Unclean: a qualitative study of nurses’ reported infection control behaviours

Background <br/>While there is a body of work describing infection control behaviours and factors affecting compliance with guidelines there has been little investigation into understanding and explaining behaviours that occur in everyday practice. Understanding such behaviours may provide a key insight into the challenges of behaviour change. Consequently the main research question in this study is "How can nurse’s infection control behaviour be explained?" <br/><br/>Methods <br/><br/>Using an ethnographic approach this interpretative qualitative study uses vignettes, developed from reported practice, to explore nurses’ perceptions of risk and contagion. Twenty semi-structured interviews using a topic guide and vignettes were conducted with registered general nurses, in three waves. Interviews were transcribed verbatim and analysed using the framework method. <br/><br/>Findings <br/><br/>Three main themes of ’The classifications of dirt’; ’Rationalizing dirt related behaviours; and ’Transitions in place and role’ were identified Firstly, the acts and behaviours reported by participants are part of a protective self defence system against dirt and germs. Protection is required more rigorously when the origin of the threat is unknown; dirt, waste products and body fluids from self and relatives are perceived as being less threatening. Furthermore, threat is reduced by social knowledge, as the person and their behaviours become known. The behaviours of others are viewed differently; if others are carrying out inappropriate behaviours it is seen as irrational, however the same behaviours in self are explained as rational in terms of protection from unknown. Secondly, a show is being performed by many nurses, influenced by the perception of patients’ increased awareness of practice and the nurse’s desire to be seen as someone who knows the correct infection control procedures. Participants reported being more<br/>Finally, there is a journey taken by healthcare workers in their working day in which their role and status changes. The participants perceive themselves as entering the unclean hospital environment in a state of cleanliness, achieved by the practices and rituals that are carried out in the home. Because of the protective behaviours they carry out whilst in the hospital they do not recognise themselves as anything but clean until they return to the home environment. It is at this stage that they recognise their state of uncleanliness. A transition has occurred from clean to dirty on entering the home. Now precautions must be taken as the home needs to be protected from any unknown dirt or germs that may have been transported by the participant and order must be maintained. Cleansing is carried out and clothing is dealt with in pre¬determined ways. <br/><br/>Conclusions <br/><br/>The participants in this study demonstrated that they had the knowledge and education required to understand the principles of infection control procedures, transmission of disease and risk of contagion. Their behaviour exists outside what is taught and accepted by themselves as correct. It is insufficient to say that education can change this behaviour; this behaviour has to be recognised first and foremost by those carrying it out before any attempt can be made to change it. What is required is an educational programme that is carried out in conjunction with a behaviour recognition campaign. Reflection may also be a way of raising self-awareness, allowing healthcare workers to express their fears regarding dirt and infection before considering whether their own behaviour is based on the scientific rationale and meets policy requirements.<br/>Reflection may also be a way of raising self-awareness, allowing healthcare workers to express their fears regarding dirt and infection before considering whether their own behaviour is based on the scientific rationale and meets policy requirements. Following these interventions an examination of whether beliefs have changed and practice has improved should be carried out.

Name dc:type.qualificationname

Doctor of Healthcare

Level dc:type.qualificationlevel

Doctoral Thesis

Grantor dc:publisher.institution

King's College London

Year dc:date.issued

2011

Author dc:creator

• Jackson, Carole

Advisors dc:contributor.advisor

• Griffiths, Peter Donald
• Lowton, Karen

Language dc:language

eng

Identifier

oai:kclpure.kcl.ac.uk:studenttheses/f66bdfa6-465e-4d56-b38b-bdf01e9a1c81

OAI identifier oai:identifier

oai:kclpure.kcl.ac.uk:studenttheses/f66bdfa6-465e-4d56-b38b-bdf01e9a1c81