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Understanding Hand Hygiene Behavior Among Jordanian Registered Nurses: An Application of Theory of Planned Behavior
| Content Provider | Semantic Scholar |
|---|---|
| Author | Hassan, Zeinab Mohamed Wahsheh, Moayad A. Hindawi, Omar S. |
| Copyright Year | 2009 |
| Abstract | The purposes of this cross-sectional study were to (a) determine the relationship between demographic characteristics of Jordanian registered nurses and theory of planned behavior concepts and (b) determine the relationships among theory of planned behavior concepts. One hundred fifty registered nurses of 250 were participated. Handwashing Assessment Instrument that assesses hand hygiene behavior, attitudes, and beliefs was used in this study. Independent t tests and correlations were used to test hypotheses. Significant and positive correlations were found between intention to perform hand hygiene and the following variables: beliefs about outcomes, subjective norm, normative beliefs, and perceived behavioral control (r = 0.566, 0.444, 0.400, and 0.500), respectively. Conclusions: Health education programs must be conducted to encourage hand hygiene behavior among Jordanian registered nurses who perceived their internal factors (eg, information, skills, and abilities) and external factors (eg, time, opportunity, and resources) to perform hand hygiene. (Infect Dis Clin Pract 2009;17: 150Y156) Inadequate hand hygiene (HH) potentially allows the transmission of microorganisms from patient to patient and from health care workers (HCWs) to patients, which can lead to the development of nosocomial infections (NIs). Nosocomial infections by definition are infections that are neither present nor incubating when the patient enters the hospital. They are caused by microorganisms that constitute an individual_s personal flora (eg, Staphylococcus aureus, Escherichia coli, Candida albicans) or by exogenous flora, which are usually acquired by immunosuppressed patients during a prolonged hospital stay. The effects of NIs vary from discomfort to prolonged or permanent disability, and in a small proportion of cases, they may contribute to a patient_s death. Nosocomial infections or hospital-acquired infections affect an average of 5% to 10% of patients admitted to acute care hospitals and can reach 30% among seriously ill patients. Burke estimates that the associated annual cost of NIs is $4.5 to $5.7 billion per year in the United States. Since 1975, the Centers for Disease Control and Prevention and the American Hospital Association have recommended standardized HH guidelines. Furthermore, the Association for Professionals in Infection Control and Epidemiology published HH guidelines in 1995 and 2002. A review of the literature from 1977 to 1995 focusing on HH showed a temporal relation between HH practices and the rates of NI. Six of 7 quasi-experimental hospital-based studies showed statistically significant results of decreased NI rates as a result of improved HH practices. Despite this established relationship, compliance with HH among HCWs remains low. A review of 11 studies conducted between 1981 and 1999 noted that the level of compliance with basic HH ranged from 16% to 81%. Of these 11 studies, only 2 noted compliance levels above 50%. These 2 studies reported that the results of the frequency of handwashing before care were 21 (27%) of 79. In addition, Davenport noted that handwashing did not occur before resuming care when health care was interrupted for any reason. Larson et al reported that only 38% of nursing staff washed their hands before performing invasive procedures. Arab countries have very few programs directed toward infection control, and there are no guidelines or regulations that encourage such a service in health care institutions. In Jordan, which is one of the Arab countries, infection control programs are not mandatory in the hospitals. Therefore, the data that describe NIs and factors contributing to NIs in Jordanian hospitals are limited because they are based on very few studies. For example, one study showed that Methicillin-resistant S. aureus infections were isolated from 18 (8.8%) of 205 of patients_ specimens. A prospective study, which was conducted for 3 years between 1993 and 1995, reported that overall infection rates in a Jordanian university hospital were 17.2 per 100 patients in the medical/surgical intensive care unit (ICU), 14.2 to 18.5 per 100 patients in the neurosurgical ICU, and 13.4 to 73.5 per 100 patients in the high-risk nursery. Lack of adherence to HW behavior increased infection rates in those units. Finally, a study published in 2004 showed that during a 1-year period, 26 inpatients at a university hospital in Amman were detected with bacteremia (23 cases) and respiratory tract colonized with Burkholderia cepacia (3 cases). All cases were caused by a single epidemic strain of B. cepacia genomovar iII. It was not possible to determine which aspect of patient care was associated with these NIs. Application of Theory of Planned Behavior and HH The guiding framework for this study was the Theory of Planned Behavior (TPB). This theory specifies that human behavior will, in general, be determined by 3 factors. The first factor is attitude, which includes positive and negative aspects of a specific behavior. The second factor is social influences or the subjective norm. The third factor is perceived behavioral control, which refers to an individual_s belief about his or her ability to perform particular behaviors (Fig. 1). According to TPB, intention to perform or not perform a behavior is the single predictor of a person_s behavior and can be affected by 3 independent variables: attitude, subjective norm, and perceived behavioral control. For example, an individual_s intention to perform physical exercise is affected by his or her attitude toward physical exercise, his or her perception of what significant others would think about exercise, and his or her ORIGINAL ARTICLE 150 www.infectdis.com Infectious Diseases in Clinical Practice & Volume 17, Number 3, May 2009 From the *Schools of Nursing and †Physical Education and Sport Sciences, Hashemite University, Zarqa, Jordan. Reprints: Zeinab M. Hassan, RN, PhD, PO Box 150459, Zarqa 13115, Jordan. E-mail: hassan_zeinab@yahoo.com. Copyright * 2009 by Lippincott Williams & Wilkins ISSN: 1056-9103 9 Copyright @ 200 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. perception of self-ability to perform physical exercise. Intention represents the immediate antecedent to behavior. Subject attitude is a function of an individual_s beliefs that performing the behavior leads to various outcomes. Attitude is affected by an individual_s belief about the consequences of this behavior, which could be positive or negative.15 Attitude is measured either by direct or indirect measures. A direct measure gives an overall evaluation of the behavior. An indirect measure contains behavioral belief and outcome evaluation. Behavioral belief is a belief that behavioral performance is associated with certain outcomes. The term evaluation refers to the value attached to the behavioral outcome. Subjective norm is a perception of social pressures to perform or not perform a behavior in question. It is measured by direct and indirect measures. Direct measure associates an individual_s belief about whether most people approve or disapprove the behavior. An indirect measure includes normative belief and motivation to comply. Normative belief refers to an individual_s belief concerning referent people_s approval or disapproval of the behavior. Motivation to comply measures the motivation to do what each referent thinks is appropriate. According to TPB, perceived behavioral control is determined by control beliefs concerning the presence or absence of facilitators and barriers to perform the behavior. It is weighted by the perceived power to impact each factor of the behavior to facilitate or inhibit it. Perceived behavioral control reflects personal beliefs about how easy or difficult it is to perform the behavior, and it is affected by external and internal factors. External factors are time availability, money, and social support, whereas the internal factors are ability, skills, and information. The Theory of Planned Behavior has been tested with a variety of health behaviors, such as smoking cessation, automobile safety behavior, exercising behavior, clinical and screening behavior, HIV/AIDS-related behavior, and oral hygiene behavior. It successfully predicted intention from perceived behavioral control and attitude (Fig. 1). RESEARCH QUESTIONS 1. What are the relationships between demographic characteristics of Jordanian registered nurses (JRNs) and TPB concepts, such as attitude, subjective norm, perceived behavioral control, intention in ICUs, and medical surgical floor? 2. What are the relationships among TPB concepts? |
| Starting Page | 150 |
| Ending Page | 156 |
| Page Count | 7 |
| File Format | PDF HTM / HTML |
| DOI | 10.1097/ipc.0b013e31818cd65f |
| Volume Number | 17 |
| Alternate Webpage(s) | https://eis.hu.edu.jo/deanshipfiles/pub106182180.pdf |
| Alternate Webpage(s) | https://doi.org/10.1097/ipc.0b013e31818cd65f |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
