Motivating healthcare professionals (nurses, nurse assistants, physicians) to integrate new practices for preventing healthcare-associated infections into the care continuum: turning Positive Deviance into positive norms

Anat Gesser-Edelsburg, Ricky Cohen, Adva Mir Halavi, Mina Zemach

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The literature examining healthcare-associated infections (HAI) points to two main problems in conforming to infection prevention and control (IPC) guidelines among healthcare professionals (HP). One is the discrepancy between HPs’ behavioral intentions and their implementation in practice. The other refers to how HPs maintain these practices after the intervention stage ends. The method proposed in this study seeks to address both these issues by using the Positive Peviance (PD) approach to focus on the dissemination stage of interventions. The study seeks to offer a method for disseminating 27 PD practices to 135 HPs, among them nurses, nurse assistants and physicians, so as to help them maintain IPC guidelines, offer feedback on the dissemination process and examine the impact of the dissemination stage on changes in their behavior. Methods: The theoretical model underlying this qualitative research was the Recognition-Primed dDecision (RPD) model, which we implemented in the field of healthcare-associated infections (HAIs). Moreover, we used the Discovery & Action Dialogue (DAD) and Think Aloud (TA) techniques to describe the methodological development of simulations for HPs. Feedback from the HP demonstrators underwent content analysis, while descriptive statistics were used to characterize behavioral changes. Results: HPs’ information processing regarding infection prevention shifts from peripheral/automatic processing to intuition and analytical/central processing, turning PD practices into positive norms. The HPs personally experienced finding a solution and made repeated corrections until they overcame the barriers. Most of the HPs (69.4%) reported that the practices were fully implemented, together with additional practices. Conclusions: Implementation of the dissemination stage indicates that in order for HPs to integrate and assimilate practices that are not in the official guidelines, merely observing simulations is not sufficient. Rather, each staff member must personally carry out the procedures.

Original languageEnglish
Article number495
JournalBMC Infectious Diseases
Volume21
Issue number1
DOIs
StatePublished - Dec 2021

Bibliographical note

Funding Information:
This research was funded by the Israel National Institute for Health Policy Research (NIHP(, grant number 2016\134\א. The NIHP had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • Dissemination
  • Hand hygiene
  • Healthcare professionals
  • Healthcare-associated infections
  • Infections prevention practices
  • Norms
  • Positive Deviance approach
  • Qualitative study
  • Recognition-Primed Decision
  • Simulation
  • Think Aloud
  • Video-Reflexive Ethnography

ASJC Scopus subject areas

  • Infectious Diseases

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