1. What do they know and what do they do?
P:120
What do they know and what do they do?
A cross - sectional mixed methods study of nursing perspectives on individual and organizational influences on infection prevention in nursing homes
J. Hammerschmidt & T. Manser
Institute for Patient Safety, University Hospital Bonn, Germany
Background
Aim
Prevailing interventional approaches to improve infection prevention in nursing homes are similar to those in other care settings. Nevertheless, the interrelations between individual and organizational factors in the nursing home setting are very complex. Thus, the change processes required for improved hygiene outcomes are often not only non-transparent but also difficult to influence (see theoretical model).
We focus on the interplay of individual and organizational factors related to compliance with hygiene management and infection prevention in nursing homes from nursing and nursing managers perspectives (see theoretical model).
Theoretical Model
Mixed Methods Design
Qualitative data collection
interviews
Data analysis
Qualitative results
Quantitative data
collection
survey
Quantitative
results
Triangulation
Interpretation integrating
qualitative
and quantitative data
Research Questions
knowledge
behavior
compliance
organizational structures
organizational processes
role model
Organizational Factors
structures
processes
Individual Factors
knowledge
behavior
role model
Outcome
Data analysis
Compliance to
infection prevention
Results / Triangulation
Quantitative and qualitative data, around similar themes expressed by nursing staff (N = 165) and nursing managers (N = 27) (see mixed methods design).
Convergent Results
Complementary Results
Divergent Results
Both groups shared the perception that hygiene and infection prevention is important in daily work and recurring training helps keeping knowledge current.
Most participants reported that they orient themselves towards what they learned in hygiene trainings. At the same time, however, referring to their own behavior, some participants described wearing artificial nails or jewelry on their hands and arms. This inconsistency was often not noticed by study participants.
Nurses and nursing managers perceived their behavior and attitudes regarding hand hygiene differently.
The risk of poisoning a resident with hand rub was perceived as more real than the possibility of nosocomial infection. However, this reasoning was abandoned when a residents` infection was known. Under those circumstances, the disinfectant would be used and deposited in the resident room immediately.
They had shared views on availability of hygiene equipment, hygiene standards and organizational procedures.
Nursing managers perceived nurses’ behavior as mostly adherent to standards. Both groups accept barriers such as not allowing hand rub in resident rooms and bathrooms that hindered infection prevention.
Nursing managers showed a lack of self-reflection concerning their function as role models. They orient their behavior mostly towards their own conceptualizations of infection risks and personal attitudes instead of hygiene standards of their organization.
Conclusion
The concurrent triangulation model helps to emerge meaningful results from the different data sources and to contrast the different perspectives of nurses and nursing managers.
Nursing managers have to be supported as role models regarding hygiene management and infection prevention.
Raising awareness and facilitating compliant infection prevention behavior requires a safety culture that recognize nursing homes as healthcare settings with high infection risk potential.
Nurses have to understand infection risks and have to shift their conceptualization of infection prevention.
Our study shows that managers and nurses in nursing homes can influence each other in terms of knowledge, behavior and compliance.
ICPIC 2017; Geneva