Problem solving and the barriers to adherence to routine infection control practices

Hamed, Abubaker M. (2021) Problem solving and the barriers to adherence to routine infection control practices. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Background: Healthcare-associated infections can be prevented through adherence to Routine Practices (RP) for infection control. Problem solving (PS) is an approach that can potentially be used to promote adherence to RP, which is suboptimal. Objectives: 1) Understand nursing students’ and instructors’ PS related to RP and barriers to RP; 2) evaluate the effects of a Problem-Solving Routine Practices (PSRP) educational program; and 3) examine the issue of negative role models and strategies that can be used. Methods: The objectives were met using a cross-sectional study that surveyed nursing students and instructors, a controlled before and after (CBA) study that evaluated a PSRP educational program, and a discussion paper about role models and adherence to RP. Results: The vast majority (83.5% to 100%) of nursing students and instructors surveyed correctly answered most, but not all, of the questions related to RP and PS. Both groups identified high nursing workload, empty alcohol-based hand rub dispensers and presence of negative role models as the most common barriers, and identified specific strategies to address them. In the CBA, significantly higher proportions of students in the intervention group compared to the control group showed increased confidence about applying PS to deal with high nursing workload (p = 0.032), correctly identified the steps of PS (p = 0.016), and reported adherence to some of the RP components (p < 0.05). The discussion paper highlighted how role models influence adherence and strategies that can be used. Conclusion: Nursing students’ and instructors’ knowledge about some RP components and application of PS to deal with the barriers to RP adherence need to be strengthened. The effectiveness of the PSRP program was varied, but further exploration of this approach is warranted. Recommendations were made for infection control practitioners, educators, nursing administrators, and future research.

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