US Nurses' Perceptions Regarding Caring for Suspected, Probable, and Confirmed Ebola Virus Disease Patients, Part 1: A Quantitative Analysis.

OBJECTIVE: This study examined US hospital, ambulatory/outpatient facility, and clinic nurses' perceptions regarding care of persons under investigation (PUIs) and confirmed Ebola virus disease (EVD) patients and EVD nursing workforce impact. BACKGROUND: Timely research was warranted to better understand nurses' perceptions. METHODS: This survey research used convenience sampling of RNs, LPNs, and nurse technicians. Respondents completed a 45-item electronic validated survey. RESULTS: Overall average perceived risk with providing care was higher for confirmed EVD patients (5.2) than PUIs (4.8) (0 = no risk, 10 = highest risk). Few had cared for confirmed EVD patients (0.3%) or PUIs (0.7%). Whereas 48.4% felt prepared in protecting themselves from contracting EVD, 25.2% were concerned with contracting EVD. More nurses (45.9%) felt they should be able to opt out of caring for confirmed EVD patients as compared with those caring for PUIs (39.2%). EVD emergence had not affected (85.8%) nurses' willingness to provide direct patient care; however, 6.8% reported EVD has decreased years planned in the nursing workforce. CONCLUSIONS: Nurses reported moderate risk for EVD-related patient care; 6.8% may leave the workforce earlier.

Nurses' Perceptions on Ebola Care in the United States, Part 2: A Qualitative Analysis.

OBJECTIVE: This study examined qualitative comments from an online survey of nurses' perceptions regarding care of persons under investigation and patients with confirmed Ebola virus disease (EVD) in the United States. BACKGROUND: Additional insight into nurses' perceptions regarding EVD was warranted. METHODS: Survey design used convenience sampling of RNs, licensed practical nurses, and nurse technicians, who responded to 8 open-ended survey questions. RESULTS: Most respondents (618/966 [64.0%]) provided comments. The top 5 of the 13 primary themes were lack of preparedness/readiness; training, education, and improved communications needed; fear of EVD transmission; lack of personal protective equipment (PPE) and infection prevention; and nurses not treated professionally. CONCLUSIONS: Noting multiple concerns, most respondents reported that EVD care could be most safely provided when all parties involved are prepared and when nurses are educated and trained in evidence-driven practices with appropriate PPE and infection control procedures.

Pilot evaluation of isolation patients' perceptions on ability to identify types of health care workers when wearing isolation gowns.

In a survey research study, perceptions of 50 hospitalized patients on contact isolation were evaluated regarding their ability to identify health care worker (HCW) type in isolation gowns with no hospital badge under or on the gown, in isolation gowns with the hospital badge partially visible through the gown, and in isolation gowns with a preprinted large font Registered Nurse and Nursing Technician sticker badge on the outside of the gown. Patients ranked their ability to identify HCWs when entering their hospital room as important (average ranking, 8.0, where 0 was not at all important and 10 was very important); 28 patients (56%) specified all HCWs entering their hospital room should wear a preprinted large font sticker badge on the outside of their isolation gowns. Patients found little difficulty identifying HCW type with the large font preprinted sticker badge (average difficulty ranking, 1.0, where 0 is not at all difficult and 10 is very difficult), a simplistic method to improve HCW type identification.

Knowledge, perceptions, and practices of methicillin-resistant Staphylococcus aureus transmission prevention among health care workers in acute-care settings.

BACKGROUND: Health care workers (HCWs) play a critical role in prevention of health care-associated infections such as methicillin-resistant Staphylococcus aureus (MRSA), but glove and gown contact precautions and hand hygiene may not be consistently used with vulnerable patients. METHODS: A cross-sectional survey of MRSA knowledge, attitudes/perceptions, and practices among 276 medical, nursing, allied health, and support services staff at an acute-care hospital in the eastern United States was completed in 2012. Additionally, blinded observations of hand hygiene behaviors of 104 HCWs were conducted. RESULTS: HCWs strongly agreed that preventive behaviors reduce the spread of MRSA. The vast majority reported that they almost always engage in preventive practices, but observations of hand hygiene found lower rates of adherence among nearly all HCW groups. HCWs who reported greater comfort with telling others to take action to prevent MRSA transmission were significantly more likely to self-report adherence to recommended practices. CONCLUSIONS: It is important to reduce barriers to adherence with preventive behaviors and to help all HCWs, including support staff who do not have direct patient care responsibilities, to translate knowledge about MRSA transmission prevention methods into consistent adherence of themselves and their coworkers to prevention guidelines.

Preventing transmission of MRSA: a qualitative study of health care workers' attitudes and suggestions.

BACKGROUND: Health care workers' (HCWs) perceptions and attitudes affect implementation of precautions to prevent transmission of drug-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). Identification of challenges and barriers to recommended practices is a critical component of promoting a safe clinical environment of care. METHODS: Semistructured interviews addressed how MRSA affects HCWs, prevention of transmission, and challenges and barriers HCWs experience when entering a MRSA isolation room and performing appropriate hand hygiene. RESULTS: The purposive sample of 26 acute care HCWs (16 registered nurses; 1 physician; 6 allied health professionals; and 3 support staff) self-selected from 276 responding to a questionnaire on MRSA. Analysis identified 18 themes across seven categories. Most participants reported feeling responsible for preventing transmission, and having the knowledge and desire to do so. However, many also reported challenges to following consistent hand hygiene and use of contact precautions. Barriers included patient care demands, equipment and environmental issues such as availability of sinks, time pressures, the practices of other HCWs, and the need for additional signs indicating which patients require contact precautions. CONCLUSIONS: The HCWs reported a need for improved clarity of isolation protocols throughout patients' hospital journey, additional rooms and staff for isolation patients, improved education and communication (including timely and appropriate signage), and an emphasis on involving all HCWs in reducing contamination.