The role of patient involvement in the promotion of hand hygiene among nurses in the hospital setting

Aim: To understand the role of patient involvement in the promotion of hand hygiene among nurses in the hospital setting. Methods: This qualitative PhD thesis is comprised of two studies; focus group discussions with nurses and interviews with patients. In the first study, focus group discussions (n = 7) were completed with nurses from Jordan and the UK (n=36) to explore nurses’ views and experiences with patient involvement in hand hygiene. Data from nurses were analysed using thematic analysis. In the second study, semi-structured telephone interviews were completed with patients from Jordan (n = 21) to understand their experiences of asking nurses to wash their hands. Data from patients were analysed by critical incident analysis resulting in the identification and analysis of 116 critical incidents. Results: The analysis of the focus group and critical incident discussions resulted in four overarching themes. Although both nurses and patients acknowledged the patients’ right to ask, both groups reported concerns that asking about hand hygiene could have an adverse impact on the nurse-patient relationship. Patients reported that the promotion of hand hygiene was not only offensive and upsetting for nurses, but also embarrassing for patients. Patients reported negative reactions from nurses when promoting handwashing, and these encounters became stressful and confrontational though both groups indicated that this could be mediated if the patient asked in the ‘right way’. It is not clear what the ‘right way’ might be. Discussion: Patients are likely to encounter confrontation if they prompt hand hygiene unless they do so in the ‘right way’. Patients seem to be discouraged from taking an active role in their care and this needs to be considered when planning patient involvement strategies. Conclusion: Findings from this study show that patients are expected to be passive, grateful and remain silent when observing noncompliance to hand hygiene practices among nurses. It could be that hospitals have not predicated the negative encounters or else they would not encourage patients to remind nurses to wash their hands. Therefore, more work needs to be done to ensure that patients can speak out and raise concerns without fearing the negative consequences when asking nurses to wash their hands. Nurses suggested a need for a new hospital culture of patient involvement in ensuring patient safety through the promotion of hand hygiene compliance