Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101 (114), 6500 HB, Nijmegen, the Netherlands.
Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, PO box 9101 (149), 6500 HB, Nijmegen, the Netherlands.
Int J Nurs Stud. 2022 Jan;125:104130. doi: 10.1016/j.ijnurstu.2021.104130. Epub 2021 Nov 6.
Home-based nursing care continues to expand, delivering care to increasingly older clients with multiple, chronic and complex conditions that require the use of additional and more numerous invasive medical devices. Therefore, the prevention of infections poses a challenge for nurses, professional caregivers and clients.
This article explores infection prevention practices and related behavioural factors in both nurses and clients to identify barriers and facilitators of infection prevention practices in home-based nursing care.
A qualitative, exploratory design.
Four healthcare organisations providing home-based nursing care in the Netherlands.
Participant observations were used as the main source of data collection complemented with focus group discussions and semi-structured interviews.
Participant observations: 16 nurses, three professional caregivers and 80 clients. Semi-structured interviews: 11 clients. Focus group discussions: 15 nurses and four professional caregivers.
A total of 87 unique care delivery situations were observed for 55 h, complemented with three focus group discussions and 11 individual semi-structured client interviews. Infection prevention practices in home-based nursing care appeared to be challenged by 1. The specific context or environment in which the care occurred, which is more autonomous, less structured, less controlled and less predictable than other care settings; 2. Suboptimal and considerable variation in professional performance concerning the application of hand hygiene and the proper use of personal protective equipment such as face masks, barrier gowns and disposable gloves; 3. Extensive use in and outside the client's surroundings of communication devices that are irregularly cleaned and tend to interrupt nursing procedures; and 4. Inadequate organisational support in the implementation and evaluation of new information or policy changes and fragmentation, variation and conflicting information regarding professional guidelines and protocols.
From a first-hand observational viewpoint, this study showed that the daily practice of infection prevention in home-based nursing care appears to be suboptimal. Furthermore, this research revealed considerable variation in the work environment, the application of hand hygiene, the proper use of personal protective equipment, the handling of communication devices and organisational policies, procedures and support. Finally, the study identified a number of important barriers and facilitators of infection prevention practices in the work environment, professional and team performance, clients and organisations.
家庭护理服务不断扩大，为越来越多患有多种慢性和复杂疾病的老年客户提供服务，这些客户需要使用更多和更复杂的侵入性医疗设备。因此，预防感染对护士、专业护理人员和客户来说都是一项挑战。
本文探讨了护士和客户在感染预防实践中的行为因素，以确定家庭护理中感染预防实践的障碍和促进因素。
定性、探索性设计。
荷兰四家提供家庭护理服务的医疗机构。
参与者观察是主要的数据收集来源，辅以焦点小组讨论和半结构化访谈。
参与者观察：16 名护士、3 名专业护理人员和 80 名客户。半结构化访谈：11 名客户。焦点小组讨论：15 名护士和 4 名专业护理人员。
共观察了 87 个独特的护理提供情况，持续了 55 小时，此外还进行了三次焦点小组讨论和 11 次单独的半结构化客户访谈。家庭护理中的感染预防实践似乎受到以下因素的挑战：1. 护理发生的特定环境或背景，其比其他护理环境更加自主、结构不完整、控制和预测性差；2. 专业人员在执行手部卫生和正确使用个人防护设备（如口罩、隔离衣和一次性手套）方面表现不佳，且存在较大差异；3. 在客户环境内外广泛使用通信设备，这些设备的清洁不规律，且往往会中断护理程序；4. 在实施和评估新信息或政策变化方面，组织支持不足，且专业准则和协议方面存在碎片化、变化和冲突信息。
从第一手观察的角度来看，本研究表明家庭护理中的感染预防日常实践似乎并不理想。此外，本研究还发现工作环境、手部卫生的应用、个人防护设备的正确使用、通信设备的处理以及组织政策、程序和支持方面存在相当大的差异。最后，研究确定了工作环境、专业和团队绩效、客户和组织中感染预防实践的一些重要障碍和促进因素。
