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Theory of Planned Behavior & Educational Intervention in Prevention of Healthcare-Associated Infections

Introduction

Although nursing is a field of science, effective application of evidence-based interventions in nursing requires artistic skills and knowledge. Fundamentally, nurses apply scientific skills and knowledge in an artistic manner to enhance the safety and efficacy of their actions in a nursing environment. In this view, nursing theories that focus on social and behavioral aspects of nurses are applicable in nursing. Nursing theorists have come up with numerous sociological and behavioral theories, which elucidate how beliefs, norms, behaviors, and attitudes influence nursing practices. The theory of planned behavior is one of the theories that nurses can apply in the prevention of healthcare-associated infections (HAIs) in the nursing environment. Creedon (2006) asserts that the theory of planned behavior perceives norms, attitudes, beliefs, and behavioral control as some of the social factors that influence behavioral change among healthcare providers, and thus, affect the adoption of nursing practices, which aid in the prevention and control of infections. Hence, the theory of planned behavior is an appropriate nursing theory that nurses need to apply in the prevention of HAIs. Therefore, this essay describes the application of the theory of planned action in enhancing the effectiveness of education programs, which is an intervention that is appropriate in the prevention and control of HAIs in the healthcare environment.

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Healthcare-Associated Infections

The prevalence of HAIs has been increasing in the healthcare environment owing to poor hygienic practices in handwashing and the application of medical devices like catheters, syringes, and ventilators. Sydnor and Perl (2011) report that about 2 million patients in the United States acquire HAIs annually, which results in more than 90,000 deaths per year. Given these statistics, it is evident that HAIs comprise a major health issue that requires effective interventions of nursing. Consequently, HAIs make patients in critical care stay longer than necessary in hospitals because they increase morbidity and reduce the recovery process among patients. Moreover, HAIs increase medical costs because additional costs are essential in the treatment of these infections, and thus place an extra burden on the health care system and families of the patients. According to Sydnor and Perl (2011), HAIs add about 5 billion dollars of medical costs per year. In this view, HAIs comprise a significant health issue that requires an effective intervention, which can reduce morbidity, mortality, and medical costs.

Deprived aseptic conditions in the utilization of devices such as catheters, syringes, and ventilators have contributed to the occurrence of HAIs. Statistics show that about 20% to 32% of patients in a critical care environment are prone to HAIs due to invasive procedures (Sydnor & Perl, 2011). This implies that critical care nurses should be sensitive to HAIs in the critical care environment because the nature of invasive procedures that patients undergo determines their susceptibility to HAIs. Medical devices such as catheters, syringes, and ventilators provide routes through which pathogens enter the body and cause diseases. Creedon (2006) states that common routes through which transmission of HAIs occur are direct contact, droplet, and airborne. In this view, maintenance of hygiene using methods such as hand washing, sterilization of medical devices and surfaces, and wearing of gloves, masks, and protective clothing determine the incidences of HAIs in a healthcare environment.

Despite the availability of evidence-based practices, nurses have partially adopted and applied these practices in the prevention of HAIs. Poor hygienic conditions in nursing practices that involve the use of catheters, syringes, and ventilators, and improper utilization of antiseptics contribute significantly to the occurrence of HAIs in the healthcare environment (Allegranzi & Pittet, 2009). Hence, there is low compliance with evidence-based practices in the prevention of HAIs in the healthcare environment, particularly the critical care environment. Majid, Foo, and Mokhtar (2011) assert that poor compliance with evidence-based practices is the main cause of HAIs in the critical care environment. Since the incidences of HAIs are increasing in the healthcare environment, the interventions should focus on enabling nurses to apply evidence-based practices because they are effective in the prevention of these infections.

Planned Intervention

The planned intervention involves the education of nurses about the application of evidence-based practices in nursing care. Strict adherence to hygienic conditions and aseptic techniques is central to the prevention of HAIs. According to Safdar and Abda (2008), education is an effective intervention in the prevention of HAIs since it enhances the acquisition of knowledge and skills among nurses, and thus, enables them to adopt and apply evidence-based practices. Education is an appropriate intervention since it empowers nurses to adopt and apply evidence-based interventions in the prevention of HAIs. Nursing practices have relied on assumptions, opinions, and hypotheses, which have contributed to the high incidences of HAIs in the critical care environment (Sydnor & Perl, 2011). In this view, it implies that nurses need to update their knowledge and skills regarding nursing practices that are crucial in the prevention and control of HAIs in the healthcare environment. Therefore, since nursing practices depend on the emergence of evidence-based practices, nurses should adopt and apply these practices in the prevention and control of HAIs, as they threaten the lives of patients in the critical care environment.

In the prevention and control of HAIs, hand hygiene is imperative. Despite the fact that hand hygiene is effective in the prevention and control of HAIs, compliance among nurses has been low. Poor hand hygiene promotes the transmission of HAIs from one surface to another, and thus negates the effectiveness of antiseptics. Evidence-based practices that focus on hand hygiene have emerged over time and have proved to be reliable in the prevention of HAIs in a nursing environment (Majid, Foo, & Mokhtar, 2011). The combination of hand washing techniques such as the use of antimicrobial soaps and antiseptic-based hand rubs is effective in the prevention and control of HAIs because it removes pathogens from the surfaces of the hands (Allegranzi & Pittet, 2009). However, various antimicrobial soaps and antiseptic-based hand rubs have different efficacies, and thus make handwashing a challenging intervention in the prevention and control of HAIs. Allegranzi and Pittet (2009) state that the use of alcohol-based hand rubs, as a gold standard without hand hygiene, is not effective in the prevention and control of HAIs because some pathogens are resistant. This means that physical washing of hands using soap and water is essential since mechanical friction removes pathogens from contaminated hands. Thus, education is critical for nurses to understand the efficacies of different interventions, which relate to the handwashing and application of antibiotics.

Moreover, the use of medical devices such as syringes, catheters, central lines, ventilators predisposes patients to HAIs. Nurses should understand aseptic techniques that prevent contamination of these medical devices. Furthermore, nurses should have essential knowledge and skills, which enable them to maintain these devices in aseptic conditions throughout the period of care. Impregnation of medical devices with antiseptics and sterilization of medical equipment is necessary to eliminate pathogens and protect patients from HAIs. In a study, Creedon (2006) states that about 39% of nurses are likely to use contaminated medical devices such as catheters if they receive instruction to catheterize a patient, while 22% can use them voluntarily. These findings show that compliance with aseptic techniques is wanting among nurses. Since medical devices create routes through which pathogens enter the body, their poor maintenance increases the risks of HAIs. Thus, nurses need to understand evidence-based strategies and procedures that are effective in the prevention of HAIs. In this view, the education of nurses is an appropriate intervention for preventing and controlling HAIs because it promotes aseptic techniques of using medical devices and maintaining their hygiene.

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Theoretical Model

The prevention and control of HAIs require the application of a nursing theory, which provides a nursing framework. In the prevention and control of HAIs, the appropriate theory is the theory of planned behavior. The theory holds that beliefs, attitudes, norms, and behavioral intentions influence human behavior in a predictable manner. According to Creedon (2006), as compliance with medical practices and guidelines is an issue in a healthcare environment, the level of compliance is dependent on the attitudes, social norms, behavioral intentions, and beliefs of healthcare providers. In this view, it implies that nurses should have attitudes, social norms, behavioral intentions, and beliefs of preventing and controlling HAIs in the critical care environment. The theory of planned behavior provides an appropriate framework of influencing attitudes, norms, beliefs, and behavioral intentions with a view of promoting a given change in a nursing environment. Grol, Bosch, Hulscher, Eccles, and Wensing (2007) state the theory of planned behavior emphasizes attitudes, norms, perceptions, and beliefs, which are the motivating factors that shape human behavior. Thus, the education of nurses regarding the prevention and control of HAIs aims at motivating them to adopt and apply evidence-based interventions.

Education of nurses, as an intervention of preventing and controlling HAIs, relies on the theory of planned behavior in encouraging nurses to adopt and apply evidence-based interventions. Although hand hygiene is an intervention that is applicable in the prevention and control of HAIs, compliance is an issue. In this case, the application of the theory of planned behavior in the education of nurses aims at changing attitudes, beliefs, norms, perceptions, and behavioral intentions of nurses so that they can adapt and apply effective hand washing techniques. Grol et al. (2007) argue that the expected outcomes and their appraisal determine the attitudes, perceptions, and beliefs, which nurses relate to certain behaviors. Therefore, education of nurses would provide positive outcomes associated with preventive interventions for nurses to develop favorable norms, beliefs, attitudes, and behavioral intentions that enhance the adoption of handwashing, aseptic techniques, and maintenance of medical devices such as syringes, catheters, ventilators, and central lines.

Theoretically, the adoption and application of diverse interventions in the prevention of HAIs are dependent on perceived control, subjective norms, dominant beliefs, and desired outcomes. Perceived control influences the behavior of nurses because they would perceive that they have to adhere to the interventions of preventing and controlling HAIs as their core obligation. Likewise, subjective norms and dominant beliefs influence the behavior of nurses because norms and beliefs compel them to adhere to the available preventive measures of HAIs. In this context, the education of nurses is imperative since it transforms their beliefs and norms and makes them subjects to the same norms and beliefs. Allegranzi and Pittet (2009) assert that educational programs do not only improve knowledge and skills among nurses, but also shape norms, beliefs, attitudes, and perceptions that promote compliance among nurses. Thus, the theory of planned behavior provides a framework that enhances the effectiveness of education in transforming attitudes, norms, perceptions, and beliefs; and hence, promotes the adoption and application of evidence-based interventions in the prevention of HAIs.

Outcomes

Since the education of nurses concerning the prevention and control of HAIs is an appropriate intervention, assessment of measurable outcomes is essential. One of the outcomes that would be evident is the handwashing behavior among nurses. Hand washing is a basic intervention that nurses need to adopt and apply in the prevention and control of HAIs in a healthcare environment (Allegranzi & Pittet, 2009). As education would enhance knowledge and skills of hand hygiene, it would enable nurses to apply evidence-based practices, which relate to hand washing. The compliance with handwashing guidelines is dependent on the knowledge, skills, attitudes, beliefs, and social norms that nurses hold (Creedon, 2006). Hence, the attitudes, beliefs, skills, and knowledge in nurses uphold regarding the prevention and control of HAIs reflect the educational outcomes among nurses. Thus, adherence to handwashing guidelines is the ultimate outcome that depicts the impact of education on the prevention and control of HAIs among nurses in various healthcare environments.

Another important outcome of the education is how nurses apply aseptic techniques when handling medical devices such as syringes, central lines, catheters, and ventilators. Ample evidence shows that poor utilization of aseptic techniques is the major cause of HAIs in the healthcare environment (Majid, Foo, & Mokhtar, 2011; Sydnor & Perl, 2011). In this case, the aseptic techniques that nurses would employ following the educational intervention provide the outcomes. The education of nurses about the prevention and control of HAIs would enable nurses to acquire knowledge and skills in handling medical devices under aseptic conditions. Given that pathogens enter into the human body through routes created by the syringes, ventilators, central lines, and catheters, aseptic techniques eliminate pathogens and thus prevent them from entering into the human body and causing HAIs. Hence, educational intervention would enable nurses to acquire advanced knowledge and skills, and consequently, change their attitudes, beliefs, norms, and perceptions regarding the use of aseptic techniques. According to Grol et al. (2007), the behavioral intentions of humans are subject to the beliefs, social norms, attitudes, and perceptions that they uphold. Therefore, beliefs, social norms, attitudes, and perceptions depict outcomes of educational intervention and form the basis of assessing the capacity of nurses to prevent and control HAIs using evidence-based practices of aseptic techniques.

Conclusion

The existence of HAIs is a health issue that is common in a critical care environment due to the use of invasive medical procedures such as catheterization and cannulation. Given that about 30% of patients in the intensive care unit are prone to HAIs, it is imperative to prevent and control these infections. Thus, the appropriate intervention is the education of nurses so that they can acquire evidence-based knowledge and skills. From the theoretical perspective, the appropriate theoretical model that provides a framework for the educational intervention is the theory of planned behavior. This theory is important in nursing because it depicts the relationships that exist between attitudes, beliefs, perceptions, and norms on one hand and human behavior on the other hand. Since the educational intervention coupled with the theory of planned behavior are effective in the prevention and control of HAIs, compliance with handwashing guidelines and utilization of aseptic techniques are major outcomes.

References

Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73(1), 305-315.

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Creedon, S. (2006). Infection a control: Behavioral issues for healthcare workers. Clinical Governance, 11(4), 316-325.

Grol, R., Bosch, M., Hulscher, M., Eccles, M., & Wensing, M. (2007). Planning and studying improvement in patient care: The use of theoretical perspectives. The Milbank Quarterly, 85(1), 93-138.

Majid, S., Foo, S., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision-making: Nurses’ perceptions, knowledge, and barriers. Journal of Medical Library Association, 99(3), 229-236.

Safdar, N., & Abda, C. (2008). Educational interventions for prevention of healthcare-associated infection: A systematic review. Critical Care Medicine, 36(3), 933-940.

Sydnor, E., & Perl, T. (2011). Hospital epidemiology and infection control in acute-care settings. Clinical Microbiology Reviews, 24(1), 141-173.

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StudyCorgi. 2022. "Theory of Planned Behavior & Educational Intervention in Prevention of Healthcare-Associated Infections." July 21, 2022. https://studycorgi.com/theory-of-planned-behavior-and-amp-educational-intervention-in-prevention-of-healthcare-associated-infections/.

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