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Rumintang Marito D, Widianto S. Link of Infection Prevention Climate to Patient-Centered Care: Role of Workplace Safety and Risk Mitigation. Risk Manag Healthc Policy 2024; 17:329-340. [PMID: 38352960 PMCID: PMC10863469 DOI: 10.2147/rmhp.s439907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
Background Healthcare-associated infections pose a substantial threat to the quality of healthcare services. Consequently, it is imperative for hospital organizations to actively support an infection prevention climate, fostering workplace safety and risk mitigation, thereby promoting patient-centered care. Purpose This study aims to explore the interconnectedness between the infection prevention climate, workplace safety, risk mitigation, and patient-centered care. Methods A cross-sectional study design was employed, utilizing a questionnaire administered to 235 healthcare professionals in intensive care and inpatient units at Bandung Kiwari Regional General Hospital. Data analysis was conducted using partial least squares structural equation modeling (PLS-SEM) with SmartPLS 4 and SPSS 25. Results The study revealed several significant relationships, including (1) between infection prevention climate and patient-centered care; (2) infection prevention climate and workplace safety; (3) workplace safety and patient-centered care; (4) infection prevention climate and patient-centered care mediated by workplace safety; (5) infection prevention climate and risk mitigation; (6) risk mitigation and patient-centered care; (7) and the relationship between infection prevention climate and patient-centered care mediated by risk mitigation. Conclusion Infection prevention climate emerges as a crucial intangible value that hospital organizations can cultivate to shape workplace safety. This, in turn, encourages healthcare workers' compliance in implementing infection prevention controls as a form of risk mitigation, ultimately contributing to the provision of patient-centered care.
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Affiliation(s)
| | - Sunu Widianto
- Department of Management and Business, Universitas Padjadjaran, Bandung, Indonesia
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Yu T, Zhang X, Wang Q, Zheng F, Wang L. Communication openness and nosocomial infection reporting: the mediating role of team cohesion. BMC Health Serv Res 2022; 22:1416. [PMID: 36434720 PMCID: PMC9701000 DOI: 10.1186/s12913-022-08646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The states of IPC (Infection Prevention and Control) is serious under the COVID-19 pandemic. Nosocomial infection reporting is of great significance to transparent management of IPC in regard to the COVID-19 pandemic. We aimed to explore the relationship between communication openness and nosocomial infection reporting, explore the mediating effect of team cohesion in the two, and provide evidence-based organizational perspective for improving IPC management in the hospitals. METHOD A questionnaire was used to collect data on communication openness, team cohesion and nosocomial infection reporting in 3512 medical staff from 239 hospitals in Hubei, China. Structural Equation Model (SEM) was conducted to examine the hypothetical model. RESULT Communication openness was positively related to nosocomial infection reporting (β = 0.540, p < 0.001), and was positively related to team cohesion (β = 0.887, p < 0.001). Team cohesion was positively related to nosocomial infection reporting (β = 0.328, p < 0.001). The partial mediating effect of team cohesion was significant (β = 0.291, SE = 0.055, 95% CI = [ 0.178,0.392 ]), making up 35.02% of total effect. CONCLUSION Communication openness was not only positively related to nosocomial infection reporting. Team cohesion can be regarded as a mediator between communication openness and nosocomial infection reporting. It implies that strengthening communication openness and team cohesion is the strategy to promote IPC management from the new organizational perspective.
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Affiliation(s)
- Tiantian Yu
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xinping Zhang
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Qianning Wang
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Feiyang Zheng
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Lu Wang
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
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Ito A, Sato K, Yumoto Y, Sasaki M, Ogata Y. A concept analysis of psychological safety: Further understanding for application to health care. Nurs Open 2021; 9:467-489. [PMID: 34651454 PMCID: PMC8685887 DOI: 10.1002/nop2.1086] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/23/2021] [Accepted: 09/02/2021] [Indexed: 12/14/2022] Open
Abstract
AIM To clarify the concept of psychological safety in a healthcare context and to provide the first theoretical framework for improving interpersonal relationships in the workplace to better patient care. DESIGN A Rodgers' concept analysis. METHODS The concept analysis was conducted using a systematic search strategy on PubMed, CINAHL, PsycINFO and Ichushi-Web. RESULTS An analysis of 88 articles studying psychological safety in health care identified five attributes: perceptions of the consequences of taking interpersonal risks, strong interpersonal relationships, group-level phenomenon, safe work environment for taking interpersonal risks and non-punitive culture. The antecedents included structure/system factors, interpersonal factors and individual factors. The four consequences included performance outcomes, organizational culture outcomes, and psychological and behavioural outcomes.
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Affiliation(s)
- Ayano Ito
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kana Sato
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yoshie Yumoto
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Miki Sasaki
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yasuko Ogata
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Lozano-Lozano JA, Chacón-Moscoso S, Sanduvete-Chaves S, Holgado-Tello FP. Work Climate Scale in Emergency Services: Abridged Version. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126495. [PMID: 34208668 PMCID: PMC8296405 DOI: 10.3390/ijerph18126495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
This study is based on a 40-item work climate scale in hospital emergency services (WCSHES). Teams working in these emergency services experience a heavy workload and have a limited amount of time with each patient. COVID-19 has further complicated these existing issues. Therefore, we believed it would be helpful to draft an abridged version of the 40-item WCSHES, considering both validity and reliability criteria, but giving greater weight to validity. One hundred and twenty-six workers between the ages of 20 to 64 (M = 32.45; standard deviation (SD = 9.73)) years old participated voluntarily in the study. The validity, reliability, and fit model were evaluated in an iterative process. The confirmatory factor analysis yielded appropriate global fit indices in the abridged 24-item version (Χ2(248) = 367.84; p < 0.01, RMSEA = 0.06 with an interval of 90% from 0.05 to 0.07, SRMR = 0.08, GFI = 0.9, AGFI = 0.96, CFI = 0.98, NFI = 0.95, and NNFI = 0.98), along with test criteria validity (ρXY = 0.68, p < 0.001) and excellent reliability (α = 0.94 and ω = 0.94), maintaining the same conceptualization and usefulness of the original scale. The abridged 24-item version was used to measure four work climate factors (work satisfaction, productivity/achievement of aims, interpersonal relations, and performance at work). Evidence of the usefulness of the new abridged scale is provided along with a description of our study limitations and future areas for development.
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Affiliation(s)
- José Antonio Lozano-Lozano
- Instituto de Ciencias Biomédicas, Instituto Iberoamericano de Desarrollo Sostenible, Universidad Autónoma de Chile, Santiago 7500912, Chile
- Correspondence: (J.A.L.-L.); ; (S.C.-M.); Tel.: +34-954-557-672 (S.C.-M.)
| | - Salvador Chacón-Moscoso
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, 41018 Sevilla, Spain;
- Departamento de Psicología, Universidad Autónoma de Chile, Santiago 7500138, Chile
- Correspondence: (J.A.L.-L.); ; (S.C.-M.); Tel.: +34-954-557-672 (S.C.-M.)
| | - Susana Sanduvete-Chaves
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, 41018 Sevilla, Spain;
| | - Francisco Pablo Holgado-Tello
- Departamento de Metodología de las Ciencias del Comportamiento y de la Salud, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain;
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Braun BI, Chitavi SO, Suzuki H, Soyemi CA, Puig-Asensio M. Culture of Safety: Impact on Improvement in Infection Prevention Process and Outcomes. Curr Infect Dis Rep 2020; 22:34. [PMID: 33288982 PMCID: PMC7710367 DOI: 10.1007/s11908-020-00741-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/21/2022]
Abstract
Purpose Safety culture is known to be related to a wide range of outcomes, and measurement of safety culture is now required for many hospitals in the U.S.A. In previous reviews, the association with outcomes has been limited by the research design and strength of the evidence. The goal of this review was to examine recent literature on the relationship between safety culture and infection prevention and control-related (IPC) processes and healthcare-associated infections (HAIs) in U.S. healthcare organizations. We also sought to quantitatively characterize the challenges to empirically establishing these relationships and limitations of current research. Recent Findings A PubMed search for U.S. articles published 2009–2019 on the topics of infection prevention, HAIs, and safety culture yielded 448 abstracts. After screening, 55 articles were abstracted for information on purpose, measurement, analysis, and conclusions drawn about the role of safety culture in the outcome. Approximately ½ were quality improvement (QI) initiatives and ½ were research studies. Overall, 51 (92.7%) concluded there was an association between safety culture and IPC processes or HAIs. However, only 39 studies measured safety culture and 26 statistically analyzed safety culture data for associations. Though fewer QI initiatives analyzed associations, a higher proportion concluded an association exists than among research studies. Summary Despite limited empirical evidence and methodologic challenges to establishing associations, most articles supported a positive relationship between safety culture, improvement in IPC processes, and decreases in HAIs. Authors frequently reported experiencing improvements in safety culture when not directly measured. The findings suggest that associations between improvement and safety culture may be bi-directional such that positive safety culture contributes to successful interventions and implementing effective interventions drives improvements in culture. Greater attention to article purpose, design, and analysis is needed to confirm these presumptive relationships.
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Affiliation(s)
- Barbara I Braun
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Salome O Chitavi
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Hiroyuki Suzuki
- Department of Internal Medicine - Infectious Diseases, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Caroline A Soyemi
- Neihoff School of Nursing, Loyola University Chicago, Chicago, IL USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, Carver College of Medicine, Iowa City, IA USA.,Present Address: Department of Infectious Diseases, Hospital Universitari de Bellvitge: L'Hospitalet de Llobregat, Barcelona, Catalunya Spain
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Tumala RB, Almazan J, Alabdulaziz H, Felemban EM, Alsolami F, Alquwez N, Alshammari F, Tork HMM, Cruz JP. Assessment of nursing students perceptions of their training hospital's infection prevention climate: A multi-university study in Saudi Arabia. NURSE EDUCATION TODAY 2019; 81:72-77. [PMID: 31330405 PMCID: PMC7131737 DOI: 10.1016/j.nedt.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/11/2019] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The risk of acquiring and spreading infection must be minimized in nursing students because they are exposed to healthcare-associated infections during clinical training. To achieve this goal, students should be knowledgeable and competent in infection control practice before proceeding to their training hospitals. OBJECTIVES This study assessed the nursing students' perception of the infection prevention climate in training hospitals in Saudi Arabia. It also examined the predictors of the students' perceptions. DESIGN A quantitative, cross-sectional design was used. METHODS This investigation was part of a large study conducted in six Saudi universities. A total of 829 Saudi nursing students were included in this study. Data were collected using the Leading Culture of Quality in Infection Prevention scale and analyzed using descriptive and inferential statistics. Ethical approval was obtained from the King Saud University, and permission was given by the administration of each participating university. RESULTS The overall perception of nursing students indicated a modest infection prevention climate. Prioritization of quality and improvement orientation was rated as the highest dimensions, whereas psychological safety and supportive environment were the lowest. The nursing students in University F had the poorest perceptions among the six universities. The predictors of nursing student perception of their training hospitals' infection prevention climates were the university where they studied, their age, and participation in infection prevention seminars. CONCLUSIONS This article describes nursing students' perception of the infection prevention climate of their training hospitals in Saudi Arabia. Results may provide a unique theoretical underpinning on the perception and factors that effect an infection prevention climate. Thereby, previous knowledge and literature may be expanded. Results can be used as a guide in establishing clinical policies in efforts toward improving the infection prevention climate.
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Affiliation(s)
- Regie B Tumala
- College of Nursing, King Saud University, Riyadh, Saudi Arabia.
| | - Joseph Almazan
- Nursing Department, Majmaah University, Majmaah, Saudi Arabia; Department of Nursing Education, College of Medicine, Nazarbayev University, Nur-Sultan City, Kazakhstan
| | - Hawa Alabdulaziz
- Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia.
| | | | - Fatmah Alsolami
- Faculty of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Nahed Alquwez
- Nursing Department, College of Applied Medical Sciences, Shaqra University, Al Dawdmi, Saudi Arabia.
| | | | - Hanan M M Tork
- College of Nursing, Qassim University, Qassim, Saudi Arabia
| | - Jonas Preposi Cruz
- Nursing Department, College of Applied Medical Sciences, Shaqra University, Al Dawdmi, Saudi Arabia.
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Alshehry AS. Culture of quality in infection prevention of a hospital as perceived by health care workers. J Nurs Manag 2019; 27:1131-1139. [PMID: 31034680 DOI: 10.1111/jonm.12783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 01/27/2023]
Abstract
AIM This research aimed to assess the culture of quality in infection prevention (CQIP) of a university hospital as perceived by health care workers (HCWs). BACKGROUND Health care-associated infections are serious concerns in hospitals in Saudi Arabia. Hence, assessing their CQIP is necessary. METHOD An investigation employing a descriptive and cross-sectional design was carried out among 623 HCWs (doctors, nurses and nursing assistants) in a university hospital in Saudi Arabia by using the Leading a Culture of Quality in Infection Prevention (LCQ-IP) scale. RESULTS The overall mean in the LCQ-IP was 3.86 (SD = 0.62). The subscale "prioritization of quality" (M = 4.11, SD = 0.79) was rated the highest dimension, whereas "supportive work environment" was perceived as the poorest dimension (M = 3.56, SD = 0.54). Gender, nationality, highest education and job title affected the four factors of the HCWs' perceptions of the hospital's CQIP. CONCLUSION HCWs modestly perceived their hospital's CQIP. The study highlighted the need for improving CQIP based on the four dimensions. IMPLICATIONS FOR NURSING AND HOSPITAL MANAGEMENT This study provided valuable implications for hospital and nursing management to ensure high-quality culture of infection prevention.
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Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units. Health Care Manage Rev 2019; 43:138-147. [PMID: 27819803 DOI: 10.1097/hmr.0000000000000134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. PURPOSE The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). METHODOLOGY/APPROACH A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. FINDINGS Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. PRACTICE IMPLICATIONS Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality.
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Cruz JP. Infection prevention climate and its influence on nursing students’ compliance with standard precautions. J Adv Nurs 2019; 75:1042-1052. [DOI: 10.1111/jan.13904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/06/2018] [Accepted: 10/02/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Jonas Preposi Cruz
- Nursing Department College of Applied Medical Sciences at Al Dawadmi Shaqra University Al Dawadmi Saudi Arabia
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Colet PC, Cruz JP, Cacho G, Al-Qubeilat H, Soriano SS, Cruz CP. Perceived Infection Prevention Climate and Its Predictors Among Nurses in Saudi Arabia. J Nurs Scholarsh 2017; 50:134-142. [PMID: 29193701 DOI: 10.1111/jnu.12360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE This study investigated the staff nurses' perception of the infection prevention climate and its predictors in two hospitals. DESIGN This is a cross-sectional study employing a convenience sample of 224 staff nurses at two general hospitals in Riyadh province. METHODS The study utilized a two-part questionnaire that captures respondents' characteristics and the validated tool on Leading a Culture of Quality for Infection Prevention (LCQ-IP). Both descriptive and inferential statistics were utilized accordingly. RESULTS The prioritization of quality received the highest mean score among the four factors of the scale (mean = 3.89, SD = 0.65), followed by supportive work environment (mean = 3.88, SD = 0.68), psychological safety (mean = 3.85, SD = 0.65), and improvement orientation (mean = 3.84, SD = 0.64). Nationality, clinical experience, and attendance to seminars or training were identified as significant predictors. CONCLUSIONS The respondents perceived the infection prevention climate of the two general hospitals positively. This study strengthens the idea that organizational context influences negatively or positively the programs on infection prevention being implemented in the hospitals. CLINICAL RELEVANCE The result may facilitate nursing and hospital management to reflect, examine, and review their organizational climate, the impact of infection prevention initiatives and patient safety strategies, and the reason to amend related policies or improve procedures, including the promotion of a healthy work environment.
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Affiliation(s)
- Paolo C Colet
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia; Assistant Professor, Nazarbayev University, School of Medicine, Astana, Kazakhstan
| | - Jonas Preposi Cruz
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia, Visiting Professor, Graduate School, Union Christian College, La Union, Philippines
| | - Gabby Cacho
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia
| | - Hikmet Al-Qubeilat
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia
| | - Shiela S Soriano
- Lecturer, Shaqra University, College of Applied Medical Sciences, Nursing Department, Al Dawadmi, Saudi Arabia
| | - Charlie P Cruz
- Assistant Lecturer, Laboratory Science Program, University of Wyoming, Casper, WY, USA; and Adjunct Professor, Graduate School, Lyceum of the Philippines University, Batangas, Philippines
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Testing the Quality Health Outcomes Model Applied to Infection Prevention in Hospitals. Qual Manag Health Care 2017; 25:149-61. [PMID: 27367216 DOI: 10.1097/qmh.0000000000000102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the Quality Health Outcomes Model to investigate the relationship between health care-associated infection (HAI) prevention interventions, organizational context, and HAI outcomes using structural equation modeling. METHODS Variables for adherence to the central line bundle, organizational context, and central line-associated bloodstream infections (CLABSIs) were selected for this secondary data analysis from 614 US hospitals that participated in the Prevention of Nosocomial Infection and Cost-effectiveness-Refined study. One half of the dataset was used for exploration of the concepts, the second half for confirmation of the measurement models and testing of the structural model. RESULTS The final model resulted in a good fit to the data (χ (1215) = 1906.86, P < .00; comparative fit index = 0.94; root mean square of error of approximation = 0.04). A significant relationship was noted between adherence to the central line bundle interventions and organizational context (β = 0.23, P < .01), whereas the relationship between context and CLABSIs was not significant (β = -0.20, P = .78). CONCLUSIONS This study supports a relationship between greater adherence to HAI interventions and higher levels of organizational context and highlights the complexity of measuring organizational context. Given the importance of preventing HAIs, ongoing research is needed to reveal the exact aspects of context that influence interventions and outcomes.
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12
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Gilmartin HM, Sousa KH, Battaglia C. Capturing the Central Line Bundle Infection Prevention Interventions: Comparison of Reflective and Composite Modeling Methods. Nurs Res 2016; 65:397-407. [PMID: 27579507 PMCID: PMC5010018 DOI: 10.1097/nnr.0000000000000168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The central line (CL) bundle interventions are important for preventing central line-associated bloodstream infections (CLABSIs), but a modeling method for testing the CL bundle interventions within a health systems framework is lacking. OBJECTIVES Guided by the Quality Health Outcomes Model (QHOM), this study tested the CL bundle interventions in reflective and composite, latent, variable measurement models to assess the impact of the modeling approaches on an investigation of the relationships between adherence to the CL bundle interventions, organizational context, and CLABSIs. METHODS A secondary data analysis study was conducted using data from 614 U.S. hospitals that participated in the Prevention of Nosocomial Infection and Cost-Effectiveness Refined study. The sample was randomly split into exploration and validation subsets. RESULTS The two CL bundle modeling approaches resulted in adequate fitting structural models (RMSEA = .04; CFI = .94) and supported similar relationships within the QHOM. Adherence to the CL bundle had a direct effect on organizational context (reflective = .23; composite = .20; p = .01) and CLABSIs (reflective = -.28; composite = -.25; p = .01). The relationship between context and CLABSIs was not significant. Both modeling methods resulted in partial support of the QHOM. DISCUSSION There were little statistical, but large, conceptual differences between the reflective and composite modeling approaches. The empirical impact of the modeling approaches was inconclusive, for both models resulted in a good fit to the data. Lessons learned are presented. The comparison of modeling approaches is recommended when initially modeling variables that have never been modeled or with directional ambiguity to increase transparency and bring confidence to study findings.
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Affiliation(s)
- Heather M Gilmartin
- Heather M. Gilmartin, PhD, NP, is Postdoctoral Nurse Fellow, Denver-Seattle Center of Innovation, Department of Veterans Affairs, Denver VA Medical Center, Colorado. Karen H. Sousa, PhD, RN, FAAN, is Professor and Associate Dean for Research and Extramural Affairs, University of Colorado College of Nursing, Anschutz Medical Campus, Aurora. Catherine Battaglia, PhD, RN, is Nurse Scientist, Denver-Seattle Center of Innovation, Department of Veterans Affairs, Denver VA Medical Center, Colorado
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