Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing

Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing This is a research pres provide three slides containing the following: Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing Topic: Hand Hygiene 1. advantages 2. disadvantages 3. implementation two research articles are attached below (use only the articles provided) Also, attached are two examples of how many words and bullet points per slides please add additional information in the notes section of each slide so that i can elaborate for the information given provide intext citations in correct APA 7th edition format. f83375d9_c38d_4863_a1c4_624aa1125596.jpeg fbb05d6_22ca_4cc3_b72e_bc244f699a82.jpeg qualitative_article.pdf qualitative_article_week_10.pdf hand_hygiene_in_children_.pdf 675098 research-article2016 SMO0010.1177/2050312116675098SAGE Open MedicineChatfield et al. SAGE Open Medicine Original Article Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis SAGE Open Medicine Volume 4: 1­–9 © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2050312116675098 smo.sagepub.com Sheryl L Chatfield, Rachael Nolan, Hannah Crawford and Jeffrey S Hallam Abstract Objective: Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals’ perceptions of hygiene might drive practices. Methods: We conducted qualitative interview research with eight nurses in the United States who were employed in various patient-care roles. We analyzed the data using an interpretative phenomenological analysis methodology to explore how nurses described their perceptions of, and experiences with, hygiene. We developed themes that explored individual, workplace, and management influences on perception of hygiene. Results: Developed themes include practical hygiene, risky business, and hygiene on trial; the latter theme described the conflict between how nurses perceived their own hygiene practices and how they felt hospital management perceived these practices. Other findings included that participants distinguished between policy-mandated use of sanitizer and a personal sense of cleanliness; the latter was more likely to be associated with scrubbing or removal of contaminants than with use of protectants. Conclusion: While participants asserted support for facility hand hygiene policies, their behavior in certain instances might be mediated by broadly defined emergent situations and a belief that it is not currently possible to establish a causal link between an healthcare-associated infections and a specific individual or occurrence. Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions, to encourage ownership, and emphasizing detailed cases as training content to take advantage of individuals’ sensory responses to hygiene. Keywords Hand hygiene, healthcare-associated infections, nurses, qualitative, interpretative phenomenological analysis Date received: 6 June 2016; accepted: 13 September 2016 Introduction. Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing According to a report compiled by the World Health Organization (WHO),1 healthcare-associated infections (HCAI) account for annual direct costs in excess of 6 billion dollars in the United States and 7 billion Euros in the European Union. Additional direct and indirect costs of HCAI are difficult to estimate with precision but are presumed substantial. Examples of specific consequences for individuals and significant others include longer hospital stays, emotional stress on caregivers or family members, extended illness, disability, or discomfort, loss of working days, diminishment of social contacts, and, in extreme instances, death.1 It has been suggested that a single modifiable factor, improvement in hand Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA Corresponding author: Sheryl L Chatfield, Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Lowry Hall, 750 Hilltop Drive, Kent, OH 44242, USA. Email: [email protected] Creative Commons Non Commercial CC-BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 hygiene among healthcare workers, has potential to greatly reduce incidence of HCAI2 although hand hygiene itself is characterized by researchers as a highly complex behavior that is influenced by varying combinations of individual, social, and administrative factors.3 Authors of six meta-studies of quantitatively measured intervention research considered and aggregated the findings from more than 100 unique intervention studies.4–9 Global findings of most intervention studies included directed educational programming or incorporated alternate methods of providing information regarding compliance or infection rates.4–10 Authors of meta-studies reported that improvements in hand hygiene rates tended to follow behavior change interventions although there were additional aspects of the behavior or facilitators that were not fully explained through analysis of the primary research studies.4–9 These aspects included lack of understanding of how to encourage and ensure long-term compliance,4 incomplete identification of specific strategies in multi-component interventions that were both most efficacious and resource effective,7,9 and lack of knowledge related to potential efficacy of interventions that might simultaneously operate at multiple levels within healthcare organizations.6 One additional study10 compiled data from 96 published observational investigations to identify correlates with compliance and non-compliance and recommended that context-specific adjustments need to be identified and implemented to make existing theoretical frameworks more effective. To lay the groundwork for development and modification of behavior change models, the authors recommended the use of qualitative inquiry to explore behavioral issues in greater depth.10 Use of this recommended exploratory and qualitative approach has the additional advantage of potentially guiding intervention development to address the outstanding items identified by the authors of the review studies described above. Therefore, the purpose of this article is to describe findings from a qualitative research study implemented to investigate hand hygiene among healthcare workers, specifically nurses, in healthcare facilities.Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing Many previously published qualitative research studies of hand hygiene among healthcare workers have featured findings from individual or group interviews framed in a descriptive, generic, or unspecified qualitative approach.11–14 Findings from descriptive or generic studies are often presented in the form of broad practice or contextual categories that falls into the classification “topical survey of findings” in which results are “organized by the research or interview questions asked, by the prevalence of topics raised, or by some other a priori but always surface classification system” (p. 910).15 Use of this presentation style in itself does not suggest lack of quality in the research design or data processing. We believe, however, that more interpretive findings have greater relevance to our research interest and more potential to help address the knowledge gaps identified above. SAGE Open Medicine We identified a small number of examples of published hand hygiene research in which authors expanded findings beyond common categories and offered interpretive explanations for findings. Only two of these research reports16,17 included healthcare workers employed in healthcare facilities as participants. Authors of one report interviewed primarily individuals in supervisory roles and considered hygiene in context of Bourdieu’s concept of habitus, defined by the authors as “an acquired, collectively held pattern of thinking and acting” (p. 1048).16 These authors suggested that nursing staff might take advantage of responsibility for cleanliness to acquire an asset the authors described as hygiene capital and considered beneficial to individuals and to nurses as a practice group, as well as a facilitator of quality improvement in healthcare practice overall. Authors of the other report compared inductively derived qualitative findings with constructs comprising the existing theory of planned behavior and recommended modifications to the theory to better explain the disconnect between intention and behavior the authors’ data analysis revealed.17 These authors also emphasized the role of experience and suggested using the emotional power of “vivid episodes” (p. 40)17 in training materials to facilitate lasting behavior change. The research described in this article was also planned using an interpretative approach to qualitative inquiry. Where our work differs from the two reports described above is in our priority placed on the described perception and experience of hygiene itself. We aimed to further investigate individuals’ perceptions of hygiene, in order to improve our understanding of how individual or subjective interpretations of this concept might influence responses to policies, communication, and education- or information-based interventions since these approaches are prevalent in hand hygiene intervention research. For this research study, we chose specifically to use an interpretative phenomenological analysis (IPA)18 approach to explore how acute care nurses described their experiences with hand hygiene. We selected nurses among healthcare workers because the frequency of direct patient contact associated with nursing practice results in frequent opportunities to participate in hand hygiene based on WHO guidelines.19 We chose to use IPA due to the priority of this qualitative approach on “offering detailed, nuanced analyses of particular instances of lived experience” (p. 37).18 What distinguishes IPA from other qualitative phenomenological approaches that are also directed at understanding lived experience is an acknowledgement of researcher interpretation; results reflect the researcher’s interpretation of the participant’s interpretation and presentation of his or her experience. Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing We believe this characteristic makes this approach particularly well suited toward investigation of subject matter such as hand hygiene in which individual practice is likely at times to differ from institutional quality control standards. To our knowledge, there have been no prior published articles in which researchers described the 3 Chatfield et al. use of IPA to investigate hand hygiene although authors of two prior research studies used IPA to investigate quality in healthcare practices among general practitioners20 and nurses.21 We identified several findings of interest and potential applicability to this research study from the first of these previous IPA research studies. These include the following: expressed distrust of evidence-based guidelines, fear of loss of autonomy from implementing guidelines, and a pessimistic view of the benefits resulting from evidence-based practice when compared to the effort required to implement guidelines.20 Authors of the second IPA study identified disconnect between ideals specified by the standard knowledge and skill-based nursing evaluation and how nurses implemented processes in practice.21 This finding supports prior research findings that speculate that activities comprising professional practice, such as hand hygiene, are influenced by factors both within and beyond the individual. Methods Participants Individual interviews are the customary means of data collection for IPA research.18 For this study, we conducted indepth interviews with eight nurses, employed in various hospitals throughout the United States, who were recruited by a research screening organization. Small samples are the norm to facilitate “detailed account of individual experience” (p. 51).18 Eligible participants were required to speak and understand English sufficiently well to participate in an in-depth interview, to consent to be interviewed, and to be currently employed fulltime in an acute care nursing position in which they spent most of their time in direct patient care. Our aim was to recruit a sample that was homogenous, by comprising nurses who engaged in hand hygiene as part of their regular duties, but that still represented some variation in the range of specific patient-care responsibilities, healthcare system, and region of employment. Our goal in seeking this limited variation was not generalizability, which is beyond the scope of IPA and many qualitative methods, but rather to be better able to distill the essence of the hygiene experience over and above factors related to specific positions, management practices, and elements of organizational cultures that might be present in a single facility. Willing participants were provided with a small financial incentive upon completion of the interview. A university institutional review board approved the research study prior to recruitment, and all participants were provided with a written information sheet and asked to provide oral consent at interview onset. Nurses represented neonatal intensive care units (two), triage, labor and delivery, intravenous team, and general care hospital nurse (one of each). The sample also included two nurses who additionally had supervisory responsibilities, one from an oncology unit and one from a pediatric unit. All were working fulltime at the time of the interview. Participants’ reported years of nursing experience ranged from 6 to 28. Interviews One of the authors who had extensive qualitative interviewing experience conducted all interviews over the telephone.Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing Prior to initiating interviews, the author discussed with the participants his role as a university-affiliated behavioral health researcher interested in exploring participants’ experiences with hand hygiene and encouraged participants to be open and thorough when describing those experiences. The author informed participants that the results of data analysis would be used to help identify alternatives for future hand hygiene intervention research. The mean duration of interviews was 56.85 min. We developed the interview guide using an example IPA framework18 with adaptations made to account for the subject matter of interest. We added one question regarding participants’ opinion about classification of hand hygiene as a medical error because it was of particular interest to the research team. All interviews were audio-recorded and professionally transcribed with a content focus. Two of the authors checked the transcripts for accuracy and made appropriate corrections to the typed interview transcripts prior to initiating data analysis. The interview guide is given in Appendix 1. Data processing Author information. Authors of qualitative research, due to the nature of the relationship with participants and with data, can be considered as analogous to instruments used for quantitative methods.22 We are all university-affiliated researchers; only one author has previous healthcare experience, and as of the time of this analysis had research responsibilities that required occasional site visits to an area hospital. Prior to and while conducting this research, we completed a comprehensive review of prior qualitative research on hand hygiene among healthcare workers. We also engaged in regular discussions with a larger group of individuals including other health behavior researchers who were involved in ongoing intervention development to improve hand hygiene in healthcare settings. We believe that our ongoing immersion in both previously published data and general subject matter helped us to better understand and interpret participant experiences although our status as relative outsiders in healthcare settings helped counter potential bias during interviews and analysis. Analytic processes. We completed descriptive, linguistic, and conceptual commenting stages that characterize IPA analysis18 using the commenting function in the Microsoft Office® software program, Word. Next, we initiated the development of themes for each participant. Following the completion of commenting and theme development for all participant transcripts, themes were 4 SAGE Open Medicine Table 1. Super-ordinate themes and subthemes by represented participants. Super-ordinate themes/subthemes Practical hygiene Soap is for old people The rise of sanitizer Alien substances Risky business The contaminated environment Long-term concerns Hygiene on trial Accused Confession Extenuating circumstances Beyond a reasonable doubt compared across cases. We used the process of abstraction18 to identify our broader themes or super-ordinate themes. Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing We consolidated the items in each cluster into the representative variations of the super-ordinate themes or subthemes.18 These processes were documented by creating and retaining edited transcripts that represented each stage of coding for each participant and several subsequent iterations of theme development documents, culminating in a master theme table that contained representative excerpts of text from each participant that contributed to each subtheme. The research team discussed various aspects of the analysis process, from initial commenting through creation of the master theme table, during regular meetings. Further analysis information, including the audit trail that represents detailed theme development, is available by contacting the first author (S.L.C.). Findings We used quality control recommendations associated with IPA23 and developed those super-ordinate themes that were supported by minimum 50%, or four of the eight participants. We identified three prevailing super-ordinate themes and the multiple subthemes represented within each. We labeled the super-ordinate themes as follows: practical hygiene, risky business, and hygiene on trial. We have shown super-ordinate themes and associated subthemes and listed the represented participants using pseudonyms in Table 1. Below, we present the themes, supporting, and when available, contradictory excerpts, and our interpretation of the findings. Themes Practical hygiene. This theme includes examples in which participants described how to attain hygiene. For participants, personal attainment was achieved either primarily through soap and water or primarily through sanitizer or, in some instances, using a combination of soap followed by Participants Angela, Barbra, Francis, Jordan, Kim, and Nicole All Barbra, Dana, and Francis Angela, Barbra, Caren, Dana, and Kim Angela, Dana, and Jordan Angela, Barbra, Caren, and Dana Angela, Caren, Dana, Francis, Jordan, Kim, and Nicole Angela, Caren, Dana, Francis, Jordan, Kim, and Nicole Caren, Dana, Francis, and Kim sanitizer. Nurses who preferred soap tended to self-associate this with mature age. We clustered those findings in a subtheme titled soap is for old people. According to Jordan, There’s no replacement for soap and water. And a good 20-second scrub … in every patient room, we have hand sanitizer and soap … I think the older nurses will do soap and water. They don’t do the hand—the gel-in, gel-out unless there’s a trigger or we have a family that’s very aware of the nurses coming in. Kim also described age-related soap preference: And I’m old-fashioned; I don’t know why, but I do a lot more of the actual soap and water. I don’t know why; I guess it’s just because of my age … I don’t know, sometimes I just feel like my hands are washed better with the soap and water. We identified a companion subtheme that reflected the increasing prevalence of alcohol-based sanitizers in acute care settings: the rise of sanitizer. Angela described her view of the role of … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing

Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing This is a research pres provide three slides containing the following: Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing Topic: Hand Hygiene 1. advantages 2. disadvantages 3. implementation two research articles are attached below (use only the articles provided) Also, attached are two examples of how many words and bullet points per slides please add additional information in the notes section of each slide so that i can elaborate for the information given provide intext citations in correct APA 7th edition format. f83375d9_c38d_4863_a1c4_624aa1125596.jpeg fbb05d6_22ca_4cc3_b72e_bc244f699a82.jpeg qualitative_article.pdf qualitative_article_week_10.pdf hand_hygiene_in_children_.pdf 675098 research-article2016 SMO0010.1177/2050312116675098SAGE Open MedicineChatfield et al. SAGE Open Medicine Original Article Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis SAGE Open Medicine Volume 4: 1­–9 © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2050312116675098 smo.sagepub.com Sheryl L Chatfield, Rachael Nolan, Hannah Crawford and Jeffrey S Hallam Abstract Objective: Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals’ perceptions of hygiene might drive practices. Methods: We conducted qualitative interview research with eight nurses in the United States who were employed in various patient-care roles. We analyzed the data using an interpretative phenomenological analysis methodology to explore how nurses described their perceptions of, and experiences with, hygiene. We developed themes that explored individual, workplace, and management influences on perception of hygiene. Results: Developed themes include practical hygiene, risky business, and hygiene on trial; the latter theme described the conflict between how nurses perceived their own hygiene practices and how they felt hospital management perceived these practices. Other findings included that participants distinguished between policy-mandated use of sanitizer and a personal sense of cleanliness; the latter was more likely to be associated with scrubbing or removal of contaminants than with use of protectants. Conclusion: While participants asserted support for facility hand hygiene policies, their behavior in certain instances might be mediated by broadly defined emergent situations and a belief that it is not currently possible to establish a causal link between an healthcare-associated infections and a specific individual or occurrence. Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions, to encourage ownership, and emphasizing detailed cases as training content to take advantage of individuals’ sensory responses to hygiene. Keywords Hand hygiene, healthcare-associated infections, nurses, qualitative, interpretative phenomenological analysis Date received: 6 June 2016; accepted: 13 September 2016 Introduction. Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing According to a report compiled by the World Health Organization (WHO),1 healthcare-associated infections (HCAI) account for annual direct costs in excess of 6 billion dollars in the United States and 7 billion Euros in the European Union. Additional direct and indirect costs of HCAI are difficult to estimate with precision but are presumed substantial. Examples of specific consequences for individuals and significant others include longer hospital stays, emotional stress on caregivers or family members, extended illness, disability, or discomfort, loss of working days, diminishment of social contacts, and, in extreme instances, death.1 It has been suggested that a single modifiable factor, improvement in hand Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA Corresponding author: Sheryl L Chatfield, Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Lowry Hall, 750 Hilltop Drive, Kent, OH 44242, USA. Email: [email protected] Creative Commons Non Commercial CC-BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 hygiene among healthcare workers, has potential to greatly reduce incidence of HCAI2 although hand hygiene itself is characterized by researchers as a highly complex behavior that is influenced by varying combinations of individual, social, and administrative factors.3 Authors of six meta-studies of quantitatively measured intervention research considered and aggregated the findings from more than 100 unique intervention studies.4–9 Global findings of most intervention studies included directed educational programming or incorporated alternate methods of providing information regarding compliance or infection rates.4–10 Authors of meta-studies reported that improvements in hand hygiene rates tended to follow behavior change interventions although there were additional aspects of the behavior or facilitators that were not fully explained through analysis of the primary research studies.4–9 These aspects included lack of understanding of how to encourage and ensure long-term compliance,4 incomplete identification of specific strategies in multi-component interventions that were both most efficacious and resource effective,7,9 and lack of knowledge related to potential efficacy of interventions that might simultaneously operate at multiple levels within healthcare organizations.6 One additional study10 compiled data from 96 published observational investigations to identify correlates with compliance and non-compliance and recommended that context-specific adjustments need to be identified and implemented to make existing theoretical frameworks more effective. To lay the groundwork for development and modification of behavior change models, the authors recommended the use of qualitative inquiry to explore behavioral issues in greater depth.10 Use of this recommended exploratory and qualitative approach has the additional advantage of potentially guiding intervention development to address the outstanding items identified by the authors of the review studies described above. Therefore, the purpose of this article is to describe findings from a qualitative research study implemented to investigate hand hygiene among healthcare workers, specifically nurses, in healthcare facilities.Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing Many previously published qualitative research studies of hand hygiene among healthcare workers have featured findings from individual or group interviews framed in a descriptive, generic, or unspecified qualitative approach.11–14 Findings from descriptive or generic studies are often presented in the form of broad practice or contextual categories that falls into the classification “topical survey of findings” in which results are “organized by the research or interview questions asked, by the prevalence of topics raised, or by some other a priori but always surface classification system” (p. 910).15 Use of this presentation style in itself does not suggest lack of quality in the research design or data processing. We believe, however, that more interpretive findings have greater relevance to our research interest and more potential to help address the knowledge gaps identified above. SAGE Open Medicine We identified a small number of examples of published hand hygiene research in which authors expanded findings beyond common categories and offered interpretive explanations for findings. Only two of these research reports16,17 included healthcare workers employed in healthcare facilities as participants. Authors of one report interviewed primarily individuals in supervisory roles and considered hygiene in context of Bourdieu’s concept of habitus, defined by the authors as “an acquired, collectively held pattern of thinking and acting” (p. 1048).16 These authors suggested that nursing staff might take advantage of responsibility for cleanliness to acquire an asset the authors described as hygiene capital and considered beneficial to individuals and to nurses as a practice group, as well as a facilitator of quality improvement in healthcare practice overall. Authors of the other report compared inductively derived qualitative findings with constructs comprising the existing theory of planned behavior and recommended modifications to the theory to better explain the disconnect between intention and behavior the authors’ data analysis revealed.17 These authors also emphasized the role of experience and suggested using the emotional power of “vivid episodes” (p. 40)17 in training materials to facilitate lasting behavior change. The research described in this article was also planned using an interpretative approach to qualitative inquiry. Where our work differs from the two reports described above is in our priority placed on the described perception and experience of hygiene itself. We aimed to further investigate individuals’ perceptions of hygiene, in order to improve our understanding of how individual or subjective interpretations of this concept might influence responses to policies, communication, and education- or information-based interventions since these approaches are prevalent in hand hygiene intervention research. For this research study, we chose specifically to use an interpretative phenomenological analysis (IPA)18 approach to explore how acute care nurses described their experiences with hand hygiene. We selected nurses among healthcare workers because the frequency of direct patient contact associated with nursing practice results in frequent opportunities to participate in hand hygiene based on WHO guidelines.19 We chose to use IPA due to the priority of this qualitative approach on “offering detailed, nuanced analyses of particular instances of lived experience” (p. 37).18 What distinguishes IPA from other qualitative phenomenological approaches that are also directed at understanding lived experience is an acknowledgement of researcher interpretation; results reflect the researcher’s interpretation of the participant’s interpretation and presentation of his or her experience. Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing We believe this characteristic makes this approach particularly well suited toward investigation of subject matter such as hand hygiene in which individual practice is likely at times to differ from institutional quality control standards. To our knowledge, there have been no prior published articles in which researchers described the 3 Chatfield et al. use of IPA to investigate hand hygiene although authors of two prior research studies used IPA to investigate quality in healthcare practices among general practitioners20 and nurses.21 We identified several findings of interest and potential applicability to this research study from the first of these previous IPA research studies. These include the following: expressed distrust of evidence-based guidelines, fear of loss of autonomy from implementing guidelines, and a pessimistic view of the benefits resulting from evidence-based practice when compared to the effort required to implement guidelines.20 Authors of the second IPA study identified disconnect between ideals specified by the standard knowledge and skill-based nursing evaluation and how nurses implemented processes in practice.21 This finding supports prior research findings that speculate that activities comprising professional practice, such as hand hygiene, are influenced by factors both within and beyond the individual. Methods Participants Individual interviews are the customary means of data collection for IPA research.18 For this study, we conducted indepth interviews with eight nurses, employed in various hospitals throughout the United States, who were recruited by a research screening organization. Small samples are the norm to facilitate “detailed account of individual experience” (p. 51).18 Eligible participants were required to speak and understand English sufficiently well to participate in an in-depth interview, to consent to be interviewed, and to be currently employed fulltime in an acute care nursing position in which they spent most of their time in direct patient care. Our aim was to recruit a sample that was homogenous, by comprising nurses who engaged in hand hygiene as part of their regular duties, but that still represented some variation in the range of specific patient-care responsibilities, healthcare system, and region of employment. Our goal in seeking this limited variation was not generalizability, which is beyond the scope of IPA and many qualitative methods, but rather to be better able to distill the essence of the hygiene experience over and above factors related to specific positions, management practices, and elements of organizational cultures that might be present in a single facility. Willing participants were provided with a small financial incentive upon completion of the interview. A university institutional review board approved the research study prior to recruitment, and all participants were provided with a written information sheet and asked to provide oral consent at interview onset. Nurses represented neonatal intensive care units (two), triage, labor and delivery, intravenous team, and general care hospital nurse (one of each). The sample also included two nurses who additionally had supervisory responsibilities, one from an oncology unit and one from a pediatric unit. All were working fulltime at the time of the interview. Participants’ reported years of nursing experience ranged from 6 to 28. Interviews One of the authors who had extensive qualitative interviewing experience conducted all interviews over the telephone.Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing Prior to initiating interviews, the author discussed with the participants his role as a university-affiliated behavioral health researcher interested in exploring participants’ experiences with hand hygiene and encouraged participants to be open and thorough when describing those experiences. The author informed participants that the results of data analysis would be used to help identify alternatives for future hand hygiene intervention research. The mean duration of interviews was 56.85 min. We developed the interview guide using an example IPA framework18 with adaptations made to account for the subject matter of interest. We added one question regarding participants’ opinion about classification of hand hygiene as a medical error because it was of particular interest to the research team. All interviews were audio-recorded and professionally transcribed with a content focus. Two of the authors checked the transcripts for accuracy and made appropriate corrections to the typed interview transcripts prior to initiating data analysis. The interview guide is given in Appendix 1. Data processing Author information. Authors of qualitative research, due to the nature of the relationship with participants and with data, can be considered as analogous to instruments used for quantitative methods.22 We are all university-affiliated researchers; only one author has previous healthcare experience, and as of the time of this analysis had research responsibilities that required occasional site visits to an area hospital. Prior to and while conducting this research, we completed a comprehensive review of prior qualitative research on hand hygiene among healthcare workers. We also engaged in regular discussions with a larger group of individuals including other health behavior researchers who were involved in ongoing intervention development to improve hand hygiene in healthcare settings. We believe that our ongoing immersion in both previously published data and general subject matter helped us to better understand and interpret participant experiences although our status as relative outsiders in healthcare settings helped counter potential bias during interviews and analysis. Analytic processes. We completed descriptive, linguistic, and conceptual commenting stages that characterize IPA analysis18 using the commenting function in the Microsoft Office® software program, Word. Next, we initiated the development of themes for each participant. Following the completion of commenting and theme development for all participant transcripts, themes were 4 SAGE Open Medicine Table 1. Super-ordinate themes and subthemes by represented participants. Super-ordinate themes/subthemes Practical hygiene Soap is for old people The rise of sanitizer Alien substances Risky business The contaminated environment Long-term concerns Hygiene on trial Accused Confession Extenuating circumstances Beyond a reasonable doubt compared across cases. We used the process of abstraction18 to identify our broader themes or super-ordinate themes. Assignment: Hand Hygiene Evidence Based Practice & Applied Nursing We consolidated the items in each cluster into the representative variations of the super-ordinate themes or subthemes.18 These processes were documented by creating and retaining edited transcripts that represented each stage of coding for each participant and several subsequent iterations of theme development documents, culminating in a master theme table that contained representative excerpts of text from each participant that contributed to each subtheme. The research team discussed various aspects of the analysis process, from initial commenting through creation of the master theme table, during regular meetings. Further analysis information, including the audit trail that represents detailed theme development, is available by contacting the first author (S.L.C.). Findings We used quality control recommendations associated with IPA23 and developed those super-ordinate themes that were supported by minimum 50%, or four of the eight participants. We identified three prevailing super-ordinate themes and the multiple subthemes represented within each. We labeled the super-ordinate themes as follows: practical hygiene, risky business, and hygiene on trial. We have shown super-ordinate themes and associated subthemes and listed the represented participants using pseudonyms in Table 1. Below, we present the themes, supporting, and when available, contradictory excerpts, and our interpretation of the findings. Themes Practical hygiene. This theme includes examples in which participants described how to attain hygiene. For participants, personal attainment was achieved either primarily through soap and water or primarily through sanitizer or, in some instances, using a combination of soap followed by Participants Angela, Barbra, Francis, Jordan, Kim, and Nicole All Barbra, Dana, and Francis Angela, Barbra, Caren, Dana, and Kim Angela, Dana, and Jordan Angela, Barbra, Caren, and Dana Angela, Caren, Dana, Francis, Jordan, Kim, and Nicole Angela, Caren, Dana, Francis, Jordan, Kim, and Nicole Caren, Dana, Francis, and Kim sanitizer. Nurses who preferred soap tended to self-associate this with mature age. We clustered those findings in a subtheme titled soap is for old people. According to Jordan, There’s no replacement for soap and water. And a good 20-second scrub … in every patient room, we have hand sanitizer and soap … I think the older nurses will do soap and water. They don’t do the hand—the gel-in, gel-out unless there’s a trigger or we have a family that’s very aware of the nurses coming in. Kim also described age-related soap preference: And I’m old-fashioned; I don’t know why, but I do a lot more of the actual soap and water. I don’t know why; I guess it’s just because of my age … I don’t know, sometimes I just feel like my hands are washed better with the soap and water. We identified a companion subtheme that reflected the increasing prevalence of alcohol-based sanitizers in acute care settings: the rise of sanitizer. Angela described her view of the role of … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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