School of Nursing, University of Nottingham, Grantham and District Hospital, Grantham, Lincolnshire NG31 8DG, United Kingdom.
Nurse Educ Today. 2009 May;29(4):380-8. doi: 10.1016/j.nedt.2008.10.010. Epub 2008 Dec 4.
Hand hygiene remains the single most effective measure to prevent hospital acquired infection and yet poor compliance is reported repeatedly. Nurses represent the largest labour group and perform the greatest amount of direct patient care in the contemporary National Health Service. They receive their initial hand hygiene training in the pre-registration curriculum within a competence framework based on knowledge, skills and attitudes. The pre-eminent training method is one that delivers behavioural competence, making the tacit assumption that compliance will follow. In this study a mixed methods approach demonstrated that students overestimated their knowledge and skills, found it difficult to give an objective account of their performance, and reported an improbable level of compliance. The reasons why people can be self serving in their judgements may be due to information processing errors, exacerbated by the model of education and training. Flawed self assessments may present major barriers to improved performance if students view their compliance as better than it actually is. Conceptualising hand hygiene as a taxonomy of learning and introducing the cognitive strategies of reflection and self assessment would better enable students to problem solve, seek out new information, draw on past experience and gain greater and deeper understanding of the complex topic of hand hygiene behaviour.
手卫生仍然是预防医院获得性感染的最有效措施，但据报道，其依从性很差。护士是现代国民保健制度中最大的劳动力群体，他们为患者提供最多的直接护理。他们在注册前的课程中接受初始手卫生培训，培训以知识、技能和态度为基础，建立在能力框架上。首要的培训方法是提供行为能力，默认的假设是依从性会随之而来。在这项研究中，混合方法表明，学生高估了他们的知识和技能，发现很难客观地描述他们的表现，并报告了一个不太可能的依从水平。人们在判断中可能会自我服务，原因可能是信息处理错误，而教育和培训模式加剧了这种错误。如果学生认为自己的依从性比实际情况要好，那么有缺陷的自我评估可能会成为提高绩效的主要障碍。将手卫生概念化为学习的分类法，并引入反思和自我评估的认知策略，可以更好地帮助学生解决问题、寻找新信息、利用过去的经验，并对手卫生行为这一复杂主题有更深入和更全面的理解。
