scholarly journals Exploring the Barriers and Levers to Hand Hygiene of Nursing and Medical Staff in Emergency Departments: A Mixed Methods Study

2021 ◽  
Author(s):  
◽  
Lorraine Rees
Keyword(s):  
Mixed Methods ◽  
New Zealand ◽  
Focus Group ◽  
Hand Hygiene ◽  
Focus Groups ◽  
Emergency Departments ◽  
Medical Staff ◽  
Healthcare Workers ◽  
Mixed Methods Study ◽  
Doctors And Nurses

<p>Background: Emergency Departments (ED) frequently host patients with undiagnosed infectious conditions and patients who are vulnerable to infection. Minimising the risk of exposure to infectious diseases is a priority in healthcare and is managed using a variety of strategies. Hand hygiene (HH) underpins these strategies, but ED have lagged behind improvement in HH compared to other units in New Zealand public hospitals. Given the consequences of healthcare associated infections (HAI), further investigation is warranted to identify barriers and levers to HH in the challenging environment of ED.  The aim of this explanatory sequential mixed methods study was to identify barriers and levers to HH practice in two ED in New Zealand.  Design: The mixed methods study was conducted in two phases. In Phase One, a questionnaire was used to survey nurses and doctors in the two ED sites. In Phase Two, follow-on focus groups were used to explore in-depth, specific aspects of the survey results.  Methods: In Phase One, doctors and nurses in the ED sites were surveyed to identify perceived barriers and levers of HH. A previously validated questionnaire from the United Kingdom was used. Following piloting, the questionnaire was circulated via email to all doctors and registered nurses. Results were analysed descriptively. Areas identified as strong barriers and levers to HH practice were identified, and used to inform development of a focus group interview guide.  In Phase Two, focus group participants were identified from a self-selected convenience sample of survey respondents. Focus groups were audio-recorded and data transcribed verbatim into NVivo Pro 11 before undergoing thematic analysis.  Results: The survey was distributed to doctors (n= 81) and nurses (n= 214). The response rate was low (11% for nurses, 12% for doctors). Two focus groups (n=6 & n=2) and one face to face interview (n=1) was held with nurses participating in each session. No medical staff participated in this phase of data collection. All respondents had worked in healthcare more than three years. Healthcare workers identified that professional role was the strongest lever for HH (93.1%, n=95), closely followed by knowledge and skills (84.3%, n=86). Healthcare workers demonstrated an awareness of benefits of HH including improving patient confidence and avoidance on infection for the patient and themselves (65.9%, n= 89). 45.6% (n=62) of responses identified a lack of encouragement or role modelling in this area of practice.  The physical environment in the ED was a major barrier (53.7%, n=73) although shorter stays in ED were not perceived as a barrier to HH (73.5%, n= 25). High patient turnover and acuity were also perceived as barriers to HH. HH initiatives were perceived to have a marginal effect (55.3%, n=57). Social influences and communication were further barriers to HH, with healthcare workers identifying discomfort when challenging others about HH.  Conclusion: Current barriers to HH including the environmental challenges, and social and cultural barriers to HH need to be addressed. Hand hygiene education that targets known challenges in, and misunderstandings about practice, need to be developed. Organisations must clearly articulate expectations of HH through policy and procedure, including a commitment to address non-compliance. Doctors and nurses should be supported in developing strategies to effectively communicate about, and challenge HH practices. With organisational support and a harnessing of the professional responsibilities that doctors and nurses hold, there is opportunity to strengthen barriers and mitigate barriers to HH.</p>

scholarly journals Exploring the Barriers and Levers to Hand Hygiene of Nursing and Medical Staff in Emergency Departments: A Mixed Methods Study

2021 ◽  
Author(s):  
◽  
Lorraine Rees
Keyword(s):  
Mixed Methods ◽  
New Zealand ◽  
Focus Group ◽  
Hand Hygiene ◽  
Focus Groups ◽  
Emergency Departments ◽  
Medical Staff ◽  
Healthcare Workers ◽  
Mixed Methods Study ◽  
Doctors And Nurses

<p>Background: Emergency Departments (ED) frequently host patients with undiagnosed infectious conditions and patients who are vulnerable to infection. Minimising the risk of exposure to infectious diseases is a priority in healthcare and is managed using a variety of strategies. Hand hygiene (HH) underpins these strategies, but ED have lagged behind improvement in HH compared to other units in New Zealand public hospitals. Given the consequences of healthcare associated infections (HAI), further investigation is warranted to identify barriers and levers to HH in the challenging environment of ED.  The aim of this explanatory sequential mixed methods study was to identify barriers and levers to HH practice in two ED in New Zealand.  Design: The mixed methods study was conducted in two phases. In Phase One, a questionnaire was used to survey nurses and doctors in the two ED sites. In Phase Two, follow-on focus groups were used to explore in-depth, specific aspects of the survey results.  Methods: In Phase One, doctors and nurses in the ED sites were surveyed to identify perceived barriers and levers of HH. A previously validated questionnaire from the United Kingdom was used. Following piloting, the questionnaire was circulated via email to all doctors and registered nurses. Results were analysed descriptively. Areas identified as strong barriers and levers to HH practice were identified, and used to inform development of a focus group interview guide.  In Phase Two, focus group participants were identified from a self-selected convenience sample of survey respondents. Focus groups were audio-recorded and data transcribed verbatim into NVivo Pro 11 before undergoing thematic analysis.  Results: The survey was distributed to doctors (n= 81) and nurses (n= 214). The response rate was low (11% for nurses, 12% for doctors). Two focus groups (n=6 & n=2) and one face to face interview (n=1) was held with nurses participating in each session. No medical staff participated in this phase of data collection. All respondents had worked in healthcare more than three years. Healthcare workers identified that professional role was the strongest lever for HH (93.1%, n=95), closely followed by knowledge and skills (84.3%, n=86). Healthcare workers demonstrated an awareness of benefits of HH including improving patient confidence and avoidance on infection for the patient and themselves (65.9%, n= 89). 45.6% (n=62) of responses identified a lack of encouragement or role modelling in this area of practice.  The physical environment in the ED was a major barrier (53.7%, n=73) although shorter stays in ED were not perceived as a barrier to HH (73.5%, n= 25). High patient turnover and acuity were also perceived as barriers to HH. HH initiatives were perceived to have a marginal effect (55.3%, n=57). Social influences and communication were further barriers to HH, with healthcare workers identifying discomfort when challenging others about HH.  Conclusion: Current barriers to HH including the environmental challenges, and social and cultural barriers to HH need to be addressed. Hand hygiene education that targets known challenges in, and misunderstandings about practice, need to be developed. Organisations must clearly articulate expectations of HH through policy and procedure, including a commitment to address non-compliance. Doctors and nurses should be supported in developing strategies to effectively communicate about, and challenge HH practices. With organisational support and a harnessing of the professional responsibilities that doctors and nurses hold, there is opportunity to strengthen barriers and mitigate barriers to HH.</p>

scholarly journals Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study

2020 ◽  
Vol 8 (15) ◽  
pp. 1-256
Author(s):  
Alicia O’Cathain ◽  
Emma Knowles ◽  
Jaqui Long ◽  
Janice Connell ◽  
Lindsey Bishop-Edwards ◽  
...  
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
General Practitioner ◽  
Health Service ◽  
Health Services ◽  
Focus Groups ◽  
Emergency Departments ◽  
Help Seeking ◽  
Mixed Methods Study ◽  
Coping Capacity

Background There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use. Objectives To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives. Design This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking. Results From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice. Limitations Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service. Conclusions Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered. Future work There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions. Study registration This study is registered as PROSPERO CRD42017056273. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

scholarly journals Young Men’s Preferences for Design and Delivery of Physical Activity and Nutrition Interventions: A Mixed-Methods Study

2017 ◽  
Vol 11 (5) ◽  
pp. 1588-1599 ◽  
Author(s):  
Lee M. Ashton ◽  
Philip J. Morgan ◽  
Melinda J. Hutchesson ◽  
Megan E. Rollo ◽  
Clare E. Collins
Keyword(s):  
Physical Activity ◽  
Mixed Methods ◽  
Focus Group ◽  
Focus Groups ◽  
Mixed Methods Study ◽  
Delivery Mode ◽  
Negative Consequences ◽  
Nutrition Interventions ◽  
Face To Face ◽  
Program Content

Young adult men are under-represented in health research, and little is known about how to reach and engage them in lifestyle interventions. This mixed-methods study aimed to explore young males’ preferences for recruitment strategies, content, format (delivery mode and program duration and frequency), and facilitator characteristics for future physical activity and nutrition interventions. Ten focus groups involving 61 men (aged 18–25 years) in the Hunter region, New South Wales, Australia and an online survey distributed within Australia were completed by 282 males (aged 18–25 years). Key focus group themes included a preference for recruitment via multiple sources, ensuring images and recruiters were relatable; intervention facilitators to be engaging and refrain from discussing negative consequences of being unhealthy. Key program content preferences included skill development and individualized goals and feedback. Focus groups and the survey confirmed a preference for multiple delivery modes, including; face-to-face (group and individual), with support using eHealth technologies. Survey results confirmed the most favored program content as: “healthy eating on a budget,” “quick and easy meals,” and “resistance training.” Focus group responses suggested a program duration of ≥6 months, with 2–3 combined face-to-face and supportive eHealth sessions per week. Survey intervention duration preference was 3 months with 4 face-to-face sessions per month. Findings can guide the design, conduct, and evaluation of relevant contemporary physical activity and or nutrition interventions for young men. There is a need to identify the most effective ways to address young men’s individual preferences in intervention research.

scholarly journals A mixed methods study on early childhood services' touchscreen tablet use and non-use in New Zealand

2021 ◽  
Author(s):  
◽  
Michael Luke Santamaria
Keyword(s):  
Early Childhood ◽  
Mixed Methods ◽  
New Zealand ◽  
Focus Group ◽  
Mixed Methods Study ◽  
Focus Group Interviews ◽  
Home Based ◽  
Education And Care ◽  
Group Interviews ◽  
Te Whāriki

<p>With the ongoing debate on young children’s Information Communication Technology (ICT) use in early childhood education (ECE), empirical studies have reported that the increase in young children’s access to and use of touchscreen tablets, hereafter referred to as tablets, could positively and negatively impact their learning and development. According to the New Zealand ECE curriculum, Te Whāriki (Ministry of Education, 2017), children growing up in the context of a changing society could benefit from using technology. This research, which explored tablet use in New Zealand’s four major early childhood service types: education and care centres, home-based services, kindergartens, and playcentres, provides useful information on the reasons why services used and did not use tablets as well as how teachers/educators used tablets to support children’s learning.  The two phases to this sequential explanatory mixed methods study were underpinned by two research paradigms, the postpositivist paradigm for the quantitative phase and the constructivist paradigm for the qualitative phase. First, a national survey that was sent to all early childhood providers from the four major service types and then a collective case study was conducted in two sub-phases. Phase 2A consisted of focus group interviews with a tablet non-user service from each of the four service types and a tablet user service from each of the four service types. Phase 2B consisted of stimulated recall (SR) focus group interviews with the same tablet users who participated in Phase 2A.  The survey responses revealed considerable variation in the use of tablets and the purposes for which tablets were used. More education and care services and kindergartens used tablets than home-based services and playcentres. Both quantitative and qualitative phases revealed complexities involving tablet use such as the types of scaffolding used and issues surrounding screen time and policies on tablet use including the use of personally-owned tablets and cybsersafety concerns. Particularly, the findings from Phase 2 confirmed that the socialized nature involving tablet use aligned with Te Whāriki. Thus, tablet use is not necessarily limited to a dichotomy of use and non-use but is spread across a spectrum ranging from limited, to specialised, and to comprehensive use.</p>

scholarly journals A mixed methods study on early childhood services' touchscreen tablet use and non-use in New Zealand

2021 ◽  
Author(s):  
◽  
Michael Luke Santamaria
Keyword(s):  
Early Childhood ◽  
Mixed Methods ◽  
New Zealand ◽  
Focus Group ◽  
Mixed Methods Study ◽  
Focus Group Interviews ◽  
Home Based ◽  
Education And Care ◽  
Group Interviews ◽  
Te Whāriki

<p>With the ongoing debate on young children’s Information Communication Technology (ICT) use in early childhood education (ECE), empirical studies have reported that the increase in young children’s access to and use of touchscreen tablets, hereafter referred to as tablets, could positively and negatively impact their learning and development. According to the New Zealand ECE curriculum, Te Whāriki (Ministry of Education, 2017), children growing up in the context of a changing society could benefit from using technology. This research, which explored tablet use in New Zealand’s four major early childhood service types: education and care centres, home-based services, kindergartens, and playcentres, provides useful information on the reasons why services used and did not use tablets as well as how teachers/educators used tablets to support children’s learning.  The two phases to this sequential explanatory mixed methods study were underpinned by two research paradigms, the postpositivist paradigm for the quantitative phase and the constructivist paradigm for the qualitative phase. First, a national survey that was sent to all early childhood providers from the four major service types and then a collective case study was conducted in two sub-phases. Phase 2A consisted of focus group interviews with a tablet non-user service from each of the four service types and a tablet user service from each of the four service types. Phase 2B consisted of stimulated recall (SR) focus group interviews with the same tablet users who participated in Phase 2A.  The survey responses revealed considerable variation in the use of tablets and the purposes for which tablets were used. More education and care services and kindergartens used tablets than home-based services and playcentres. Both quantitative and qualitative phases revealed complexities involving tablet use such as the types of scaffolding used and issues surrounding screen time and policies on tablet use including the use of personally-owned tablets and cybsersafety concerns. Particularly, the findings from Phase 2 confirmed that the socialized nature involving tablet use aligned with Te Whāriki. Thus, tablet use is not necessarily limited to a dichotomy of use and non-use but is spread across a spectrum ranging from limited, to specialised, and to comprehensive use.</p>

The Influence of Visibility on Medical Teamwork in Emergency Departments: A Mixed-Methods Study

2019 ◽  
Vol 13 (2) ◽  
pp. 218-233
Author(s):  
Arsalan Gharaveis ◽  
Debajyoti Pati ◽  
D. Kirk Hamilton ◽  
Mardelle Shepley ◽  
Susan Rodiek ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Healthcare System ◽  
Emergency Departments ◽  
Medical Staff ◽  
Mixed Methods Study ◽  
Future Research ◽  
Staff Members ◽  
Nurses And Physicians ◽  
Objectively Measured ◽  
Staff Behavior

Aim: This mixed-methods study delivers empirical evidence on the influence of visibility on healthcare teamwork in Emergency Departments (EDs). This study researchers hypothesized that with changes of visibility in EDs, teamwork among medical staff members will be impacted. Background: Prior research results suggest that visibility can influence health-setting efficacy. Teamwork is one of the components of each healthcare system that can be supported by environmental design. Method: Visibility in four subject sites from the same healthcare system was objectively measured by morphology plan analyses. Teamwork among medical staff members was the behavioral variable of interest and explored through field observations, interviews, and surveys. Results: The qualitative outcomes demonstrated that teamwork can be enhanced by improved visibility, while the quantitative findings supported the idea that some specific measures of visibility were correlated with teamwork. Conclusion: This study provides a model for future research on the association between healthcare staff behavior and ED plan configuration. The enhancement of ED design, considering the significance of visibility, enhances the perceptions of nurses and physicians in terms of teamwork.

scholarly journals An intervention to decrease burnout and increase retention of early career nurses: a mixed methods study of acceptability and feasibility

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Judy Brook ◽  
Leanne M. Aitken ◽  
Julie-Ann MacLaren ◽  
Debra Salmon
Keyword(s):  
Mixed Methods ◽  
Nursing Students ◽  
Focus Groups ◽  
Academic Staff ◽  
Skills Training ◽  
Early Career ◽  
Mixed Methods Study ◽  
Healthcare Organisation ◽  
Structured Interviews ◽  
Over Time

Abstract Aims To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre. Background Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses. Methods This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention. Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoretical Framework of Acceptability. Wilcoxon Signed Ranks test was used to assess change in acceptability over time. Qualitative data from semi-structured interviews, focus groups and field notes were thematically analysed, adhering to COREQ guidelines. Data were collected February to December 2019. Results One hundred and five questionnaires, 12 interviews with students and 2 focus groups engaging 7 academic staff were completed. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Student nurses perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Challenges related to the practice environment and academic assessment pressures. Reported benefits align with known protective factors against burnout and leaving the profession. Conclusion Planning is needed to embed the intervention into curricula and maximise relationships with placement partners. Evaluating acceptability and feasibility offers new knowledge about the value of the intervention for increasing retention and decreasing burnout for early career nurses. Wider implementation is both feasible and recommended by participants.

Impact of Engaging Students in Health Survey Data Analysis and as Full Partners in School Change: Results From a Mixed Methods Study

2021 ◽  
pp. 152483992110484
Author(s):  
Helen M. Beattie ◽  
Courtney A. FitzGerald ◽  
Sharon N. Koller ◽  
Karen S. Scott ◽  
Bernice Raveche Garnett ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Focus Groups ◽  
Risk Behavior ◽  
Youth Development ◽  
School Change ◽  
Well Being ◽  
Youth Risk Behavior Survey ◽  
Youth Risk Behavior ◽  
Health And Well Being

Young people demand and deserve participation in shaping the health and well-being of their community. Getting to Y: Youth Bring Meaning to the Youth Risk Behavior Survey (GTY) is a positive youth development initiative, whereby students analyze local youth health data and create change. This article adds definitive evidence to support the theoretical foundations of GTY expounded by Garnett et al. (2019). A mixed methods convergent study design, collecting quantitative data from pre- and postintervention surveys and qualitative data from focus groups, was enacted during the 2018–2019 school year. Survey participants were 256 students attending 20 Vermont middle/high schools. Surveys measured self-efficacy, health literacy, civic engagement, resiliency, and knowledge. Focus groups with 50 students solicited open-ended feedback. Wilcoxon signed-rank tests determined student-level change over time. Focus group transcripts were coded using grounded theory and a priori codes from the survey. Statistically significant improvements were seen in average scores from pre- to postintervention surveys in all five domains and differences in effect by gender. Results from the focus group complement the quantitative findings. Participation in GTY positively affected youth participant’s understanding of their own health and well-being and increased agency to take action on behalf of themselves and their community. As the Youth Risk Behavior Survey is available nationwide, GTY is poised for replication to critically engage youth with relevant data to inform social change.

scholarly journals Burnout, resilience, and perception of mindfulness programmes among GP trainees: a mixed-methods study

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101058
Author(s):  
Petra Hanson ◽  
Amy Clarke ◽  
Manuel Villarreal ◽  
Majid Khan ◽  
Jeremy Dale
Keyword(s):  
Mixed Methods ◽  
Focus Groups ◽  
Help Seeking ◽  
High Stress ◽  
Mixed Methods Study ◽  
Mindfulness Practice ◽  
Negative Effects ◽  
High Prevalence ◽  
High Level ◽  
And Coping

BackgroundTrainee GPs are at risk of developing burnout as a result of high stress levels. Improving resilience may prevent the negative effects of stress on wellbeing, morale, and patient care, thereby supporting recruitment to general practice.AimTo explore experiences of stress and burnout among GP trainees, and their level of interest in undertaking a mindfulness programme.Design & settingA qualitative study was performed with a cohort of GP trainees in Coventry and Warwickshire.MethodThis mixed-methods study utilised a survey with validated measures to investigate the prevalence of burnout, state of wellbeing, and resilience in GP trainees. Focus groups were also used to explore experiences of stress and burnout, and perceptions of mindfulness practice.ResultsIn total, 47 (response rate 39%) trainees completed the survey and 14 participated in focus groups. There was a high prevalence of disengagement (n = 36; 80%) and emotional exhaustion (n = 35; 77%), with 29 (64%) scoring above the cut-off value for both. While 16 (34%) reported already practising mindfulness, 39 (83%) described interest in engaging in mindfulness practice. The focus groups identified a range of issues relating to how trainees recognise stress and burnout, their help-seeking and coping strategies, the perceived barriers to practising self-care, and motivations for participating in mindfulness training.ConclusionThis study confirms the degree of stress and burnout that GP trainees experience, and their desire for greater wellbeing and resilience support. It identified a high level of interest in attending a mindfulness programme, but also barriers to engagement. Results of this research shaped the Mindful Practice Curriculum programme, which was later provided to this cohort of trainees.

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