A return to the basics; nurses’ practices and knowledge about interventional patient hygiene in critical care units

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Abstract

Background

The Nursing profession is struggling to return to basic nursing care to maintain patients’ safety. “Interventional patient hygiene” (IPH) is a measurement model for reducing the bioburden of both the patient and health care worker, and its components are hand hygiene, oral care, skin care/antisepsis, and catheter site care.

Objectives

To identify the level of nurses’ practice and knowledge about interventional patient hygiene and identify barriers for implementing interventional patient hygiene in critical care units.

Methodology

A descriptive research design was used and three tools were applied in this study: “The Interventional Patient Hygiene Observational Checklist”, “The Interventional Patient Hygiene Knowledge Questionnaire” and “The Barriers for Implementing Interventional Patient Hygiene in Critical Care Units”.

Results

The mean percentage nurses’ knowledge score is higher than the mean percentage practice score in all items (hand hygiene (71.28 ± 25.46, compared with 46.15 ± 17.87), oral care (100.0 ± 0.0, compared with 25.32 ± 24.25), catheter care (75.76 ± 9.40, compared with 8.97 ± 24.14) and skin care (47.80 ± 6.79, compared with 26.28 ± 16.57). Barriers for implementing hand hygiene are workload (71.79%), insufficient resources (61.53%), and lack of knowledge (10.25%).

Conclusion

The mean percentage IPH knowledge score is higher than the mean percentage IPH practice score of all IPH items. Barriers for implementing IPH include workload, insufficient resources, and lack of knowledge/training.

Introduction

Critical care nurses are facing challenges to integrate interventions, sophisticated technologies and implement care based on current evidence, while simultaneously caring for the whole person by addressing the psychosocial challenges and ethical conflicts associated with critical illness (Morton and Fontaine, 2013). Watson (2009) defined nursing as the science of caring in which the primary goal is to assist the client reach the greatest level of personal potential. The nurse should hold certain beliefs for caring activities, which are values, and caring. In addition, the American Association of Critical-Care Nurses (AACN) has identified caring practices as “nursing activities that create a compassionate, supportive, and therapeutic environment for patients and staff, with the aim of promoting comfort and healing and preventing unnecessary suffering” (Morton and Fontaine, 2013). Thus, a positive movement within the profession of nursing to return to basic nursing care to maintain patients’ safety is needed (Burns and Day, 2013).

Basic nursing care aims to prevent the occurrence of health care related complications through providing proactive nursing interventions that focus on applying evidence-based mobility strategies and hygienic care. “Interventional patient hygiene” (IPH) is a model using evidence based nursing care interventions as a systematic approach for health care acquired conditions prevention. Hand hygiene, oral hygiene, catheter care and skin care are the major components of the IPH model (Vollman et al., 2005, Vollman, 2009).

Primarily the nursing action plan was focused on the strengthening of patients’ host defenses concerning skin care, oral care and management of continence, then the IPH concept has been expanded to hand hygiene, catheter care and skin antisepsis (McGuckin et al., 2008). The provision of hygiene and of being hygienic, are the focus of IPH that should have an equal priority to all other nursing interventions (Vollman, 2013).

If basic nursing care is not performed as recommended, it is important to identify the barriers that hinder nurses from implementing it. Basic nursing care may be devalued or absent by narrow or restricted structures that support the importance of basic nursing care, failure to hold nurses accountable or reward/recognition for doing them. This may necessitate changing nursing culture with an emphasis on the significance of basic nursing care (Vollman, 2013, McGuckin et al., 2008).

Section snippets

Research questions

  • Do nurses implement interventional patient hygiene (IPH) practices in critical care units?

  • Do nurses have interventional patient hygiene (IPH) knowledge?

  • What are the nurses’ perceived barriers to implementing interventional patient hygiene in critical care units?

Materials

A descriptive design was used for this study.

Setting

This study was carried out in two general adult critical care units (CCUs) in a selected hospital in Alexandria- Egypt. Procedures & infection control policies and staff orientation programmes were the same in both CCUs.

Subjects

A convenience sample of 39 nurses involved in providing direct care to critically ill patients in the previously mentioned CCUs was included in this study. Nurses with less than a year of CCU experience and intern nurses were excluded

Results

More than 80% of nurses were females. More than half of nurses were in the age group (20–25 years old). More than three quarters of nurses held a diploma nursing degree (graduated after preparatory school). The mean years of experience in ICU was 5.62 years, 46.15% of nurses had experience <5 years and 84.6% of nurses were caring for two patients/shift (Table 1). Only 7.7% of nurses carried out proper oral care practice and nurses’ practices were improper regarding catheter care (94.9%), skin

Discussion

The current study results indicate that nurses’ IPH practices were improper. In addition, nurses’ IPH knowledge was satisfactory regarding skin care and unsatisfactory regarding hand hygiene, oral care and catheter care. However, the mean percentage IPH knowledge score is higher than the mean percentage IPH practice score of IPH in all items. In a study aimed to identify the relationship between the nurses’ practices including IPH practices and the occurrence of adverse events in the same ICUs

Conclusion

The current study results indicate that nurses’ IPH practices were improper. In addition, nurses’ IPH knowledge was satisfactory regarding skin care and unsatisfactory regarding hand hygiene, oral care and catheter care. However, the mean percent IPH knowledge score is higher than the mean percentage IPH practice score of IPH in all items. Barriers for implementing IPH in ICUs include; workload, insufficient resources, lack of knowledge/training and absence of policy for implementing IPH.

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