In a healthcare setting, it is important to comply with the organizational protocols to ensure effectiveness in overall health care delivery. Undertaking clinical placements are effective for nurses in increasing and gaining vital knowledge of clinical reasoning and true experience of a day to day clinical practice (Leung et al., 2016). While undertaking a clinical placement in a medical ward, it has been identified that there is 30% compliance with hand hygiene protocols among healthcare professionals found within a recent audit. Thus, by using the 5A’s evidence-based practice approach, most probable solutions to the problem of non-compliance of hand hygiene protocols by health professionals will be provided for an in depth understanding of the factors involved.
The research questions for the problem will be as follows:
This is the questions that arise while looking at the scenario of identified 30% compliance to hand hygiene protocol by the healthcare professionals in a recent audit. According to the 5A’s evidence-based approach, asking the clinical question is the first step towards finding solutions to the problem effectively and providing adequate knowledge about the skills and requirements to address such issues effectively in real-life clinical practices (Leung et al., 2016).
There are several pieces of literature present that are focused on assessing the adherence to hygiene especially hand hygiene protocol by healthcare employees or staffs within healthcare settings. Several researchers have presented their study in a logical manner that provides adequate and in depth understanding of various aspects that are associated with adherence and non-adherence to hygiene and hand hygiene protocols by many healthcare professionals. According to a research study by a group of authors, Coppola et al., (2017), have provided a significant analysis of compliance of hand hygiene protocols by health care works in six different ICU settings of healthcare organizations (Coppola et al., 2017). The study reveals that as per the findings of the data calculations and evaluation, there is a low level of compliance to best hand hygiene protocols by healthcare workers (Coppola et al., 2017). As per the findings of the data, it has been suggested that by using multidisciplinary interference shall be an effective strategy to ensure effectiveness and prevent the healthcare associated infections that are transmitted through hand contacts (Coppola et al., 2017). Besides, increasing the level of knowledge regarding healthcare associated infections and importance of hand hygiene to healthcare workers such as nurses will be beneficial to strengthen the compliance to the required protocol (Coppola et al., 2017). In another research study by Zimmerman et al., (2020), that describes and discusses the factors that influence hand hygiene practice of students who are studying nursing signifies that nursing students have good knowledge of infection prevention control, but when it when comes to hand hygiene practice they still lack in it (Zimmerman et al., 2020). The research study has indicated that workplace culture is a significant aspect that negatively affects infection prevention control and hand hygiene practice which are co-related to each other (Zimmerman et al., 2020). Besides, the socialization of students within clinical placements is another factor that influences hand hygiene practice among nursing students (Zimmerman et al., 2020). The authors have suggested that effectual strategies and upgrading knowledge on hand hygiene can address the identified factors effectively leading to a substantial increase in hand hygiene practice in workplaces (Zimmerman et al., 2020). On the other hand, in a research study by Korhonen et al., (2019), which have described the evidence-based practice as a fundamental issue within the health care about making sure safe, effectual, high quality, and patient-centred treatment to patients (Korhonen et al., 2019). As stated in the study, evidence-based hand hygiene has been introduced within international guidelines that are based on reliable indication concerning guidelines’ effectiveness on the outcomes of patients (Korhonen et al., 2019). The study indicates that in collaboration with education and practice, there is an immense need for increasing knowledge of hand hygiene in context to evidence-based practice. Besides that, it also signifies that whilst nursing students gain theoretical knowledge in education; however, differences between practice and theory shall become clear during clinical placement (Korhonen et al., 2019). Thus, it is essential for nursing students to increase their knowledge regarding the evidence-based approach of hand hygiene effectively (Korhonen et al., 2019).
Quality of evidence plays an important role in determining the effectiveness of the identified and gathered information related to the research topic. Authenticity and dependency are the two factors that are essential to determine the importance of the selected information. As the research study of Coppola et al., (2017), which has provided a significant analysis of adherence to hand hygiene protocol by healthcare professionals signifies that there is a low level of compliance to the protocol (Coppola et al., 2017). The data has been collected from six different ICUs that consists of 73 out of 142 needed protocols and procedures were available in the findings of the research study (Coppola et al., 2017). On the other hand, the study by Zimmerman et al., (2020), which states the significant factors that influence hand hygiene approach of nursing students has indicated a lack of knowledge of hand hygiene practice; however, knowledge of infection prevention control is adequate among the students (Zimmerman et al., 2020). It has been identified that a two-phase descriptive, mixed-method study has been performed in a bachelor of nursing program in an Australian university that aims to explore the theoretical knowledge of such students effectively (Zimmerman et al., 2020). The study involved a non-probability purposive sample of all years including 1st, 2nd, and 3rd year nursing students respectively of a total of 930 students (Zimmerman et al., 2020). Besides, within the study of Korhonen et al., (2019), that performs a quasi-experimental design on 146 nursing students from two universities of applied sciences to conclude the study effectively (Korhonen et al., 2019).
By reviewing the literature various factors of hand hygiene approach and evidence-based practice have been identified that are crucial for healthcare setting and nursing students as well. Applying the identified factors and strategies to solve the issue of a given scenario of hand hygiene practice in a clinical placement by healthcare professionals shall face several barriers and enablers of interventions. Concerning such fact, there is a probability of not obtaining enough resources and materials while applying the factors of hand hygiene practice such as surveillance and effective monitoring by auditors of clinical placement’s protocols. As stated in a study by Coppola et al., (2017), compliance with hand hygiene practice which is considered as the gold standard by WHO can represent a limitation or barrier due to observer effect or the Hawthorne effect concerning psychological response that helps create an enhancement in performance (Coppola et al., 2017). Besides, as identified in another study by Zimmerman et al., (2020), the nursing students are well aware of the infection prevention control, but they lack when applying such in hand hygiene practice which is considered as an essential approach in any healthcare setting or clinical placements (Zimmerman et al., 2020). In addition, participants of the study have reported a lack of good underpinning knowledge of the hand hygiene practice apart from theoretical knowledge of hygiene. On the other hand, the intervention of final year nursing students with the first year and second year students in clinical placements influences negatively in adherence to hand hygiene practice (Zimmerman et al., 2020).
By looking at the pieces of literature and included strategies and methods to overcome from the issue of non-adherence to hand hygiene practice in clinical placements and healthcare settings, it has been analysed that in every study performed by various respective researchers have signified the same findings. The findings of every study have indicated that there is a lack of good and adequate knowledge of hand hygiene practice and its importance towards ensuring infection prevention control effectively. According to the scenario, 30% of the students have compliance with the hand hygiene practice, it means rest of the students are either influenced by the socialization or workplace culture or been disempowerment by the fellow registered nurse or senior students concerning power difference within the healthcare setting (Zimmerman et al., 2020). In addition, it is important to have a surveillance team involved to monitor the hand hygiene practice of nursing students can ensure effectiveness in compliance (Zimmerman et al., 2020).
Hand hygiene practice is an essential factor to consider by nursing students and compliance with the protocols is vital to ensure effectiveness. Thus, using effectual strategies and methods to increase awareness of the importance of hand hygiene practice and how it improves patient care and quality of care will help increase the percentage from 30% to a greater level.
Coppola, R., Musu, M., Mura, P., Colombo, S., Massidda, M., Spada, L., & Piazza, M. (2017). Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units. PubMed Central (PMC). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5668933/.
Korhonen, A., Vuori, A., Lukkari, A., Laitinen, A., Perälä, M., Koskela, T., & Pölkki, T. (2019). Increasing nursing students’ knowledge of evidence-based hand-hygiene: A quasi-experimental study. Nurse Education In Practice, 35, 104-110. https://doi.org/10.1016/j.nepr.2018.12.009
Leung, K., Trevena, L., & Waters, D. (2016). Development of a competency framework for evidence-based practice in nursing. Nurse Education Today, 39, 189-196. https://doi.org/10.1016/j.nedt.2016.01.026
Zimmerman, P., Sladdin, I., Shaban, R., Gilbert, J., & Brown, L. (2020). Factors influencing hand hygiene practice of nursing students: A descriptive, mixed-methods study. Nurse Education In Practice, 44, 102746. https://doi.org/10.1016/j.nepr.2020.102746
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