Improving children's and their visitors' hand hygiene compliance.

BACKGROUND: Numerous interventions have tried to improve healthcare workers' hand hygiene compliance. However, little attention has been paid to children's and their visitors' compliance. AIM: To test whether interactive educational interventions increase children's and visitors' compliance with hand hygiene. METHODS: This was a cluster randomised study of hand hygiene compliance before and after the introduction of educational interventions. Observations were compared for different moments of hygiene and times of the day. Qualitative data in the form of questionnaire-based structured interviews were obtained. FINDINGS: Hand hygiene compliance increased by 24.4% (P < 0.001) following the educational interventions, with children's compliance reaching 40.8% and visitors' being 50.8%. Compliance varied depending on which of the five moments of hygiene was observed (P < 0.001), with the highest compliance being 'after body fluid exposure' (72.7%). Responses from questionnaires showed educational interventions raised awareness of the importance of hand hygiene (69%, 57%) compared to those who had not experienced the educational intervention (50%). CONCLUSION: Educational interventions may result in a significant increase in children's and visitors' hand hygiene (P < 0.001).

An observational study of hand hygiene adherence following the introduction of an education intervention.

Hand hygiene adherence needs to be increased and sustained in order to prevent and reduce healthcare associated infections. We implemented an educational intervention and observed the adherence of healthcare workers, patients and visitors over 24 hour periods at four observation points. For healthcare workers a total of 2,294 opportunities were observed and for patients and visitors, a total of 597 opportunities were observed. Healthcare worker adherence increased following the introduction of the educational intervention, with 53.0% (282/532) adherence at baseline (observation point 1), and was sustained varying between 67.7% and 70.8% in the post-intervention points (p=0.0007). The greatest increase in adherence was observed between baseline and the observation point 2. Adherence varied according to type of opportunity (p<0.0001) with the lowest level of adherence observed after contact with patient surroundings, however there was no obvious trend across the observation points. There was an interaction between point of study and ward (p=0.0001). For patients and visitors, adherence did differ according to the point of study (p=0.0074) with adherence prior to the intervention being 49.1% and then ranging from 43.5-61.8%. We suggest that future educational interventions should be implemented as this study implies that there is potential for increased and sustained adherence to hand hygiene protocols.

An observational study of hand hygiene compliance in paediatric wards.

AIMS AND OBJECTIVES: To measure healthcare workers', children's and visitors' hand hygiene compliance in a paediatric oncology ward and a paediatric respiratory ward in an English hospital. BACKGROUND: Children are especially vulnerable to healthcare-associated infections, yet few studies have reported on hand hygiene compliance in paediatric clinical areas. DESIGN: This was an observational study. METHOD: We measured hand hygiene compliance over an eight-hour period in two hospital wards using the 'five moments of hand hygiene' observation tool. We monitored a total of 407 hand hygiene opportunities. RESULTS: Overall opportunities for compliance were 74% for healthcare workers (n = 315) and children and visitors 23% (n = 92). Compliance was 84% for allied health professionals, 81% for doctors, 75% for nurses and 73% for ancillary and other staff. Hand hygiene compliance varied depending on which of the five moments of hygiene healthcare workers were undertaking (p < 0·001), with compliance before child contact 90% (140/155); after child contact 78% (89/114); after body fluid exposure 75% (3/4); and after surroundings contact 36% (15/42). For healthcare workers and visitors, there was no evidence of an association between time of day and their hand hygiene compliance, and for visitors to the oncology ward, hand hygiene compliance was higher (p < 0·05). CONCLUSION: Owing to the nature of the clinical environments, we are unable to draw conclusions about children's hand hygiene compliance; however, visitors' compliance was low. Among healthcare workers, levels of compliance were higher compared with previous reported estimates. RELEVANCE TO CLINICAL PRACTICE: Visitors had the lowest level of compliance yet owing to the nature of the clinical environments, nearly a quarter of care is delivered by them rather than healthcare workers, and so, this offers opportunities for specific future interventions aimed at families and carers.

Workplace bullying in the NHS.

Bullying is a sensitive issue which is no longer confined to the school playground; adults are increasingly aware that workplace bullying is on the rise. Healthcare workers as well as patients are affected by bullying which can result in anxiety, dismay and powerlessness. The impact of workplace bullying on patient care is identified in this article as this is an under-researched area. The influence of the environment on workplace bullying is also considered. The NHS, like any other organisation, is characterised by circumstances that make bullying and harassment likely. Healthcare workers can minimise these and strategies are offered in this paper to make the workplace environment more positive from both an individual and an organisational perspective.

Infection control nurses' perceptions of the Code of Hygiene.

AIM: The aim of the study was to understand senior infection prevention and control nurses' experiences and perceptions of implementing the day to day aspects of the Code of Hygiene. BACKGROUND: The Code of Hygiene is legislative and sets out compliance standards in order to reduce infection rates. It details standards by which health-care providers failing to comply with infection control standards can be subject to improvement notices and actions. METHODS: Senior nurses from five infection prevention and control teams in England participated in taped, qualitative interviews which were analysed. FINDINGS: Two themes emerged from the data: 'Interventions' and 'Barriers to compliance'. Interventions were driven by senior NHS managers and necessitated organizational change. It was senior NHS managers who were considered as being the force for change and who intervened and took responsibility for implementation. Change was achieved by a top-down approach and was driven by senior managers' fear of external censure. At the same time, participants felt they had more authority as a consequence of these changes as they too, felt they could enforce change. Barriers to compliance were identified as: a lack of facilities, specifically a lack of side rooms and isolation facilities, and the non-engagement of medical staff. IMPLICATION FOR NURSING MANAGEMENT: Compliance was achieved by organizational change and senior managerial intervention. Barriers to compliance must be addressed to meet the Code of Hygiene's compliance criteria.

Hand hygiene practices: nursing students' perceptions.

AIMS AND OBJECTIVES: The present study examines nursing students' perceptions of hand hygiene practices in clinical settings. The objectives were to investigate any factors that affect students' perceptions of their own and healthcare workers' (HCWs) hand hygiene compliance, and to make recommendations for future practice and hand hygiene training in preregistration nursing courses. BACKGROUND: Effective hand hygiene decontamination can lower the prevalence of healthcare-associated infections (HCAIs); unfortunately, the prevalence of HCAIs continues to rise and so poses challenges to healthcare providers to reduce such infections. Previous studies have shown that hand hygiene compliance in HCWs is generally low and that any increase in compliance is difficult to sustain. Several barriers to hand hygiene compliance have been identified in the literature. DESIGN: A qualitative interpretive design was used to examine nursing students' perceptions of hand hygiene practices. METHODS: Ten preregistration students participated in semi-structured qualitative interviews, which were analysed thematically. RESULTS: Hand hygiene compliance was perceived to be effected by specific barriers which included: time and busyness; clinical procedure; skin condition; lack of knowledge and glove use. Importantly, students perceived other HCWs as being the influencing factor for hand hygiene compliance resulting from the perception that they should 'fit in' with those working in the clinical area. CONCLUSIONS: The findings support previous literature and found that respondents emphasised the importance of fitting into the clinical area and role models in shaping hand hygiene compliance. RELEVANCE TO CLINICAL PRACTICE: For nursing students, the influence of other HCWs as role models should not be underestimated.

The professional self-concept of nurses: a review of the literature from 1992-2006.

OBJECTIVE: This paper will discuss some recent concerns about research in the area of the professional self-concept of nurses, and trace the development of the literature on professional self-concept of nurses over the last 14 years. PRIMARY ARGUMENT: Professional self-concept or how nurses feel about themselves as nurses is vital in examining current and future nursing practice and education, as it affects patient care. CONCLUSION: The essence of the paper is the identification of three streams of literature: (1) which has 'emerged from the development of the Professional Self-Concept of Nurses instrument'; (2) literature which fails to consider recent or current research in the area; and (3) 'well-conducted work in the topic area'. The implications for nurses, educators and students are presented.

How knowledgeable are nurses about C. difficile?

Jacqueline Randle and colleagues report the results of their small-scale study of infection control link professionals' knowledge about Clostridium difficile and how they use this knowledge in practice.

Reducing workplace bullying in healthcare organisations.

Workplace bullying in the NHS is an important issue that is growing in significance as it becomes clear that bullying is not just a personal matter but also an organisational one. It may be that healthcare organisations, such as the NHS, foster or sustain workplace bullying. This article provides an overview of the key issues in workplace bullying and suggests individual, team and organisational solutions to reduce its incidence.

The risk of infection from toys in the intensive care setting.

The risk of cross-transmission of infection for patients in intensive care is substantial. The increasing use of new technologies and invasive procedures increases the risk of acquiring a healthcare-associated infection. The routine and effective disinfection of toys, unlike other equipment, is often overlooked and research into toys as a potential source of infection is sparse. A small-scale study measured the prevalence of micro-organisms on toys in the intensive care setting. It was conducted in a paediatric intensive care unit (ICU) at a large teaching hospital but the results will have resonance with adult ICUs. The study involved swabbing toys that had been brought in by families and those that were provided by the hospital. Recommendations for future practice are identified to ensure that toys can still be made available in hospital and are safe in relation to the transmission of infection.

Toys--friend or foe? A study of infection risk in a paediatric intensive care unit.

Toys are an established part of the hospital experience for the child and family. They are seen as a source of comfort and security and form part of the child-friendly environment. However, they can also act as a source of healthcare associated infection which can be harmful to children, especially those who are in intensive care environments. This small-scale study was conducted in a paediatric intensive care unit at a large teaching hospital and involved swabbing those toys that had been brought in by families and those that were provided by the hospital. Findings show that 85 per cent of the toys harboured viable bacteria, which could be damaging to the child's health. Recommendations for practice are identified to ensure that toys remain a component of the child's hospitalisation yet are safe in relation to the transmission of infections not just in PICU but in all paediatric settings.

Alzheimer's disease and the psychosocial burden for caregivers.

The majority of patients with Alzheimer's disease are cared for by their families at home. Caring for someone with Alzheimer's disease is commonly portrayed in terms of 'problematic' behaviour. This study explored the level of understanding carers have of the illness and the psychosocial impacts carers experience. Qualitative interviews were conducted with eight carers who had been looking after their relatives in community settings. Findings suggest that the carers in this study had a distinct lack of knowledge regarding Alzheimer's disease and its management. A number of psychosocial consequences of caring were identified, including: isolation; feelings of guilt; uncertainty regarding lack of knowledge; and loneliness. Carers failed to utilise available services appropriately, and thus gained little benefit from their presence. Carers perceived their experiences as 'problematic' and they suffered negative psychosocial effects due to their caring experiences. The findings suggest that carers require more information and explanation of their experiences. This would help them in their ability to cope with their spouses.

Inter-group conflict in health care: UK students' experiences of bullying and the need for organisational solutions.

This paper addresses bullying of United Kingdom (UK) nursing students whilst on work placement as a specific issue of inter-group difficulty that currently affects nurses and students working in the UK National Health Service. The authors begin by discussing the concept of bullying and sharing the types of bullying reported in two recent studies involving UK nursing students. Both studies illustrate the effects that negative workplace experiences can have on new entrants to the profession. After reviewing various individual solutions which have been recommended for reducing bullying, they suggest that the most effective solution is for health care organisations offering placement training to become much more proactive in creating a culture that will not tolerate bullying behaviour by staff at any level. The literature suggests bullying is a phenomenon affecting workplaces in many countries. Thus the issues described in this article, and the solutions offered have relevance to a variety of health care settings.

Living with a stoma: a review of the literature.

AIMS AND OBJECTIVES: This systematic review looks at the psychological and social impact of stoma surgery on peoples' lives. BACKGROUND: The formation of a stoma can have a negative effect on a person's quality of life and affect lifestyle in a number of ways. METHODS: The review examines nursing literature from 1990 to date and focuses on how stoma patients' lives are affected by the presence of a stoma. It informs nursing practice so nurses are better able to help individuals improve, maintain or recover their health following ostomy surgery. RESULTS: The findings of the review indicate that stoma surgery can impact on individuals' lives in many different ways. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the problems stoma patients can experience can help nurses plan care in an individualized way. Recommendations for nursing practice and future research are made.

Strengthening workforce relationships: developing practice learning.

A joint partnership between a University and its local hospitals developed and implemented Practice Learning Teams (PLTs) to enhance student nurse learning experiences. In order to achieve this, PLTs arrived at clear aims and purposes, with educators and nurses working collaboratively and being jointly responsible for the quality of students' placement experience. This study occurred after a year of implementation, and a range of stakeholders were interviewed in order to evaluate perceived effectiveness. Findings of this report suggest the majority of respondents thought PLTs should be retained, recognising that they were new, and thus required development. There was a clear difference between effective and ineffective PLTs. Effective teams were considered to support the students' practice-based learning and mentors, while providing a forum for sharing 'good practice', discussion and problem solving. Less effective teams were characterised by having a low attendance or a membership that lacked enthusiasm and/or willingness to participate.

Breaking sexuality taboos.

Sexuality and relationships are an integral component of personhood, regardless of whether people have special needs or not. This paper reports findings from a qualitative study exploring pre-registration nursing students' knowledge and attitudes towards the sexuality of children with special needs. Interview data were analysed thematically. Although participants felt confident about defining sexuality, the application of addressing sexuality was hampered in practice. Specific issues identified by students were those of consent, parental choices and potential for the abuse of children. It was also felt that more education and training was required for nurses to effectively begin to address sexuality in this client group.

Bullying in the nursing profession.

BACKGROUND: Self-esteem is a major predictor of behaviour. Nurses with healthy self-esteem are likely to deliver therapeutic patient care, while those with low self-esteem are less likely to do so. AIM: The aim of the 3-year study discussed here was to explore students' self-esteem and how their experiences of preregistration education influenced its development over the period of the programme. RESEARCH METHODS: Students participated in unstructured qualitative interviews at the beginning and end of their 3-year preregistration course and a grounded theory approach was used for data collection and analysis. FINDINGS: Bullying was found to be commonplace in the transition to becoming a nurse. Students were bullied and also witnessed patients being bullied by qualified nurses. The internalization of nursing norms meant that students then bullied others. Students' self-esteem was low. CONCLUSION: Bullying, and its effects on self-esteem, are perpetuated by practices within nursing. This situation will only be changed if nurses and educators transform their practice and the context in which bullying occurs. Otherwise, each new generation of nurses will continue to be socialized into negative practices which undermine both their own feelings of self-worth and standards of nursing care.

Changes in self-esteem during a 3-year pre-registration Diploma in Higher Education (Nursing) programme.

Nurses' self-esteem affects patient care. This study measured self-esteem of pre-registration nursing students over their 3-year training programme. Quantitative data were measured by the Professional Self-Concept Nursing Inventory and the Tennessee Self-Concept Scale. Students's self-esteem decreased during their training programme. Results indicate a need to address the damaging effects of the process of becoming a nurse.

Communication skills training in healthcare: a review of the literature.

This article is based on a literature review carried out as part of a study of communication skills teaching in pre-registration nurse education in England in 2000. The rationale for the study was two-fold: the history of patient dissatisfaction with communications and information-giving in the National Health Service and concern about skills deficits in alumnae of recent educational programmes. A lack of research evaluating communications skills training was found in relation to both pre- and post-registration nursing education, and in other healthcare disciplines. Furthermore, the research that has been done is limited by methodological deficiencies in many cases. Recommendations are made concerning improved methods for future research evaluating communication skills training.