Elsevier

Applied Nursing Research

Volume 49, October 2019, Pages 35-40
Applied Nursing Research

Experiences of compliance with standard precautions during emergencies: A qualitative study of nurses working in intensive care units

https://doi.org/10.1016/j.apnr.2019.07.007Get rights and content

Highlights

  • ICU nurses' compliance with SP can reduce exposure to biohazards during an emergency.

  • Conflict, competencies, and context, can affect compliance for ICU nurses.

  • Conflict was noted when deciding to save the patient or prioritize the nurse's self-protection.

  • Infection control programs and training for ICU nurses should address these aspects.

Abstract

Aim

To explore factors that influence intensive care nurses' experiences of being compliant with standard precautions (SP) during emergencies.

Background

Intensive care nurses can be exposed to a greater risk of biohazardous exposure during an emergency. The primary strategy to address the complex variety of biological hazards in clinical practice is represented by the implementation of SP guidelines. Previous research has indicated that nurses' compliance rates with SPs are suboptimal, but no study has focused on the factors influencing compliance during an emergency.

Design

A descriptive qualitative study was conducted in an Italian university hospital with 19 intensive care nurses who had at least two years of work experience in critical care. The nurses were interviewed in four focus groups and were asked about their experiences of being compliant with SPs during an emergency. Data were analyzed using conventional content analysis.

Results

Three themes emerged: conflict, competencies, and context. Conflict was reported regarding the need to save the patient and the need for self-protection through the use of SPs. In particular, nurses had to manage the pressure of limited time. Competencies were identified by nurses' knowledge, attitude, skills, training, and experience. Context was related to the work and organizational conditions during the emergency, including overcrowding.

Conclusion

To support intensive care nurses' compliance with SPs during emergencies, conflict, competencies, and context should be audited regularly in clinical practice. The findings of this study could inform infection control programs and training that targets intensive care nurses.

Section snippets

Background

Hospital-acquired infections (HAIs) represent a major public health problem that can involve both patients and healthcare workers while in a hospital or other healthcare facility (Kärki, Plachouras, Cassini, & Suetens, 2019; World Health Organization [WHO], 2011). Regarding patients, HAIs are defined as an infection that was not present or incubating at the time of admission (WHO, 2011). Regarding healthcare workers, HAIs include occupational infections contracted during clinical practice (WHO,

Research design

This paper's design was a descriptive qualitative study that used content analysis to describe nurses' experiences of being compliant with SPs during an emergency. We conducted 4 focus groups (FGs) to collect qualitative data (Krueger & Casey, 2014). Krueger and Casey (2014) have defined FGs as a “carefully planned series of discussions designed to obtain perceptions on a defined area of interest in a permissive, non-threatening environment.”

Since the phenomenon under study addressed nurses'

Findings

The content analysis process led to the identification of three themes that describe the nurses' experiences of being compliant with SPs during an emergency. The three themes addressed are conflict, competencies, and context.

Discussion

This study aimed to explore ICU nurses' experiences of compliance with SPs during emergencies. One finding that emerged from this study was the nurses' conflict between the need to save the patient's life and the need for self-protection through the use of SPs. Participants reported being partially compliant with SPs and using only gloves when the patient's life was at risk. The reason behind this conflict could be related to the prosocial nature of the discipline of nursing (Biagioli, Prandi,

Limitations

The first limitation of this study was that participants were recruited from a single ICU in a university hospital where many courses about SPs were offered to staff, PPE was largely available, and organizational support was provided. Therefore, even if some participants have reported experiences from the ICU of other hospitals, they may not be a good representation of the largest nursing population. A second limitation was the interactive and collective nature of FGs, which could have limited

Conclusion

To the extent of our knowledge, this study is the first to provide an in-depth and thorough understanding of the factors that can influence intensive care nurses' compliance with SPs during an emergency. HAIs in the ICU can have significant consequences for both patients' outcomes and nurses' occupational safety. However, it is important to remember that HAIs are preventable, even during an emergency. For this reason, ICU nurses should be aware of preventable risks to themselves and their

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Source of funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Declaration of Competing Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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