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Papers by Dr Sile Creedon
Journal of Hospital Infection, 2017
Healthcare-associated infection is spread by direct contact and the importance of hand hygiene to... more Healthcare-associated infection is spread by direct contact and the importance of hand hygiene to break the chain of infection is recognised internationally. In many countries hand hygiene is regularly audited as part of quality assurance based on recommendations issued by the World Health Organization (WHO). Direct observation is the recommended audit method but is associated with a number of disadvantages, including potential for being observed to alter usual behaviour. The Hawthorne effect in relation to hand hygiene is equated with productivity by increasing the frequency that hand hygiene is undertaken. Unobtrusive and/or frequent observation to accustom staff to the presence of observers are considered acceptable ways of reducing the Hawthorne effect but little has been written about how to implement these techniques or assess their effectiveness. There is evidence that awareness of being watched can disrupt the usual behaviour of individuals in complex and unpredictable ways other than simple productivity effect. Health workers might defer or avoid activities that require hand hygiene in the presence of auditors but these issues are not addressed in guidelines for practice or research studies. This is an important oversight with implications for the validity of hand hygiene audit findings. It needs to be considered if such findings are taken as indicators of quality of care and if the results of hand hygiene research are used to inform future policy and practice. Product uptake overcomes avoidance tactics. It is cheaper and generates data continuously to give a 24 hour picture of compliance for all clinicians without disrupting patient care. Disadvantages are the risk of overestimating uptake through spillage, wastage or use by visitors and non-clinical staff entering patient care areas. Electronic devices can overcome Hawthorne and avoidance effects but are costly and are not widely used outside research studies.
Applied Nursing Research, 2011
![Research paper thumbnail of Referee report. For: Educational sessions may not be enough to improve knowledge about hand hygiene: Assessing the knowledge about hand hygiene of health workers before and after an educational workshop in Sudan [version 1; referees: 1 approved with reservations]](https://attachments.academia-assets.com/81537142/thumbnails/1.jpg)
](In an attempt to defeat the high prevalence of health care Background: associated infections, by ... more In an attempt to defeat the high prevalence of health care Background: associated infections, by raising the awareness about hand hygiene, we implemented a quasi-experimental study as part of a quality improvement project to evaluate the efficacy of focused educational workshop on knowledge about hand hygiene among health care workers in Sudan. Seventy-three participants were recruited from two public Methods: hospitals and one private hospital in Khartoum, Sudan in September 2017. The knowledge before and after the educational workshop was assessed for each participant using the World Health Organization hygiene associated infection questionnaire. We analyzed data using SPSS v22 and used McNemar's test to compare knowledge before and after the workshop. Around 40% of participants worked in general ward and 85% of Results: them were women. Almost 70% were midwives or nurses. The mean age of participants was 28.4 years. We compared the knowledge of hand hygiene between nurses and doctors before the workshop, and the results showed that nurses had better knowledge in almost all aspects of hand hygiene. When we compared the knowledge before and immediately after the workshop for all participants, we found that there was no significant improvement in almost all aspects of knowledge about hand hygiene (P>0.05). Comparing the knowledge before and after the workshop, we Conclusion: found no significant improvement in almost all aspects of hand hygiene. Of note, nurses' knowledge about hand hygiene was consistently higher than doctors. Additional studies are needed to identify the optimal design of educational sessions.
Purpose – The purpose of this research is to explore healthcare workers ’ infection control pract... more Purpose – The purpose of this research is to explore healthcare workers ’ infection control practices from a behavioural viewpoint. Major behavioural theories are explored. Findings from a study which drew heavily from the PRECEDE theoretical framework are presented. The main purpose of this quasi-experimental study was to observe health care workers ’ behavioural compliance with hand hygiene guidelines during patient care in an Intensive Care Unit in Ireland before (pre test) and after (post test) implementation of a multifaceted hand hygiene program. Health care workers ’ attitudes, beliefs and knowledge in relation to compliance with hand-washing guidelines were also investigated. Design/methodology/approach – Data were collected through non-participant observation and survey methods. A convenience sample of nurses, doctors, physiotherapists and care assistants (n 73 observational subjects, n 62 questionnaire respondents) was used. Findings – Data (n 314 observations, 62 question...
BACKGROUND The issue of 'centre' or 'hospital' as an independent variable has not... more BACKGROUND The issue of 'centre' or 'hospital' as an independent variable has not been studied extensively in healthcare workers' hand-hygiene practices. AIM To investigate healthcare workers' compliance with hand-hygiene guidelines in four acute-care hospitals in Ireland and to examine factors that contributed to non-compliance. METHOD Data collectors observed healthcare workers in four hospitals. RESULTS Data (n = 1,737 observations) was drawn from a random sample of nurses, doctors, physiotherapists and HCAs (n = 280 staff). Findings revealed that the individual hospital has a significant impact. Multivariate logistic regression analysis showed healthcare workers in centre 4 had a significantly higher likelihood of non-compliance than those in all other centres (p = 0.003), irrespective of gender, discipline or area of work. CONCLUSION The findings make an important contribution to the study of healthcare workers' hand-hygiene behaviour and control of ...
The article presents an abstract of a research paper on nursing informatics program for undergrad... more The article presents an abstract of a research paper on nursing informatics program for undergraduate nurses in Ireland.
BMJ Open
ObjectiveThe aim of this study was to explore how infection prevention and control (IPC) guidelin... more ObjectiveThe aim of this study was to explore how infection prevention and control (IPC) guidelines are used and understood by healthcare professionals, patients and families.DesignEthnographic study with 59 hours of non-participant observation and 57 conversational interviews. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework.SettingFour hospitals in Ireland.ParticipantsHealthcare professionals, patient and families.ResultsFive themes emerged through the analysis. Four themes provided evidence of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring). Our findings revealed the existence of a ‘dissonance between IPC guidelines and the reality of clinical practice’ (theme 1) and ‘Challenges to legitimatize guidelines’ recommendations in practice’ (theme 3). These elements contributed to ‘Symbolic implementation of IPC guidelines’ (theme 2), which was also determined by a ‘Lack of shared reflec...
International Wound Journal
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
BMJ Leader
BackgroundLeadership is a key component for infection prevention and control and plays an importa... more BackgroundLeadership is a key component for infection prevention and control and plays an important role in the implementation of guidelines on healthcare-associated infections. A body of literature exists on healthcare workers’ perspectives on implementing these types of guidelines; however, there is a paucity of data on the leadership perspectives on implementation. This study aims to contribute to the evidence base of leadership perspectives.ObjectiveTo explore the implementation of National Clinical Guidelines pertaining to methicillin-resistant Staphylococcus aureus and Clostridium difficile from the leadership angle.SettingHealthcare organisations.ParticipantsClinical and non-clinical leaders.DesignThis research used a mixed-methods approach comprising qualitative individual interviews (n=16) and quantitative surveys (n=51) underpinned by the integrated Promoting Action on Research Implementation in Health Services framework.ResultsLeaders recognise the value and innovation of...
BMJ Open
ObjectiveTo explore patient involvement in the implementation of infection prevention and control... more ObjectiveTo explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions.DesignScoping review.MethodsA methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013–2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted.ResultsFrom an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to on...
Nurses at all levels of preparation and in all clinical specialties will find this an important i... more Nurses at all levels of preparation and in all clinical specialties will find this an important introduction to the extent of nursing research. Previous editions have been most helpful to basic and graduate students. The summary entries provide the reader with an important starting point for future content and references and a timely source of the most relevant and recent research. The alphabetical ordering of entries is provided to assist the reader in easily locating a topic. Every effort has been made to be inclusive of all relevant terms in nursing research, which were selected on the basis of the review of previous editions and the extant nursing research literature.
The impetus for this book came from the experience of teaching undergraduate and postgraduate nur... more The impetus for this book came from the experience of teaching undergraduate and postgraduate nursing students and the realisation that a comprehensive textbook on medical and surgical nursing was needed to inform and guide learning related to the nursing care of adults. This book is designed to provide a broad overview and a practical understanding of the principles related to adult nursing. It examines the principles underpinning medical and surgical nursing and includes contemporary developments in clinical care, drawing extensively on national and international evidence.
DESCRIPTION This is a discussion paper sent to a high impact nursing journal for review
This article provides an insight into the economic impact of hospital infection acquisition.
DESCRIPTION This is the abstract of a paper that I recently submitted to a high impact Nursing jo... more DESCRIPTION This is the abstract of a paper that I recently submitted to a high impact Nursing journal.
American journal of infection control, 2015
Acquisition of a health care-associated infection is a substantial risk to patient safety. When h... more Acquisition of a health care-associated infection is a substantial risk to patient safety. When health care workers comply with hand hygiene guidelines, it reduces this risk. Despite a growing body of qualitative research in this area, a review of the qualitative literature has not been published. A systematic review of the qualitative literature. The results were themed by the factors that health care workers identified as contributing to their compliance with hand hygiene guidelines. Contributing factors were conceptualized using a theoretical background. This review of the qualitative literature enabled the researchers to take an inductive approach allowing for all factors affecting the phenomenon of interest to be explored. Two core concepts seem to influence health care workers' compliance with hand hygiene guidelines. These are motivational factors and perceptions of the work environment. Motivational factors are grounded in behaviorism, and the way in which employees perc...
Online Journal of Nursing Informatics
Journal of Hospital Infection, 2017
Healthcare-associated infection is spread by direct contact and the importance of hand hygiene to... more Healthcare-associated infection is spread by direct contact and the importance of hand hygiene to break the chain of infection is recognised internationally. In many countries hand hygiene is regularly audited as part of quality assurance based on recommendations issued by the World Health Organization (WHO). Direct observation is the recommended audit method but is associated with a number of disadvantages, including potential for being observed to alter usual behaviour. The Hawthorne effect in relation to hand hygiene is equated with productivity by increasing the frequency that hand hygiene is undertaken. Unobtrusive and/or frequent observation to accustom staff to the presence of observers are considered acceptable ways of reducing the Hawthorne effect but little has been written about how to implement these techniques or assess their effectiveness. There is evidence that awareness of being watched can disrupt the usual behaviour of individuals in complex and unpredictable ways other than simple productivity effect. Health workers might defer or avoid activities that require hand hygiene in the presence of auditors but these issues are not addressed in guidelines for practice or research studies. This is an important oversight with implications for the validity of hand hygiene audit findings. It needs to be considered if such findings are taken as indicators of quality of care and if the results of hand hygiene research are used to inform future policy and practice. Product uptake overcomes avoidance tactics. It is cheaper and generates data continuously to give a 24 hour picture of compliance for all clinicians without disrupting patient care. Disadvantages are the risk of overestimating uptake through spillage, wastage or use by visitors and non-clinical staff entering patient care areas. Electronic devices can overcome Hawthorne and avoidance effects but are costly and are not widely used outside research studies.
Applied Nursing Research, 2011
In an attempt to defeat the high prevalence of health care Background: associated infections, by ... more In an attempt to defeat the high prevalence of health care Background: associated infections, by raising the awareness about hand hygiene, we implemented a quasi-experimental study as part of a quality improvement project to evaluate the efficacy of focused educational workshop on knowledge about hand hygiene among health care workers in Sudan. Seventy-three participants were recruited from two public Methods: hospitals and one private hospital in Khartoum, Sudan in September 2017. The knowledge before and after the educational workshop was assessed for each participant using the World Health Organization hygiene associated infection questionnaire. We analyzed data using SPSS v22 and used McNemar's test to compare knowledge before and after the workshop. Around 40% of participants worked in general ward and 85% of Results: them were women. Almost 70% were midwives or nurses. The mean age of participants was 28.4 years. We compared the knowledge of hand hygiene between nurses and doctors before the workshop, and the results showed that nurses had better knowledge in almost all aspects of hand hygiene. When we compared the knowledge before and immediately after the workshop for all participants, we found that there was no significant improvement in almost all aspects of knowledge about hand hygiene (P>0.05). Comparing the knowledge before and after the workshop, we Conclusion: found no significant improvement in almost all aspects of hand hygiene. Of note, nurses' knowledge about hand hygiene was consistently higher than doctors. Additional studies are needed to identify the optimal design of educational sessions.
Purpose – The purpose of this research is to explore healthcare workers ’ infection control pract... more Purpose – The purpose of this research is to explore healthcare workers ’ infection control practices from a behavioural viewpoint. Major behavioural theories are explored. Findings from a study which drew heavily from the PRECEDE theoretical framework are presented. The main purpose of this quasi-experimental study was to observe health care workers ’ behavioural compliance with hand hygiene guidelines during patient care in an Intensive Care Unit in Ireland before (pre test) and after (post test) implementation of a multifaceted hand hygiene program. Health care workers ’ attitudes, beliefs and knowledge in relation to compliance with hand-washing guidelines were also investigated. Design/methodology/approach – Data were collected through non-participant observation and survey methods. A convenience sample of nurses, doctors, physiotherapists and care assistants (n 73 observational subjects, n 62 questionnaire respondents) was used. Findings – Data (n 314 observations, 62 question...
BACKGROUND The issue of 'centre' or 'hospital' as an independent variable has not... more BACKGROUND The issue of 'centre' or 'hospital' as an independent variable has not been studied extensively in healthcare workers' hand-hygiene practices. AIM To investigate healthcare workers' compliance with hand-hygiene guidelines in four acute-care hospitals in Ireland and to examine factors that contributed to non-compliance. METHOD Data collectors observed healthcare workers in four hospitals. RESULTS Data (n = 1,737 observations) was drawn from a random sample of nurses, doctors, physiotherapists and HCAs (n = 280 staff). Findings revealed that the individual hospital has a significant impact. Multivariate logistic regression analysis showed healthcare workers in centre 4 had a significantly higher likelihood of non-compliance than those in all other centres (p = 0.003), irrespective of gender, discipline or area of work. CONCLUSION The findings make an important contribution to the study of healthcare workers' hand-hygiene behaviour and control of ...
The article presents an abstract of a research paper on nursing informatics program for undergrad... more The article presents an abstract of a research paper on nursing informatics program for undergraduate nurses in Ireland.
BMJ Open
ObjectiveThe aim of this study was to explore how infection prevention and control (IPC) guidelin... more ObjectiveThe aim of this study was to explore how infection prevention and control (IPC) guidelines are used and understood by healthcare professionals, patients and families.DesignEthnographic study with 59 hours of non-participant observation and 57 conversational interviews. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework.SettingFour hospitals in Ireland.ParticipantsHealthcare professionals, patient and families.ResultsFive themes emerged through the analysis. Four themes provided evidence of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring). Our findings revealed the existence of a ‘dissonance between IPC guidelines and the reality of clinical practice’ (theme 1) and ‘Challenges to legitimatize guidelines’ recommendations in practice’ (theme 3). These elements contributed to ‘Symbolic implementation of IPC guidelines’ (theme 2), which was also determined by a ‘Lack of shared reflec...
International Wound Journal
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial ... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
BMJ Leader
BackgroundLeadership is a key component for infection prevention and control and plays an importa... more BackgroundLeadership is a key component for infection prevention and control and plays an important role in the implementation of guidelines on healthcare-associated infections. A body of literature exists on healthcare workers’ perspectives on implementing these types of guidelines; however, there is a paucity of data on the leadership perspectives on implementation. This study aims to contribute to the evidence base of leadership perspectives.ObjectiveTo explore the implementation of National Clinical Guidelines pertaining to methicillin-resistant Staphylococcus aureus and Clostridium difficile from the leadership angle.SettingHealthcare organisations.ParticipantsClinical and non-clinical leaders.DesignThis research used a mixed-methods approach comprising qualitative individual interviews (n=16) and quantitative surveys (n=51) underpinned by the integrated Promoting Action on Research Implementation in Health Services framework.ResultsLeaders recognise the value and innovation of...
BMJ Open
ObjectiveTo explore patient involvement in the implementation of infection prevention and control... more ObjectiveTo explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions.DesignScoping review.MethodsA methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013–2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted.ResultsFrom an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to on...
Nurses at all levels of preparation and in all clinical specialties will find this an important i... more Nurses at all levels of preparation and in all clinical specialties will find this an important introduction to the extent of nursing research. Previous editions have been most helpful to basic and graduate students. The summary entries provide the reader with an important starting point for future content and references and a timely source of the most relevant and recent research. The alphabetical ordering of entries is provided to assist the reader in easily locating a topic. Every effort has been made to be inclusive of all relevant terms in nursing research, which were selected on the basis of the review of previous editions and the extant nursing research literature.
The impetus for this book came from the experience of teaching undergraduate and postgraduate nur... more The impetus for this book came from the experience of teaching undergraduate and postgraduate nursing students and the realisation that a comprehensive textbook on medical and surgical nursing was needed to inform and guide learning related to the nursing care of adults. This book is designed to provide a broad overview and a practical understanding of the principles related to adult nursing. It examines the principles underpinning medical and surgical nursing and includes contemporary developments in clinical care, drawing extensively on national and international evidence.
DESCRIPTION This is a discussion paper sent to a high impact nursing journal for review
This article provides an insight into the economic impact of hospital infection acquisition.
DESCRIPTION This is the abstract of a paper that I recently submitted to a high impact Nursing jo... more DESCRIPTION This is the abstract of a paper that I recently submitted to a high impact Nursing journal.
American journal of infection control, 2015
Acquisition of a health care-associated infection is a substantial risk to patient safety. When h... more Acquisition of a health care-associated infection is a substantial risk to patient safety. When health care workers comply with hand hygiene guidelines, it reduces this risk. Despite a growing body of qualitative research in this area, a review of the qualitative literature has not been published. A systematic review of the qualitative literature. The results were themed by the factors that health care workers identified as contributing to their compliance with hand hygiene guidelines. Contributing factors were conceptualized using a theoretical background. This review of the qualitative literature enabled the researchers to take an inductive approach allowing for all factors affecting the phenomenon of interest to be explored. Two core concepts seem to influence health care workers' compliance with hand hygiene guidelines. These are motivational factors and perceptions of the work environment. Motivational factors are grounded in behaviorism, and the way in which employees perc...
Online Journal of Nursing Informatics