School of Nursing and Midwifery, Nairobi, Kenya.
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Int Nurs Rev. 2015 Sep;62(3):404-11. doi: 10.1111/inr.12188. Epub 2015 Apr 28.
This study examined the effects of healthcare-associated infectious disease outbreaks on nurses' work in a large acute care hospital in Ontario, Canada.
The incidence of healthcare-associated infections has increased. Previous research focuses on epidemiology, healthcare systems, and the economic burden of outbreaks. Few published studies focus on the impact of outbreaks on nurses' work in acute care facilities.
Since the severe acute respiratory syndrome epidemic in 2003, combating infectious diseases has become a key issue. Hospitals have implemented measures related to healthcare-associated infections. However, nurses experience challenges in preventing, controlling, and contending with outbreaks.
A retrospective exploratory case study approach was used. Data were collected over a 4-month period in 2012. The incidence rates of site-specific HAIs were analysed, and individual interviews were held with 23 bedside nurses and five nurse managers.
Five themes emerged from the interviews: comparison of healthcare-associated infections outbreaks; the nature of nurses' work; impact of outbreaks on patient care; innovation and quality control in clinical practice; and increased and expanded IPAC measures. The incidence rates of methicillin-resistant Staphylococcus aureus, Clostridium difficile and vancomycin-resistant enterococci at the study site decreased, but remained above provincial benchmarks. Nurses experienced workload challenges, time pressures and psychological effects stemming from outbreaks and developed various innovations in response. Patient care was also affected.
Nurses' work has been impacted by healthcare-associated infectious disease outbreaks. Nursing workloads should be quantified to facilitate the development of guidelines for optimum nurse-patient ratio during outbreaks.
IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: A strong evidence-based policy framework is required to address healthcare-associated infectious disease outbreaks. Infection prevention and control guidelines and procedures should be established provincially and nationally. An interdisciplinary approach is essential for the creation of comprehensive and innovative strategies. Nursing research has increased understanding of the implications of infectious diseases in hospitals. Building on the literature, findings from this study can be used to influence policies on the care of patients who have secondary infections. Nurse-driven protocols are important and can lead to the creation of best practice guidelines that can be implemented across settings.
本研究旨在考察加拿大安大略省一家大型急症护理医院中与医疗保健相关的传染病暴发对护士工作的影响。
与医疗保健相关的感染发生率有所增加。先前的研究侧重于传染病的流行病学、医疗保健系统以及暴发的经济负担。很少有已发表的研究关注暴发对急症护理机构护士工作的影响。
自 2003 年严重急性呼吸综合征流行以来，防治传染病已成为一个关键问题。医院已采取与与医疗保健相关的感染有关的措施。然而，护士在预防、控制和应对暴发方面面临挑战。
采用回顾性探索性病例研究方法。于 2012 年 4 个月期间收集数据。分析了特定部位医院获得性感染的发病率，并对 23 名床边护士和 5 名护士长进行了个人访谈。
访谈中出现了五个主题：与医疗保健相关的传染病暴发的比较；护士工作的性质；暴发对患者护理的影响；临床实践中的创新和质量控制；以及增加和扩大感染预防与控制措施。研究地点耐甲氧西林金黄色葡萄球菌、艰难梭菌和万古霉素耐药肠球菌的发病率有所下降，但仍高于省级基准。护士因暴发而面临工作量挑战、时间压力和心理影响，并做出了各种创新应对。患者护理也受到了影响。
与医疗保健相关的传染病暴发影响了护士的工作。应量化护理工作量，以便为暴发期间最佳护士与患者比例制定指南。
对护理和/或卫生政策的意义：需要建立一个强有力的循证政策框架来应对与医疗保健相关的传染病暴发。应在省和国家一级制定感染预防与控制准则和程序。跨学科方法对于制定全面和创新的策略至关重要。护理研究增加了对医院传染病影响的理解。在此基础上，本研究的结果可用于影响针对继发感染患者的护理政策。以护士为主导的方案很重要，并可导致创建可在不同环境中实施的最佳实践指南。
