An elicitation study of critical care nurses’ salient hand hygiene beliefs

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Abstract

Aim

To describe critical care nurses’ hand hygiene attitudinal, normative referent, and control beliefs.

Background

Hand hygiene is the primary strategy to prevent healthcare-associated infections. Social influence is an underdeveloped hand hygiene strategy.

Methods

This qualitative descriptive study was conducted with 25 ICU nurses in the southeastern United States. Data were collected using the Nurses’ Salient Belief Instrument.

Results

Thematic analysis generated four themes: Hand Hygiene is Protective; Nurses look to Nurses; Time-related Concerns; and Convenience is Essential.

Conclusion

Nurses look to nurses as hand hygiene referents and believe hand hygiene is a protective behaviour that requires time and functional equipment.

Section snippets

Background and significance

Healthcare-associated infections (HAIs) acquired while receiving medical or surgical care are the most common hospital care complication (>700,000 annually) and result in 99,000 deaths each year with estimated annual direct hospital costs up to $45 billion (Agency for Healthcare Research and Quality [AHRQ], 2014; Scott, 2009). These infections are associated with prolonged hospital stays, increased hospital costs, increased mortality rates, and the need for further clinical interventions and

Theoretical framework

Since the ground-breaking work conducted by LaPiere with Chinese-Americans, researchers have explored the enigmatic gap between one’s intention to perform an overt behaviour and the actual demonstration of the behaviour (LaPiere, 1934). The most widely accepted theory used to describe, explain, and predict overt choice behaviour is the TPB.

The TPB is a social cognitive theory that posits an individual’s expectations and values about performing a behaviour contribute to their behavioural,

Setting and sample

This descriptive, exploratory study was conducted in the critical care unit setting at 2 acute-care institutions located in the south-eastern United States: (a) an academic medical centre (>750 adult beds); and (b) a regional medical centre (<250 adult beds). Five critical care units were included in this study: two Cardiovascular ICUs (one unit at each institution), one ICU, one Medical ICU and one Surgical ICU. The critical care settings were chosen based on comparable patient acuity, nurse:

Data analysis

A deductive, theory-driven thematic analysis, as described by Braun and Clarke, was used to analyse the Nurses’ Salient Belief Instrument data (Braun and Clarke, 2006). This method involves identifying, analysing, and reporting repeating patterns of meaning using a recursive movement across the data (Braun and Clarke, 2006).

Responses to nurse’s salient belief instrument

The data were complete for each nurse participant (n-25). Nurses’ salient HH attitudinal beliefs were analysed based on nurses’ subjective responses to three open-ended belief questions focused on identified benefits, disadvantage, and general belief(s) about HH. Nurses responded the major advantage of performing HH was patient, nurse, and institutional protection against bacterial and pathogen transmission and cross-contamination. Nurses’ overall HH belief responses included the logistical

Nursing practice implications

Based on this study’s findings, critical care nurse participants look to unit nurse leaders and fellow nurses as their HH referents and believe HH is a protective behaviour that requires time and functional equipment positioned in strategic locations. These salient beliefs, grounded in the TPB, provide valuable insight into the cognitive and social beliefs of these critical care nurses. Discussion of these findings will be organized in alignment with TPB constructs and include theory

Limitations

The findings from our study should be considered in light of its limitations. First, this study design allowed for a one-time snapshot analysis of unit nurses’ HH beliefs, thus limiting our understanding of the contextual factors contributing to nurses’ responses. Second, because of faculty: student associations formed with the PI during students’ prelicensure nursing education, the PI was familiar with some of the most recent nurse hires on the ICUs at one institution. This familiarity may

Conclusion

Our data validate previous HH behavioural outcome and control beliefs: Hand Hygiene is Protective; Convenience is Essential; and Time-related Concerns. Nurses (fellow nurses and nurse leaders) were overwhelmingly identified as those who are looked to and most likely to perform HH on their unit. Our hope is that the aforementioned data will contribute to the present literature addressing critical care nurses’ salient HH beliefs, paying particular attention to further explore the effects of

Role of funding source

There are no funding sources to declare for this manuscript.

Acknowledgements

We acknowledge the unit nurse managers, nurse educators, and nursing staff for their assistance with this research study.

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