The patient experience of partnering with healthcare professionals for hand hygiene compliance: a systematic review of qualitative literature

Background Healthcare associated infections pose a significant risk to patients in acute healthcare settings such as hospitals. Increasingly patients are encouraged to be active participants and to partner with healthcare professionals to positively influence their own safety and overall experience throughout their healthcare journey. Patient focused safety initiatives include the empowerment of patients to be active partners with healthcare professionals to influence the hand hygiene behaviors and compliance of the healthcare professionals providing care to them. Partnering between the patient and healthcare professional within the healthcare context can be considered a general concept involving the empowerment of patients to participate in their care. Terms used to describe patient partnering within healthcare vary and include patient participation, patient centeredness, patient empowerment and patient engagement. Although patients generally appear to have positive attitudes and intentions about engaging in their safety and partnering in the healthcare setting, their intentions and actual behaviors vary considerably. Patients appear less likely to engage in behaviors that require questioning of the perceived or real authority of healthcare professionals. A patient’s intention and subsequent act of partnering with healthcare professionals for hand hygiene compliance by the healthcare professional is influenced by complex internal, external and social factors as well as cultural, behavioral and systematic factors. Objectives To identify and synthesize the best available evidence in relation to the experiences of the patient partnering with healthcare professionals in hand hygiene compliance. To explore the question: What is the experience of partnership between healthcare professionals (doctors and nurses) and patients in relation to hand hygiene compliance in the acute adult hospital setting? Design A systematic review of qualitative evidence using the Joanna Briggs Institute metaaggregative approach to qualitative evidence synthesis. Inclusion criteria Participants This review considered qualitative (critical or interpretive) papers that included adult inpatients and healthcare professionals, defined as a healthcare worker being a doctor or nurse in the acute hospital care setting. Adult was defined as any person aged 18 years or older. It should be noted that consumers in this context are patients and visa versa; the term patient is therefore used throughout this report for consistency. Phenomena of interest This review considered studies that investigated the experience of partnership between patients and healthcare professionals in relation to hand hygiene compliance. This review investigated the phenomena of partnering from the perspective of both the patient and the healthcare professional. The phenomenon of interest was the patient’s partnering experience with healthcare professionals within the adult acute healthcare setting and the influence of the associated behaviors and cultures that influence this experience. Context This review considered studies that investigated the experience of partnering between patients and healthcare professionals in hand hygiene compliance in the adult acute healthcare setting. Studies This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. As qualitative studies were identified and on appraisal found to be of sufficient quality for inclusion, this review did not seek alternate forms of evidence such as text and opinion. Search strategy The search strategy aimed to find both published and unpublished studies from 1990 to May 2015. Studies published in English were considered for inclusion in this review. Methodological quality Qualitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data extraction Qualitative data was extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data synthesis Qualitative research findings were pooled using the Qualitative Assessment and Review Instrument. This involved the aggregation and synthesis of findings to generate categories, which then underwent meta-synthesis to produce synthesized findings. The synthesized findings then were used to provide an evidence base to generate implications for practice and research. Results Following the systematic search and critical appraisal process, three studies were included in the review for data extraction and synthesis of findings. The review process resulted in 29 study findings that were aggregated into seven categories. The categories generated two meta-synthesized findings. The two final synthesized findings are as follows: Synthesized finding 1: Organizational structures enable partnering between healthcare professionals and patients for hand hygiene compliance; however the cultures, beliefs and behaviors of healthcare professionals and patients do not fully support this partnership. Synthesized finding 2: Patients have differing levels of knowledge and balance partnering in hand hygiene against its possible detrimental impact on the caring relationship provided by healthcare professionals, out of concern for their wellbeing, health outcomes, treatment and or recovery. Rating of synthesized findings – ConQual Recommendations from the systematic review findings presented in this thesis are derived from a list of study findings with illustrations. The recommendations from the findings have been subjected to the ConQual process to establish confidence in their strength and meaningfulness. Conclusions This review highlights the complexity of the patient experience of partnering with healthcare professionals for hand hygiene compliance. The experiences reported indicated that there is a disparity between the intent and promotion of partnering for hand hygiene compliance within healthcare facilities and healthcare professionals, and the actual patient’s acceptance, participation, partnership and experience, and the implementation of this initiative. This disconnect between intent and action appears to be influenced by a number of factors including organizational structures as well as drivers such as cultural beliefs and behavior. Implications for practice Recognizing the unique objective and subjective needs of and influencers on patients’ and healthcare professionals’ hand hygiene partnering experiences in the acute hospital setting is vital to improving the journey, pathways, facilitators, barriers and interactions of these individuals and groups. Implications for research Further qualitative studies should be undertaken in the area of partnering for hand hygiene in the acute care setting, both from the patients’ and healthcare professionals’ perspectives. Research should include seeking to understand patient confidence levels and barriers and facilitators that affect patient intention and actions to partner for hand hygiene in the acute healthcare setting.Thesis (MClinSc.) -- University of Adelaide, Joanna Briggs Institute, 201