| Popis: |
INTRODUCTION Compliance with evidence-based Standard Precautions Guidelines (SPGs) among healthcare practitioners is essential to combat Healthcare Associated Infections (HCAI). However, it is widely understood that non-compliance with these precautions remains a common problem in paediatric nursing practice. Most existing studies into this problem have used quantitative methods. However, these studies have failed to explain noncompliant behaviour or address the issues that are specific to paediatric clinical areas. AIM This study is designed to investigate paediatric nurses' perceptions and experiences of infection control measures and to achieve a better understanding of the factors that influence nurses’ compliance with SPGs. METHODS This qualitative study used an adapted constructivist grounded theory approach. The study was conducted in five Jordanian hospitals. Thirty one (n=31) qualified paediatric nurses from different paediatric areas were reccruited to the study. Data were gathered using face-to-face semi-structured audio-taped interviews, which were transcribed and coded through constant comparative analysis. RESULTS This study identified causes of enduring failure by nurses to comply fully with SPGs. Four themes emerged (Children are different; Nurses are human first; Limited professional status; The challenges of the working environment). Paediatric nurses claim to be willing to comply with SPGs, but sometimes fail to achieve this. Risk of exposure to microorganisms was perceived as a major factor in compliance. Paediatric nursing practice was seen as different to adult practice and nurses construed the need for SPGs differently. DISCUSSION A key issue is the fact that nurses were reluctant to see themselves as change-agents to improve practice. This resulted in problems with SPGs being well understood but not acted on. Nurse’s prioritised compliance with the nursing culture in their specific clinical area, over more general principles of care, such as SPGs. Nurses did appreciate that compliance with SPGs was suboptimal and did sometimes criticise this situation. However, most nurses had a value system, which militated against the proper use of Standard Precautions and which served to diminish the influence of them. IMPLICATION The chief implication of this study is that infection control is unlikely to improve further until nurses feel empowered to initiate change. Nursing in this area of the world is essentially semi-professional in nature. Nursing needs to develop to become fully professional in its orientation so that nurses take full responsibility for their actions. Only when nurses see their actions and behaviour as fully their responsibility, will nursing issues such as this be properly addressed. Until this occurs, the imposition of rules and guidelines, documentation and policies, will not be sufficient to progress care in this important area of practice. |
