Medical interns' reflections on their training in use of personal protective equipment.

BACKGROUND:The current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore medical graduates' experiences of the use of PPE and identify opportunities for improvement in education and training programmes, to improve occupational and patient safety. METHODS:This study was undertaken in 2018 in a large tertiary-care teaching hospital in Sydney, Australia, to explore medical interns' self-reported experiences of PPE use, at the beginning of their internship. Reflexive groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour. RESULTS:80% of 90 eligible graduates participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use. CONCLUSIONS:Undergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices

Selective self-categorization: Meaningful categorization and the in-group persuasion effect

Research stemming from self-categorization theory (Turner et al., 1987) has demonstrated that individuals are typically more persuaded by messages from their in-group than by messages from the out-group. The present research investigated the role of issue relevance in moderating these effects. In particular, it was predicted that in-groups would only be more persuasive when the dimension on which group membership was defined was meaningful or relevant to the attitude issue. In two studies, participants were presented with persuasive arguments from either an in-group source or an out-group source, where the basis of the in-group/out-group distinction was either relevant or irrelevant to the attitude issue. Participants' attitudes toward the issue were then measured. The results supported the predictions: Participants were more persuaded by in-group sources than out-group sources when the basis for defining the group was relevant to the attitude issue. However, when the defining characteristic of the group was irrelevant to the attitude issue, participants were equally persuaded by in-group and out-group sources. These results support the hypothesis that the fit between group membership and domain is an important moderator of self-categorization effects

To follow a rule? On frontline clinicians’ understandings and embodiments of hospital-acquired infection prevention and control rules.

This article reports on a study of clinicians’ responses to footage of their enactments of infection prevention and control. The study’s approach was to elicit clinicians’ reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation, and in situ application of those rules. The findings of the study are that clinicians responded to footage of their own IPC practices by articulating previously unheeded tensions and constraints including: infection control rules that were incomplete, undergoing change, and conflicting; material obstructions limiting infection control efforts; and habituated and divergent rule enactments and rule interpretations that were problematic but disregarded. The reflexive process is shown to elicit clinicians’ learning about these complexities as they affect the accomplishment of effective infection control. The process is further shown to strengthen clinicians’ appreciation of infection control as necessitating deliberation to decide what are locally appropriate standards, interpretations, assumptions, habituations and enactments of infection control. The article concludes that clinicians’ ‘practical wisdom’ is unlikely to reach its full potential without video-assisted scrutiny of and deliberation about in situ clinical work. This enables clinicians to anchor their in situ enactments, reasonings and interpretations to local agreements about the intent, applicability, limits and practical enactment of rules. Key words: video-reflexivity, rules, infection control, patient safety, embodied practice, practical wisdom, abductio

An innovative approach to strengthening health professionals’ infection control and limiting hospital-acquired infection: video-reflexive ethnography

Objective To strengthen clinicians’ infection control awareness and risk realisation by engaging them in scrutinising footage of their own infection control practices and enabling them to articulate challenges and design improvements. Design and participants Clinicians and patients from selected wards of 2 hospitals in western Sydney. Main outcome measures Evidence of risk realisation and new insights into infection control as articulated during video-reflexive feedback meetings. Results Frontline clinicians identified previously unrecognised infection risks in their own practices and in their team's practices. They also formulated safer ways of dealing with, for example, charts and patient transfers. Conclusions Video-reflexive ethnography enables frontline clinicians to identify infection risks and to design locally tailored solutions for existing risks and emerging ones

Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination in hospital wards

Background Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. Methods We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. Results We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving ‘from clean to dirty’ when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Conclusions Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.Funding source NHMRC APP100917

'Like building a plane and flying it all in one go': an interview study of infection prevention and control in Australian general practice during the first 2 years of the SARS-CoV-2 pandemic.

OBJECTIVES: General practitioners (GPs) and their staff have been at the frontline of the SARS-CoV-2 pandemic in Australia. However, their experiences of responding to and managing the risks of viral transmission within their facilities are poorly described. The aim of this study was to describe the experiences, and infection prevention and control (IPC) strategies adopted by general practices, including enablers of and challenges to implementation, to contribute to our understanding of the pandemic response in this critical sector. DESIGN: Semistructured interviews were conducted in person, by telephone or online video conferencing software, between November 2020 and August 2021. PARTICIPANTS: Twenty general practice personnel working in New South Wales, Australia, including nine GPs, one general practice registrar, four registered nurses, one nurse practitioner, two practice managers and two receptionists. RESULTS: Participants described implementing wide-ranging repertoires of IPC strategies-including telehealth, screening of patients and staff, altered clinic layouts and portable outdoor shelters, in addition to appropriate use of personal protective equipment (PPE)-to manage the demands of the SARS-CoV-2 pandemic. Strategies were proactive, influenced by the varied contexts of different practices and the needs and preferences of individual GPs as well as responsive to local, state and national requirements, which changed frequently as the pandemic evolved. CONCLUSIONS: Using the 'hierarchy of controls' as a framework for analysis, we found that the different strategies adopted in general practice often functioned in concert with one another. Most strategies, particularly administrative and PPE controls, were subjected to human variability and so were less reliable from a human factors perspective. However, our findings highlight the creativity, resilience and resourcefulness of general practice staff in developing, implementing and adapting their IPC strategies amidst constantly changing pandemic conditions

Should I stay or should I go? Patient understandings of and responses to source-isolation practices,

Isolation of patients, who are colonised or infected with a multidrug-resistant organism (source-isolation), is a common practice in most acute health-care settings, to prevent transmission to other patients. Efforts to improve the efficacy of source-isolation in hospitals focus on healthcare staff compliance with isolation precautions. In this article we examine patients’ awareness, understandings and observance of source-isolation practices and directives with a view to understanding better the roles patients play or could play in transmitting, or limiting transmission, of multidrug-resistant organisms (MRO). Seventeen source-isolated adult surgical patients and two relatives participated in video-reflexive ethnography and interviews. We learned that, although most of these patients wanted to protect themselves and others from colonisation/infection with a MRO, they had a limited understanding of what precautions they could take while in isolation and found it difficult to obtain ongoing information. Thus, many patients regularly left their source-isolation rooms without taking appropriate precautions and were potentially contributing to environmental contamination and transmission. Some patients also interacted with other patients and their personal belongings in ways that exposed other patients, unnecessarily, to colonisation/infection risk. By not providing patients with adequate information on infection risk or how they could contribute to their own safety or that of others, they are denied the opportunity to fully engage in their healthcare. To improve the efficacy of source-isolation and contact precautions in general, patient care providers should consider colonised or infected patients as active partners in reducing transmission and involve patients and relatives in regular, ongoing conversations about transmission prevention.Keywords: Patient involvement, patient experience, patient engagement, patient- and family-centred care, source-isolation, MRSA, infection prevention and control, qualitative methods, health literacyThis study was funded by the National Health and Medical Research Council (project grant # 1009178

A functional-cognitive framework for attitude research

In attitude research, behaviours are often used as proxies for attitudes and attitudinal processes. This practice is problematic because it conflates the behaviours that need to be explained (explanandum) with the mental constructs that are used to explain these behaviours (explanans). In the current chapter we propose a meta-theoretical framework that resolves this problem by distinguishing between two levels of analysis. According to the proposed framework, attitude research can be conceptualised as the scientific study of evaluation. Evaluation is defined not in terms of mental constructs but in terms of elements in the environment, more specifically, as the effect of stimuli on evaluative responses. From this perspective, attitude research provides answers to two questions: (1) Which elements in the environment moderate evaluation? (2) What mental processes and representations mediate evaluation? Research on the first question provides explanations of evaluative responses in terms of elements in the environment (functional level of analysis); research on the second question offers explanations of evaluation in terms of mental processes and representations (cognitive level of analysis). These two levels of analysis are mutually supportive, in that better explanations at one level lead to better explanations at the other level. However, their mutually supportive relation requires a clear distinction between the concepts of their explanans and explanandum, which are conflated if behaviours are treated as proxies for mental constructs. The value of this functional-cognitive framework is illustrated by applying it to four central questions of attitude research

Accessible Content and Accessibility Experiences: The Interplay of Declarative and Experiential Information in Judgment

Recall tasks render 2 distinct sources of information available: the recalled content and the experienced ease or difficulty with which it can be brought to mind. Because retrieving many pieces of information is more difficult than retrieving only a few, reliance on accessible content and subjective accessibility experiences leads to opposite judgmental outcomes. People are likely to base judgments on accessibility experiences when they adopt a heuristic processing strategy and the informational value of the experience is not called into question. When the experience is considered nondiagnostic, or when a systematic processing strategy is adopted, people rely on accessible content. Implications for the operation of the availability heuristic and the emergence of knowledge accessibility effects are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68686/2/10.1207_s15327957pspr0202_2.pd

Talking to the dead in the classroom. How a supposedly psychic event impacts beliefs and feelings

Paranormal beliefs (PBs) are common in adults. There are numerous psychological correlates of PBs and associated theories, yet, we do not know whether such correlates reinforce or result from PBs. To understand causality, we developed an experimental design in which participants experience supposedly paranormal events. Thus, we can test an event’s impact on PBs and PB-associated correlates (Mohr, Lesaffre, & Kuhn, 2018). Here, 419 naïve students saw a performer making contact with a confederate’s deceased kin. We tested participants’ opinions and feelings about this performance, and whether these predicted how participants explain the performance. We assessed participants’ PBs and repetition avoidance (PB related cognitive correlate) before and after the performance. Afterwards, participants rated explanations of the event and described their opinions and feelings (open-ended question). Overall, 65% of participants reported having witnessed a genuine paranormal event. The open-ended question revealed distinct opinion and affect groups, with reactions commonly characterized by doubt and mixed feelings. Importantly, paranormal explanations were more likely when participants reported their feelings than when not reported. Beyond these results, we replicated that 1) higher pre-existing PBs were associated with more psychic explanations (confirmation bias), and 2) PBs and repetition avoidance did not change from before to after the performance. Yet, PBs reminiscent of the actual performance (spiritualism) increased