Professional Practice Description
Various nursing practices, such as assessment of pain, nurse-to-nurse shifts, effective patient care, improving patients’ satisfaction, and infection control, occupy an important place within the healthcare industry. Nurses must perform at their best level and seek to deliver excellent service and care. Careful analysis and evaluation of nursing practices are essential in developing clear instructions and objectives, as well as in achieving great results through the implication of those practices. The purpose of this paper is to analyze the infection control or prevention nursing practice and observe the necessity of change and possible alternatives based on prior researches.
Within the analyzed facility, infection control is an integral concept that implies dangers and problematic issues. The primary point in infection prevention lies in the extensive existence of healthcare-associated infections (HAI) that can be caught by the patients while getting their treatment. The WHO defines infection prevention and control (IPC) as “a specific approach and practical solution designed to prevent harm caused by infection to patients and healthcare workers” (“Infection prevention and control,” 2017, para. 1).
Different infectious diseases, social sciences, epidemiology, and the enhancement of the health practices lie in the foundation of infection control practice (“Infection prevention and control,” 2017). Besides, infection control practice has a unique position, because each encounter of the health professional and a patient has a threat of infection development (“Infection prevention and control,” 2017). Consequently, one can see the significance of proper techniques to prevent possible infections within the healthcare organization and not to expose anyone to unfavorable outcomes.
The analyzed healthcare facility possesses weaknesses in infection control practice. Firstly, there is a lack of handwashing dispensers, which creates burdens to the timely access to the infection prevention procedures for the professionals. Besides, the chosen organization does not have enough cleaning personnel and environmental safety employees, which decreases the effectiveness of the current ICP practice. The analyzed facility also lacks in the strength of the organizational culture, which creates limitations for successful infection control. The chosen healthcare organization has a limited budget, while the ICP practice improvements require investments. Thus, it is crucial to find practical implementations and emphasize the advantages of the change to the board.
Within the last decades, more hospitals have become aware of infection control and aim to strengthen their position in this field. Healthcare-associated diseases represent a severe complication of modern medicine internationally. Several reasons, such as the utilization of the devices, older population, or incorrect use of antimicrobial practices, contribute to the emergence of this problem (Al-Tawfiq & Tambyah, 2014). Today, medicine is full of new complicated procedures that might put the immune system at risk (Nelson & Williams, 2014).
The wide use of invasive devices and the complexity of the treatment techniques can compromise the health of the patients and increase the possibility of infection. Nelson and Williams (2014) claim that within the nearest future, the number of HAIs will increase due to the reasons described above. Moreover, weak ICP methods imply high costs for a healthcare organization. Therefore, infection control practices require a change to keep up with the developments of healthcare procedures and to be able to provide an appropriate level of safety for the patients and workers.
Key Stakeholders
It is essential to identify the stakeholders, the parties who are influenced by infection control and prevention practice, and its change. Firstly, the patients are at a higher risk and, therefore, the members of the society, where every single individual can become a patient, are the integral stakeholders in this field. Invasive devices are used during clinical procedures and treatment, which has a chance to cause infection directly for the patient.
Consequently, it is within the interests of the community to pursue effective ICP practices because they play the primary role within the possible impact of healthcare techniques and methods. As an influential stakeholder group, the patients can contribute to the change by providing feedbacks on their experiences within the facility. Besides, the recommendations and expectations for the services from the community can be beneficial to the strengthening of the current ICP practice.
Another essential group to consider is the healthcare industry professionals. Infections can have a rapid spread in a wide area within a short period. HAIs occur in various health organizations that are full of patients, but also doctors, nurses, and medical assistants. Interesting, that healthcare professionals have two different roles within the investigated concept. From one perspective, they, just like patients, can catch an infection after specific procedures.
In this way, they represent a group that is at risk of being infected. From another perspective, doctors and nurses can compromise themselves by being the ones who performed the procedures on a patient who got the infection later. Due to the diversity of reasons for the HAIs, it is difficult to determine the causes of related diseases. However, the professionals performing operations or having contact before the infection period, are at stake of carrying the blame and having legal and social consequences.
The healthcare professionals must take the ICP practice change seriously because it directly involves their awareness and participation. The medical workers will be responsible for the specific stages of change implementation. Besides, it is fundamental for them to follow all the guidelines carefully, evaluate their performance, stick to the regulations, and maintain the proposed company’s culture. Encouragement among colleagues will also be an advantage for successful change integration.
Besides the stakeholders described in this section, patients’ relatives and friends, non-medical healthcare employees and visitors, and a specific health organization’s board of directors can be influenced by ICP practices. Healthcare-associated infections might be spread to people, with whom the infected ones interact before the detention of the disease. Also, HAIs imply costs for the healthcare facility, which puts the board of directors at stake.
The role of this stakeholder group with the ICP practice change process is to conduct the objective analysis of the proposed strategies and ensure the participation of all the parties involved. Raising awareness among the visitors, conducting continuous checks on the new implementations, and offering incentives to the other stakeholder groups is essential. Changes to improve infection control practices require significant investments, making more influence on the private hospitals’ shareholders or the chefs of the organizations. However, to make a positive impact on the stakeholders and increase the level of their satisfaction, it is essential to undertake specific measures.
Evidence Critique Table
Evidence Summary
The concept of nurses’ behavior plays a role when it comes to infection control practice. Jackson, Lowton, and Griffiths (2014) claim that healthcare professionals often present self-defensive behaviors in case of inappropriate HAIs prevention. The primary goal of their analysis was to understand the fundamental reason for the complex behaviors of the nurses in response to infections among their patients (Jackson et al., 2014).
The findings revealed that despite the focus on the rules for compliance with the existing ICP practices, different factors like individual perception, motivation, or pressure might influence professional’s behavior (Jackson et al., 2014). Thus, the integration of “reflective sessions or clinical supervision programs” can become a useful change for the existing infection control practices (Jackson et al., 2014, p. 407). From this article, one can withdraw the problematic issues and proposed strategies to implement a change.
Hand hygiene is another crucial aspect of ICP practice, which is directly connected to the emergence of HAIs. The researchers suggest that hand-rub dispensers and hand-hygiene facilities play an essential role in the effectiveness of infection prevention (Zingg et al., 2015). The systematic review concluded that several critical components make ICP practice effective. Among them, there are availability and access to the materials, use of guidelines, bed occupancy, and auditing and feedback (Zingg et al., 2015).
According to Zing et al., positive OC also favorably contributes to the success of infection control (2015). Besides, limited access to the hand-hygiene equipment within specific hospitals becomes “a source of frustration” for the professionals, which harms various levels of the organization, including behaviors and satisfaction (Zing et al., 2015, p. 214). Consequently, this study shows the connection among the elements of the healthcare facilities, highlights the importance of hand hygiene and the necessity in creating easy access to the related equipment.
The organizational culture occupies a significant spot within healthcare facilities. The researchers argue that organizational culture (OC) is a mirror of the professionals, services, activities, and patients (De Bono, Heling, & Borg, 2014). Throughout time, the essence of the company’s culture transformed into the norms of behavior and expectations (De Bono et al., 2014). Today, positive organizational beliefs and thinking can portray the legitimacy and desirable attitudes towards the patients. In such a way, focusing on modifying organization culture “appears to be promising, albeit challenging target for IPC improvement campaigns” (De Bono et al., 2014, p. 1). Thus, another study emphasized that alterations in OC can have a positive impact on the effectiveness of ICP performance.
It is crucial to take a look at the effectiveness of ICP practices. Mitchell, Hall, MacBeth, Gardner, and Halton (2015) conducted a cross-sectional study among Australian hospitals. The findings have revealed that private hospitals possessed lower levels of infection control, in comparison with the publicly funded healthcare facilities (Mitchell et al., 2015). Moreover, the analysis showed that in smaller hospitals, the professionals had identified the need for “increased access to infectious diseases or microbiology support” (Mitchell et al., 2015, p. 612).
Besides, the researchers have concluded that the most significant change would be implementing information technology within the practice (Mitchell et al., 2015). Therefore, one can see that this research portrays the lack of ICP in small and private healthcare institutions and emphasized the usefulness of the further integration of improved technologies.
One more study focused on investigating the cost-effectiveness of the investments in fighting HAIs within intensive care units. Dick et al. (2015) have examined five years of data and concluded that current ICP strategies proved themselves to be cost-effective. However, besides the analysis of the financial side of infection control, the researches emphasized that HAIs remain to be a severe issue and impose high social costs (Dick et al., 2015). Consequently, although changes in ICP will require higher investments, “efforts to develop new prevention strategies” are integral for the healthcare industry (Dick et al., 2015, p. 9). Thus, this article highlights the importance of integrating the change to reduce the problems and costs associated with HAIs.
Evidence-Based Practice Recommendation
From the summary of various studies in the previous section, one can claim that the focus of change in ICP practice lies within the organizational culture, employees’ behaviors’ evaluation, and hygiene equipment access. OC improvement implies investing in education and knowledge of the professionals, as well as maintaining positive relationships among the leaders and their subordinates. Also, the behavioral concept goes deep into infection control performance.
As the studies indicate, despite knowledge in ICP regulations, nursing professionals often portray inappropriate behaviors, which is also the issue in the analyzed healthcare facility. Thus, integrating more self-assessment tools, implementing audit and feedback from both nurses and patients, and emphasizing the individual’s value among all the parties involved can have a positive impact on the organization.
Another crucial recommendation, based on the evidence summary, is the investments in hand-rub dispensers, hand-hygiene facilities, and related information technology. For instance, automatic reminders of the system for the professionals to perform infection prevention procedures can make the practice more efficient. Hence, the change in ICP practice requires careful attention to various levels within the healthcare organization, including OC, and investments into physical equipment and technologies.
Practice Change Model
Havelock’s theory of change is a great model for the implementation of changes in infection control and prevention practice within the analyzed healthcare facility. Integrating a specific model aims to create a planned and positive change within the organization, which is crucial in improving nursing practices. Havelock’s theory developed from Lewin’s initial change model that included unfreezing, moving, and refreezing stages (Kearney-Nunnery, 2016). Havelock’s approach broadens the three phases and offers detailed steps for the implementation of modifications. This model fits the chosen recommendations for the ICP because it “reflects the empirical-rational nature of humans” (Kearney-Nunnery, 2016, p. 185). The list below represents Havelock’s theory’s stages and provides details for the ICP changes within the analyzed organization:
- Perception of need: despite proper knowledge and education, as well as investments in ICP, HAIs keep occurring within the organization, which requires change.
- Problem’s diagnosis and identification: careful analysis of the current ICP practice reveals that it needs to be more effective to maintain a positive image, meet the patients’ expectations, and respond to desired safety levels.
- Devising a plan of action: the company will emphasize the major recommendations, as well as specific details on the change plan. The first integral part is investing in new technologies and establishing more hand-hygiene facilities within the organization. The next step is integrating proper auditing and evaluation techniques for the professionals and focusing on creating positive OC through teambuilding, special seminars, and educational sessions.
- Gaining acceptance of the plan: communicating the need for change for ICP practice among nursing professionals, discussing the planned actions with them, and earning their approval through emphasizing advantages that the moves will bring.
- Stabilization: implementing the action plan and working on stabilizing the new approach to ICP practice within the organization.
- Self-renewal: maintaining the improved ICP practice within the facility by sustaining the implemented measures and techniques.
Potential Barriers
Every change strategy implies the presence of possible barriers either for its full realization or the burdens for sustaining the improvements. In the case of the proposed recommendations through Havelock’s model of change, a potential obstacle can be the reaction and misunderstanding of the employees. Modifications in the OC involve active interactions with the professional and their aspiration for positive change and development. As far as ICP practice change implicates the evaluation of behaviors, it might generate discontent or unwillingness to participate. Another potential barrier is the financial cost of the change.
As far as the new strategy means investing in new equipment, new technology, seminars, and education, the analyzed healthcare facility should carefully design an action plan considering the current budget. Consequently, the perception of the transformation, its communication to the organization, and financial implications represent possible obstacles for the ICP change.
Ethical Considerations
Ethics is in the core of nursing practices and plays a significant role in ICP in particular. The Code of Ethics was developed by the American Nurses Association to highlight the importance of integrity and morality when it comes to healthcare activities (Haddad & Geiger, 2019). This code includes nine provisions that serve as guidance for the professional nurses to perform at their best levels (Haddad & Geiger, 2019). One of the parts related to the suggested changes in ICP practice is the fact that the patient represents a primary concern and commitment for the professionals (Haddad & Geiger, 2019).
Another integral one is that the nurse “has authority, accountability, and responsibility for nursing practice” (Haddad & Geiger, 2019, para. 10). Those points require thorough consideration for the chosen recommendations for ICP change. Thus, one can claim that throughout the implementation of change within the analyzed healthcare facility, it is crucial to remember the Code of Ethics and carefully examine each action.
In conclusion, the chosen healthcare organization needs to integrate changes into the current infection control and prevention practice to enhance its operations, improve patients’ experience, and minimize the chance of HAIs’ occurrence. Careful analysis of various researches provides the foundation for the recommendations. Working towards positive organizational culture, conducting professionals’ evaluations, and investing in new equipment and techniques based on Havelock’s model of change can have a positive impact.
References
Al-Tawfiq, J. A., & Tambyah, P. A. (2014). Healthcare-associated infections (HAI) perspectives. Journal of Infection and Public Health, 7(4), 339-344.
De Bono, S., Heling, G., & Borg, M. A. (2014). Organizational culture and its implications for infection prevention and control in healthcare institutions. Journal of Hospital Infection, 86(1), 1-6.
Dick, A. W., Perencevich, E. N., Pogorzelska-Maziarz, M., Zwanziger, J., Larson, E. L., & Stone, P. W. (2015). A decade of investment in infection prevention: A cost-effectiveness analysis. American Journal of Infection Control, 43(1), 4-9.
Haddad, L. M., & Geiger, R. A. (2019). Nursing ethical considerations. Web.
Infection prevention and control. (2017). Web.
Jackson, C., Lowton, K., & Griffiths, P. (2014). Infection prevention as “a show”: A qualitative study of nurses’ infection prevention behaviours. International Journal of Nursing Studies, 51(3), 400-408.
Kearney-Nunnery, R. (2016). Advancing your career: Concepts in professional nursing (6th ed.). Philadelphia, PA: F.A. Davis Company.
Mitchell, B. G., Hall, L., MacBeth, D., Gardner, A., & Halton, K. (2015). Hospital infection control units: Staffing, costs, and priorities. American Journal of Infection Control, 43(6), 612–616.
Nelson, K. E., & Williams, C. M. (2014). Infectious disease epidemiology. Burlington, MA: Jones & Bartlett Learning.
Zingg, W., Holmes, A., Dettenkofer, M., Goetting, T., Secci, F., Clack, L.,… Pittet, D. (2015). Hospital organization, management, and structure for prevention of health-care-associated infection: A systematic review and expert consensus. The Lancet Infectious Diseases, 15(2), 212-224.