Behavioural determinants of hand hygiene of nurses in a private healthcare institution: a qualitative exploration
Patient safety is one of the most important focus points of global healthcare. According to the World Health Organization (2017:1) patient safety is the prevention of errors and adverse ef-fects on patients while receiving medical care. Hand hygiene is classified as one of the initia-tives to ensure safe efficient clinical care to people in need of healthcare. Poor hand hygiene compliance, and emerging multidrug resistant organisms, not only pose a threat to the health of the community but could become the central point of failure of the entire global currently known healthcare system. Despite available knowledge and the implementation of hand hygiene educational programmes, hand hygiene compliance levels remain low in a private hospital in the Mpumalanga Province of South Africa. Organisational leaders identified behavioural anomalies as a possible reason for poor compliance yet the behavioural determinants of nurses' hand hygiene compliance have not been investigated. A literature review, regarding national and international trends and guidelines concerning hand hygiene, was conducted. This review identified behavioural determinants of hand hygiene as a gap in efforts to improve hand hygiene compliance. The aim of this study was to identify the behavioural determinants of hand hygiene of nurses working in a private hospital. The objec-tives of the study were to explore and describe hand hygiene practices of nurses, working in a private hospital, from a qualitative perspective and to formulate recommendations based on the study's findings. The study followed a qualitative, interpretive and descriptive design. An all-inclusive purposive sample was selected of registered and enrolled nurses (N=143). Participants were recruited by an independent mediator who explained ethical aspects, including informed consent. Data were collected by trained facilitators by means of two World Café data collection sessions. Data satu-ration occurred with 22 participants. Data were transcribed by the researcher. Five themes with 9 descriptive categories and 13 subcategories emerged. The realities of different knowledge bases, whether embedded or acquired, influenced established hand hygiene patterns. Although established hand hygiene patterns might be dysfunctional and unscientific, they could become the truth within a practise gap and therefore become reality for the persons concerned. Hand hygiene compliance might be disrupted due to the misalignment of organisational processes causing inner conflicts for nurses. Although nurses strive for operational efficiency, inner con-flicts between the organisational culture, nurse's personal value system and the hospital's hand hygiene culture, operational efficiency might become impossible, leaving nurses disengaged from the workplace and the patient. A direct consequence of disengagement is non-patient cen-tred nursing care with negative impacts on patients' safety. Recommendations are formulated to address deviations in practice e.g. to advocate a task group within the hospital assigned to im-prove hand hygiene as well as recommendations for future research and policy.
- Health Sciences