Factors affecting operating room nurses' compliance with standard precautions at private hospital : a qualitative study using health belief model

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Factors affecting operating room nurses' compliance with standard precautions at private hospital : a qualitative study using health belief model

 

Author: Li, Yuen Fun Daisy
Title: Factors affecting operating room nurses' compliance with standard precautions at private hospital : a qualitative study using health belief model
Degree: M.Sc.
Year: 2013
Subject: Operating rooms -- Standards.
Sterilization.
Infection -- Prevention.
Operating room nurses.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xvi, 160 leaves : color illustrations ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2761748
URI: http://theses.lib.polyu.edu.hk/handle/200/7854
Abstract: Background: Health care professionals are often exposed to microorganisms, in which may cause serious or even lethal infections. Standard Precautions is a set of guidelines not only that can prevent the health care professionals from the exposure of microorganisms when contacting with blood or other body fluids, but it can also protect patients from blood borne transmitted disease during the exposure prone procedure. Health care professionals are at a high risk of occupational exposure and possible infections during their clinical practices in hospitals and health centres, and nurses are those with the most incidences of occupational injury and illness. Standard precautions has been widely promoted all over the world to protect health care professionals from occupational exposure to blood and the consequent risk of infection with blood borne pathogens (Kermode et al. 2005, WHO 2010, CDC 1998, CHP 2007-2011). However, among all healthcare professionals, operating room nurses are the ones with the highest frequency of occupational injury because of noncompliance with standard precautions (McCoy et al. 2001). The common factors that may affect the compliance of standard precautions include the following: lack of knowledge, lack of time and too busy to follow the standard precautions policy, non-availability of equipment, high work stress and the perception of conflict of interest between providing patient care and protecting the health care professionals themselves (WHO, 2009). Aim and objectives: This study aimed to identify the factors affecting operating room nurses' compliance with standard precautions (specifically, scrub nurses in operating room) at a private hospital in Hong Kong, by employing a qualitative research design and incorporating a theoretical framework, the Health Belief Model, so as to understand the different behaviors or attitudes that nurses may develop under the same condition by following or not following certain guidelines. There were five objectives in this study: A. To explore the views of nurses who work at operating room of a private hospital about the standard precautions on infection control in operating room. B. To identify facilitators and barriers on the compliance of standard precautions on infection control in a private hospital. C. To examine the differences in the perceived facilitators and barriers in complying with standard precautions among operating room nurses with different socio-demographic characteristics (to find out which group of operating room are trend to non-compliance with standard precautions). D. To classify and cluster those facilitators and barriers identified by using Health Belief Model. E. To explain the behavior of safety in complying with the standard precautions on infection control by using the Health Belief Model. Method: This was a qualitative research performed to investigate the factors that may affect operating room nurses' compliance with the standard precautions. Cross-sectional study was conducted at a private hospital and a hierarchical approach including focus group discussions and panel reviews was used. Four focus groups (was conducted among 28 participants) were organized to form and validate the perceived data that is related to the factors affecting operating room nurses' compliance with standard precautions. Descriptive statistics and intra-class correlation were used to describe the importance of influences of compliance and the degree of agreement on the classification of different domains. Lastly, a theoretical framework, the Health Belief Model was used to classify and cluster the factors that may affect the nurses' compliance of standard precautions in operating room after content analysis.
Results: Hundred percent of the participants described peer group influence, resources and accessibility of barrier precaution whilst approximately 85% of participants reported that an emergent/urgent situation, careless, no communication with others, and time restraint are the factors affecting an operating room nurse not to use the barrier precautions and not to follow the work practice control. In addition, approximately 15% of participants described surgeons' preference is another factor influencing an operating room nurse not to follow the work practice control. Besides, approximately 58% of respondents agreed that there is a possibility that they may contact an occupational exposure to microorganisms or incidents if they do not recap the needle after usage; this indicated that some of the operating room nurses are malpractice in handling sharps and this may cause an occupational exposure to microorganisms or incidents. Furthermore, approximately 85% of the respondents agreed that they will result from acquiring an occupational exposure to microorganisms or incidents if they do not report the exposure incident either an incident is too minor. Most respondents agreed that they are protected by using the gown, face shield, mask, gloves, cap, apron and doing the hand hygiene as a barrier precaution in their daily practice. Moreover, they believed that safety of themselves, their family, patients and to provide a safe working environment for other colleagues are the convincing reasons for them to follow the recommended standard precautions. Majority of them agreed that it is beneficial for all the operating nurses when the hospital management provides advice to them, such as putting up posters to promote standard precautions, research of the number of incidents, protocols, regular lectures, announcements and road shows about standard precautions. Conclusion: As operating room nurses work in a high-risk specialty, they should have the knowledge of preventive measures to protect themselves from risk of disease transmission and understand what influences their self-protective behaviors. The results of this study showed that the majority of factors affecting operating room nurses' compliance with standard precautions were group influence, resources and accessibility of barrier precaution, emergency/ urgent situation, careless, no communication with others, time restraint and surgeons' preference. Therefore, hospital should develop and adopt targeted measures and provide relevant training to improve their compliance with standard precautions. In order to provide and maintain a quality and safe health services to patients and health care professionals, to minimize occupational exposure to microorganisms and change the current behavior of the health care professionals, strategies of risk management, clinical audit and staff development are indispensable.

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