Topic: Improving Infection Control Practices among Nurses through sensitization and motivation
Ward: PW-3
Group Members
Problem Identification
With the increased demand of the nursing profession, there has been increasing attention on nursing practices and therefor the expectations from nurses have also increased. The problem arises when the expectations are greater than the performance as it affects patent-care badly. While we were on clinical rotation we identified many major and minor issues due to which patient’s care was compromised. The one major issue that we identified was non-compliance to infection-control practices and aseptic techniques among nurses. Because of the high severity index, we highlighted this topic as our main concern. The other major issues that were observed include: communication issues, incomplete documentation, incomplete discharge teaching, work overload and work related stress. (For further details about the severity index of each problem refer to appendix A)
We carried out informal observation to identify the severity of the issue. We found out that the staff didn’t throw used needle in danger box and he mistakenly pricked himself with the same needle. Nurses were using one isolation gown on many infected patients and checking patient’s blood sugar without wearing gloves. Splashing urine in commode, wearing rings, applying mehndi and nail polish on long nails were few very common observations. The identified issue was creating a gap between care expected from staff and care delivered. Therefore it was very important to reinforce and motivate the staff to practice aseptic techniques and to make them realize about the consequences of these malpractices. So we decided to run a project on improving infection control practices through staff sensitization and motivation. According to Efstathiou, Papastavrou, Raftopoulos and Anastasios (2011) besides the fact that patients are prone to acquire nosocomial infections, healthcare professionals are also at higher risk to get affected as they are directly exposed to hazards of hospital infection. Thus, remain compliant to infection control practices is not only important for the sake of patients but also for nurses and their family members.
Root cause analysis
To deal with the problem at the level of its origin, analyzing the causes of the issue is a prime thing. According to pyrek (2011) although nurses are aware about infection control practices and they know the importance, but compliance is usually absent. Through discussion and informal interviews we tried to find out the reason for non-compliance. The data we received, suggested that lack of time, forgetfulness, work overload, hurry to complete tasks, lack of reinforcement and lack of knowledge were the causes behind this problem. Pyrek (2011) also mentioned in his article that lack of time, equipment hinder in performing nursing skills, lack of knowledge and training of the staff are few of the common causes of non-compliance.
Moreover, we used fishbone diagram for further systematic review and to classify each identified cause into specific categories. The first category is of people, which includes lack of insight related to the consequences and lack of knowledge. The second category is of equipment, which includes lack of availability of resources. The third category defines the factors specific to patient, which includes nature of disease and affordability. Fourth category is specific to practices include improper execution of infection control guidelines and ineffective use of resources. The last category was miscellaneous factors which include high nurse patient ratio and increased workload (Refer appendix B for fishbone diagram). Both strategies helped us in comprehensive analysis of the cause and also provided us with the direction for further action plan.
Action plan
Change is important for any organization because, without change, it would lose its competitive edge so for the growth of an organization; change is a vital component (Shirey, 2013). In order to bring that change, one should be able to understand the basic principles and process involved in change management. For our project we used Kurt Lewin’s three step model for planned change that recognizes three distinct stages i.e., unfreezing, changing and refreezing (Refer appendix C). During unfreezing phase we tried to build good rapport with the staff and identified the need for change. We also tried to make them realize that their infection control practices are not effective and this behavior causing harm not only to their patients but to themselves and their loved ones. During the changing phase we developed strategies to bring change in behaviors. We conducted teaching sessions in which we taught them the ways to modify their practices. We gathered resources by collaborative approach and we took steps to put these changes into practice. During the last phase we tried to stabilize the change by creating a sense of acceptance among staff. We also gave rewards and positive reinforcement to the staffs that modified their practices and accepted the change. With Lewin’s model, we also used sandwich technique to motivate the staff and to give them constructive and corrective feedback. (The three step sandwich model is described in described in appendix D)
Implementation
Pashler, McDaniel, Rohrer and Bjork (2009) suggested that spatial and visual learning techniques with demonstration and discussion help the individuals to learn concepts easily and apply them in their life. Therefore we made PowerPoint presentations (Appendix E1 and E2) and we conducted two teaching sessions in which we showed them the video about the consequences of malpractices. We gave them real life examples of staff who suffered through it due to noncompliance of infection control practices. We prepared charts and pasted them on notice board in staff lounge. We gathered the material resources within the hospital by collaborating with CSSD department and we arranged few extra isolation gowns. Moreover, we also re-emphasized on the AKUH policy and guidelines of infection control practices. (For Teaching plan refer to appendix F)
Evaluation
For evaluation, we assessed the staff individually on an ongoing basis. We observed their practices throughout the shift and at the end of shift we appreciated those staff that applied infection control practices. We also evaluated their knowledge through a MCQs based paper. With these strategies we created sense of acceptance of change and sustainability of the project. (Refer appendix G). We observed that staff were applying infection control practices, i.e. hand hygiene, appropriately using personal protective equipment, disposing sharps in danger box, wearing gloves and gown properly. Moreover, special attention was given to the patients with CRE+ve patients. Separate room was assigned to them. Regular checking of isolation trolley were the evidences of our achievement. We felt accomplished on the completion of this project.
Reflection
Our Leadership and Management clinical journey in private wing 3 was a great experience and a learning opportunity. We were able to learn the managerial role of higher authorities in managing organizational issues and bringing change for the betterment of the organization. This clinical rotation helped us in identifying, understanding, developing and nourishing management qualities and skills by observing our preceptor and learning from her. Moreover, these clinical facilitated us in learning many concepts that we had learnt in class, like problem solving and conflict resolution, change management and performance appraisal etc. We were able to integrate those concepts into practice.
The overall experience provided us with many opportunities and channels of learning that flourished our leadership skills. We are really very grateful to our preceptor and our faculty who helped us in identifying gaps in our knowledge and also for being the role models for us. Their support, empathetic nature and leadership role guided us at each and every step of this project, making it successful.
APPENDICES
(Refer the zipped folder for appendices)
1. Appendix A- Issues identified and their severity index
2. Appendix B- Fishbone Diagram
3. Appendix C- Lewin’s model
4. Appendix D- Sandwich model
5. Appendix E1 and E2- PowerPoint presentations
6. Appendix F- Teaching plan
7. Appendix G- Evaluation questions
8. Appendix H- Individual reflection
9. Appendix I- Action plan in detail
Note: *Document containing each item of appendix has been named and attached separately.
References
Berhe, M., Edmond, M., & Bearman, G. (2005). Practices and an assessment of health care workers'
perceptions of compliance with infection control knowledge of nosocomial infections. American Journal Of Infection Control, 33(1), 55-57. doi:10.1016/j.ajic.2004.07.011
Efstathiou, G., Papastavrou, E., Raftopoulos, V., & Merkouris, A. (2011). Factors influencing nurses'
compliance with Standard Precautions in order to avoid occupational exposure to microorganisms: A focus group study. BMC Nurs, 10(1), 1. doi:10.1186/1472-6955-10-1
Gammon, J., Morgan-Samuel, H., & Gould, D. (2007). A review of the evidence for suboptimal compliance
of healthcare practitioners to standard/universal infection control precautions. J Clin Nurs, 1(1), 070621074500057- doi:10.1111/j.1365-2702.2006.01852.x
Gogia, H., & Das, J. (2013). Awareness and Practice Of Infection Control amongst doctors and nurses in
two ICUS of a tertiary care hospital in Delhi. Health And Population – Perspectives And Issues, 36 (1& 2), 1- 11.
Phillips J, Simmonds L (2013). Using fishbone analysis to investigate problems. Nursing Times; 109: 15: 18-20.
Roussel, L. (2011). Management and leadership for nurse administrators (6th ed.). Sudbury, Mass.: Jones and Bartlett Publishers.
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