Health is no different to other areas of the economy , but arguably is dealing with the conflating issues of ageing populations , which means an increased volume of the population with complex illnesses that require ongoing treatment
( rather than dying from their conditions ); as well as increased expectations about health and medical care due to increased technology and specialization in responding to conditions , as well as increased transparency in terms of clinical governance .” commonly rationed nursing tasks . But my hospital used to have backup toothbrushes and toothpastes but no longer does ; we hardly seem to have any kidney dishes and most of the patients are bedbound so without a kidney dish it ’ s hard to help them brush their teeth in bed . And not all wards stock the mouth buds , which quite frankly are fine for a quick mouth refresh for a dying patient but not particularly useful if someone needs a vigorous toothbrushing . So , if there isn ’ t the environmental nudge toward this good practice then it can reinforce this habitual de-prioritization . Will the after-hours shift coordinator prioritize delivery of a toothbrush at 9pm ? I doubt it ( I ’ m happy to be corrected !), but they would an antibiotic , so that helps you see what practices get enabled and prioritized systemwide . I think that increasingly missed nursing care is also being taught in the nursing curricula , particularly given the increasing science supporting and investigating the phenomena . I think the bigger issue is the shock that people experience about nurses having to ration their care . There will always be a finite number of resources . Health is no different to other areas of the economy , but arguably is dealing with the conflating issues of ageing populations , which means an increased volume of the population with complex illnesses that require ongoing treatment ( rather than dying from their conditions ); as well as increased expectations about health and medical care due to increased technology and specialization in responding to conditions , as well as increased transparency in terms of clinical governance . These do great things to support quality care , but they also put additional pressure on those settings to deliver . Nurses will always be the face of many of these health interactions , and in hospital settings in particular , the tensions between who receives the resource – in this case , nursing time — is more visible .
HHM In your study , were the nurses working as general floor / unit nurses or were they specifically tasked with infection control-related duties ? Did this make any difference in their behavior ?
KB : Seven of the 11 interviewees were directly in infection control nursing roles . The other four had varied roles which are specified . Further research , including quantitative research which seeks to differentiate different types of nurses and their value of infection control practices , would be interesting . I think this article highlights , however , that staffing needs to be controlled for the questions of “ Do higher proportions of RNs affect the value placed on infection control ? Or does a higher proportion of RNs reduce the incidence of missed nursing care ?” Missed nursing care research is very hard to do prospectively however , hence the dearth of research in this arena .
HHM Is missed care attributable to a gap in knowledge or a gap in practice , or both , and should this be a wake-up call that training and education need improvement ?
KB : I think that is an oversimplification of complex issues , which is all too common in the interpretation of nursing work . I would encourage a review of the sections in our paper on the “ whole of hospital ” approach on pages 4-5 . These nurses talked about how they needed to be able to talk convincingly to get the support of accountants to make appropriate purchases . The nurses also talked about there being excellent policies in place , but not enough nurses to make the policies deliverable . These are issues beyond teaching undergraduate nurses , or a gap in translating their learnings into practice – it ’ s a wake-up call that all layers of hospital administrators need to better understand and respect infection control nursing work , collect local data , and respond meaningfully .
HHM Is it simply a matter of resourcing and staffing , to address missed nursing care in infection control-related practices , or is it also a behavioral issue / human factors engineering-related issue ?
KB : It ’ s absolutely both . We know from the magnet hospital research , which has continued to be supported through decades of research ( and increasing continental reach , with the European Magnet Hospital program in mid-delivery ) that hospitals with good work environments have better outcomes . We know that the ingredients of these healthy work environments include resourcing and staffing as well as sound clinical governance and trusting and effective relationships between nurses , managers and other health professionals .
HHM You make a very key statement in your paper when you observe “ There are many situations of clinical care delivery that have not had robust research conducted to support the practice , despite widespread expert recommendations .” This is a very big reason why many nurses in the U . S . believe they can skip some infection prevention-related practices , so how can this be addressed by health systems ?
KB : Great question . Healthcare is always delivered in a state of uncertainty – evidence is continually being developed and refined , and some elements of care will always have a more theoretical principled approach and will not be able to develop a gold standard prospective clinical trial to “ prove ” an association or demonstrate the ‘ best ’ way . There ’ s an interesting article on the World Health Organization ’ s 5 Moments of Hand Hygiene highlighting the impracticality of this “ protocol ” which doesn ’ t have an evidence base . That doesn ’ t mean it doesn ’ t work – it is a very sound theoretical approach , and as an adoptable system has likely increased the hand
14 august 2023 • www . healthcarehygienemagazine . com