website. Research in progress was sought through Current Clinical Trials, Gateway to Reseach, and HSRProj (Health Services Research Projects in Progress). SELECTION CRITERIA All randomised and controlled clinical trials, controlled before and after studies and interrupted time series studies of infection prevention and control interventions in nursing homes for older people were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed the results of the searches. Another review author appraised identified papers and undertook data extraction which was checked by a second review author. MAIN RESULTS For this third update only one study was identified, therefore it was not possible to undertake a meta-analysis. A cluster randomised controlled trial in 32 nursing homes evaluated the effect of an infection control education and training programme on MRSA prevalence. The primary outcome was MRSA prevalence in residents and staff, and a change in infection control audit scores which measured adherence to infection control standards. At the end of the 12 month study, there was no change in MRSA prevalence between intervention and control sites, while mean infection control audit scores were significantly higher in the intervention homes compared with control homes. AUTHORS' CONCLUSIONS There is a lack of research evaluating the effects on MRSA transmission of infection prevention and control strategies in nursing homes. Rigorous studies should be conducted in nursing homes, involving residents and staff to test interventions that have been specifically designed for this unique environment.
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Affiliation(s)
- Carmel Hughes
- Queen's University BelfastSchool of Pharmacy97 Lisburn RoadBelfastNorthern IrelandUKBT9 7BL
| | - Michael Tunney
- Queen's University BelfastSchool of Pharmacy97 Lisburn RoadBelfastNorthern IrelandUKBT9 7BL
| | - Marie C Bradley
- Queen's University BelfastSchool of Pharmacy97 Lisburn RoadBelfastNorthern IrelandUKBT9 7BL
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Gould D, Drey N. Student nurses' experiences of infection prevention and control during clinical placements. Am J Infect Control 2013; 41:760-3. [PMID: 23993761 DOI: 10.1016/j.ajic.2013.01.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/20/2013] [Accepted: 01/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Little is known about nursing students' experiences of infection control in the clinical setting despite its importance protecting patients and reducing risks of occupational exposure. METHODS We conducted an online survey involving a fixed choice Likert-type scale with 19 items and an open question to solicit more detailed information with a national sample of student nurses in the United Kingdom. RESULTS Four hundred eighty-eight student nurses completed questionnaires. All participants reported lack of compliance for every item on the Likert scale, most frequently from community settings and long-term care facilities for older people. Incidents most commonly witnessed were failure to comply with hand hygiene protocols, failure to comply with isolation precautions, poor standards of cleaning in the patient environment, not changing personal protective clothing between patients, and poor management of sharp instruments. Qualified nurses did not provide good role models. Medical staff were the occupational group most heavily criticized for poor compliance. CONCLUSION Students demonstrated sound understanding of infection control and were able to identify lack of compliance on the basis of preclinical classroom instruction. The study findings indicate that ensuring safe infection control practice remains a challenge in the United Kingdom despite its high priority.
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Jackson C, Lowton K, Griffiths P. Infection prevention as "a show": a qualitative study of nurses' infection prevention behaviours. Int J Nurs Stud 2013; 51:400-8. [PMID: 23915562 DOI: 10.1016/j.ijnurstu.2013.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/28/2013] [Accepted: 07/05/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers' practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned "How can nurses' infection prevention behaviour be explained?" This paper presents one of three identified themes 'Rationalising dirt-related behaviour'. DESIGN This interpretative qualitative study uses vignettes, developed from nurses' accounts of practice, to explore nurses' reported infection prevention behaviours. PARTICIPANTS Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University. METHODS Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method. RESULTS The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a 'show' or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny. CONCLUSIONS This study contributes to the identification and explanation of nurses' infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely 'scientific' understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection.
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Affiliation(s)
- Carole Jackson
- Department of Postgraduate Research, Florence Nightingale School of Nursing and Midwifery, King's College London, Room 1.21a, James Clerk Maxwell Building, Waterloo Campus, 57 Waterloo Road, London SE1 8WA, United Kingdom.
| | - Karen Lowton
- Institute of Gerontology, Department of Social Science, Health & Medicine, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Peter Griffiths
- Chair of Health Services Research, Faculty of Health Sciences, University of Southampton, Room E4015, Building 67, Highfield Campus, SO17 1BJ, United Kingdom
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Burnett E, Kearney N, Johnston B, Corlett J, MacGillivray S. Understanding factors that impact on health care professionals' risk perceptions and responses toward Clostridium difficile and meticillin-resistant Staphylococcus aureus: a structured literature review. Am J Infect Control 2013; 41:394-400. [PMID: 23489738 DOI: 10.1016/j.ajic.2012.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/02/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Clostridium difficile is the most common health care-associated infection. Despite considerable efforts to prevent and manage C difficile, poor clinical practice and nonadherence to policy continues to compromise patient safety. Risk perception research is essential in gaining understanding about how health care professionals respond. METHODS A structured literature review examined empirical evidence regarding health care professionals' risk perceptions and responses toward C difficile. Because of limited evidence available, the review was extended to include other health care-associated infections. Only studies related to methicillin-resistant Staphylococcus aureus (MRSA) could be identified. RESULTS Eleven studies were included. Four were specific to C difficile and 7 to MRSA. All studies found that technical understanding of C difficile was poor and that staff were concerned about risks to patients and themselves. Technical understanding for MRSA, however, was good, and staff were less concerned about their own health. Information provision was perceived to be inadequate and untrustworthy, which included the media. Practice in most studies was poor. CONCLUSION There is a need to build on the efforts of risk perception research from other disciplines to understand how health care professionals think and make decisions about C difficile. This can help inform the development of effective management and communication strategies to maximize the quality of care provided.
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Ojo O, Bowden J. Infection control in enteral feed and feeding systems in the community. ACTA ACUST UNITED AC 2012; 21:1070-2, 1074-5. [PMID: 23123838 DOI: 10.12968/bjon.2012.21.18.1070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article examines the infection risk to adult patients receiving home enteral nutrition (HEN) and strategies for its prevention and management. Enteral nutrition was historically associated with acute care settings owing to its invasive nature. The changing landscape of community care means that it is now likely to be administered in the patient's home or in other community settings such as nursing homes. HEN is associated with two main routes of infection risks: the risk of gastrointestinal infection from contamination of the feed and feeding accessories, and local wound infection at the stoma site. Guidelines for the prevention and control of HEN-associated infection are provided and explained. These guidelines emphasise patient and carer education, effective hand hygiene, correct storage and administration of the feed, early detection and management of potential infections.
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Affiliation(s)
- Omorogieva Ojo
- Department of Acute and Continuing Care, School of Health and Social Care, University of Greenwich, Avery Hill Campus, London
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