The role of patient involvement in the promotion of hand hygiene among nurses in the hospital setting

Aim: To understand the role of patient involvement in the promotion of hand hygiene among nurses in the hospital setting. Methods: This qualitative PhD thesis is comprised of two studies; focus group discussions with nurses and interviews with patients. In the first study, focus group discussions (n = 7) were completed with nurses from Jordan and the UK (n=36) to explore nurses’ views and experiences with patient involvement in hand hygiene. Data from nurses were analysed using thematic analysis. In the second study, semi-structured telephone interviews were completed with patients from Jordan (n = 21) to understand their experiences of asking nurses to wash their hands. Data from patients were analysed by critical incident analysis resulting in the identification and analysis of 116 critical incidents. Results: The analysis of the focus group and critical incident discussions resulted in four overarching themes. Although both nurses and patients acknowledged the patients’ right to ask, both groups reported concerns that asking about hand hygiene could have an adverse impact on the nurse-patient relationship. Patients reported that the promotion of hand hygiene was not only offensive and upsetting for nurses, but also embarrassing for patients. Patients reported negative reactions from nurses when promoting handwashing, and these encounters became stressful and confrontational though both groups indicated that this could be mediated if the patient asked in the ‘right way’. It is not clear what the ‘right way’ might be. Discussion: Patients are likely to encounter confrontation if they prompt hand hygiene unless they do so in the ‘right way’. Patients seem to be discouraged from taking an active role in their care and this needs to be considered when planning patient involvement strategies. Conclusion: Findings from this study show that patients are expected to be passive, grateful and remain silent when observing noncompliance to hand hygiene practices among nurses. It could be that hospitals have not predicated the negative encounters or else they would not encourage patients to remind nurses to wash their hands. Therefore, more work needs to be done to ensure that patients can speak out and raise concerns without fearing the negative consequences when asking nurses to wash their hands. Nurses suggested a need for a new hospital culture of patient involvement in ensuring patient safety through the promotion of hand hygiene compliance

Use of focus group data from countries with linguistic differences: translation, analysis and presentation

Background: Focus group discussions for data collection in nursing research has increased. Data from focus groups provides rich in-depth understanding of a phenomenon, which can inform clinical practice. Guidance on facilitating focus groups has been developed, however there is a lack of guidance on techniques of translating, analysing and presenting focus group data from countries with linguistic differences Aim: To explore contemporary examples of translating, analysing and presenting focus group data from countries with linguistic differences and provide an in-depth example of the decision making process from one study with focus group data from two countries. Methods: A discussion paper to guide recommendations for focus group data analysis from countries with linguistic differences. Discussion: The experience from undertaking focus groups across two countries and contemporary nursing research has highlighted the need for a clear rationale and transparency in the reporting of translating, analysing and presentation of data. Detailed and transparent reporting needs to include not only the translation process, but when this occurred, either pre or post analysis, and when or if the data was amalgamated. Implications for research/practice: There is a clear need for evidence-based guidance on the reporting of translation, transcription and analysis of focus group data from countries with linguistic difficulties

The use of focus group data from countries with linguistic differences: A discussion of methodological and pragmatic issues

Background: Focus group discussions for data collection in nursing research has increased. Data from focus groups provides rich in-depth understanding of a phenomenon, which can inform clinical practice. Guidance on facilitating focus groups has been developed, however there is a lack of guidance on techniques of translating, analysing and presenting focus group data from countries with linguistic differences. Aim: To explore contemporary examples of translating, analysing and presenting focus group data from countries with linguistic differences and provide an in-depth example of the decision making process from one study with focus group data from two countries. Methods: A discussion paper to guide recommendations for focus group data analysis from countries with linguistic differences. Discussion: The experience from undertaking focus groups across two countries and contemporary nursing research has highlighted the need for a clear rationale and transparency in the reporting of translating, analysing and presentation of data. Detailed and transparent reporting needs to include not only the translation process, but when this occurred, either pre or post analysis, and when or if the data was amalgamated. Implications for research/practice: There is a clear need for evidence-based guidance on the reporting of translation, transcription and analysis of focus group data from countries with linguistic difficulties

The role of patient involvement in the promotion of hand hygiene among nurses in hospital settings: A qualitative study of nurses’ and patients’ experiences

Background: To date, there is a wealth of evidence that patients have been invited to take an active role in prompting handwashing of hospital staff, but there is insufficient evidence on what happens in practice and whether this is acceptable to both staff and patients. Objective: To understand the role of patient involvement in the promotion of hand hygiene among nurses in the hospital setting. Methods: This qualitative interpretive study comprised of focus group discussions conducted with nurses (n = 36) and interviews with patients (n = 21). Data from nurses were analysed using inductive thematic analysis. Data from patients were analysed by critical incident analysis. Results: Experiences from nurses and patients can be summarised into 4 themes (1) both nurses and patients acknowledged the patients’ right to ask, (2) both groups reported concerns that asking about hand hygiene could have an adverse impact on the nurse-patient relationship, (3) patients reported negative reactions from nurses when promoting handwashing, and (4) patients reported that the promotion of hand hygiene was not only offensive and upsetting for nurses, but also embarrassing for patients. Conclusions: Findings from this study suggest that patients are expected to adopt a passive role in infection control and remain silent when observing non-compliance to hand hygiene within the hospital setting, to avoid being embarrassed, offensive and upsetting to nurses