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Barratt R, Gilbert GL. Hospital health care workers' use of facial protective equipment before the COVID-19 pandemic, implications for future policy. Am J Infect Control 2024; 52:502-508. [PMID: 38092070 DOI: 10.1016/j.ajic.2023.12.003] [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: 08/26/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Prepandemic routine use of facial (respiratory and eye) protective equipment (FPE) by health care workers was suboptimal. Understanding factors affecting routine use would facilitate escalation to high level use during infectious disease emergencies. This study explored health care workers FPE-related knowledge, attitudes and behaviors. METHODS Mixed methods were used in a respiratory ward and adult and pediatric emergency departments (EDs), prior to the COVID-19 pandemic. Study design and thematic analysis were based on the theoretical domains framework. Emergent themes were categorized, using the COM-B behavior model, into capability(C), opportunity(O) and motivation(M), which influence behavior(B). RESULTS 22 emergent themes, representing factors influencing FPE use, were mapped to theoretical domains framework domains. Personal experience and departmental cultures influenced motivation. Compared with respiratory ward staff, ED clinicians were less knowledgeable about FPE; the unique ED environment and culture inhibited opportunities and motivation for FPE use. Eye protection was infrequently used. DISCUSSION Optimal FPE use is challenged by ED care models and settings. Changes are needed to translate pandemic-related improvements into routine care of other respiratory infections. CONCLUSIONS This study identified key determinants of FPE behavior. A review of context-specific FPE guidance for ED by infection prevention and control professionals would help to promote practicable, sustainable compliance.
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Affiliation(s)
- Ruth Barratt
- Westmead Clinical School, University of Sydney, Westmead, NSW 2145, Australia.
| | - Gwendolyn L Gilbert
- Westmead Clinical School, University of Sydney, Westmead, NSW 2145, Australia; Sydney Institute for Infectious Diseases, University of Sydney, Westmead, NSW 2145, Australia
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Wyer M, Hor SY, Barratt R, Garrahy P, Moore C, Williams Veazey L, Degeling C, Gilbert GL. Exploring the safety and quality of mobile X-ray imaging in a new infectious disease biocontainment unit: an in situ simulation and video-reflexive study. BMJ Open 2024; 14:e080152. [PMID: 38382961 PMCID: PMC10882301 DOI: 10.1136/bmjopen-2023-080152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES During a precommissioning inspection of a new biocontainment centre, radiographers noted structural features of quarantine rooms that could compromise staff and patient safety and the X-ray image quality, even after significant modifications had been made to an earlier radiography protocol. The aim of this study was to explore the safety and effectiveness of the modified protocol, in the new space, and identify improvements, if required. DESIGN A qualitative study using in situ simulation and video-reflexive methods. SETTING A newly built biocontainment centre, prior to its commissioning in 2021, in a large, tertiary hospital in Sydney, Australia. PARTICIPANTS Five radiographers, and a nurse and a physician from the biocontainment centre, consented to participate. All completed the study. INTERVENTIONS Two simulated mobile X-ray examinations were conducted in the unit prior to its commissioning; simulations were videoed. Participants and other stakeholders analysed video footage, collaboratively, and sessions were audio recorded, transcribed and analysed thematically. Problems and potential solutions identified were collated and communicated to the hospital executive, for endorsement and actioning, if possible. RESULTS Four themes were identified from the data: infection exposure risks, occupational health and exposure risks, communication and X-ray image quality. Facilitated group reviews of video footage identified several important issues, across these four areas of risk, which had not been identified previously. CONCLUSIONS In situ simulation is used, increasingly, to evaluate and improve healthcare practices. This study confirmed the added value of video-reflexive methods, which provided experienced participants with a richer view of a familiar protocol, in a new setting. Video footage can be examined immediately, or later if required, by a broader group of stakeholders, with diverse experience or expertise. Using video reflexivity, clinicians identified potential safety risks, which were collated and reported to the hospital executive, who agreed to implement modifications.
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Affiliation(s)
- Mary Wyer
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- K7c-NSW Biocontainment Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Su-Yin Hor
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ruth Barratt
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Phillip Garrahy
- Radiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Cameron Moore
- Radiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Leah Williams Veazey
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Degeling
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - G L Gilbert
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, New South Wales, Australia
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Manojlovich M, Rizvi-Toner A, DasGupta R, Farris K, Friese C, Kostoff D, Mackler E, Millisor V, Titler MG. Video reflexive ethnography as an intervention to improve oral anti-cancer agent patient education: A pilot study. PEC INNOVATION 2023; 2:100148. [PMID: 37214518 PMCID: PMC10194178 DOI: 10.1016/j.pecinn.2023.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 05/24/2023]
Abstract
Objective Oral anticancer agents (OAAs) are associated with side effects that interfere with medication adherence, despite patient education regarding side effect management. Video reflexive ethnography (VRE) captures care processes on video that allow participants to learn from videos. The purpose of this pilot study was to assess the usefulness and impact of VRE on improving OAA education. Methods This qualitative study was conducted in a pharmacist-managed OAA clinic: two pharmacists and four patients participated. We filmed each pharmacist providing education to two patients. We conducted patient interviews and one reflexivity session with both pharmacists to learn participants' perspectives. We used thematic content analysis to analyze data. Results Two themes emerged: what patients liked/helped, and things that were unclear. Patients liked instructions on temperature taking, directions to safely handle and store OAAs. Unclear areas included knowing the timing of the worst side effects.During the reflexivity session, pharmacists found patients' comments useful to improve their practice. Conclusion VRE was acceptable to pharmacists and patients. Pharmacists recognized VRE as a helpful technique to improve patient education on OAAs. Innovation The use of video enables participants to scrutinize and reshape their practices, making VRE a powerful innovation and adjunct to quality improvement initiatives.
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Affiliation(s)
| | - Amna Rizvi-Toner
- University of Michigan College of Pharmacy, United States of America
| | | | - Karen Farris
- University of Michigan College of Pharmacy, United States of America
| | - Chris Friese
- University of Michigan School of Nursing, United States of America
| | | | - Emily Mackler
- University of Michigan College of Pharmacy, United States of America
| | | | - Marita G. Titler
- University of Michigan School of Nursing, United States of America
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McHugh S, Sheard L, O'Hara J, Lawton R. The feasibility and acceptability of implementing video reflexive ethnography (VRE) as an improvement tool in acute maternity services. BMC Health Serv Res 2022; 22:1308. [PMID: 36324173 PMCID: PMC9629879 DOI: 10.1186/s12913-022-08713-9] [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: 08/19/2022] [Accepted: 10/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Video-reflexive ethnography (VRE) has been argued to be an alternative approach to collaborative learning in healthcare teams, more able to capture the complexities of the healthcare environment than simulation. This study aims to explore the feasibility and acceptability of employing VRE as an improvement tool in acute maternity services. METHOD Focused ethnography and semi-structured interviews (n = 17) explored the feasibility of employing VRE from the perspective of the researcher-facilitator, and that of the healthcare staff participants. Reflexive thematic analysis was used to generate key themes. RESULTS We identified four themes related to feasibility of employing VRE as an improvement approach: laying the groundwork; challenges of capturing in-situ video footage; effective facilitation of reflexive feedback; and, power to change. Of note was the central role of the facilitator in building and maintaining staff trust in the process, particularly in being able to guide collaborative, non-punitive discussion during reflexive feedback sessions. Interestingly, when considering implementation of change, structural hierarchies were evident with more senior staff better able to develop and effect ideas. Two themes related to acceptability of VRE among healthcare staff were identified: staff response to the role of VRE in improvement; and the power of a different perspective. Staff were overwhelmingly positive about their experience of VRE, particularly appreciating the time, space and autonomy it afforded them to navigate and articulate ideas for change and improvement. CONCLUSION VRE is both feasible and acceptable as an improvement tool with acute, multi-disciplinary maternity staff teams. It is an important healthcare improvement tool that could prompt the development and maintenance of team resilience factors in the face of increasing stress and burn-out of healthcare staff in maternity services.
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Affiliation(s)
- Siobhan McHugh
- School of Healthcare, University of Leeds, Baines Wing, Leeds, LS2 9JT, UK. .,School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
| | - Laura Sheard
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Jane O'Hara
- School of Healthcare, University of Leeds, Baines Wing, Leeds, LS2 9JT, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
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Todd AL, Roberts L, Foster K. Feasibility of video recording interpersonal interactions between patients and hospital staff during usual care. Pilot Feasibility Stud 2022; 8:96. [PMID: 35488183 PMCID: PMC9052656 DOI: 10.1186/s40814-022-01052-w] [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: 11/09/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Video-reflexive ethnography (VRE) has been used to record aspects of patient care which are then shared with staff to drive self-identified improvements. Interpersonal interactions between patients and hospital staff are key to high-quality, patient-centred care and mostly occur randomly throughout a patient’s hospital stay. One of the most common types of hospital admission is for women giving birth. Aims To assess the feasibility of adapting the VRE methodology to capture naturally occurring interactions between patients and health staff over an extended period during hospital admission, and to assess whether the approach would yield useful interaction data. Participants Twelve women, who had a planned caesarean section at 37+ weeks, were considered low risk (no known medical or obstetric complication) and were admitted to a postnatal unit after giving birth, and the staff who attended them. Methods This study took place in a large hospital in Sydney, Australia, where approximately 2200 women give birth each year. Continuous unattended video recordings were made during each woman’s hospital stay to capture interactions with hospital staff. The recordings were reviewed to determine what kinds of interaction data could be obtained. Results In order to recruit 12 eligible women, we needed to invite 45 to participate. The estimated recruitment period of 3–4 months had to be extended to 8 months. A fixed video camera was successfully installed in the hospital room of each woman and a remote control provided. A total of 246.5 h of video recordings was obtained, of which 38 h (15.5%) involved interpersonal interactions with staff. Two women reported negative responses from staff about being video recorded. Both quantitative and qualitative data could be obtained from the recordings. Conclusion Video recordings of interpersonal interactions between patients and staff in an in patient hospital care setting can be obtained and can provide unique insights into the complexity of healthcare delivery. However, significant contextual barriers can exist to engaging staff in quality improvement initiatives that are not part of their usual healthcare activities.
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Affiliation(s)
- Angela L Todd
- Women and Babies Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, The Douglas Building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. .,Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW, 2065, Australia.
| | - Lynette Roberts
- Women and Babies Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, The Douglas Building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.,Northern Sydney Local Health District, The Kolling Institute, St Leonards, NSW, 2065, Australia
| | - Kirsty Foster
- Academy for Medical Education, University of Queensland, Herston, QLD, 4006, Australia.,Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW, 2065, Australia
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Wyer M, Hor SY, Barratt R, Gilbert GL. Testing the efficacy and acceptability of video-reflexive methods in personal protective equipment training for medical interns: a mixed methods study. BMJ Open 2021; 11:e052985. [PMID: 34635528 PMCID: PMC8506871 DOI: 10.1136/bmjopen-2021-052985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To test the efficacy and acceptability of video-reflexive methods for training medical interns in the use of personal protective equipment (PPE). DESIGN Mixed methods study. SETTING A tertiary-care teaching hospital, Sydney, January 2018-February 2019. PARTICIPANTS 72 of 90 medical interns consented to participate. Of these, 39 completed all three time points. INTERVENTIONS Participants received a standard infection prevention and control (IPC) education module during their hospital orientation. They were then allocated alternately to a control or video group. At three time points (TPs) over the year, participants were asked to don/doff PPE items based on hospital protocol. At the first two TPs, all participants also participated in a reflexive discussion. At the second and third TPs, all participants were audited on their performance. The only difference between groups was that the video group was videoed while donning/doffing PPE, and they watched this footage as a stimulus for reflexive discussion. PRIMARY AND SECONDARY OUTCOME MEASURES The efficacy and acceptability of the intervention were assessed using: (1) comparisons of audit performance between and within groups over time, (2) comparisons between groups on survey responses for evaluation of training and self-efficacy and (3) thematic analysis of reflexive discussions. RESULTS Both groups improved in their PPE competence over time, although there was no consistent pattern of significant differences within and between groups. No significant differences were found between groups on reported acceptability of training, or self-efficacy for PPE use. However, analysis of reflexive discussions shows that the effects of the video-reflexive intervention were tangible and different in important respects from standard training. CONCLUSIONS Video reflexivity in group-based training can assist new clinicians in engagement with, and better understanding of, IPC in their clinical practice. Our study also highlights the need for ongoing and targeted IPC training during medical undergraduate studies as well as regular workplace refresher training.
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Affiliation(s)
- Mary Wyer
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- The University of Sydney Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia
| | - Su-Yin Hor
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ruth Barratt
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - G L Gilbert
- The University of Sydney Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, New South Wales, Australia
- Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Increasing patient participation in hand hygiene practices in adult surgical wards in a tertiary institution: a best practice implementation project. JBI Evid Implement 2021; 20:53-62. [PMID: 34369896 DOI: 10.1097/xeb.0000000000000290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The WHO states that hospital-acquired infections may be transmitted through contaminated hands. Practicing hand hygiene using alcohol-based handrub or soap and water reduces harmful organisms. The Joanna Briggs Institute (JBI) best practice recommends empowering patients with hand hygiene knowledge and engaging their involvement to strengthen hand hygiene practices. AIMS The aim of this project was to improve hand hygiene among surgical inpatients. METHODS This evidence-based quality improvement project was conducted in three phases: the baseline audit, implementing best practice, and the postimplementation audit. Participants were patients hospitalized in three surgical wards of a 1200-bed acute care tertiary hospital. This project utilized the online JBI Practical Application of Clinical Evidence System and The Getting Research into Practice program to identify barriers and strategies. Nurses provided patients with an education pamphlet and regularly reminded them to improve their hand hygiene practices. RESULTS Ninety-four patients were audited between April and June 2018. Patients' hand hygiene practices improved from 19.1% at baseline audit to 61.7% (P < 0.01) at first follow-up audit. Patients' hand hygiene improved from 48.9 to 72.3% (P = 0.03) before meals, and from 92.6 to 98.9% (P = 0.65) after toileting. The proportion of patients who received a hand hygiene information leaflet in an appropriate language increased from 64.9 to 89.4% (P < 0.01). CONCLUSION Patients' involvement in the hand hygiene program has significantly improved their hand hygiene practices. Patient education and patient information leaflet continue to be an effective strategy to improve knowledge and practices.
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Roche D, Jones A. A qualitative study of nurse-patient communication and information provision during surgical pre-admission clinics. Health Expect 2021; 24:1357-1366. [PMID: 34089627 PMCID: PMC8369095 DOI: 10.1111/hex.13270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background Health‐care service users are often being described as ‘co‐producers’ with an active role in their care. However, there are challenges associated with this approach, including how standardization affects personalized care, and the ability of patients to retain high volumes of information. Objective Our study explores patient and nursing perspectives of information provision in the pre‐admission element of an Enhanced Recovery After Surgery programme, an evidence‐based approach implemented to improve the quality of surgical care. Our analysis has been informed by an evidence‐based model developed by Grande et al Patient Educ Couns. 2014;95:281. Design/Setting and participants This was a qualitative study including observations of pre‐admission clinics and semi‐structured interviews across three surgical wards. Patients (n = 21) and registered nurses (n = 21) were purposively selected for interviews. Results Patients welcomed the opportunity for active involvement in their care. However, we also identified informational boundaries and how illness and treatment‐related anxieties were barriers to patient engagement with the information provided. Discussion We recommend that to support a patient‐centred and individualized approach to patient involvement the ‘information (giving) + activation’ element of Grande et al Patient Educ Couns. 2014;95:281 model be reconfigured to allow for ‘information (giving) + exploration +activation’. Conclusion Nurses need to feel empowered to adopt strategies that allow for different informational needs, rather than adopting a one‐size‐fits‐all paternalistic approach. Patient contribution This study focused on patient involvement and we give thanks to all the patients who took part in interviews and those who allowed us to observe their care.
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Affiliation(s)
- Dominic Roche
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Huang F, Brouqui P, Boudjema S. How does innovative technology impact nursing in infectious diseases and infection control? A scoping review. Nurs Open 2021; 8:2369-2384. [PMID: 33765353 PMCID: PMC8363394 DOI: 10.1002/nop2.863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/28/2021] [Accepted: 03/04/2021] [Indexed: 12/22/2022] Open
Abstract
Aim Considering the increasing number of emerging infectious diseases, innovative approaches are strongly in demand. Additionally, research in this field has expanded exponentially. Thus, faced with this diverse information, we aim to clarify key concepts and knowledge gaps of technology in nursing and the field of infectious diseases. Design This scoping review followed the methodology of scoping review guidance from Arksey and O’Malley. Methods Six databases were searched systematically (PubMed, Web of Science, IEEE Explore, EBSCOhost, Cochrane Library and Summon). After the removal of duplicates, 532 citations were retrieved and 77 were included in the analysis. Results We identified five major trends in technology for nursing and infectious diseases: artificial intelligence, the Internet of things, information and communications technology, simulation technology and e‐learning. Our findings indicate that the most promising trend is the IoT because of the many positive effects validated in most of the reviewed studies.
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Affiliation(s)
- Fanyu Huang
- IRD, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France
| | - Philippe Brouqui
- IRD, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,AP-HM, IHU-Méditerranée Infection, Marseille, France
| | - Sophia Boudjema
- IRD, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France
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Hammoud S, Amer F, Lohner S, Kocsis B. Patient education on infection control: A systematic review. Am J Infect Control 2020; 48:1506-1515. [PMID: 32512081 DOI: 10.1016/j.ajic.2020.05.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lately, suggestions have been emphasizing the importance of engaging patients and family members in infection control (IC) through participation and education after showing that patients and family members can aid in preventing the transmission of health care-associated infections. However, assessing patient education on IC measures in hospitals is poorly investigated. PURPOSE To identify all available studies in the literature that assessed hospitalized patients' education on IC measures. METHODS PubMed, Embase, and CINAHL were searched from inception till May 6, 2020 without restrictions. We used Strengthening the Reporting of Observational Studies in Epidemiology tool for assessing the reporting quality of each eligible study. MAIN FINDINGS Of the 6,740 identified papers, 25 were eligible for inclusion. Education on health care-associated infections was investigated in 8 studies, education on central line-associated bloodstream infections in 1, education on surgical site infections in 2, education on hand hygiene in 12, education on isolation rationale, precautions, usage of personal protective equipment in 3, and education on respiratory hygiene in 1. In general, a low percentage of patient education on IC was found in most of the included papers. CONCLUSIONS The low percentage of patient education on IC in hospitals highlights the need for additional emphasis on patient involvement in IC. Further studies are needed to assess patient education on several IC measures and to explore the education of family members as well.
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Diedrich S, Görig T, Dittmann K, Kramer A, Heidecke CD, Hübner NO. Active Integration of Patients into Infection Control, as perceived by Health Care Professionals: Results of the AHOI Pilot Study. Infect Drug Resist 2020; 13:4009-4019. [PMID: 33204118 PMCID: PMC7667167 DOI: 10.2147/idr.s261343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
Objective Medical professionals have a key role in active patient involvement in infection control and prevention (ICP). ICP of hospital-associated infections is critical for patient safety and requires targeted integration of patients and their relatives. The possibilities of proper involvement are identified, tested and realized in the innovative AHOI project. Its acronym stands for Activation, Help, Open communication and Infection prevention. The project is based on the three dimensions acceptance, empowerment and adherence. The results presented here are from a health-care professional (HCP) focused part of a pilot study to implement AHOI intervention. This section aimed at the HCPs’ evaluation of the intervention material, their perception and acceptance of the adherence and empowerment of patients, as well as the perception of their and colleagues’ own behavior. Methods The cross-sectional survey was conducted with a questionnaire at two surgical wards of a third-level hospital for 14 weeks. All HCPs with contact to patients were entitled to voluntarily participate in the study. AHOI instruments such as visual reminder, videos for patients and the AHOI-box were implemented on the wards. Additionally, the ward personnel received a psychological and practical train-the-trainer curriculum. Results Sixty-nine questionnaires were handed out and 29 returns were analyzed. The results show a strong identification and acceptance of HCPs with their role in the AHOI project. No additional workload was perceived by implementing AHOI. Teaching of medical professionals and information materials are seen as good supports. HCPs are empowering hygienic behavior in patients and colleagues. HCPs observed increasing adherence of patients. Conclusion HCPs positively perceived acceptance, support and identification with the ideas of the AHOI project. Therefore, since HCPs are key for patients and their relatives, AHOI intervention seems to be a feasible instrument and aid in implementing national and international recommendations for hygienic behavior.
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Affiliation(s)
- Stephan Diedrich
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Tillmann Görig
- Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Kathleen Dittmann
- Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Claus-Dieter Heidecke
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Nils-Olaf Hübner
- Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Greifswald, Germany
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Duhn L, Godfrey C, Medves J. Scoping review of patients' attitudes about their role and behaviours to ensure safe care at the direct care level. Health Expect 2020; 23:979-991. [PMID: 32755019 PMCID: PMC7696111 DOI: 10.1111/hex.13117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/10/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To improve harm prevention, patient engagement in safety at the direct care level is advocated. For patient safety to most effectively include patients, it is critical to reflect on existing evidence, to better position future research with implications for education and practice. METHODS As part of a multi-phase study, which included a qualitative descriptive study (Duhn & Medves, 2018), a scoping review about patient engagement in safety was conducted. The objective was to review papers about patients' attitudes and behaviours concerning their involvement in ensuring their safe care. The databases searched included MEDLINE, CINAHL and EMBASE (year ending 2019). RESULTS This review included 35 papers about "Patient Attitudes" and 125 papers about "Patient Behaviours"-indicative of growing global interest in this field. Several patterns emerged from the review, including that most investigators have focused on a particular dimension of harm prevention, such as asking about provider handwashing, and there is less known about patients' opinions about their role in safety generally and how to actualize it in a way that is right for them. While patients may indicate favourable attitudes toward safety involvement generally, intention to act or actual behaviours may be quite different. CONCLUSION This review, given its multi-focus across the continuum of care, is the first of its kind based on existing literature. It provides an important international "mapping" of the initiatives that are underway to engage patients in different elements of safety and their viewpoints, and identifies the gaps that remain.
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Affiliation(s)
- Lenora Duhn
- School of NursingQueen’s UniversityKingstonONCanada
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13
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Prior SJ, Mather C, Ford K, Bywaters D, Campbell S. Person-centred data collection methods to embed the authentic voice of people who experience health challenges. BMJ Open Qual 2020; 9:bmjoq-2020-000912. [PMID: 32699082 PMCID: PMC7375396 DOI: 10.1136/bmjoq-2020-000912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/23/2020] [Accepted: 07/03/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sarah Jane Prior
- Tasmanian School of Medicine, University of Tasmania, Cradle Coast Campus, Tasmania, Australia
| | - Carey Mather
- School of Nursing, University of Tasmania, Newnham Campus, Tasmania, Australia
| | - Karen Ford
- School of Nursing, University of Tasmania, Hobart, Tasmania, Australia
| | - Danielle Bywaters
- School of Nursing, University of Tasmania, Newnham Campus, Tasmania, Australia
| | - Steven Campbell
- School of Nursing, University of Tasmania, Newnham Campus, Tasmania, Australia
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Hooker C, Hor S, Wyer M, Gilbert GL, Jorm C, Iedema R. Trajectories of hospital infection control: Using non-representational theory to understand and improve infection prevention and control. Soc Sci Med 2020; 256:113023. [DOI: 10.1016/j.socscimed.2020.113023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/18/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
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Gilbert GL, Hor S, Wyer M, Sadsad R, Badcock CA, Iedema R. Sustained fall in inpatient MRSA prevalence after a video-reflexive ethnography project; an observational study. Infect Dis Health 2020; 25:140-150. [PMID: 32089464 DOI: 10.1016/j.idh.2020.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maintaining optimal infection prevention and control (IPC) in a busy, clinical environment is challenging. Video-reflexive ethnography (VRE) is a collaborative, interventionist approach to practice improvement. We hypothesised that giving clinicians opportunities to view and reflect on video footage of everyday ward activities would raise awareness of, and suggest strategies to reduce, pathogen transmission risks. We undertook a VRE project, between March and September 2013, in two tertiary hospital surgical wards, with persistently high methicillin resistant Staphylococcus aureus (MRSA) endemicity, despite previous IPC interventions. METHODS This study was a retrospective/prospective observational study, using interrupted time-series analyses, to assess the effects of the VRE project on hand hygiene compliance, inpatient MRSA infections (newly infected patients, per 1000 occupied bed days) and inpatient MRSA colonisation prevalence, measured by serial point prevalence surveys. Follow-up continued until June 2016. RESULTS The VRE project was associated with changes in IPC behaviour and outcomes. Hand hygiene compliance increased (from 62% to 75%; p < 0.0001) and MRSA colonisation prevalence decreased significantly, in both wards (baseline 42%; average post-VRE 12%; p=<0.0001), MRSA infection rate decreased in one ward. Interpretation of results was complicated by a potential confounding effect of unplanned environmental hydrogen peroxide decontamination (HPD). Improved hand hygiene compliance was a predicted outcome of VRE, but also a potential contributor to reduced MRSA transmission. CONCLUSION Separate contributions of VRE (the intervention), HPD and hand hygiene compliance were uncertain, but their combined effect was significantly reduced MRSA endemicity, which previously had been resistant to attempted IPC interventions.
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Affiliation(s)
- Gwendolyn L Gilbert
- Centre for Infectious Diseases and Microbiology, ICPMR, Westmead Hospital, Cnr Darcy and Hawkesbury Rds, Westmead, 2145, NSW, Australia.
| | - Suyin Hor
- University of Technology Sydney, 15 Broadway, Ultimo, 2007, NSW, Australia.
| | - Mary Wyer
- University of Technology Sydney, 15 Broadway, Ultimo, 2007, NSW, Australia.
| | - Rosemarie Sadsad
- Centre for Infectious Diseases and Microbiology, ICPMR, Westmead Hospital, Cnr Darcy and Hawkesbury Rds, Westmead, 2145, NSW, Australia; Sydney Informatics Hub, University of Sydney, 32 Queen St, Chippendale, 2008, NSW, Australia.
| | - Caro-Anne Badcock
- Shimsco Consulting, Pty, Ltd, Largs North, 5016, South Australia, Australia.
| | - Rick Iedema
- University of Technology Sydney, 15 Broadway, Ultimo, 2007, NSW, Australia.
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Görig T, Dittmann K, Kramer A, Heidecke CD, Diedrich S, Hübner NO. Active involvement of patients and relatives improves subjective adherence to hygienic measures, especially selfreported hand hygiene: Results of the AHOI pilot study. Antimicrob Resist Infect Control 2019; 8:201. [PMID: 31890157 PMCID: PMC6909614 DOI: 10.1186/s13756-019-0648-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background The prevention of nosocomial infections requires participation from the patients themselves. In the past, however, patients have been apprehensive to point out hygiene-relevant behaviour to the personnel. In the project AHOI, the possibilities of active patient involvement in infection prevention are identified, tested and realized. The goal is a prevention strategy based upon three dimensions: “adherence”, “empowerment” and “acceptance”. “AHOI” stands for the “Activation of patients, persons in need of care and care givers for a Hygiene-conscious participatiOn in Infection control”. Results from the AHOI pilot study on the implementation of a multimodal intervention bundle are reported. Methods In 2017, a two-stage patient survey was conducted on two surgical wards for 14 weeks. In addition to the intervention bundle, acceptance, adherence and empowerment regarding individual hygiene behaviour and perception were evaluated. The bundle included an AHOI-welcome-box with an informational and entertaining brochure and supportive incentives. Furthermore, multiple visual materials like video presentations for patients’ bedside TV, posters and visual reminders in the patients’ bedrooms and sanitary facilities were installed. Results 179 respondents were surveyed at admission, 139 at discharge and 133 at both time points. Almost all respondents wanted to contribute to infection control. The AHOI project was well accepted by patients. Two-thirds wanted to be more involved. More than a third expected a negative response from staff after pointing out hygiene deficiencies. Four respondents observed a deficiency in hygiene with healthcare personnel and reported a very positive reaction once this was communicated to the personnel. More than four-fifths of the respondents felt well integrated and adequately informed post intervention. The feeling of active involvement correlated significantly with subjective participation and adherence to hygienic measures, especially self-reported hand disinfection. Conclusion The results demonstrated that the required inclusion of patients in infection control is possible with AHOI. Active involvement of patients and relatives is associated with improvements in adherence to infection prevention measures.
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Affiliation(s)
- Tillmann Görig
- 1Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 49A, Greifswald, 17475 Germany
| | - Kathleen Dittmann
- 1Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 49A, Greifswald, 17475 Germany
| | - Axel Kramer
- 2Institute of Hygiene and Environmental Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Claus-Dieter Heidecke
- 3Polyclinic and Clinic for General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany.,4Medical Chairman of Universitätsmedizin Greifswald, Greifswald, Germany
| | - Stephan Diedrich
- 3Polyclinic and Clinic for General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Nils-Olaf Hübner
- 1Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 49A, Greifswald, 17475 Germany
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Dadich A, Moore L, Eapen V. What does it mean to conduct participatory research with Indigenous peoples? A lexical review. BMC Public Health 2019; 19:1388. [PMID: 31660911 PMCID: PMC6819462 DOI: 10.1186/s12889-019-7494-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 08/14/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To better understand and promote public health, participatory research with Indigenous peoples represents recommended practice, worldwide. However, due to the different ways such research is referred to, described, and used, it is unclear what might (and might not) warrant the term when collaborating with Indigenous peoples. As such, this article expands conceptual understandings of participatory research with Indigenous peoples, across timelines and regions. METHOD Following a systematic search of 29 academic databases in April 2018, a lexical analysis of the methods sections was conducted, which were sourced from 161 publications across 107 journals. RESULTS The active involvement of Indigenous peoples in research that is expressly participatory is limited across all project phases. This might be because the ways in which Indigenous peoples were involved throughout were not reported - however, it might also be because Indigenous peoples were not involved in all project phases. Furthermore, descriptions differ by study location and publication timeframe - notably, studies in the region of the Americas chiefly refer to pandemics, surveyors, and art; and those published in the last two decades have given primacy to artifacts of interest. CONCLUSIONS Findings from this corpus of data suggest participatory research with Indigenous peoples is not always described across different project phases; furthermore, it differs according to study location and publication timeframe. This offers considerable opportunity to further this important research area via alternative methodologies that award primacy to Indigenous expertise and agency.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, 169 Macquarie Street, Parramatta, NSW, 2150, Australia. .,1797 Locked Bag, Western Sydney University, 1797 Locked Bag, Penrith, NSW, 2751, Australia.
| | - Loretta Moore
- Autism Spectrum Australia (Aspect), Building 1, Level 2, 14 Aquatic Drive, Frenchs Forest, NSW, 2086, Australia.,, Forestville, NSW, 2087, Australia
| | - Valsamma Eapen
- Academic Unit of Infant, Child, Adolescent Psychiatry South West Sydney, University of New South Wales, Sydney, Australia.,ICAMHS, L1 MHC, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia.,University of New South Wales Sydney, Sydney, NSW, 2052, Australia
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Gilbert GL, Kerridge I. The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians' perceptions of professional and cultural factors that influence doctors' attitudes and practices in a large Australian hospital. BMC Health Serv Res 2019; 19:212. [PMID: 30940153 PMCID: PMC6444390 DOI: 10.1186/s12913-019-4044-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/27/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hospital infection prevention and control (IPC) programs are designed to minimise rates of preventable healthcare-associated infection (HAI) and acquisition of multidrug resistant organisms, which are among the commonest adverse effects of hospitalisation. Failures of hospital IPC in recent years have led to nosocomial and community outbreaks of emerging infections, causing preventable deaths and social disruption. Therefore, effective IPC programs are essential, but can be difficult to sustain in busy clinical environments. Healthcare workers' adherence to routine IPC practices is often suboptimal, but there is evidence that doctors, as a group, are consistently less compliant than nurses. This is significant because doctors' behaviours disproportionately influence those of other staff and their peripatetic practice provides more opportunities for pathogen transmission. A better understanding of what drives doctors' IPC practices will contribute to development of new strategies to improve IPC, overall. METHODS This qualitative case study involved in-depth interviews with senior clinicians and clinician-managers/directors (16 doctors and 10 nurses) from a broad range of specialties, in a large Australian tertiary hospital, to explore their perceptions of professional and cultural factors that influence doctors' IPC practices, using thematic analysis of data. RESULTS Professional/clinical autonomy; leadership and role modelling; uncertainty about the importance of HAIs and doctors' responsibilities for preventing them; and lack of clarity about senior consultants' obligations emerged as major themes. Participants described marked variation in practices between individual doctors, influenced by, inter alia, doctors' own assessment of patients' infection risk and their beliefs about the efficacy of IPC policies. Participants believed that most doctors recognise the significance of HAIs and choose to [mostly] observe organisational IPC policies, but a minority show apparent contempt for accepted rules, disrespect for colleagues who adhere to, or are expected to enforce, them and indifference to patients whose care is compromised. CONCLUSIONS Failure of healthcare and professional organisations to address doctors' poor IPC practices and unprofessional behaviour, more generally, threatens patient safety and staff morale and undermines efforts to minimise the risks of dangerous nosocomial infection.
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Affiliation(s)
- Gwendolyn L Gilbert
- Sydney Health Ethics, University of Sydney, Level 1, Building 1, Medical Foundation Building, 92/94 Parramatta Rd, Camperdown, NSW, 2050, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW, 2145, Australia.
| | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Level 1, Building 1, Medical Foundation Building, 92/94 Parramatta Rd, Camperdown, NSW, 2050, Australia.,Department of Haematology, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia
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Fernandes Agreli H, Murphy M, Creedon S, Ni Bhuachalla C, O’Brien D, Gould D, Savage E, Barry F, Drennan J, Smiddy MP, Condell S, Horgan S, Murphy S, Wills T, Burton A, Hegarty J. Patient involvement in the implementation of infection prevention and control guidelines and associated interventions: a scoping review. BMJ Open 2019; 9:e025824. [PMID: 30904866 PMCID: PMC6475448 DOI: 10.1136/bmjopen-2018-025824] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions. DESIGN Scoping review. METHODS A methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013-2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted. RESULTS From an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to one that involves a collaborative relationship between HCPs and patients. This change should be underpinned by a clear understanding of patient roles, potential levels of patient involvement in IPC and strategies to overcome barriers to patient involvement focusing on the professional-patient relationship (eg, patient encouragement through multimodal educational strategies and efforts to disperse professional's power). CONCLUSIONS There is limited evidence regarding the best strategies to promote patient involvement in the implementation of IPC interventions and guidelines. The findings of this review endorse the need for targeted strategies to overcome the lack of role clarity of patients in IPC and the power imbalances between patients and HCPs.
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Affiliation(s)
| | - Michael Murphy
- Department of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sile Creedon
- Department of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Deirdre O’Brien
- Department of Clinical Microbiology, Mercy University Hospital, Cork, Ireland
| | - Dinah Gould
- School of Healthcare Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Eileen Savage
- Department of Nursing and Midwifery, Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fiona Barry
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- Department of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Maura P Smiddy
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Sarah Condell
- Department of Health, National Patient Safety Office, Dublin, Ireland
| | | | - Siobhan Murphy
- Department of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Teresa Wills
- Department of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Aileen Burton
- Department of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- Department of Nursing and Midwifery, Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Brys N, Keating JA, Knobloch MJ, Safdar N. Engaging patients in health care epidemiology research: A case example. Am J Infect Control 2019; 47:139-143. [PMID: 30314749 DOI: 10.1016/j.ajic.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/10/2018] [Accepted: 08/12/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND We describe stakeholder engagement from a Patient-Centered Outcomes Research Institute-funded project to identify patients' research priorities for health care-associated infections (HAI). We summarize insights from these activities to highlight feasibility and benefits of stakeholder engagement in health care epidemiology research.Patients and caregivers who had an HAI experience were involved in a patient and caregiver stakeholder group. We engaged clinicians, infection prevention experts, state public health professionals, and quality improvement experts in an institutional stakeholder (IS) group in an academic tertiary care medical center. METHODS Through individual and combined group activities, we identified stakeholders' HAI research priorities. Existing engagement resources from the Wisconsin Network for Research Support (WINRS) guided the process. RESULTS Given the patients' and caregivers' experiences with HAIs, their perspectives broadened IS understanding of the impact of HAIs and the relevance of proposed research topics. After introductory activities described here, the patient and caregiver stakeholder group actively engaged with researchers and the IS group in discussing complex systems-level topics to reduce HAIs. We have sustained this engagement through continued collaboration. CONCLUSIONS Our engagement experience provides one example of how patients can be engaged in health care epidemiology research. Our experiences and lessons learned may be helpful to others interested in stakeholder engagement.
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Affiliation(s)
- Nicole Brys
- Department of Medicine, Division of Infectious Disease, University of Wisconsin School of Medicine & Public Health, Madison, WI.
| | - Julie A Keating
- Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Mary Jo Knobloch
- Department of Medicine, Division of Infectious Disease, University of Wisconsin School of Medicine & Public Health, Madison, WI; Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nasia Safdar
- Department of Medicine, Division of Infectious Disease, University of Wisconsin School of Medicine & Public Health, Madison, WI; Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI
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Alzyood M, Jackson D, Brooke J, Aveyard H. An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting. J Clin Nurs 2018; 27:1329-1345. [PMID: 29423965 DOI: 10.1111/jocn.14305] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To review patients' and healthcare professionals' perceptions of patient involvement in promoting hand hygiene compliance in the hospital setting. BACKGROUND Initiatives continue to emphasise the importance of involving patients in their safety at the point of care. A patient-centred care approach aimed to empower patients to become active members of the healthcare team. However, understanding the perceptions of patients and healthcare professionals of patient involvement in promoting hand hygiene compliance among healthcare professionals has yet to be fully explored. DESIGN Integrative literature review. METHODS A five-stage review process informed by Whittemore and Knafl's methodology was conducted. MEDLINE and CINAHL were searched for papers published between January 2009-July 2017. Data were extracted manually, organised using NVivo 11 and analysed using thematic analysis. RESULTS From an identified 240 papers, 19 papers were included in this review. Thematic analysis revealed two main themes with three related subthemes. Patients were willing to remind healthcare professionals (especially nurses) to wash their hands, healthcare professionals perception towards patients' involvement varied from one study to another. However, an overall positive attitude towards patient involvement was related to how patients asked and how healthcare professionals responded to being asked. CONCLUSION There is limited evidence regarding patients' actual intention to ask healthcare professionals to wash their hands, and some evidence that patients are reluctant to do so. Further research is required to understand this area thoroughly, including which situations patients would feel more empowered to speak up. RELEVANCE TO CLINICAL PRACTICE Simple messages promoting patient involvement may lead to complex reactions in both patients and healthcare professionals. It is unclear, yet how patients and staff react to such messages in clinical practice. There is a need for a deeper understanding of how they can work together to support harm free care.
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Affiliation(s)
- Mamdooh Alzyood
- Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery, and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery, and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
| | - Joanne Brooke
- Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery, and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
| | - Helen Aveyard
- Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery, and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
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Carroll K, Mesman J. Multiple Researcher Roles in Video-Reflexive Ethnography. QUALITATIVE HEALTH RESEARCH 2018; 28:1145-1156. [PMID: 29478407 DOI: 10.1177/1049732318759490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hospital-based video-reflexive ethnography (VRE) is a collaborative visual methodology used by researchers and/or health professionals to understand, interpret, and optimize health professionals' work practices and patients' experiences. For more than a decade, the VRE methodology has spread throughout (research) institutions and hospitals internationally, and VRE has evolved and broadened. Different ways of doing VRE have implications for the role of the researcher. A thorough examination of the consequences for the researcher's position is the central focus of this article. We outline three typical styles of researcher engagement with VRE: clinalyst, affect-as-method, and planned obsolescence. We argue that by examining these different styles of doing VRE research, academic researchers can then critically review and carefully choose which styles of VRE research best meet the needs of their research questions, their field relationships, their disciplinary background, and the expectations of their clinical research collaborators.
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Affiliation(s)
- Katherine Carroll
- 1 The Australian National University, Canberra, Australian Capital Territory, Australia
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Patient Involvement in Healthcare-Associated Infection Research: A Lexical Review. Infect Control Hosp Epidemiol 2018; 39:710-717. [PMID: 29606155 DOI: 10.1017/ice.2018.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVEThis review examines patient involvement in healthcare-associated infection (HAI) research. Healthcare-associated infections represent an intractable issue with considerable implications for patients and staff. Participatory methodologies that involve patients in healthcare research are associated with myriad benefits.DESIGNLexical review.METHODSPubMed was searched to identify all publications on patient involvement in HAI research since 2000; publications were also identified from the cited references. A lexical analysis was conducted of the methods sections of 148 publications.RESULTSThe findings reveal that HAI research that actively involves patients and members of the public is limited.CONCLUSIONSPatient involvement is largely limited to recruitment to HAI studies rather than extended to patient involvement in research design, implementation, analysis, and/or dissemination. As such, there is considerable opportunity to further this important research area via alternative methodologies that award primacy to patient expertise and agency.Infect Control Hosp Epidemiol 2018;39:710-717.
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Hung L, Phinney A, Chaudhury H, Rodney P. Using Video-Reflexive Ethnography to Engage Hospital Staff to Improve Dementia Care. Glob Qual Nurs Res 2018; 5:2333393618785095. [PMID: 30014004 PMCID: PMC6041992 DOI: 10.1177/2333393618785095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 11/16/2022] Open
Abstract
In this article, we discuss how video-reflexive ethnography may be useful in engaging staff to improve dementia care in a hospital medical unit. Seven patients with dementia were involved in the production of patient-story videos, and fifty members of staff (nurses, physicians, and allied health practitioners) participated in video-reflexive groups. We identified five substantial themes to describe how video-reflexive groups might contribute to enacting person-centered care for improving dementia care: (a) seeing through patients' eyes, (b) seeing normal strange and surprised, (c) seeing inside and between, (d) seeing with others inspires actions, and (e) seeing with the team builds a culture of learning. Our findings suggest that video reflexivity is not only useful for staff engagement but also effective in enhancing team capacity to enact person-centered care in the hospital setting.
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Affiliation(s)
- Lillian Hung
- Simon Fraser University, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison Phinney
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Habib Chaudhury
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Paddy Rodney
- University of British Columbia, Vancouver, British Columbia, Canada
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Knobloch MJ, Thomas KV, Patterson E, Zimbric ML, Musuuza J, Safdar N. Implementation in the midst of complexity: Using ethnography to study health care-associated infection prevention and control. Am J Infect Control 2017; 45:1058-1063. [PMID: 28774756 DOI: 10.1016/j.ajic.2017.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Contextual factors associated with health care settings make reducing health care-associated infections (HAIs) a complex task. The aim of this article is to highlight how ethnography can assist in understanding contextual factors that support or hinder the implementation of evidence-based practices for reducing HAIs. METHODS We conducted a review of ethnographic studies specifically related to HAI prevention and control in the last 5 years (2012-2017). RESULTS Twelve studies specific to HAIs and ethnographic methods were found. Researchers used various methods with video-reflexive sessions used in 6 of the 12 studies. Ethnography was used to understand variation in data reporting, identify barriers to adherence, explore patient perceptions of isolation practices and highlight the influence of physical design on infection prevention practices. The term ethnography was used to describe varied research methods. Most studies were conducted outside the United States, and authors indicate insights gained using ethnographic methods (whether observations, interviews, or reflexive video recording) as beneficial to unraveling the complexities of HAI prevention. CONCLUSIONS Ethnography is well-suited for HAI prevention, especially video-reflexive ethnography, for activating patients and clinicians in infection control work. In this era of increasing pressure to reduce HAIs within complex work systems, ethnographic methods can promote understanding of contextual factors and may expedite translation evidence to practice.
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Butenko S, Lockwood C, McArthur A. Patient experiences of partnering with healthcare professionals for hand hygiene compliance: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1645-1670. [PMID: 28628522 DOI: 10.11124/jbisrir-2016-003001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Healthcare-associated infections pose a significant risk to patients in acute healthcare settings such as hospitals. Increasingly, patients are encouraged to be active participants and partner with healthcare professionals to positively influence their own safety and overall experience throughout their healthcare journey. Patient-focused safety initiatives include the empowerment of patients to be active partners with healthcare professionals in order to influence the hand hygiene behaviors and compliance of the healthcare professionals providing care to them. Partnering within the context of healthcare, and between the patient and healthcare professional, can be considered as a general concept that involves the empowerment of patients to participate in their care. Terms used to describe patient partnering within healthcare vary and include patient participation, patient-centeredness, patient empowerment and patient engagement. Although patients appear generally to have positive attitudes and intentions about engaging in their safety and partnering in the healthcare setting, their intentions and actual behaviors vary considerably. Patients appear less likely to engage in behaviors that require questioning of the perceived or real authority of healthcare professionals. A patient's intention and subsequent act of partnering with healthcare professionals for hand hygiene compliance by the healthcare professional are influenced by complex internal, external and social factors as well as cultural, behavioral and systematic factors. OBJECTIVES To determine the best available evidence in relation to the experiences of the patient partnering with healthcare professionals for hand hygiene compliance. INCLUSION CRITERIA TYPES OF PARTICIPANTS The current review considered qualitative (critical or interpretive) papers that included adult in-patients and healthcare professionals (medical and nursing staff), in the acute hospital-care setting. Adult was considered to be any person aged 18 years or over. It should be noted that consumers in this context were patients and vice versa; the term patient is therefore used throughout this report for consistency. PHENOMENA OF INTEREST The current review considered studies that investigated the experience of partnership between patients and healthcare professionals in relation to hand hygiene compliance. This review investigated the phenomena of partnering from both the perspectives of the patient and the healthcare professional. TYPES OF STUDIES The current review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. As qualitative studies were identified and on appraisal found to be of sufficient quality for inclusion, this review did not seek alternate forms of evidence such as text and opinion. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies from 1990 to May 2015. Studies published in English were considered for inclusion in this review. METHODOLOGICAL QUALITY Qualitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION Qualitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-QARI. DATA SYNTHESIS Qualitative research findings were pooled using JBI-QARI. RESULTS Following the systematic search and critical appraisal process, three studies were included in the review for data extraction and synthesis of findings. The review process resulted in 29 study findings that were aggregated into seven categories. The categories generated two meta-synthesized findings. The two final synthesized findings were as follows. Synthesized finding 1: Organizational structures enable partnering between healthcare professionals and patients for hand hygiene compliance; however, the culture, beliefs and behaviors of healthcare professionals and patients do not fully support this partnership. Synthesized finding 2: Patients have differing levels of knowledge and balance partnering in hand hygiene against possible detrimental impacts on the caring relationship provided by healthcare professionals, out of concern for their own wellbeing, health outcomes, treatment and/or recovery. CONCLUSION The current review highlights the complexity of the patient's experience of partnering with healthcare professionals for hand hygiene compliance. The experiences reported indicated that there is a possible disparity between the healthcare facility and healthcare professionals' promotion and intention of partnering for hand hygiene compliance, and the actual patient's acceptance, participation, partnership, experience and implementation of this initiative. This disconnect between intent and action appears to be influenced by a number of factors including organizational structures as well as drivers such as cultural beliefs and behavior.
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Affiliation(s)
- Samantha Butenko
- 1Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 2Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
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Collier A, Wyer M. Researching Reflexively With Patients and Families: Two Studies Using Video-Reflexive Ethnography to Collaborate With Patients and Families in Patient Safety Research. QUALITATIVE HEALTH RESEARCH 2016; 26:979-993. [PMID: 26658233 DOI: 10.1177/1049732315618937] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Patient safety research has to date offered few opportunities for patients and families to be actively involved in the research process. This article describes our collaboration with patients and families in two separate studies, involving end-of-life care and infection control in acute care. We used the collaborative methodology of video-reflexive ethnography, which has been primarily used with clinicians, to involve patients and families as active participants and collaborators in our research. The purpose of this article is to share our experiences and findings that iterative researcher reflexivity in the field was critical to the progress and success of each study. We present and analyze the complexities of reflexivity-in-the-field through a framework of multilayered reflexivity. We share our lessons here for other researchers seeking to actively involve patients and families in patient safety research using collaborative visual methods.
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Affiliation(s)
- Aileen Collier
- Flinders University, Adelaide, South Australia, Australia
| | - Mary Wyer
- University of Tasmania, Sydney campus, New South Wales, Australia
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