Research Critique On Hand Hygiene And Infection Prevention Behaviours Among Medical And Nursing Students

Background/Literature Review

A research critique is a systematic review of a research article to highlight the strengths and weaknesses of the study and also determining how it is applicable to its field of practice. Every research is supposed to have a grand challenge where it follows previously done studies and develops new results that are applicable in the field. This means that a good research should draw on the works of other researchers by focusing on the limitations of the studies they undertook, the recommendations they made for further study or gaps in the literature that were left out. From this, the researcher should adhere to a certain line of research by observing the current practices in the field and the same time evaluation of current literature in the field to understand the directions for future research.

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Kingstona, O’Connell, & Dunne (2018) study sought to study hand hygiene and alcohol-based hand rub use in Irish medical and nursing students. The study was informed by a 5.2% prevalence of acute care infections through hand hygiene. The researchers used a cross-sectional self-reported observation study while the data was collected through an electronic questionnaire. The results indicated that most nurses used my five moments of hang hygiene model. Further, it was found that hand hygiene compliance was high after body fluid exposure. From the study, most nurses used hand rubbing while medical students used an alcohol-based hand.

Jackson, Lowton, & Griffiths (2014) study focused on infection prevention through preventive behaviours by nurses. This study is informed by the fact that despite control and prevention strategies being put in place there are minimal effects in the reduced rate of infections around the globe. Previous studies have only focussed on predicting infection and prevention behaviours but failed to understand and explain the behaviours that occur daily in the process of infection prevention by nurses. This means that there is a need to focus on rationalizing dirt-related behaviour to improve response to preventive approaches. The study used a qualitative interpretive study to explore how registered nurse reported infection prevention behaviours. The nurses were picked from acute healthcare settings and were initially recruited before they graduated from college. Interviews were used to collect data which was later transcribed and analyzed. The findings indicated that nurses rationalize their own behaviour and justified any deviation from the normal policy process. The participants also showed the desire to protect themselves and satisfy scrutiny from patients.

Research Design

Kingstona, L. M., O’Connell, N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118.

General credibility of the research process and conclusions

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The findings of the study are credible since they identified challenges and gaps in the areas of patient safety education that need to be addressed. This calls for the need to address the issue of infection prevention in medical and nursing students by streamlining their syllabus to cover the issues raised in the research. According to Bhakar & Nathani (2005), a good research article needs to have a grand challenge approach where the findings of the study can be applied in the field or form the direction of new research. This study offers directions for new research on how training medical and nursing students can be used to reduce infections while at the same time how the field can be improved through reducing infections.

Introduction

The introduction gives the background of the study by focussing on previous studies from reputable organizations like the WHO  to give a general perspective on the topic. According to Elliott & Timula (2005) the introduction part presents the research problem and the main focus of the study. The introduction for this research is good since it illustrates the nature of the research problem and how it relates to previous studies.

Background/ Literature Review

The background of the study focusses on the research topic by discussing hand hygiene from a global context as advocated by the gold standard approach. The literature study reviews the amount of literature available for the study which shows that there are limited studies that have discussed the topic. This review focusses on the global context to highlight the work of other researchers and showing how they inform the direction of the study. According to Caldwell, Bennett, & Mellis (2012), a literature review is a scholarly approach to analyzing relevant literature on a research topic and identifying the gaps that exist in the research. These gaps are what forms the basis of new research and the research question that needs to be answered. The gaps in the literature indicate that no Irish study has explored the hygiene practices of hand rubbing among medical and nursing students.

Research Design

The study used a cross-sectional, self-reported observation study due to the nature of the research topic and settings. The observation process is the preferred method of study in epidemiology and medical studies since it allows the drawing of inferences from the sampled population without the use of sample controls (Weathington, Cunningham & Pittenger, 2015)). Since the sample population was not controlled cross-sectional self-reported observation worked well since it allows the study of many subjects within the research study. Since the researcher was having two groups: nurses and medical students, the cross-sectional self-reported method worked well where the observed finding is documented and analyzed for the study.

Methodology

The participants were invited in a blinded innovation to participate in the study. The survey questions for the study were modified to reflect WHO standards where the students self-reported in the questionnaires with Likert scaled questions. Blinded approaches are preferred in research since they reduce biases and increase the genuineness of the findings (Babbie, 2013). This is the reason why the study was blinded to yield unbiased results.

Ethical considerations

considerations    The researchers observed the ethical standards of The Declaration of Helsinki (2013) which requires no risk or harm to participants, minimal or no emotional questions and protection of the privacy of the respondents. According to Florczak (2017), ethical considerations regulate the researcher and protect the respondents against harm to ensure that the findings of the study are legitimate.  

Discussion

According to Elliott & Timula (2005) the role of the discussion part of research is to give the reader evidence of the field work that is presented in a manner that allows the reader to evaluate the effectiveness of the study. The reported highest compliance in both nursing and medical students at the moment of 3 medical model. However, some of the students reported compliance after the risk of exposure to HCAI thus this formed the consistency and motivator to hand hygiene. The study reported poor compliance with moment 5 hand hygiene after contact with the patient. This calls for the need to ensure practitioners acquire relevant adequate knowledge that leads to professional competencies in practice. The study also found that some medical students were not aware of clinical contradictions for ABHR use especially in first and second-year students, this implies the need for curricular readjustment to empower students with these skills as suggested by Huang, Xie, Zeng, Law, & Ba-Thein (2013). Barriers to hand rubbing inform reasons for its optimal use among practitioners which include skin sensitivity and skin damage thus forcing almost half of the students not to follow the hand rubbing recommendations. This means that there is a need to address the perceived barriers for hand rubbing to increase student compliance (Hughes, 2001). The research data was presented in a guise and compared with other studies to show the consistency of the findings with what other researchers have done.

Limitations

One major limitation of the study is the potential bias of self-reported questionnaires. Howell (2013) argues that if the questions for the study are not properly designed in self-reported approaches, they can be judgemental and led to the respondent which makes the research biased. In this case, the researchers ensured that the questions were non-judgemental and sensitively worded by balancing between the negative and positive words.  

Recommendation

The study was based on only one institution thus the need to expand the sample frame and ensure that at least more institutions are used in the research to make the findings of the research more reliable. This means that the findings will not be limited to one institution just in case it had curricular weaknesses.

Conclusion

The study offers reliable findings for the study that can be used to offer an insight on how college education for nursing and medical students can be improved leading to informed graduates who understand the requirements of their profession.  This will lead to improved service delivery within the healthcare sector.

Jackson, C., Lowton, K., & Griffiths, P. (2014). Infection prevention as ‘‘a show’’: A qualitative study of nurses’ infection prevention behaviours. International Journal of Nursing Studies, 51, 400-408.

General credibility of the research process and conclusions

The paper forms the basis for new research which proposes the need to address prevention behaviour among nurses through a lens of social theory. This article views the nursing field as both performance and the message that the practitioner sends to the patients. The findings of this study are credible since they create room for future research on how nursing preventive behaviours can be improved. According to Colquitt & George (2011), every study is supposed to have a grand challenge that forms the basis of its study and the influence that it has on the field of study.

Introduction

According to Kush (2015) the introduction of the research study should give an overview of the research problem and the field of study. The introduction traces the research problem in history as far as 1860 from the time of Nightingale and the importance of hygiene to what is happening in 21st century today. From the introduction, the research topic is introduced where the authors argue that compliance with good practice has been a problem in the nursing sector despite the training that they receive. The researchers argue that behaviour may not be congruent with the policy since it is influenced by irrational thoughts that people have. From the introduction, the reader can trace the source of the study which is part of a larger study to understand nurse infection prevention behaviours. In this study, the theme of participants explaining their own and others behaviours are reviewed. Cooper (2010) suggests that a good introduction should draw from a generation perspective to a specific one as seen in Jackson, Lowton, & Griffiths (2014) where the reader understands the requirements of the study thus this introduction was organised in a scientific way.

Background/ Literature Review

The background of the study is based on previous themes that exist in studies that had been done before. The research background relied on the work of other researchers who explored the concept of behaviour within practice settings. This traces the social construction of prevention and hygiene and how they can be understood by identifying knowledge, interpretations, and reality that inform behaviours. Therefore, the background of the study has been defined well from the general perspective to narrow where it identifies a specific theme that informed the research. According to Derntl (2014), the background and literature part offers an insight into the research gap that the researcher has chosen to explore as shown in this study.

Research Design

The study used an interpretive qualitative study so that the perceptions of the nurses can be explored by providing an analysis of their behaviours and those of others. Ralph, Birks, & Chapman (2015) argues that this type of study is good for studying medical phenomena since it allows the researcher to understand the experiences of respondents from a subjective experience. Denyer & Tranfield (2006) add that this method works well based on the relationship that exists between the researcher and the respondent through the use of data collection methods like interviews and observation. The outcome is non-biased data collected from self-reports.

Methodology

The study applied the interview technique lasting between thirty to forty-five minutes which were audiotaped and transcribed later. The participants for the study ranged from 24 to 53 years who had the previous diploma in nursing. Interviews are preferred in qualitative studies because they allow the researcher to deeply engage the respondent and explore every available information relevant to the study (Weathington, Cunningham, & Pittenger, 2015).

Ethical considerations

Ethical considerations were applied to ensure that the study was approved by the King’s College London. This means that the study was done according to the requirements of the college.

Discussion

The role of the discussion part is to allow the researcher to present the findings of the study according to themes or research objectives of the study (Barker, Pistrang, & Elliott, 2002). The findings indicated that the participants were willing to report the failed policy procedures at work. This research thus reported that participants failed to see similarities between their practice and that of others since they believed their behaviour was rationalized as a response to external circumstances. This rationalization made them see their own behaviour as appropriate even if it failed to comply with policy requirements. However, when nurses were under patient scrutiny they put on the show of knowing what to do by giving the right impression and carrying out the correct procedure regardless of if they did it well or not. On the other hand, use of gloves when handling patients had a negative review of patients since they felt as they were dirty due to the symbolic reference of gloves, uniforms, and gloves as seen in the Twigg (2000) study. Therefore, the study concluded that the participants had their own presentation that they were trying to convey rather than following a certain code of practice. This calls for the need to enforce the professional code of practice at all times.

Limitations

The study was limited by the self-reported information gathered from the study since infection prevention is different from what students learn in class and what they apply in the field. This is further limited by the potential disparity between actual and reported behaviour when respondents are allowed to discuss the practice of others and their vignette character. Howell (2013) suggests that self-reporting questions need to be designed in a way that meets the requirements of the research topic and reduces bias. The questions were designed well to adress this limitation.

Recommendation

One evident theme in the study is the fact that the nurses lacked adequate knowledge on infection prevention, therefore this study offers an eye opener on how behaviour can be used as an important element infection prevention. Thus the need to ensure that nurses are trained on the right procedure of for infection prevention while at the same time there is need to ensure that there are adequate policies that guide the conduct of professions within the workplace.

Conclusion

From the study nurse behaviour was found to be a vital element in infection prevention since it shapes the conduct of the proffessions at the workplace. Nurses who have adequate infection prevention knowledge understand the requirements of the profession and adapt appropriate infection prevention behaviours. This study offers an insight on how behaviour can be used as a way of preventing infections in the medical sector.

References

Babbie, E. (2013). The practice of social research. Belmont. California, Wadsworth: Cengage Learning.

Barker, C., Pistrang, N., & Elliott, R. (2002). Research methods in clinical psychology: An introduction for students and practitioners. Chichester: Willey.

Bhakar, S., & Nathani, N. (2005). A Handbook on writing Research Paper in Social. . New Delhi: Bharti Publications.

Caldwell, P., Bennett, T., & Mellis, C. (2012). Easy guide to searching for evidence for the busy clinician. Journal of Paediatric Child Health, 48(12), 1095-1100.

Colquitt, J., & George, G. (2011). From the editor publishing in amj—Part 1: Topic Choice. Academy of Management Journal, 54(3), 432-435.

Cooper, H. (2010). Research synthesis and meta-analysis: A step-by-step approach. Thousand Oaks: Sage.

Denyer, D., & Tranfield, D. (2006). Using qualitative researh synthesis to build an actionable knowledge base. Management Decisions,, 44(2), 213-227.

Derntl, M. (2014). Basics of research paper and writing and publishing. International Journal of Technology Enhanced Learning, 6(2), 105-123.

Elliott, R., & Timula, L. (2005). Descriptive and interpretive approaches to qualitative research. London: Wiley.

Florczak, K. L. (2017). Adding to the Truth of the Matter: The Case for Qualitative Research. Nursing Science Quarterly,, 30(4), 296-299.

Howell, K. E. (2013). Introduction to the Philosophy of Methodology. London: Sage Publishers.

Huang, Y., Xie, W., Zeng, J., Law, F., & Ba-Thein, W. (2013). 2013. Limited knowledge and practice of Chinese medical students regarding health-care associated infections. Journal of Infection Development Countries, 7(2), 144-151.

Hughes, W. (2001). What makes a good research paper. ARCOM News Letter, 16(3).

Jackson, C., Lowton, K., & Griffiths, P. (2014). Infection prevention as ‘‘a show’’: A qualitative study of nurses’ infection prevention behaviours. International Journal of Nursing Studies, 51, 400-408.

Kingstona, L. M., O’Connell, N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118.

Kush, M. (2015). The Statement Problem. Quality Progress,, 48(6).

Ralph, N., Birks, M., & Chapman, Y. (2015). The methodological dynamism of grounded theory. International Journal of Qualitative Methods, 14(4).

Twigg, J. (2000). Carework as a form of bodywork. Ageing and Society, 20, 389-411.

Weathington, B., Cunningham, C., & Pittenger, D. (2015). Research Methods for the Behavioural and Social Sciences. Hoboken: John Wiley & Sons.

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