Schlegel-University of Waterloo Research Institute for Aging-RIA & School of Health & Life Sciences and Community Services, Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON, Canada.
Implement Sci. 2012 Aug 28;7:77. doi: 10.1186/1748-5908-7-77.
Careful hand hygiene (HH) is the single most important factor in preventing the transmission of infections to patients, but compliance is difficult to achieve and maintain. A lack of understanding of the processes involved in changing staff behaviour may contribute to the failure to achieve success. The purpose of this study was to identify nurses' and administrators' perceived barriers and facilitators to current HH practices and the implementation of a new electronic monitoring technology for HH.
Ten key informant interviews (three administrators and seven nurses) were conducted to explore barriers and facilitators related to HH and the impact of the new technology on outcomes. The semi structured interviews were based on the Theoretical Domains Framework by Michie et al. and conducted prior to intervention implementation. Data were explored using an inductive qualitative analysis approach. Data between administrators and nurses were compared.
In 9 of the 12 domains, nurses and administrators differed in their responses. Administrators believed that nurses have insufficient knowledge and skills to perform HH, whereas the nurses were confident they had the required knowledge and skills. Nurses focused on immediate consequences, whereas administrators highlighted long-term outcomes of the system. Nurses concentrated foremost on their personal safety and their families' safety as a source of motivation to perform HH, whereas administrators identified professional commitment, incentives, and goal setting. Administrators stated that the staff do not have the decision processes in place to judge whether HH is necessary or not. They also highlighted the positive aspects of teams as a social influence, whereas nurses were not interested in group conformity or being compared to others. Nurses described the importance of individual feedback and self-monitoring in order to increase their performance, whereas administrators reported different views.
This study highlights the benefits of using a structured approach based on psychological theory to inform an implementation plan for a behavior change intervention. This work is an essential step towards systematically identifying factors affecting nurses' behaviour associated with HH.
认真进行手部卫生（HH）是防止感染传播给患者的最重要因素，但依从性难以实现和维持。对改变员工行为所涉及的过程缺乏了解可能是未能取得成功的原因之一。本研究的目的是确定护士和管理人员对当前 HH 实践的感知障碍和促进因素，以及实施新的 HH 电子监测技术的障碍和促进因素。
进行了 10 次关键知情人访谈（3 名管理人员和 7 名护士），以探讨与 HH 相关的障碍和促进因素，以及新技术对结果的影响。半结构化访谈基于 Michie 等人的理论领域框架，并在干预实施之前进行。使用归纳定性分析方法探索数据。比较管理人员和护士的数据。
在 12 个领域中的 9 个领域，护士和管理人员的反应不同。管理人员认为护士进行 HH 的知识和技能不足，而护士则对自己具备所需的知识和技能充满信心。护士关注即时后果，而管理人员则强调系统的长期结果。护士主要将个人安全及其家人的安全作为进行 HH 的动机来源，而管理人员则确定了专业承诺、激励和目标设定。管理人员表示，员工没有适当的决策过程来判断 HH 是否必要。他们还强调了团队作为社会影响的积极方面，而护士则对团队一致性或与他人比较不感兴趣。护士描述了个人反馈和自我监测的重要性，以提高他们的绩效，而管理人员则报告了不同的观点。
本研究强调了使用基于心理理论的结构化方法为行为改变干预措施制定实施计划的好处。这项工作是系统地确定影响与 HH 相关的护士行为的因素的重要步骤。
