Determinants of hand hygiene compliance among nurses in US hospitals: A formative research study.

Hand hygiene is the simplest and most effective measure for preventing healthcare-associated infections. Despite the simplicity of this procedure and advances made in infection control, hospital health care workers' compliance to hand hygiene recommendations is generally low. Nurses have the most frequent patient care interactions, and thus more opportunities to practice hand hygiene. As such, it is important to identify and understand determinants of nurses' reported compliance. Formative research was undertaken to assess the potential impact of several unexamined factors that could influence HH among nurses: professional role and status, social affiliation, social norms, and physical modifications to the work environment (as well as institutional factors like safety climate). A survey questionnaire was developed primarily to inform the creation of a behaviour change intervention. The survey looked at how these factors influence HH among nurses and sought to identify barriers and levers to reported hand hygiene. It was administered to a survey panel of acute care nurses, working in US hospitals, with a year or more of experience. Multivariate regression modelling suggested that reported hand hygiene compliance was most likely to be a function of a hospital management's communication openness, perceived performance by peers, increased interactions with patients and other staff members, and the reduction in stress, busyness, and cognitive load associated with role performance. A powerful, effective intervention on HH among nurses therefore could be directed at improving communication openness, consider the impact of perceived performance by peers, increase interactions with patients and staff, and determine how to reduce the stress and cognitive load associated with role performance

Development of a behaviour change intervention using a theory-based approach, Behaviour Centred Design, to increase nurses' hand hygiene compliance in the US hospitals.

Background A behaviour change campaign is unlikely to be effective if its intervention is not carefully designed. While numerous frameworks are widely used to develop and evaluate interventions, the steps detailing how to create an intervention are not as clear because the process of linking behaviour analysis to the intervention design is seldom discussed. We document the application of the Behaviour Centred Design (BCD) approach to the development of an intervention to improve hand hygiene (HH) rates among nurses' hospital units in the USA. Methods Intervention development is divided into the first three steps of the BCD approach: Assess, Build, and Create. The Assess step centres on understanding the target behaviour. The Build step expands the knowledge of the target behaviour and population through formative research which leads to a creative brief that explains the focus of the intervention. In the Create step, the creative brief guides the intervention design. Results Drawing from the main findings of the Asses and Build steps, a focal insight was developed positing that nurses can rediscover the meaning and purpose of their role as a nurse and thus as a caregiver by practicing HH; in the process of cleaning their hands, nurses are living up to their ideal nurse-self. The focal insight was linked linguistically into a theory and change. The outcome was a simple intervention, called the Mainspring Intervention, which consisted of three major parts: a self-affirmation exercise to reduce defensiveness, a message that challenged nurses' perceptions about their HH practice, and an implementation intention activity to help nurses link HH behaviour to a cue. Conclusions We detailed the creation of an original HH intervention that used the BCD approach. The intervention is relatively simple compared to most HH initiatives in the literature, both in terms of having relatively few components to the intervention and relatively easy field implementation. This intervention will allow us to test how specific psychological processes contribute to the problem of low HH rates, how our proposed intervention changes these processes in the hospital setting, and how the expected change in nurses' cognition transforms over time because of the intervention

America's Skills Challenge: Millennials and the Future

Recent research reveals an apparent paradox for U.S. millennials (born after 1980, ages 16–34): while they may be on track to be our most educated generation ever, they consistently score below many of their international peers in literacy, numeracy and problem solving in technology-rich environments. Equally troubling is that these findings represent a decrease in literacy and numeracy skills when compared to results from previous years of U.S. adult surveys. As a country, simply providing more education may not be the answer. There needs to be a greater focus on skills -- not just educational attainment -- or we are likely to experience adverse consequences that could undermine the fabric of our democracy and community.This vital new report sheds light on the growing inequality of opportunity in the United States and the impact this has on both skills acquisition and outcomes for both current and future generations

Grande demais para falhar a Geração Millennial nas margens

Este trabalho é financiado por fundos nacionais através da FCT – Fundação para a Ciência e a Tecnologia, I.P., no âmbito do projeto UIDP/05198/2020 (Centro de Investigação e Inovação em Educação, inED). https://doi.org/10.54499/UIDP/05198/2020Em Grande demais para falhar: A Geração Millennial nas margens, as autoras abordam a questão de como as competências se encontram distribuídas no seio da Geração Millennial, concentrando-se na dimensão e características demográficas dos millennials dos Estados Unidos da América que apresentam baixas competências de literacia e numeracia, bem como no impacto nas relações sociais e resultados económicos dessas baixas competências. Fazem-no, em parte, examinando a questão dos “jovens desconectados”, um termo normalmente aplicado às pessoas com idades compreendidas entre os 16e os 24 anos que não estão empregadas nem envolvidas em educação ou formação formal. Desde a Grande Recessão de 2008, a investigação neste âmbito tem-se preocupado cada vez mais com estes “jovens desconectados”, que, de acordo com algumas estimativas, representam aproximadamente 6 milhões de jovens adultos nos EUA. O foco destas pesquisas tem incidido sobre o seu nível educacional e a participação no mercado de trabalho. Embora útil, esta abordagem é limitada, em dois sentidos. Em primeiro lugar, centra-se apenas nos adultos mais jovens, numa época em que a transição para a idade adulta é mais prolongada. Em segundo lugar, baseia-se na premissa de que o emprego e/ou mais educação são impulsionadores garantidos de entrada na classe média e de melhoria dos resultados de vida. As autoras questionam se esta suposição é apropriada às circunstâncias atuais e sugerem que olhar para os jovens adultos apenas em termos de ligações ao mercado de trabalho ou à educação formal pode subestimar a dimensão dos desafios que enfrentamos e distorcer a nossa compreensão das políticas necessárias para alterar o rumo atual.info:eu-repo/semantics/publishedVersio

The effect of behavioural interventions targeting hand hygiene practices among nurses in high-income hospital settings: a systematic review.

BACKGROUND: Hand hygiene is a critical behaviour for infection control but efforts to raise compliance among clinical professionals have been met with mixed success. The aim of this systematic review was to identify the effectiveness of the behaviour change techniques utilised in recent hand hygiene interventions that seek to improve hand hygiene compliance among nurses in hospitals in high-income countries. Nurses are at the frontline of healthcare delivery, and so improving their HH behaviour and thus increasing HHC rates will have a relatively large impact on reducing transmission and preventing healthcare acquired infections. METHODS: High-quality studies among nurses in high-income countries were surveyed from the scientific literature, following PRISMA guidelines, to identify which kinds of behaviour change mechanisms have been used to effectively increase hand hygiene compliance. Only seven studies met all inclusion criteria. A formal meta-analysis was not conducted due to the heterogeneity of the included studies. Instead, the review analysed studies in line with the Intervention Component Analysis approach to identify which differences in intervention characteristics appear to be important. Analysis proceeded in two steps: first, the Effective Practice and Organization of Care Data Extraction Checklist was used to identify the study design and to describe the intervention, target population, setting, results, outcome measures, and analytic approach. The second step involved inferring the behavioural change techniques used in the complex study interventions. Following coding, logic models were then inferred for each study to identify the Theory of Change behind each intervention. These Theories of Change were then examined for suggestions as to which BCTs were likely to have been responsible for any effectiveness observed. RESULTS: Goals and planning (to achieve specific ends), comparison of behaviour (to peers or some ideal) and feedback and monitoring (observing and providing feedback about behaviour or outcomes) were the most frequently used behaviour change technique groupings used across studies and within interventions. CONCLUSION: The complexity of the interventions used and lack of sufficient studies makes assignment of responsibility for behaviour change to specific behaviour change techniques difficult. Delivery channels and activities identified in the study Theories of Change were also highly individualized and so difficult to compare. However, we identified a temporal shift in types of techniques used in these recent studies on HH interventions, as compared with studies from prior to the review period. These newer interventions did not focus on providing access to alcohol-based hand rub or trying to solely encourage administrative support. Instead, they had nurses create goals and plan how to best facilitate HH, compared both individuals' and the group's behaviour to others, and focused on providing feedback

Impartial Institutions, Pathogen Stress and the Expanding Social Network

Anthropologists have documented substantial cross-society variation in people’s willingness to treat strangers with impartial, universal norms versus favoring members of their local community. Researchers have proposed several adaptive accounts for these differences. One variant of the pathogen stress hypothesis predicts that people will be more likely to favor local in-group members when they are under greater infectious disease threat. The material security hypothesis instead proposes that institutions that permit people to meet their basic needs through impartial interactions with strangers reinforce a tendency toward impartiality, whereas people lacking such institutions must rely on local community members to meet their basic needs. Some studies have examined these hypotheses using self-reported preferences, but not with behavioral measures. We conducted behavioral experiments in eight diverse societies that measure individuals’ willingness to favor in-group members by ignoring an impartial rule. Consistent with the material security hypothesis, members of societies enjoying better-quality government services and food security show a stronger preference for following an impartial rule over investing in their local in-group. Our data show no support for the pathogen stress hypothesis as applied to favoring in-groups and instead suggest that favoring in-group members more closely reflects a general adaptive fit with social institutions that have arisen in each society