Factors responsible for student nurses' use of non-sterile gloves: An exploratory qualitative study

Background

Disposable non-sterile gloves are part of the personal protective equipment (PPE) to be considered to protect oneself from the risk of infection. They have subsequently become the topic of concern related to increased use, inappropriate use, and potentially increasing the risk of cross-infection and environmental impact of plastic waste.

Aim/objective

This study aimed to explore the views of pre-registration student nurses about non-sterile glove use in clinical practice and to identify the factors that impact student nurses' decision on whether to wear non- sterile gloves.

Methods

Using a social constructivist approach, the study was organised in a higher education institution. Semi-structured interviews were conducted with second year student nurses, utilising a theoretical domains framework (TDF).

Findings/Results

The key findings showed that students had limited awareness of the national infection prevention and control best practice procedures. The primary influential factors for non-sterile gloves use behaviour were personal protection, the type of care interventions required and the observations of peers and role models.

Discussion

The study found limited awareness on the importance of infection prevention and control precautions, including the correct procedure for donning, and doffing of personal protection equipment, along with a lack of confidence to challenge non-compliance.

Capability, Opportunity, Motivation, and Hand Hygiene Behavior in Healthcare Workers: A Structural Equation Modeling

Background

Hand hygiene among healthcare workers is the leading measure to reduce healthcare-associated infections. However, hand hygiene behavior is complex and not readily understood. This study aimed to identify the determinants and the underlying mechanism of hand hygiene behavior based on the capability, opportunity, motivation-behavior model.

Methods

A self-constructed questionnaire survey was conducted among healthcare workers in Chongqing, China. Capability, opportunity, and motivation were designed as independent variables, and hand hygiene behavior was measured as a dependent variable. Internal consistency reliability analysis and confirmatory factor analysis were applied to examine the reliability and validity of the questionnaire. Structural equation modeling was performed to explore the relationships among capability, opportunity, motivation, and hand hygiene behavior.

Results

Four hundred and ninety-nine physicians and nurses were investigated. The Cronbach’s α coefficients were above 0.764. Confirmatory factor analysis was confirmed with good data fitness. The structural equation modeling had a good fit (root mean square error of approximation=0.070, comparative fit index=0.960, Tucker–Lewis index=0.956). Both opportunity (β=0.265, p<0.05) and motivation (β=0.333, p<0.05) directly affected hand hygiene behavior. Both capability (β=0.194, p<0.001) and opportunity (β=0.719, p<0.001) were indirectly linked to hand hygiene behavior through motivation.

Conclusion

To improve hand hygiene behavior, more efforts need to be focused on resource provision and motivation enhancement in the future compared to training.

Clinical learning spaces: Crucibles for practice development in physiotherapy clinical education

This paper, through a deep examination of clinical workplaces as learning spaces, uses a holistic interpretation of clinical education and offers a practice development crucible metaphor as a useful way to deepen how clinical education can be conceptualized. An in-depth conceptualization of clinical education is needed if educators are able to develop wise educational practice and optimize the time students spend in clinical learning settings. The research reported here was undertaken in the qualitative paradigm guided by philosophical hermeneutics. Data collection strategies included observation, semi-structured interviews, focus groups and photo-elicitation. Twenty-four undergraduate physiotherapy students and twelve physiotherapy clinical supervisors participated in this research. Consistent with hermeneutic principles of dialogue of question and answer and hermeneutic circle, data analysis was achieved through an iterative process of reading, interpreting and re-reading the transcripts resulting in the emergence of a deeper understanding of clinical education that is represented for the reader. Clinical education has been revealed as a multidimensional learning space where workplace influences, engagement in professional practices, clinical supervisors' intentions and actions in combination with students' dispositions interact to shape and challenge students' clinical learning. A practice development crucible metaphor has been introduced as a way to represent this complexity and conceptualize clinical education, not as a set of techniques or supervision ratios but as a relational, fluid, complex space where learning is catalyzed. Importantly, the crucible metaphor assists academics, clinical supervisors and students to harness the power of clinical education to facilitate learning during clinical placements.

Hand hygiene among healthcare workers: A qualitative meta summary using the GRADE-CERQual process

BACKGROUND

Hand hygiene is considered an effective and potentially modifiable infection control behaviour among healthcare workers (HCW). Several meta-studies have been published that compare quantitatively expressed findings, but limited efforts have been made to synthesise qualitative research.

OBJECTIVES

This paper provides the first report of integrated findings from qualitative research reports on hand hygiene compliance among HCW worldwide that employs the GRADE-CERQual process of quality assessment.

METHODS

We conducted database searches and identified 36 reports in which authors conducted qualitative or mixed methods research on hand hygiene compliance among HCW. We used Dedoose analysis software to facilitate extraction of relevant excerpts. We applied the GRADE-CERQual process to describe relative confidence as high, moderate or low for nine aggregate findings.

FINDINGS

Highest confidence findings included that HCW believe they have access to adequate training, and that management and resource support are sometimes lacking. Individual, subjective criteria also influence hand hygiene.

DISCUSSION

These results suggest the need for further investigation into healthcare cultures that are perceived as supportive for infection control. Surveillance processes have potential, especially if information is perceived by HCW as timely and relevant.

Public perceptions of the use of gloves by healthcare workers and comparison with perceptions of student nurses

INTRODUCTION

There is evidence that non-sterile clinical gloves (NSCG) are over-used by healthcare workers (HCWs) and are associated with cross-contamination. This study aimed to determine attitudes of student nurses and members of the public to the use of NSCG.

METHODS

Third-year student nurses completed a questionnaire indicating tasks for which they would wear NSCG and influences on their decision. Correlations between tasks were identified using exploratory factor analysis. An online survey of the public was conducted using snowball sampling method.

RESULTS

Sixty-seven students completed the questionnaire; they indicated use of NSCG for low-risk tasks and reported their own judgement as the main influence on their decision to wear them. Correlated tasks included 'perceived to be risky' or 'definitive indication for gloves/no gloves' and 'related to personal hygiene'. A total of 142 respondents completed the public survey. They reported being uncomfortable with HCW wearing gloves for some personal tasks, e.g. assisting to toilet and dressing, but 94% preferred their use for washing 'private parts'; 29% had observed inappropriate glove use by HCWs during recent contact with healthcare.

CONCLUSION

Student nurses reported using NSCG routinely for tasks for which they are neither required nor recommended. The public observe inappropriate glove use and are uncomfortable with their use for some personal tasks.