Department of Postgraduate Research, Florence Nightingale School of Nursing and Midwifery, King's College London, Room 1.21a, James Clerk Maxwell Building, Waterloo Campus, 57 Waterloo Road, London SE1 8WA, United Kingdom.
Institute of Gerontology, Department of Social Science, Health & Medicine, King's College London, Strand, London WC2R 2LS, United Kingdom.
Int J Nurs Stud. 2014 Mar;51(3):400-8. doi: 10.1016/j.ijnurstu.2013.07.002. Epub 2013 Aug 1.
Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers' practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned "How can nurses' infection prevention behaviour be explained?" This paper presents one of three identified themes 'Rationalising dirt-related behaviour'.
This interpretative qualitative study uses vignettes, developed from nurses' accounts of practice, to explore nurses' reported infection prevention behaviours.
Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University.
Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method.
The 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 rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised 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.
This study contributes to the identification and explanation of nurses' infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted 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.
感染控制和预防医源性感染是全球范围内持续存在的问题。尽管已经采取了各种举措和策略来减轻这些感染带来的负担，但医护人员的实践仍然被认为是不理想的，这些感染仍然存在。迄今为止，大部分研究主要集中在预测感染预防行为和与指南依从性相关的因素上。虽然这提供了宝贵的见解，但从行为者自身的角度出发，旨在理解和解释日常实践中发生的行为的研究可能是解决行为改变挑战的关键。本研究提出了一个问题：“如何解释护士的感染预防行为？”本文介绍了三个已确定主题之一的“合理化与污垢相关的行为”。
这项解释性定性研究使用情景描述来探索护士报告的感染预防行为，这些情景描述是从护士的实践中提取的。
在伦敦大学兼职学习的急症医院工作的注册护士，已经有一年以上的工作经验。他们在学习期间被招募。
使用主题指南和情景描述进行了 20 次半结构化访谈。访谈记录被逐字转录，并使用框架方法进行分析。
研究结果表明，参与者渴望给人留下良好的印象，并表现出自己是知识渊博的从业者，尽管他们显然并不总是遵循程序和政策。他们对自己的行为进行合理化解释，并从逻辑上为任何偏离政策的行为辩护。对他人的偏离行为则被批评为不合理，并被解释为表面的、“作秀”的一部分。然而，参与者也表现出了自己的一面：一种受到保护自我和满足病人监督欲望的影响的展示或表演。
这项研究有助于识别和解释被认为是不适当或有害的护士感染预防行为。行为是多方面的、复杂的，源于对感染的科学理解之外的因素的反应，而不仅仅被理解为知识的缺失。这需要教育干预措施来考虑对污垢和感染的信念、价值观和社会理解。
