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
