Putting on a Show for Infection Prevention and Control
An intriguing aspect of nursing care is the study of practitioners who “ put on a show ” related to infection prevention behavior in healthcare .
Jackson , et al . ( 2013 ) acknowledge that while “ Much of the research to date has primarily focused on predicting infection prevention behaviors and factors associated with guideline compliance ,” studying behaviors that occur in everyday practice from the nurses ’ perspective “ may hold the key to the challenges of effecting behavior change ,” the researchers say . Their study questioned “ How can nurses ’ infection prevention behavior be explained ?” and explored the concept of rationalizing dirt-related behavior .
Their interpretative qualitative study utilized vignettes developed from nurses ’ accounts of practice to explore nurses ’ reported infection prevention behaviors . They recruited registered nurses working in an acute-care hospital setting .
The researchers say their findings demonstrate that “ Participants were keen to give a good impression and present themselves as knowledgeable practitioners , although it was evident that they did not always follow procedure and policy . They rationalized their own behavior and logically justified any deviations from policy . Deviations in others were criticized as irrational and explained as superficial and part of a ‘ show ’ or display . However , participants also gave a presentation of themselves : a show or display that was influenced by the desire to protect self and satisfy patient scrutiny .”
They add , “ Behavior is multi-faceted and complex , stemming from a response to factors that are outside a purely ‘ scientific ’ understanding of infection and not simply understood as a deficit in knowledge . This calls for educational interventions that consider beliefs , values and social understanding of dirt and infection .”
Gould ( 2014 ) notes that infection prevention involves complex social behavior and that “ Education is unlikely to be sufficient when seeking to improve nurses ’ infection prevention practice . Multi-faceted campaigns that include education are more likely to be effective . Further research is needed to identify the beliefs held by other health workers about healthcare-associated infection .”
References :
Gould D . Infection control practice : interview with 20 nurses reveals themes of rationalizing their own behavior and justifying any deviations from policy . Evid Based Nurs . 2015 Apr ; 18 ( 2 ): 59 . Epub July 21 , 2014 . DOI : 10.1136 / eb-2014-101882 .
Jackson C , Lowton K and Griffiths P . Infection prevention as ‘ a show ’: a qualitative study of nurses ’ infection prevention behaviors . Int J Nurs Stud . 2014 Mar ; 51 ( 3 ): 400-8 . Epub Aug . 1 , 2013 . DOI : 10.1016 / j . ijnurstu . 2013.07.002 fully understand what they were being told . They also wanted nurses to spend more time with them discussing their care and to be listened to . Patients often felt that their need to develop a relationship , a connection with the healthcare team was not possible due to a lack of in-depth communication and relationship building by the nursing team .”
Disturbingly , fundamental physical care was lacking , according to numerous studies . As Bagnasco , et al . ( 2020 ) note , “ Patients also identified unmet care needs in what could be described as basic or essential care . Issues like help with hygiene , eating and drinking and help mobilizing were present in many of the studies . Other unmet needs were , help with oral care and help with dressing – an issue that was seen as important for self-esteem and autonomy .”
Pain management was among the patient complaints identified in the studies . According to Bagnasco , et al . ( 2020 ), “ Many studies have investigated patients ’ perceptions of the efficacy of pain management interventions , patient empowerment in the management of therapy and symptoms , and nurses ’ attention to this symptom . Despite being among the most met needs , it is still only partially satisfied .”
Being treated with dignity was another common complaint , part of emotional and psychological care that was missing . As Bagnasco , et al . ( 2020 ) note , “ Throughout the studies patients identified how they want to be treated as a ‘ person ,’ or an ‘ individual ’ whose dignity should be respected despite hospitalization and the situations of reduced autonomy . This often is not adequately addressed in hospital settings . This theme includes also the need for emotional and spiritual support , which , in some papers , is described as not always adequately met . Receiving good care in the emotional and psychological sphere allows the patient to develop a sense of safety and confidence toward the nursing staff and the care environment . When this sense of protection is lacking , it generates a psycho-physical malaise that is then reflected in the patient ’ s well-being .”
As the researchers note , “ It is important for patients to feel that they are being cared for in their entirety as persons , and not seen as an item on the ‘ to do ’ list , or merely as a clinical condition to be dealt with . All this also involves the patient ’ s need to feeling safe and protected throughout their stay in hospital , although hospitalization on the contrary has often been described as a place that generates feelings of unsafety due to uncertainty and lack of knowledge about hospital dynamics .”
They observe further , “ This reinforces the need for a joint agenda to be developed in addressing these gaps in nursing care recognizing that nursing is a partnership that relies on both parties understanding each other and being able to communicate effectively to ensure that both care and care needs are holistic and complete .” They underscore the importance of taking the patient ’ s point of view into account throughout the healthcare delivery process , noting that “ Although research into missed care from the professional perspective is valuable , we must also ensure we check that against the experiences of patients too . Furthermore , this reflection should also involve the leaders and stakeholders of the profession , at all levels . When basic needs such as hygiene , nutrition , mobilization , communication are not recognized , the patient feels humiliated , ignored ; missed care creeps into the patient-nurse relationship and undermines confidence , esteem ,