Ethnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Ireland (original) (raw)
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British Journal of Infection Control, 2008
Aims: This paper aims to provide a better understanding of divisions between the espoused and actual infection control practice of staff working within a renal unit and to investigate the sources of knowledge used to underpin practice. Background: Healthcare associated infection continues to be a major problem for health services. It has been claimed that healthcare associated infections may be reduced by around a third through the use of effective infection control measures. The effectiveness of these measures will rely upon the learning and skills of those implementing them. Methods: The study employed a primarily qualitative approach using participant observation and semi structured interviews over a six month period on a renal unit within a district general hospital. Results: Results gained provided some indication of a gap between espoused and actual compliance with infection control policy in practice while also indicating that tacit knowledge and learning in practice may offe...
Translating Infection Control Guidelines Into Practice
Qualitative Health Research, 2014
Health-care-associated infections (HAIs) remain a major patient safety problem even as policy and programmatic efforts designed to reduce HAIs have increased. Although information on implementing effective infection control (IC) efforts has steadily grown, knowledge gaps remain regarding the organizational elements that improve bedside practice and accommodate variations in clinical care settings. We conducted in-depth, semistructured interviews in 11 hospitals across the United States with a range of hospital personnel involved in IC ( n = 116). We examined the collective nature of IC and the organizational elements that can enable disparate groups to work together to prevent HAIs. Our content analysis of participants’ narratives yielded a rich description of the organizational process of implementing adherence to IC. Findings document the dynamic, fluid, interactional, and reactive nature of this process. Three themes emerged: implementing adherence efforts institution-wide, promo...
Journal of Hospital Infection, 2015
Background: Improving behaviour in infection prevention and control (IPC) practice remains a challenge, and understanding the determinants of healthcare workers' (HCWs) behaviour is fundamental to develop effective and sustained behaviour change interventions. Aim: To identify behaviours of HCWs that facilitated non-compliance of IPC practices, focusing on how appraisals of IPC duties and social and environmental circumstances shaped and influenced non-compliant behaviour. This study aimed to: (1) identify how HCWs rationalized their own behaviour and the behaviour of others; (2) highlight challenging areas of IPC compliance; and (3) describe the context of the working environment that may explain inconsistencies in IPC practices. Methods: Clinical staff at a National Health Service hospital group in London, UK were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework. Findings: Three ways in which HCWs appraised their behaviour were identified through accounts of IPC policies and practices: (1) attribution of responsibilities, with ambiguity about responsibility for certain IPC practices; (2) prioritization and risk appraisal, which demonstrated a divergence in values attached to some IPC policies and practices; and (3) hierarchy of influence highlighted that traditional clinical roles challenged work relationships. Conclusions: Overall, behaviours are not entirely independent of policy rules, but often an amalgamation of local normative practices, individual preferences and a degree of professional isolation. compounded by the complexity of health care, and remains a key issue. 22-25 The use of qualitative research allows the identification of behavioural patterns and values about IPC policies and practices. 26 Whilst HCWs' attitudes and beliefs about IPC activities have been well researched, 23 few studies have investigated simultaneous perceptions from different professional groups. 27-29 In such studies, the main focus was compliance with policies and guidelines, 4,17,22,23 with lack of teamwork and communication, competing priorities and disagreement with policies identified as barriers to compliance. 29-33 However, it is still unclear how and why these affect IPC practice. 34 Given that much <insert Table 3 near here> Results Key themes emerging from the analysis were: attribution of responsibility; prioritization and risk appraisal; and hierarchy of influence. These are described in detail below. They highlight inconsistencies and ambiguity in practice, and depict HCWs' different motivations for compliance with IPC practice and antimicrobial prescribing. Participants' demographics are provided in Table I. Attribution of responsibility Attributing certain IPC responsibilities to other HCWs was a prominent behaviour among participants. HCWs focused their attention on perceived responsibilities, whilst 'When people come into hospital, they don't want to use the hand gel. So sometimes this is a challenge but we have to challenge everybody...some of the staff, even the doctors have been offended...' (Staff Nurse) Personal experience was highly valued amongst HCWs and used to override policy. HCWs tried to achieve a balance in their practice between HCAI risks and other patient needs, with 'shortcuts' reported by HCWs to reflect how such risk evaluations tended to overrule organizational standards. As such, policies were valued only to the extent to which they met the perceived reality of clinical practice: 'Regarding peripheral lines, there was a big emphasis on taking them out [at] three days, but that almost started to override clinical need of having a line in people who were difficult to get a line.' (Junior Doctor) Perhaps not surprisingly, resource constraints facilitated 'cutting corners' leading to suboptimal practices, with implications for HCAI prevention: 'Nurses know what they're supposed to be doing, and when they don't do it, it's because we're too busy, short staffed, too stretched, they're cutting that corner when they feel under pressure to prioritize other things.' (Senior Nurse) Hierarchy of influence Although influencing the IPC compliance of others was reported as challenging, it was felt to be achievable if the working environment was supportive: 'I only get so far in challenging a visiting consultant if...I have the support of my consultant team to do that.' (Senior Nurse)
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
This article reports on a study of clinicians’ responses to footage of their enactments of infection prevention and control. The study’s approach was to elicit clinicians’ reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation and in situ application of those rules. The findings of the study are that clinicians responded to footage of their own infection prevention and control practices by articulating previously unheeded tensions and constraints including infection control rules that were incomplete, undergoing change, and conflicting; material obstructions limiting infection control efforts; and habituated and divergent rule enactments and rule interpretations that were problematic but disregarded. The reflexive process is shown to elicit clinicians’ learning about these complexities as they affect the accomplishment of effective infection control. The process is fu...
International Journal of Nursing Didactics, 2017
This paper reports on a socio-anthropological fieldwork to understand the barriers that have impacts on applying infection control standards at King Fahd Hospital_ We conducted qualitative study in various hospital departments on 40 nurses and one person from Continuous Nursing Education canter important to infection control. Audio-recorded interviewswere transcribed verbatim and transcripts were analyzed using conventional content analysis. Five key themes emerged as perceived barriers to effective infection prevention and control (IPC) practices 1) language 2, knowledge 3,part-time staff-, 4, workload; and 5 accountability). BACKGROUND Health care worker especially, nurses as healthy worker are oftenexposed to pathological infection, many of which can cause serious infections. (1) Standard precautions are defined by Wisconsin Department of Health Services a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. These measures usually used when providing care to all clinics, whether they appear infectious or symptomatic. (2) Standard precautions are meant to reduce the risk of transmission of blood borne and other pathogens from both recognized and unrecognized sources. They are the basic level of infection control precautions which are to be used, as a minimum, in the care of all patients. (3)
Should I stay or should I go? Patient understandings and enactments of infection control
SHOULD I STAY OR SHOULD I GO?: PATIENT UNDERSTANDINGS AND ENACTMENTS OF INFECTION CONTROL Authors: Wyer M, Centre For Health Communication University of Technology, Sydney Background: There is growing evidence that patients actively contribute to the safety of their own care. There is a lack of evidence, however, about how clinicians acknowledge and engage with these activities. Aims: This paper presents data from current research investigating how patients’ understandings and enactments of infection control are shaped through their interactions with clinicians, and how these may shape clinicians' understandings and practices. Methods: The project involves filming patient/clinician care interactions, which are then shown back in one-on-one reflexive sessions between patient and researcher. This novel approach offers participants the opportunity to a) articulate their understandings of infection control as they are experiencing it and b) determine better ways to have their health...
BMC Family Practice, 2020
Background Normalisation Process Theory (NPT) provides a framework to understand how interventions are implemented, embedded, and integrated in healthcare settings. Previous reviews of published literature have examined the application of NPT across international healthcare and reports its benefits. However, given the distinctive clinical function, organisational arrangements and the increasing management of people with a wide variety of conditions in primary care settings in the United Kingdom, it is important to understand how and why authors utilise and reflect on NPT in such settings to inform and evaluate implementation processes. Methods A systematic review of peer-reviewed literature using NPT in primary care settings in the United Kingdom (UK) was conducted. Eight electronic databases were searched using replicable methods to identify articles published between January 2012 and April 2018. Data were analysed using a framework approach. Results Thirty-one articles met the inc...
BMJ Open
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...
Lessons in implementing infection prevention
Journal of Infection Prevention, 2016
This paper has been developed from a conference presentation given by Professor Alison Holmes at the IPS Learning Labs launch event (2015). In it the implementation of research into clinical practice is discussed with reference to the upcoming Health Foundation Spotlight Report. The difficulties of engaging those in clinical practice are discussed with the importance of involvement of clinical leaders being highlighted. The importance of recognising that implementation science as a social process to bring credibility and legitimacy is also stressed. Following this, the Spotlight Report that is focused on strengthening implementation in the UK is discussed. There remains considerable scope for improvement and the impact of surveillance, targets and fatigue are considered. The tension between top–down and bottom–up approaches to implementation are discussed and a recommendation for a blended approach when implementing measures that are the components of an organisational infection pre...