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Albarmawi M, Al Hadid L, Alnjadat R, Aljabery A. A multi-institute, follow-up, observational study measuring nursing students' adherence to infection prevention and control protocols in Saudi Arabia. Front Med (Lausanne) 2024; 10:1282723. [PMID: 38274447 PMCID: PMC10808488 DOI: 10.3389/fmed.2023.1282723] [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: 08/31/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Background Nursing students learn principles of infection prevention and control (IPC) and hand hygiene (HH) in clinical courses, and their learning is reflected in their practice. Objectives The knowledge, attitude, and practice of principles of IPC and HH of the students were measured prior to and after attending an educational workshop. The adherence of the students to the IPC and HH protocols at the hospital was also observed. Methods This study included a pretest-posttest time series follow-up and an observational part. During the first part of the study, students attended a workshop, which was preceded by a pretest. It was then followed by a posttest directly after finishing the workshop and in 12 weeks. Participants were submitted to an observational part by a trained observer to document certain skills taught earlier during the workshop. Settings Students from three nursing schools in Saudi Arabia participated in the study. Participants A total number of 130 completed the study protocol, and 100 completed the observation part. Results Students were found to experience an improvement in their knowledge, beliefs, and commitment scales after the workshop. The attitude scale remained relatively unchanged over different tests. Most students performed the skills properly and adequately, but some failed to perform certain skills, like hand rub, and the proper use of disinfectants.
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Affiliation(s)
- Marwa Albarmawi
- Department of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
| | | | - Rafi Alnjadat
- Department of Nursing, Al-Balqa Applied University, Al-Salt, Jordan
| | - Ahmad Aljabery
- Department of Nursing, Al-Balqa Applied University, Al-Salt, Jordan
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Szumska E, Czajkowski P, Zablocki M, Rozkiewicz D. A Multifaceted Approach to the "Bare below the Elbow" Concept and Hand Hygiene Compliance among Healthcare Professionals-Multicenter Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4435. [PMID: 36901445 PMCID: PMC10002297 DOI: 10.3390/ijerph20054435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Nosocomial infections remain an important issue for patient safety concerns. Since hospital infections are mainly connected with healthcare professionals' routines, an increase in hand hygiene effectiveness through compliance with the "bare below the elbow" (BBE) concept could reduce the number of nosocomial infections. Therefore, this study aims to evaluate hand hygiene and to investigate healthcare professionals' compliance with the BBE concept. We performed our study on a group of 7544 hospital professionals involved in patient care. During the national preventive action, questionnaires, demographic data, and hand hygiene preparations were recorded. Hand disinfection was verified by COUCOU BOX, containing a UV camera. We noted that 3932 (52.1%) persons complied with the BBE rules. Nurses and non-medical personnel were significantly more often classified as BBE rather than non-BBE (2025; 53.3% vs. 1776; 46.7%, respectively, p = 0.001 and 1220; 53.7% vs. 1057; 46.3%, p = 0.006). Different proportions were demonstrated for the groups of physicians-non-BBE (783; 53.3%) compared to BBE (687; 46.7%) (p = 0.041). Healthcare workers from the BBE group statistically more often disinfected their hands correctly (2875/3932; 73.1%) compared to the non-BBE group (2004/3612; 55.5%) (p < 0.0001). This study demonstrates the positive impact of compliance with the BBE concept on effective hand disinfection and patient safety. Therefore, education and infection-prevention actions should be popularized to improve the BBE policy's effectiveness as well.
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Affiliation(s)
- Emilia Szumska
- Medilab Sp. z o. o., Niedzwiedzia 60, 15-531 Bialystok, Poland
| | - Przemyslaw Czajkowski
- Clinical Research Centre, Medical University of Bialystok, Jana Kilinskiego 1, 15-089 Bialystok, Poland
| | - Michal Zablocki
- Medilab Sp. z o. o., Niedzwiedzia 60, 15-531 Bialystok, Poland
| | - Dorota Rozkiewicz
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
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Meza Sierra CU, Perez Jaimes GA, Rueda Díaz LJ. Interventions to improve knowledge or compliance to hand hygiene in nursing students: A scoping review. J Infect Prev 2023; 24:30-44. [PMID: 36644521 PMCID: PMC9834423 DOI: 10.1177/17571774221127696] [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: 03/11/2022] [Accepted: 09/04/2022] [Indexed: 01/18/2023] Open
Abstract
Background During their training process, nursing students carry out internships in different care settings, which implies direct contact with more than one patient simultaneously. Their hands represent a vehicle for transmitting pathogens that cause healthcare-related infections. Various interventions have been proposed to improve nursing students' knowledge or compliance to hand hygiene. However, the information on these interventions is scattered in the literature. Objectives This study was conducted to identify and describe the interventions to improve knowledge or compliance to hand hygiene in nursing students evaluated in the scientific literature. Methods The scoping review methodology guided by the Joanna Briggs Institute (JBI) was adopted. Screening and data extraction were performed by two reviewers using templates developed by the authors. Results Thirteen studies were included. Education and training were highlighted as the central core components for interventions. The duration ranged from 15 min to 1 week. The number of sessions varied between one to three sessions. The content was based mainly on the recommendations of the World Health Organization and the Centers for Disease Control and Prevention (CDC). Conclusions There is a limited body of interventions to improve knowledge or compliance to the hand hygiene technique in nursing students. Education and training were highlighted as the central core components for interventions. New primary studies are needed and should include a description in detail of the characteristics of the interventions.
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Perception of Shame in the Plastic Surgery Field. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4621. [PMID: 36312904 PMCID: PMC9612954 DOI: 10.1097/gox.0000000000004621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/25/2022] [Indexed: 02/25/2023]
Abstract
UNLABELLED Doctors and postgraduate students, especially those in the surgical field, face a highly stressful environment and are exposed to various emotions that have been studied, but the concept of shame-based learning (SBL) is still undergoing investigation, especially in the field of plastic surgery. SBL is a teaching method in which an instructor instills a sense of shame in the student, which may cause depression, anxiety, aggression, and poor job performance, leading to burnout, mental health illness, substance abuse, and suicide. METHODS From March to May 2022, two cross-sectional electronic surveys were conducted for residents and consultants in Saudi Arabia, respectively, which used a validated questionnaire to assess SBL. RESULTS Among the 70 responses received (29 residents and 41 consultants), 75.9% of the residents and 80.5% of the consultants were shamed. For residents, a wrong answer was the most common trigger for shame (44.8%), and the operating room was the most common place for it (51.7%). Losing self-confidence was the most common result of shaming (37.9%) and (41.4%) dealt with it by keeping it to themselves. Although 27.6% of residents stated that they had no negative effect, 20.7% stated that they were motivated. There are consultants who practice shaming directly or indirectly (65.9%), while some agreed that it is not necessary (80.5%). CONCLUSIONS Although both groups agreed that SBL is unnecessary for the field and will not be practiced in the future, most residents and consultants experienced shame. The negative impact of SBL has several effects on the trainer, the teaching environment, and patient care.
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Allen LM, Hay M, Palermo C. Evaluation in health professions education-Is measuring outcomes enough? MEDICAL EDUCATION 2022; 56:127-136. [PMID: 34463357 DOI: 10.1111/medu.14654] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 05/28/2023]
Abstract
INTRODUCTION In an effort to increase the rigour of evaluation in health professions education (HPE), a range of evaluation approaches are used. These largely focus on outcome evaluation as opposed to programme evaluation. We aim to review and critique the use of outcome evaluation models, using the Kirkpatrick Model as an example given its wide acceptance and use, and advocate for the use of programme evaluation models that help us understand how and why outcomes are occurring. METHODS We systematically searched OVID medline, Scopus, CINAHL and Pubmed, and hand searched six leading HPE journals to provide an overview of the use of the Kirkpatrick Model as well as a range of programme evaluation models in HPE. In addition to this, we synthesised the existing critiques of the Kirkpatrick Model as an example of outcome evaluation, to highlight the limitations of such models. RESULTS The use of the Kirkpatrick Model in HPE is widespread and increasing; however, studies focus on categorising outcomes, rather than explaining how and why they occur. The main criticisms of the model are as follows: it is outcomes focused and fails to consider factors that can impact training outcomes; it assumes positive casual linkages between the levels; there is an assumption that the higher-level outcomes are more important; and unintended impacts are not considered. The use of the Kirkpatrick Model by the MERSQI, BEME and WHO contribute to the myth that the Kirkpatrick Model is the gold standard for programme evaluation. DISCUSSION Moving forward, evaluations of HPE interventions must shift from focusing largely on measuring outcomes of interventions with little consideration for how and why these outcomes are occurring to programme evaluation that investigates what contributes to these outcomes. Other models that facilitate the evaluation of the complex processes that occur in HPE should be used instead of Kirkpatrick's.
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Affiliation(s)
- Louise M Allen
- Monash Centre for Professional Development and Monash Online Education, Monash University, Clayton, Victoria, Australia
| | - Margaret Hay
- Monash Centre for Professional Development and Monash Online Education, Monash University, Clayton, Victoria, Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
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Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. THE LANCET. INFECTIOUS DISEASES 2021; 21:e209-e221. [PMID: 34331890 DOI: 10.1016/s1473-3099(21)00383-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022]
Abstract
Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.
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Affiliation(s)
- Nasim Lotfinejad
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alexandra Peters
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ermira Tartari
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Faculty of Health Sciences, University of Malta, Malta
| | | | - Daniela Pires
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Nalule Y, Buxton H, Flynn E, Oluyinka O, Sara S, Cumming O, Dreibelbis R. Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria. BMC Pregnancy Childbirth 2020; 20:589. [PMID: 33023531 PMCID: PMC7541299 DOI: 10.1186/s12884-020-03282-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/24/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility-based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. METHODS This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first 6 hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. RESULTS Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. CONCLUSIONS In this setting, hand hygiene practices during post-natal care and the first 6 hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.
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Affiliation(s)
- Yolisa Nalule
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Helen Buxton
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Erin Flynn
- Infection and Immunity, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
| | - Olutunde Oluyinka
- Maternal and Child Survival Program (MCSP)/Save the Children Nigeria, Abuja, Nigeria
| | - Stephen Sara
- Maternal and Child Survival Program (MCSP)/Save the Children US, Washington, DC, 20036, USA
| | - Oliver Cumming
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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Stanulewicz N, Knox E, Narayanasamy M, Shivji N, Khunti K, Blake H. Effectiveness of Lifestyle Health Promotion Interventions for Nurses: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E17. [PMID: 31861367 PMCID: PMC6981404 DOI: 10.3390/ijerph17010017] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/15/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prior research has investigated various strategies to improve health, wellbeing and the job-related outcomes of nurses. However, the scope of this evidence is not clear and the types of intervention most likely to have positive outcomes are unknown. OBJECTIVE To provide an overview and synthesis of the effectiveness of interventions conducted with the goal of improving health, wellbeing and the job-related outcomes of nurses. METHODS A systematic database search was conducted from January 2000 to December 2018, with pre-defined criteria (Cochrane Central Register of Controlled Trials; MEDLINE and PubMed; EMBASE; CINAHL; PsycINFO; and BioMed Central). In total, 136 intervention studies with a total sample of 16,129 participants (range 9-3381) were included and evaluated. Data extraction, quality assessment and risk of bias analyses were performed. RESULTS Studies included randomised controlled trials (RCTs; n = 52, 38%), randomised crossover design studies (n = 2, 1.5%) and non-randomised pre-post studies with a control group (n = 31, 23%) and without a control group (n = 51, 37.5%). The majority of interventions focused on education, physical activity, mindfulness, or relaxation. Thirty-seven (27%) studies had a multimodal intervention approach. On average, studies had relatively small samples (median = 61; mode = 30) and were conducted predominantly in North America (USA/Canada, n = 53). The findings were mixed overall, with some studies reporting benefits and others finding no effects. Dietary habits was the most successfully improved outcome (8/9), followed by indices of body composition (20/24), physical activity (PA) (11/14), and stress (49/66), with >70% of relevant studies in each of these categories reporting improvements. The lowest success rate was for work-related outcomes (16/32). Separate analysis of RCTs indicated that interventions that focus solely on education might be less likely to result in positive outcomes than interventions targeting behavioural change. CONCLUSIONS Interventions targeting diet, body composition, PA, or stress are most likely to have positive outcomes for nurses' health and/or wellbeing. The methodologically strongest evidence (RCTs) is available for body composition and stress. Interventions relying solely on educational approaches are least likely to be effective. Organisational outcomes appear to be more challenging to change with lifestyle intervention, likely requiring more complex solutions including changes to the work environment. There is a need for more high-quality evidence since many studies had moderate or high risk of bias and low reporting quality.
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Affiliation(s)
- Natalia Stanulewicz
- School of Applied Social Sciences, De Montfort University, Leicester LE1 9BH, UK
| | - Emily Knox
- Infant Nutrition and Metabolism, University of Granada, 52005 Granada, Spain;
| | - Melanie Narayanasamy
- School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK; (M.N.); (H.B.)
| | - Noureen Shivji
- School of Primary, Community and Social Care, Keele University, Staffordshire ST5 5BG, UK;
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK;
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK; (M.N.); (H.B.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
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Interventions to improve healthcare workers' hand hygiene compliance: A systematic review of systematic reviews. Infect Control Hosp Epidemiol 2019; 39:1449-1456. [PMID: 30526716 DOI: 10.1017/ice.2018.262] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). METHODS PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. RESULTS Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness. CONCLUSIONS This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.
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Hammerschmidt J, Manser T. Nurses' knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC Health Serv Res 2019; 19:547. [PMID: 31382968 PMCID: PMC6683349 DOI: 10.1186/s12913-019-4347-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Infections with multi-resistant bacteria’s, associated with healthcare, is a known problem. The nursing home setting differs from other healthcare environments in individual and organisational factors such as knowledge, behaviour, and attitude to improve hand hygiene and it is therefore difficult to research the influential factors to improve hand hygiene. Studies have shown that increasing knowledge, behaviour and attitudes could enhance hand hygiene compliance in nursing homes. Therefore, it may be important to examine individual and organisational factors that foster improvement of these factors in hand hygiene. We aim to explore these influences of individual and organisational factors of hand hygiene in nursing home staff, with a particular focus on the function of role modelling by nursing managers. Methods We conducted a mixed-methods study surveying 165 nurses and interviewing 27 nursing managers from nursing homes in Germany. Results Most nurses and nursing managers held the knowledge of effective hand hygiene procedures. Hygiene standards and equipment were all generally available but compliance to standards also depended upon availability in the immediate work area and role modelling. Despite a general awareness of the impact of leadership on staff behaviour, not all nursing managers fully appreciated the impact of their own consistent role modelling regarding hand hygiene behaviours. Conclusion These results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.
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Affiliation(s)
- Judith Hammerschmidt
- Institute for Patient Safety, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Tanja Manser
- University of Applied Sciences and Arts Northwestern Switzerland, FHNW School of Applied Psychology, Olten, Switzerland
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Kamran A, Rahimi G, Sharifian E, Zandian H. Predictors of hand hygiene behavior among nurses: A theoretical cross-sectional study. JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.4103/jmedsci.jmedsci_47_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hand hygiene is linked to microbial keratitis and corneal inflammatory events. Cont Lens Anterior Eye 2018; 42:132-135. [PMID: 30413375 DOI: 10.1016/j.clae.2018.10.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 11/21/2022]
Abstract
Lack of or inadequate hand washing is a risk factor in the development of contact lens related microbial keratitis and corneal inflammatory events. In the public health domain there is compelling evidence that proper hand washing with soap can save lives. The purpose of this review is to draw attention to some of the public health literature in support of hand washing and how education can influence patients' hand hygiene behavior. Contact lens wearers are also guilty of poor hand washing behavior but there is scant evidence that education of hand washing procedures of lens wearers alters patient non-compliance. It is well known that pathogenic microbial contamination of contact lenses, lens cases, care solutions and anterior ocular components have been found with contact lens wear. However while the originating source may be hands or water, it is most likely both of these. Besides proper hand washing this paper will include mitigating strategies for avoiding microbial contamination.
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Maggio LA, Thomas A, Chen HC, Ioannidis JPA, Kanter SL, Norton C, Tannery NH, Artino AR. Examining the readiness of best evidence in medical education guides for integration into educational practice: A meta-synthesis. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:292-301. [PMID: 30229529 PMCID: PMC6191397 DOI: 10.1007/s40037-018-0450-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND To support evidence-informed education, health professions education (HPE) stakeholders encourage the creation and use of knowledge syntheses or reviews. However, it is unclear if these knowledge syntheses are ready for translation into educational practice. Without understanding the readiness, defined by three criteria-quality, accessibility and relevance-we risk translating weak evidence into practice and/or providing information that is not useful to educators. METHODS A librarian searched Web of Science for knowledge syntheses, specifically Best Evidence in Medical Education (BEME) Guides. This meta-synthesis focuses on BEME Guides because of their explicit goal to inform educational practice and policy. Two authors extracted data from all Guides, guided by the 25-item STructured apprOach to the Reporting In healthcare education of Evidence Synthesis (STORIES). RESULTS Forty-two Guides published in Medical Teacher between 1999 and 2017 were analyzed. No Guide met all STORIES criteria, but all included structured summaries and most described their literature search (n = 39) and study inclusion/exclusion (n = 40) procedures. Eleven Guides reported the presence of theory and/or educational principles, and eight consulted with external subject matter experts. Accessibility to each Guide's full-text and supplemental materials was variable. DISCUSSION For a subset of HPE knowledge syntheses, BEME Guides, this meta-synthesis identifies factors that support readiness and indicates potential areas of improvement, such as consistent access to Guides and inclusion of external subject matter experts on the review team. This analysis is useful for understanding the current readiness of HPE knowledge syntheses and informing future reviews to evolve so they can catalyze translation of evidence into educational practice.
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Affiliation(s)
- Lauren A Maggio
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | | | - H Carrie Chen
- Georgetown University School of Medicine, Washington, DC, USA
| | - John P A Ioannidis
- School of Medicine and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Steven L Kanter
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | - Anthony R Artino
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Hay E, Dziedzic K, Foster N, Peat G, van der Windt D, Bartlam B, Blagojevic-Bucknall M, Edwards J, Healey E, Holden M, Hughes R, Jinks C, Jordan K, Jowett S, Lewis M, Mallen C, Morden A, Nicholls E, Ong BN, Porcheret M, Wulff J, Kigozi J, Oppong R, Paskins Z, Croft P. Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elaine Hay
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Danielle van der Windt
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Milisa Blagojevic-Bucknall
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - John Edwards
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Emma Healey
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Melanie Holden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rhian Hughes
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Kelvin Jordan
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Andrew Morden
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bie Nio Ong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jerome Wulff
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jesse Kigozi
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Raymond Oppong
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Keele, UK
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Phan HT, Tran HTT, Tran HTM, Dinh APP, Ngo HT, Theorell-Haglow J, Gordon CJ. An educational intervention to improve hand hygiene compliance in Vietnam. BMC Infect Dis 2018. [PMID: 29514595 PMCID: PMC5840927 DOI: 10.1186/s12879-018-3029-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Hand hygiene compliance is the basis of infection control programs. In developing countries models to improve hand hygiene compliance to reduce healthcare acquired infections are required. The aim of this study was to determine hand hygiene compliance following an educational program in an obstetric and gynecological hospital in Vietnam. Methods Health care workers from neonatal intensive care, delivery suite and a surgical ward from Hung Vuong Hospital, Ho Chi Minh City, Vietnam undertook a 4-h educational program targeting hand hygiene. Compliance was monitored monthly for six months following the intervention. Hand hygiene knowledge was assessed at baseline and after six months of the study. Results There were 7124 opportunities over 370 hand hygiene recording sessions with 1531 opportunities at baseline and 1620 at 6 months following the intervention. Hand hygiene compliance increased significantly from baseline across all sites (43.6% [95% Confidence interval CI: 41.1–46.1] to 63% [95% CI: 60.6–65.3]; p < 0.0001). Health care worker hand hygiene compliance increased significantly after intervention (p < 0.0001). There were significant improvements in knowledge scores from baseline to 2 months post educational intervention with mean difference standard deviations (SD): 1.5 (2.5); p < 0.001). Conclusions A simple educational model was implemented in a Vietnamese hospital that revealed good hand hygiene compliance for an extended period of time. Hand hygiene knowledge increased during the intervention. This hand hygiene model could be used in developing countries were resources are limited.
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Affiliation(s)
| | | | | | | | | | - Jenny Theorell-Haglow
- Department of Medical Sciences; Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Abstract
OBJECTIVES To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. DATA SOURCES Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened. STUDY SELECTION English language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included. DATA EXTRACTION Data were extracted on the setting, participant characteristics, experimental design, hand hygiene measurement, intervention characteristics, and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist. DATA SYNTHESIS Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 of 24 (SD= 2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were education (78.9%), enablement (71.1%), training (68.4%), environmental restructuring (65.8%), and persuasion (65.8%). Intervention outcomes were variable, with a mean relative percentage change of 94.7% (SD= 195.7; range, 4.3-1155.4%) from pre to post intervention. CONCLUSIONS This review demonstrates that best practice for improving hand hygiene in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.
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Škodová M, Gimeno-Benítez A, Martínez-Redondo E, Morán-Cortés JF, Jiménez-Romano R, Gimeno-Ortiz A. Hand hygiene technique quality evaluation in nursing and medicine students of two academic courses. Rev Lat Am Enfermagem 2017; 23:708-17. [PMID: 26444174 PMCID: PMC4623734 DOI: 10.1590/0104-1169.0459.2607] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: because they are health professionals, nursing and medical students' hands during
internships can function as a transmission vehicle for hospital-acquired
infections. Method: a descriptive study with nursing and medical degree students on the quality of
the hand hygiene technique, which was assessed via a visual test using a
hydroalcoholic solution marked with fluorescence and an ultraviolet lamp. Results: 546 students were assessed, 73.8% from medicine and 26.2% from nursing. The area
of the hand with a proper antiseptic distribution was the palm (92.9%); areas not
properly scrubbed were the thumbs (55.1%). 24.7% was very good in both hands,
29.8% was good, 25.1% was fair, and 20.3% was poor. The worst assessed were the
male, nursing and first year students. There were no significant differences in
the age groups. Conclusions: hand hygiene technique is not applied efficiently. Education plays a key role in
setting a good practice base in hand hygiene, theoretical knowledge, and in skill
development, as well as good practice reinforcement.
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Affiliation(s)
- Manuela Škodová
- Faculdad de Medicina, Universidad de Extremadura, Badajoz, Extremadura, ES
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18
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Chatfield SL, DeBois K, Nolan R, Crawford H, Hallam JS. Hand hygiene among healthcare workers: A qualitative meta summary using the GRADE-CERQual process. J Infect Prev 2017; 18:104-120. [PMID: 28989515 PMCID: PMC5418899 DOI: 10.1177/1757177416680443] [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] [Received: 09/17/2016] [Accepted: 10/27/2016] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Sheryl L. Chatfield
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Kristen DeBois
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Rachael Nolan
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Hannah Crawford
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Jeffrey S. Hallam
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
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Chatfield SL, Nolan R, Crawford H, Hallam JS. Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE Open Med 2016; 4:2050312116675098. [PMID: 27803809 PMCID: PMC5077071 DOI: 10.1177/2050312116675098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/13/2016] [Indexed: 02/05/2023] Open
Abstract
Objective: Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals’ perceptions of hygiene might drive practices. Methods: We conducted qualitative interview research with eight nurses in the United States who were employed in various patient-care roles. We analyzed the data using an interpretative phenomenological analysis methodology to explore how nurses described their perceptions of, and experiences with, hygiene. We developed themes that explored individual, workplace, and management influences on perception of hygiene. Results: Developed themes include practical hygiene, risky business, and hygiene on trial; the latter theme described the conflict between how nurses perceived their own hygiene practices and how they felt hospital management perceived these practices. Other findings included that participants distinguished between policy-mandated use of sanitizer and a personal sense of cleanliness; the latter was more likely to be associated with scrubbing or removal of contaminants than with use of protectants. Conclusion: While participants asserted support for facility hand hygiene policies, their behavior in certain instances might be mediated by broadly defined emergent situations and a belief that it is not currently possible to establish a causal link between an healthcare-associated infections and a specific individual or occurrence. Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions, to encourage ownership, and emphasizing detailed cases as training content to take advantage of individuals’ sensory responses to hygiene.
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Affiliation(s)
- Sheryl L Chatfield
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA
| | - Rachael Nolan
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA
| | - Hannah Crawford
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA
| | - Jeffrey S Hallam
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA
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20
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Konicki T, Miller E. Use of a simulation intervention to examine differences in nursing students' hand hygiene knowledge, beliefs, and behaviors. NURSE EDUCATION TODAY 2016; 45:96-101. [PMID: 27429413 DOI: 10.1016/j.nedt.2016.06.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/19/2016] [Accepted: 06/29/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Although hand hygiene remains an essential aspect of quality care, adherence to best patient safety practices continues to pose major challenges. OBJECTIVES The objectives of this study are to examine hand hygiene knowledge, beliefs, practices, perceived importance and behaviors using Social Cognitive Theory and simulation-based intervention. DESIGN Participants were taken from a convenience sample of 131 undergraduate nursing students enrolled in a nursing fundamentals course at an urban university in the midwestern United States, and then randomly assigned to their respective groups. Using an experimental pretest-posttest design, control and intervention groups received the same lecture pertaining to hand hygiene and 3 data collection points where van de Mortel's Hand Hygiene Questionnaire (HHQ) was administered. In addition, the intervention group viewed a 6.5min video related to healthcare acquired infection and participated in 4 simulated situations requiring hand hygiene, based on World Health Organization guidelines. For all students, the hand hygiene technique was assessed through the use of Glo Germ, followed by handwashing and photography under ultraviolet light (posttest only). Image illumination was analyzed using image processing software. Microbiological sampling plates (pretest-posttest) were assessed quantitatively by colony counting. RESULTS Study findings did not support differences in the intervention group for the 5 hypothesized relationships. Social desirability responding and negative item confusion were found to occur with the HHQ in the student population. There was a significant difference in the UV hand photographs, with students in the afternoon having lower values than students in the morning. CONCLUSIONS Given the study results, there were no definitive educational recommendations to teach hand hygiene to nursing students. Future research should continue to further examine multi-focal modalities to enhance adherence to hand hygiene practices, as well as control for extraneous mediating or moderating variables found in educational settings.
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Affiliation(s)
- Tara Konicki
- Wright State University, College of Nursing and Health, 3640 Colonel Glenn Hwy, Dayton, Ohio 45435, United States.
| | - Elaine Miller
- University of Cincinnati, College of Nursing, Cincinnati, Ohio, United States
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21
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de Beurs DP, de Groot MH, de Keijser J, van Duijn E, de Winter RFP, Kerkhof AJFM. Evaluation of benefit to patients of training mental health professionals in suicide guidelines: cluster randomised trial. Br J Psychiatry 2016; 208:477-83. [PMID: 26678866 DOI: 10.1192/bjp.bp.114.156208] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 05/09/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Randomised studies examining the effect on patients of training professionals in adherence to suicide guidelines are scarce. AIMS To assess whether patients benefited from the training of professionals in adherence to suicide guidelines. METHOD In total 45 psychiatric departments were randomised (Dutch trial register: NTR3092). In the intervention condition, all staff in the departments were trained with an e-learning supported train-the-trainer programme. After the intervention, patients were assessed at admission and at 3-month follow-up. Primary outcome was change in suicide ideation, assessed with the Beck Scale for Suicide Ideation. RESULTS For the total group of 566 patients with a positive score on the Beck Scale for Suicide Ideation at baseline, intention-to-treat analysis showed no effects of the intervention on patient outcomes at 3-month follow-up. Patients who were suicidal with a DSM-IV diagnosis of depression (n = 154) showed a significant decrease in suicide ideation when treated in the intervention group. Patients in the intervention group more often reported that suicidality was discussed during treatment. CONCLUSIONS Overall, no effect of our intervention on patients was found. However, we did find a beneficial effect of the training of professionals on patients with depression.
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Affiliation(s)
- Derek P de Beurs
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Marieke H de Groot
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Jos de Keijser
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Erik van Duijn
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Remco F P de Winter
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Ad J F M Kerkhof
- Derek P. de Beurs, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Marieke H. de Groot, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam; Jos de Keijser, PhD, GGZ Foundation for Mental Health Care Friesland and Groningen University, Groningen, The Netherlands; Erik van Duijn, PhD, MD, GGZ Foundation for Mental Health Care Delfland, Delft; Remco F. P. de Winter, PhD, MD, GGZ Foundation for Mental Health Care Parnassia, The Hague; Ad J. F. M. Kerkhof, PhD, Department of Clinical Psychology, VU University, Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review. Nurs Res Pract 2015; 2015:796762. [PMID: 26075093 PMCID: PMC4446481 DOI: 10.1155/2015/796762] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/19/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Needleless connectors (NC) are used on virtually all intravascular devices, providing an easy access point for infusion connection. Colonization of NC is considered the cause of 50% of postinsertion catheter-related infections. Breaks in aseptic technique, from failure to disinfect, result in contamination and subsequent biofilm formation within NC and catheters increasing the potential for infection of central and peripheral catheters. Methods. This systematic review evaluated 140 studies and 34 abstracts on NC disinfection practices, the impact of hub contamination on infection, and measures of education and compliance. Results. The greatest risk for contamination of the catheter after insertion is the NC with 33-45% contaminated, and compliance with disinfection as low as 10%. The optimal technique or disinfection time has not been identified, although scrubbing with 70% alcohol for 5-60 seconds is recommended. Studies have reported statistically significant results in infection reduction when passive alcohol disinfection caps are used (48-86% reduction). Clinical Implications. It is critical for healthcare facilities and clinicians to take responsibility for compliance with basic principles of asepsis compliance, to involve frontline staff in strategies, to facilitate education that promotes understanding of the consequences of failure, and to comply with the standard of care for hub disinfection.
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23
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de Beurs DP, de Groot MH, de Keijser J, Mokkenstorm J, van Duijn E, de Winter RFP, Kerkhof AJFM. The effect of an e-learning supported Train-the-Trainer programme on implementation of suicide guidelines in mental health care. J Affect Disord 2015; 175:446-53. [PMID: 25679199 DOI: 10.1016/j.jad.2015.01.046] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary suicide prevention guideline. METHODS 45 psychiatric departments from all over the Netherlands were clustered in pairs and randomized. In the experimental condition, all of the staff of psychiatric departments was trained by peers with an e-learning supported Train-the-Trainer programme. Guideline adherence of individual professionals was measured by means of the response to on-line video fragments. Multilevel analyses were used to establish whether variation between conditions was due to differences between individual professionals or departments. RESULTS Multilevel analysis showed that the intervention resulted in an improvement of individual professionals. At the 3 month follow-up, professionals who received the intervention showed greater guideline adherence, improved self-perceived knowledge and improved confidence as providers of care than professionals who were only exposed to traditional guideline dissemination. Subgroup analyses showed that improved guideline adherence was found among nurses but not among psychiatrists and psychologists. No significant effect of the intervention on team performance was found. LIMITATIONS The ICT environment in departments was often technically inadequate when displaying the video clips clip of the survey. This may have caused considerable drop-out and possibly introduced selection bias, as professionals who were strongly affiliated to the theme of the study might have been more likely to finish the study. CONCLUSIONS Our results support the idea that an e-learning supported Train-the-Trainer programme is an effective strategy for implementing clinical guidelines and improving care for suicidal patients. TRIAL REGISTRATION Netherlands Trial Register (NTR3092 www.trialregister.nl).
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Affiliation(s)
- Derek P de Beurs
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - Marieke H de Groot
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
| | | | - Jan Mokkenstorm
- GGZ Foundation for Mental Health Care GGZ inGeest, The Netherlands.
| | - Erik van Duijn
- GGZ Foundation for Mental Health Care Delfland, The Netherlands.
| | - Remco F P de Winter
- GGZ Foundation for Mental Health Care, Parnassia, The Hague, The Netherlands.
| | - Ad J F M Kerkhof
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
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Jansson MM, Ala-Kokko TI, Ohtonen PP, Meriläinen MH, Syrjälä HP, Kyngäs HA. Human patient simulation education in the nursing management of patients requiring mechanical ventilation: a randomized, controlled trial. Am J Infect Control 2014; 42:271-6. [PMID: 24581015 DOI: 10.1016/j.ajic.2013.11.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge among critical care nurses and their adherence to evidence-based guidelines for preventing ventilator-associated pneumonia is reported to be low. The aim of our study was to evaluate the effectiveness of human patient simulation (HPS) education in the nursing management of patients requiring mechanical ventilation. METHODS A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Finland from February-October 2012. Thirty critical care nurses were allocated evenly to intervention and control groups (n = 15 each). The effectiveness of HPS education was evaluated through the validated Ventilator Bundle Questionnaire and Ventilator Bundle Observation Schedule at baseline and repeated twice-after the clinical and simulation settings, respectivley. RESULTS After HPS education, the average skill scores (Ventilator Bundle Observation Schedule) in the intervention group increased significantly (46.8%-60.0% of the total score) in the final postintervention observation. In the average skill scores, a linear mixed model identified significant time (Pt < .001) and group (P(g) = .03) differences and time-group interactions (P(t*g) = .02) between the study groups after the HPS education. In contrast, the model did not identify any significant change over time (P(t) = .29) or time-group interactions (P(t) = .69) between groups in average knowledge scores (Ventilator Bundle Questionnaire). CONCLUSIONS Our study identified significant transfer of learned skills to clinical practice following HPS education but no influence on the level of participants' factual knowledge.
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Affiliation(s)
- Miia M Jansson
- University of Oulu Graduate School, University of Oulu, Faculty of Medicine, Institute of Health Sciences, Nursing Science, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland; Division of Intensive Care Medicine, Department of Anesthesia, Oulu University Hospital, Oulu, Finland.
| | - Tero I Ala-Kokko
- Division of Intensive Care Medicine, Department of Anesthesia, Oulu University Hospital, Oulu, Finland
| | - Pasi P Ohtonen
- Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
| | - Merja H Meriläinen
- Division of Intensive Care Medicine, Department of Anesthesia, Oulu University Hospital, Oulu, Finland
| | - Hannu P Syrjälä
- Department of Infection Control, Oulu University Hospital, Oulu, Finland
| | - Helvi A Kyngäs
- Institute of Health Science, University of Oulu, Medical Research Center Oulu, Oulu, Finland
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25
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Heinrich ERE, KuKanich KS, Davis E, White BJ. Public health campaign to promote hand hygiene before meals in a college of veterinary medicine. JOURNAL OF VETERINARY MEDICAL EDUCATION 2014; 41:301-310. [PMID: 24981423 DOI: 10.3138/jvme.0913-124r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Veterinary students can be exposed to environmental infectious agents in school that may include zoonotic pathogens. Encouraging effective hand hygiene can minimize the spread of zoonoses and promote public health and the One Health concept among veterinary students. The purpose of this study was to determine if a campaign could improve hand hygiene among veterinary students at extracurricular meetings serving meals. Nine Kansas State University College of Veterinary Medicine (KSU-CVM) extracurricular organizations participated in the study, sanitizer was provided at each meeting, and baseline hand-hygiene data were observed. A hand-hygiene opportunity was defined as any student observed to approach the buffet food line. Sanitizer use (yes/no) and gender (male/female) were recorded. Campaign interventions included a 3.5-minute educational video and a novel motivational poster. The video was presented to all first-year, second-year, and third-year veterinary students. Posters encouraging hand sanitization were displayed on doors and tables alongside sanitizers at each meeting. Observational hand-hygiene data were collected immediately after introduction of interventions and again 3 months later. Environmental sampling for presence of bacteria in and around meeting locations was also performed. Observed hand hygiene was lowest during baseline (11.0% ± 1.7), improved significantly post-intervention (48.8% ± 3.2), and remained improved at 3-month follow-up (33.5% ± 4.0). Females had higher probability of hand sanitizing (35.9% ± 2.2) than males (21.4% ± 2.4) (p<.01). Clostridium perfringens was isolated from 2/42 samples, and Salmonella spp. were isolated from 4/42 samples. A short-term public health campaign targeting veterinary students successfully improved hand hygiene before meals.
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26
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Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M, UK Department of Health. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014; 86 Suppl 1:S1-70. [PMID: 24330862 PMCID: PMC7114876 DOI: 10.1016/s0195-6701(13)60012-2] [Citation(s) in RCA: 660] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001(1) and updated in 2007.(2) A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated. These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of health care in NHS hospitals in England can be minimised.
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Affiliation(s)
- H P Loveday
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London).
| | - J A Wilson
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - R J Pratt
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - M Golsorkhi
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - A Tingle
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - A Bak
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - J Browne
- Richard Wells Research Centre, College of Nursing, Midwifery and Healthcare, University of West London (London)
| | - J Prieto
- Faculty of Health Sciences, University of Southampton (Southampton)
| | - M Wilcox
- Microbiology and Infection Control, Leeds Teaching Hospitals and University of Leeds (Leeds)
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Hammick M. Evidence shaped health professional education: can we talk about a new paradigm? MEDICAL TEACHER 2012; 34:435-438. [PMID: 22578041 DOI: 10.3109/0142159x.2012.682185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This commentary accompanies the publication of several Best Evidence Medical Education systematic reviews together with invited discussion papers on issues of key importance to evidence shaped health professional education. The reviews and papers signify positive developments for the still very young movement where practitioners and policy makers use evidence to help their decision making in health professional education. They provide this commentary with exemplar material to highlight some key points about the process of education systematic review and some of the conceptual and methodological issues presently being discussed by colleagues interested in taking the evidence shaped education movement in a forward direction. These include the need for more funded reviews, greater commitment to question-driven research (primary and secondary) and further debate about power, evidence and change. It is hoped that this will lead to a broader debate, a widening of interest and a deepening of scholarship related to evidence shared health professional education.
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Affiliation(s)
- Marilyn Hammick
- Best Evidence Medical Education, Tay Park House, 484 Perth Road, Dundee DD2 1LR, United Kingdom.
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