Factors Affecting Perception of Students on Hand Hygiene - Assignment Example

HAND HYGIENE CRITIQUING AN ARTICLE USING QUALITATIVE TECHNIQUE [Insert al Affiliation] Introduction The nursing profession has recently attracted many scholars primarily driven by the desire to ensure that nurses, clients and patients benefit from the continuously advancing nursing care and technology. The development of quality nursing care and health practices is overly dependent on research, a more reason why many evidence and trustworthy on various issues has been sorted (Burns & Grove, 2007). What’s more, the making of professional decisions regarding patient care relies on research. Various evidential researches that have often been perceived as a seminal moment in the nursing field has been published; Karen Lee’s article “student and infection prevention and control nurses’ hand hygiene decision making in stimulated clinical scenarios and the use of hand washing, gel and glove” is one such articles. This paper shall candidly and comprehensively critique the aforementioned article. Firstly, research critique is an informed stepwise process of carefully and objectively gauging the weaknesses and strengths of a particular study with the particular motive of improving the research skills by effecting changes in the critiqued or apparently wrong or weak areas or sections. While there are many frameworks used in critiquing a research, this paper critiques Lee’s article using the step-by-step guide posited by Patricia Cronin, Michael Coughlan, and Frances Ryan (2007). A critique of the research To begin with, the title of a research should be precise, 15-20 words, contain key terminologies in the pertinent field, arouse curiosity and interest while attracting the readers’ attention. While the title of Lee’s research strives to be objective, Lee ends up with an excessively long title, 27 words, that is more general and lacking details as it simply mentions controlling of infections through hand hygiene in nurses and students. Shortening the title and adding more terminologies that will ground it in the nursing field will create a more professional look and make the article quite enlightening without the need to go into finer details in the body of the research (LoBiondo-Wood & Haber, 2006). The author’s professional and academic qualification significantly determines their ability to deliver in a given field. Polit and Berk (2009) assert that the author’s attained domain, integrity and professional be reflected in a research article. Lee meets this threshold as he has an apposite academic, and proficient qualification in the nursing field having taught in a medicine school for 30 years. The article’s credibility, quality, and acceptability was broadened through various reviews before it was finally approved for publication on March 10th 2013. The author’s contact information such as email are also provided in the article to increase the easy and efficiency of addressing any concerns that might be raised by subsequent assessors. Additionally, Cargill and O’Connor (2011) posit that the abstract or summary should have the list of aim, main results, conclusion, using simple, factual, numbered statements, having the final point synthesized and emphasized with keywords of the main article and its general importance, should specify clearly how the chosen topic has highly developed environmental understanding. Apart from communicating, it should also be interesting as well as pinpoint the importance of the article to the larger professional community to maximize the impact on the reader. These assertions are bolstered by Glasman-Deal (2010) who maintains that the abstract must not encourage the readers, but must provide a transitory preview to expedite continuity of reading. Considering Newell and Burnard (2011) who posit that the abstract needs to describe various aspects of the study including sample, methods used in collection and analysis of data, findings, conclusions and recommendations, Lee’s abstract can be considered a success. The purpose of the article was identified as trying to understand the factors nurses take into consideration in selecting a decontamination technique or to wear gloves. The use of a qualitative research design was stated, recording nurses verbalizing their hand hygiene decision-making, the use of grounded theory entailing semi structured interviews was also highlighted (Lee, 2013). The reader was as well briefed on research findings (Hek & Moule, 2006). However, while it contained all this information, the abstract left out some more finer details to ensure that clinical care decisions are not made by merely reading the abstract thus complying with Macnee and McCabe (2008) suggestion that the abstract should only be helpful in providing a vivid understanding of the research, but should not provide enough details for making clinical decisions. Thomas, Nelson and Silverman (2010) suggest that for the research problems to be well-developed, the must have read and comprehended existing publications about the problem since a myriad of researchers might have already explored the problem and published information that might be of interest and beneficial to the current study. A review of literature identifies knowledge gaps, giving the researcher the ability to reason inductively and synthesize information relevant to the topic (Price, 2009). It further helps the researcher to develop an explanation or theory to account for a certain phenomenon (Kirby, Greaves & Reid, 2006). Lee undertook a fundamental literature review that meets the philosophical underpinnings of a study in the nursing field, identifies the weaknesses of previous studies, findings and how they inform his study. Moreover, sources are adeptly acknowledged using the correct APA style (Timmins & McCabe, 2005; Lahlafi, 2007). However, some of the resources reviewed are journals, articles, and which seemingly do not have adequate information regarding the research title considering the titles of the books. However, the use of updated sources and scientific language in the review is laudable. A qualitative research does not often include a research hypothesis but instead includes aims of the study according to (2011). Lee abides by this. He does not include a research hypothesis but instead includes the aims which he undoubtedly states as “to record participants verbalizing their hand hygiene decision-making while working through clinical scenarios on a computer to understand what factors they were taking into account in choosing a hand decontamination method and/or to wear gloves” (Lee, 2013). However, Lee’s aim can be considered to be too long. The aim of a research should be stated and explained specifically without making it too diminutive or overly elongated (Munhall, 2011). Kothari (2008) defines research methodology as the method and logical way of carrying out scientific research and provides answers to the research problems. Polit and Beck (2006) further clarify this by indicating that with research, the researcher has to specify clearly and precisely what methodology is selected, the reason for selection, so that it can be evaluated by him or herself or by others. It should state how the problem was defined, in what ways and why the hypothesis was formulated, what data was collected and what particular method was adopted, why particular technique of analyzing data was used and a host of similar other questions are usually answered. Methodology for Lee’s research was identified as qualitative research design using a grounded theory with the rationale to draw out and explore nurses’ attitudes surrounding the topic “hand washing hygiene and factors influencing selection of a decontaminant” (Lee, 2013). It is defensible that qualitative research approach was utilized with tangible guidelines on how to advance an empirical-based theory were provided (Newell & Burnard, 2006). Holland and Ress (2010) hold that this could potentially be obtained through collection of qualitative data through interviews, making observations, analyzing, testing of theories and categorization of findings in a methodical manner before arriving at the conclusions. In conducting an in-depth research and exploring human behaviours, explanatory qualitative designs are the best. This research method used by Lee is appropriate to the aim as it was set out to explore student nurses perceptions, which is explored through in-depth interviews about human behaviour (Crowther & Lancaster, 2008). Nonetheless, there could be the influence of researcher bias as both the researchers were nurses and could of screw the results. Moreover, their professional opinion might have influenced how they interpreted the data as well as shifting the ultimate deduction. The method enabled Lee to extensively explain and illustrate the philosophical bedrocks of his study. Similarly, the method allowed Lee to use Barrett and Randle (2008 1851-1857) Journal of Clinical nursing which focuses on the perceptions held by nursing students regarding hand hygiene practices in clinical settings. The study recommended that increasing compliance is the best method of reducing the continuously rising cases of HCAIs (healthcare-associated infections). Lee further used convenience sampling by approaching nursing students in lecture halls. This method of sampling is where the researcher selects a sample based on availability (Marshall, 1996). However, sampling based on accessibility has the major drawback; bias and special characteristics of the selected sample may lead to lack of credibility and validity hence findings not generalizable (Immy & Stephanie, 2009). Use of this method, however, helped Lee in minimizing the social desirability outcome, saving time and cost of the research hence is still praiseworthy, although future researchers must be keen to ensure the convenience sampling does not compromise the credibility and validity of the data. A researcher needs to use a sample size that effectively portrays diversity and inclusion. Lees sample of 22 participants (pre-registration nursing students). However, since the scholar required undertaking an exhaustive study of the perceptions of nursing students, the small sample was proper. Lee strived to attain consistency, validity, and representation in the sample by taking students from all subdivisions of nursing; children, adult, and mental health (Ely& Scott, 2007). Moreover, the target population is not declared by Lee, a factor that makes it more problematic to tell whether Lee’s research can be indiscriminate at all. The vagueness of the sample is also furthered by the researchers’ failure to indicate the sex and age of the pre-registration nursing students as well as their age. While he significantly tries to state the age of the participants, 5 students were under 25 years, 3 were in the 26-35 age bracket, and 3 were aged between 36 and 46, provision of the specific ages is necessary as age significantly affects the results (Brooker & Waugh, 2007). In Lee’s article, ethical considerations were satisfactorily recognized and addressed. The researchers sent letters of consent to pre-registration nursing students and all participants to ask them to participate (Lee, 2013). The letters also contained information on how the interview will be conducted, information sheets, how they were required to help, as well as how the researcher will handle and report the information. In Lee’s article, the anonymity, confidentiality, and participants rights are upheld. The ethical consent was approved by the UREC (university research ethics committee) (Lee, 2013). We must acclaim the researchers’ decision to interview participants individually and assign each of them a study number. This is among the best practices in conducting research and Lee portrays a proper understanding of the same. Interviews were used to collect data, however the setting of the interviews is not known. The setting could have an influence as it may influence the answers of the nurses if is set in an hospital setting as they may be more aware of hand hygiene and may feel less relaxed to provide their true opinions which could invalidate the research (Sackett et al., 2000). The use of open-ended questions in the semi-structured interview gives the researcher an inordinate advantage of probing the interviewee further after they respond to the first question (Dearnley,2005). This provides a high level of in-depth qualitative information ensuring all the possible answers given in the interview provide suitable findings that can be used in the research. These interviews were audio-taped for data analysis where the data was then transcribed and coded and re-analyzed until no new themes were identified. Recording the interview is important as it allows the researcher to analyze verbatim. This means that nothing can be missed out and allowing the researcher to concentrate on the content of the interview and not have to make notes during the process (Whiting, 2008). However, it isn’t clearly explicated whether notes were made about the interviewee’s non-verbal communications. Understanding the interviewees’ non-verbal cues is important as it helps in analyzing the findings and context of the research. According to Parahoo (2006), the themes acknowledged during the data analysis phase should be melted down to abandon the less imperative ones while building the strong ones. In Lee’s research, it is not evident what themes were discarded and the ones that were kept and the degree of certainty and credibility of the process. In the research, there does not seem to be strenuous checks to ensure validity. Even though the data was analysed and re-analysed until no themes could be identified, there are other methods which could be employed to ensure credibility. One method which could have been used to ensure validity is to send the themes to the interviewees during the analysis to see if the key issues have been identified. However, Lee supports his themes by including direct quotations from the interviews. This bolsters the explication that he offers in an effort to advance the themes, and broadens the readers understanding of the themes and the students’ perceptions on hand hygiene. Lee’s decision to use nurses in data collection and analysis is questionable. The nurses, whose professional ethics is debatable, might have shifted the data to obtain the results they desired. The phrasing of the questions could also have been made in a way that would trigger the interviewees to respond in a given way as the nurses strived to obtain the answers they desired (Jackson, 2010). Elimination of researcher bias was necessary. One way that would have ensured no researcher bias would have been to employ an independent person to analyze the data and then compare notes later (Lester, 1999; Parahoo, 2006). There are no qualms regarding the trustworthiness/rigour of Lee’s study. It considers all ethical issues. Moreover, it was certified by “The medical school ethical committee” (Lee, 2013). Holloway (2009) pinpoints that ethical controls are imperative in qualitative studies as they allow the researcher to build a strong relationship with the participants, thus making the participants to open-up. Despite this, the study’s rigour could be ameliorated through triangulation which predominantly tests the internal cogency of the research findings by using several data collection methods (Popay, Williams & Rogers, 1998). While triangulation would have brought difficulty in comparison of data, the researchers should have hold group interviews and the records reviewed by autonomous external parties. What’s more, rigour is concerned with transferability which connotes the applicability of the findings to a different group in a similar context. In the study, transferability is lacking as the sampling method used, convenience sampling, resulted in small samples which are hardly representative. An Extra fact to contemplate in analysing the study is the Hawthorne effect that might have emerged in the interview process. While it is not clear, the students might have altered some aspects of their behaviour as they knew that they were being studied (Alkemi, 2012). The author, Lee, does not indicate whether the Hawthorne effect took place at all so it is prudent to leave it at that. Lee’s study could have been improved through audit trailing. According to Lincoln (1995), this is where a record describing the research steps that the researcher took from the start of the research to the attainment of findings is kept. Moreover, the records act as a reference and easily signals when the investigator diverges from the preliminary protocol. Since audit trails are not provided in Lee’s study, the researchers might have digressed from the starting protocol, a factor that might have conceded the internal legitimacy. Lee’s article presents the idea that there are various factors affecting students’ perceptions on hand hygiene. It further provides recommendations that would help in ensuring that more nurses and students conform to hand hygiene conventions. According to the research, nurses think that lack of time was a major reason why nurses failed to comply with hand hygiene procedures. Moreover, the findings indicate that most nurses believe it is superfluous to follow hand hygiene measures in tasks that are perceived as being rather ‘light’ and less risky (Lee, 2013). Other researchers have shown that gloves often substitute hand hygiene. Lee’s study does not offer a profound analysis of this. Another factor found was that nurses “fitting in” also effect hand hygiene practices and students identified saying that they wanted to fit in as part of a team. It’s suggested that doing this will be easier and stops the fear of retaliation. However, this is a point that has not been evaluated by the researchers, participants may not have given their true viewpoints leading to the findings being inaccurate (Beecroft, Rees & Booth, 2006; White, 2005). This is a concern as hand hygiene should be known to help the care of the patient and to prevent infections. Moreover, the study fails to provide a clear answer to the factors that affect compliance of student hand hygiene which is shown in the research by several factors acknowledged. It is unmanageable to define a solitary cause, and this makes it more challenging to make endorsements of how to increase hand hygiene compliance. As hand hygiene is an essential in providing high quality care to all patients, this research could be applicable in many different health professions (Heneghan & Badenoch, 2002). In applying the results, it could be possible that patients are at risk and could likely get infections, therefore, it is important to carefully consider views given by the participants. This will, consequently, maximize patient healthcare (Williams & Hywel, 2003; Garrard, 2010). Noteworthy, the fact that is the perception of individuals means that every person will have dissimilar outlooks, hence different compliance rates (Williams, 2003). The researcher should have admitted that attaining complete acquiescence is impossible, and indicate how these differences can be contained in improving health care and quality of life. The above elucidation candidly and comprehensively indicates that various researchers are unremittingly exploring various aspects in the nursing and care management field. However, findings from the study may not be meaningful due to lack of validity and transferability. While Lee’s research design was significantly appropriate, his sample was too small and not representative. The interview processes and the data analysis phases might as well been affected by researcher bias as the nurses envisioned some kind of results that would not defy conventionality. This paper has proposed some changes that need to be implemented in future studies if researchers need to acquire findings that will be valid, accurate, and dependable. Reference List Alkemi R. 2012. Keyword Research for Search Engine Optimization.Http//www.redalkemi.com/articles/keyword.research-article.php Barrett, R., Randle, J. 2008 1851-1857 Hand hygiene practices: Nursing students’ perceptions. Journal of Clinical Nursing Dearnley Improving Health Through Nursing Research. Beecroft, C., Rees, A. and Booth, A. 2006. Finding the evidence. In: Gerrish K,Lacey A, eds. 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