Qualitative Research Critique and Ethical Considerations

Qualitative Research Critique and Ethical Considerations

Healthcare-associated infections (HAIs) significantly threaten patient safety. HAIs are directly linked to longer lengths of stay, higher cost of care, and higher risks of death and mortality rates (Serra-Burriel et al., 2020). Infection prevention and control (IPC) within hospital settings employs various precautions aimed at preventing HAIs. Hand hygiene is the most essential and effective IPC approach to preventing HAIs. Notably, hand hygiene can effectively prevent the spread of infectious conditions such as influenza, enterovirus, pneumonia, and COVID-19 (Chiu et al., 2020). Nurses and other healthcare workers know the effectiveness and need for maintaining hand hygiene (Van Nguyen et al., 2020). However, adherence to handwashing protocols tends to decrease with time, especially if related interventions are ended (Stangerup et al., 2021). Due to the high risk of exposure to HAI-causing bacteria among healthcare workers and the risk of transferring such bacteria to other patients and workers, as well as cross-contamination, employing strategies that promote adherence to such protocols is important in hospitals. This paper provides a summary and comparison of two articles that can help answer the PICOT question developed and support the nursing problem identified.

Revised PICOT Question

In healthcare workers (P), does hand hygiene education (I) compared to regular hand washing protocols (C) improve adherence to hand hygiene protocols and reduce the rate of hospital-acquired infections (O) over six months?

Background of Studies

The article “Nurses’ Knowledge, Behaviour and Compliance Concerning Hand Hygiene in Nursing Homes: A Cross-Sectional Mixed-Methods Study” by Hammerschmidt and Manser (2019) aimed to explore how individual and organizational factors such as role modeling by nursing managers influence compliance with hand hygiene in nursing home nurses. The study’s objective was to overcome the difficulties of research on hand hygiene in nursing homes due to the specific nature of such care settings and provide deeper insights into the organizational factors that can be considered during initiatives aimed at improving hand hygiene in nursing home settings. The main problem identified in the article is that, despite hand hygiene being a major measure aimed at preventing HAIs, compliance with established hand hygiene protocols remains low in nursing homes. This article is significant in nursing as it provides a better understanding of the influential factors that determine nurses’ knowledge, behavior, and compliance with hand hygiene. It also provides evidence-based guidance to help nursing leaders develop and implement strategies to improve adherence to hand hygiene practices and reduce the risk of HAIs. The article uses research questions focused on nurses’ and nursing managers’ hand hygiene knowledge, practices and compliance, behaviors, and organizational factors influencing hand hygiene behaviors. These questions include “What knowledge do nurses have concerning hygiene management and infection prevention? Which hygiene behaviors do nurses report? What are the perceptions of nurses and nursing managers of organizational structures and processes supporting hand hygiene? and In what way do nurses perceive nursing?”

In the article “Qualitative Assessment of Hand Hygiene Knowledge, Attitudes and Practices among Healthcare Workers Prior to the Implementation of the WHO Hand Hygiene Improvement Strategy at Faranah Regional Hospital” by Douno et al. (2023), the main purpose was to develop qualitative insights about knowledge, attitudes, and practices on health hygiene among healthcare workers to help with planning and implementing the WHO hand hygiene strategy in Faranah Regional Hospital, Guinea. The main problem identified in the article is the lack of enough qualitative studies exploring healthcare workers’ knowledge, attitudes, and practices of hand hygiene. Therefore, the study’s main objective was to fill in the qualitative research gap and provide a foundation for future qualitative studies on the topic. The article is significant to nursing as it was developed through an in-depth assessment of HCWs’ knowledge, attitudes, and practices towards hand hygiene. It supports the implementation, improvement of, and compliance with the WHO’s hand hygiene. This can help guide the adoption and sustainability of such protocols in similar settings. Although no clear questions were provided, the study observed and interviewed the participants during data collection.

How the Two Articles Support the Chosen Nursing Practice Problem

The two articles’ summaries provide evidence that can help address the nursing problem of improving adherence to hand hygiene practices and preventing HAIs. For instance, the evidence and insights provided by Hammerschmidt and Manser (2019) create awareness of the various factors that influence nurses’ knowledge, behavior, and compliance with hand hygiene. Such evidence can help address the problem in this paper by guiding the development of problem-specific interventions that focus on supporting and improving such factors among nurses. The article also provides evidence of the importance of educating nurses on hand hygiene and role-modeling hand hygiene to ensure compliance with set practices.

The article by Douno et al. (2023) also supports the nursing problem focused on in this paper as it provides evidence of the efficacy of hand hygiene in preventing HAIs and the spread of infectious diseases. The article also identifies how HCWs’ knowledge, attitudes, and practices towards hand hygiene are essential factors to consider when aiming to promote or implement and ensure compliance with hand hygiene protocols such as the ones provided by the WHO. The article also provides ways to improve compliance with set protocols, such as having committees mandated to promote hand hygiene.

Method of Studies

The article by Hammerschmidt and Manser (2019) employs a mixed methods approach to developing and conducting the study. On the other hand, Douno et al. (2023) apply purely qualitative methods of study, such as in-depth interviews. The main difference between the two methods is that the mixed-methods study employs both qualitative and quantitative methods of research, and data can be thematically and statistically analyzed, while qualitative methods utilize only qualitative methods for data collection and analysis, such as interviews and thematic analysis.

One benefit of using mixed methods in research is that it allows the researcher to explore a problem broadly by allowing the use of a wider range of research questions (Younas et al., 2019). However, it is limited if resources for carrying out the research are insufficient as it is resource intensive. On the other hand, the main benefit of a qualitative approach is providing provider perspectives that can create new insights and solutions to a problem. However, qualitative methods provide more subjective views that can be biased and ungeneralizable.

Results of Studies

Hammerschmidt and Manser (2019) found that nurses were highly knowledgeable concerning hygiene management and hand hygiene; 56% of nurses noted that it was possible to always adhere to hand hygiene practices while taking care of nursing home residents, while 79% of the nurses stated that organizational factors such as resources and accessible were essential to adhering to hand hygiene practices. All nurses noted that they viewed their supervisors as role models. The article further found that, although nurse managers view nurses as knowledgeable enough to carry out hand hygiene practices on their own, protocols and practices need to be communicated frequently. At the same time, the availability and accessibility of resources influence behaviors and compliance with practices.

Douno et al. (2023) found that the knowledge of hand hygiene protocol influenced attitudes towards hand hygiene while attitudes influence hand hygiene practices both in the prevention of infections and spread. The results of both articles have implications in addressing adherence and compliance issues towards hand hygiene practices and in the prevention of HAIs.

Ethical Considerations

Two major ethical considerations when conducting research using humans include collecting informed consent from the participants and ensuring participation, information privacy, and security. Informed consent includes ensuring that each participant is provided with necessary and sufficient information related to the study to help them decide whether to participate or withdraw from the study. Participant privacy ensures that no other people outside of the research will have unauthorized access to the participant’s personal information. Notably, the researchers in both articles observed the ethics of informed consent and participant privacy. For instance, Hammerschmidt and Manser (2019) stored collected information in line with the data protection requirements of the University Hospital Bonn, Germany archives; none of the data was available publicly. Both articles also indicate that written informed consent was obtained and all provisions of the consent observed.

Conclusion

In conclusion, as hand hygiene is an essential part of IPC, it is important to ensure adherence to the set protocol to sustain the efficacy of hand hygiene in the prevention of HAIs among healthcare workers. Developing PICOT questions can help search for peer-reviewed articles that can provide evidence-based approaches to addressing compliance with hand hygiene protocols and preventing HAIs. High-quality sources of evidence to support addressing the nursing problem must meet the methodological and ethical standards to be considered for inclusion in developing evidence to support nursing practice.

References

Chiu, N. C., Chi, H., Tai, Y. L., Peng, C. C., Tseng, C. Y., Chen, C. C., Tan, B. F., & Lin, C. Y. (2020). Impact of wearing masks, hand hygiene, and social distancing on influenza, enterovirus, and all-cause pneumonia during the coronavirus pandemic: Retrospective national epidemiological surveillance study. Journal of Medical Internet Research, 22(8), e21257. https://doi.org/10.2196/21257

Douno, M., Rocha, C., Borchert, M., Nabe, I., & Müller, S. A. (2023). Qualitative assessment of hand hygiene knowledge, attitudes and practices among healthcare workers prior to the implementation of the WHO hand hygiene improvement strategy at Faranah Regional Hospital, Guinea. PLOS Global Public Health, 3(2), e0001581. https://doi.org/10.1371/JOURNAL.PGPH.0001581

Hammerschmidt, J., & Manser, T. (2019). Nurses’ knowledge, behaviour and compliance concerning hand hygiene in nursing homes: A cross-sectional mixed-methods study. BMC Health Services Research, 19(1), 1–13. https://doi.org/10.1186/S12913-019-4347-Z/FIGURES/2

Serra-Burriel, M., Keys, M., Campillo-Artero, C., Agodi, A., Barchitta, M., Gikas, A., Palos, C., & López-Casasnovas, G. (2020). Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. PLOS ONE, 15(1), e0227139. https://doi.org/10.1371/JOURNAL.PONE.0227139

Stangerup, M., Hansen, M. B., Hansen, R., Sode, L. P., Hesselbo, B., Kostadinov, K., Olesen, B. S., & Calum, H. (2021). Hand hygiene compliance of healthcare workers before and during the COVID-19 pandemic: A long-term follow-up study. American Journal of Infection Control, 49(9), 1118–1122. https://doi.org/10.1016/J.AJIC.2021.06.014

Van Nguyen, H., Tran, H. T., Khuong, L. Q., Van Nguyen, T., Ho, N. T. N., Dao, A. T. M., & Van Hoang, M. (2020). Healthcare workers’ knowledge and attitudes regarding the World Health Organization’s “My 5 Moments for Hand Hygiene”: Evidence from a Vietnamese Central General Hospital. Journal of Preventive Medicine and Public Health, 53(4), 236. https://doi.org/10.3961/JPMPH.19.319

Younas, A., Pedersen, M., & Tayaben, J. L. (2019). Review of mixed-methods research in nursing. In Nursing research (Vol. 68, Issue 6, pp. 464–472). https://doi.org/10.1097/NNR.0000000000000372

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Qualitative Research Critique and Ethical Considerations

In this assignment, you will write a critical appraisal that demonstrates comprehension of two qualitative research studies.

For this assignment, use the nursing practice problem and two qualitative peer-reviewed research articles you identified in Topic 1 (or two new articles based on instructor feedback in Topic 1). In a 1,000-1,250-word essay, summarize two qualitative studies.

In high-exposure populations such as children and healthcare workers (P), what are the individual, organizational, and environmental factors that influence compliance to and the effectiveness of hand hygiene (I) in infection prevention and control (O)? This is not a PICO question. You need a nursing intervention with a specific population and a measurable outcome. You could ask: Will educating healthcare staff about hand hygiene compared to no education result in decreased HAIs in hospitalized patients in 3 months? Please revise
Use the “Research Critique Guidelines – Part I” document to organize your essay.

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.