Hand Hygiene among Healthcare Workers in Saudi Arabia - Research Paper Example

Study design Overview of the study A research methodology is usually established to inform the process of an investigation or an enquiry. Ranjit (2005) defines research methodology as a systematic enquiry to develop new knowledge or to find solutions to an existing problem. Scientists such as Creswell (2009) emphasise the importance of an accurate and detailed methodology in the validity and acceptability of a research. A research methodology is developed based on the researchers philosophical stance and knowledge of the subject being studied (Bowen, Rowlins & Martin, 2010). Researchers have diverging perspectives on accuracy, reliability, validity and acceptability of research methodology; hence, the existence of various methods of conducting research. It is, therefore, understandable that philosophy transverses research methodology to question the underlying technique. Philosophy, therefore, guarantees the validity of a research study by criticising the data collection process, analysis, and reporting. A research design is a conceptual structure for conducting research to ensure that the empirical data connects to the initial research questions of the study (Bhattacharyya, 2006, p. 40). According to Yin (2009, p. 27), a research design is a workplan that ensures that the evidence from the research addresses the research questions. The purpose of a research design, therefore, is to provide the researcher with a benchmark for effective deduction of conclusions. This kind of a rational process is obtained from the research philosophies applied in the selection of a suitable research methodology. This research study will employ qualitative study design. Qualitative method is interchangeably used with other terminologies such as post-positivistic naturalistic, subjective, and ethnographic. It is a study intended to create a conception of human systems whether small such as healthcare workers’ use of technology or large as a cultural system including hand hygiene. Qualitative research studies usually range from general descriptive studies to case studies and ethnographies (Savenye and Robinson, 2005). They are conducted in natural settings free from any manipulation by the researcher. Thus, qualitative research responds to the research question through a detailed, rich account of human views and actions. It is informed by the belief that humans are the creators of their reality based on their understanding of the convictions they have in their actions. The study evolves, which may affect the initial research questions because the researcher’s intention is to answer the research question without creating a bias by narrowly focusing the investigation. Hence, the researcher partakes passively in the study. The research is supposed to be open to perceptions, views and world views of the subjects in order to derive and explanation behind such cultures (Savenye and Robinson, 2005). The unique study settings affect the study findings generalization and thus they may be limited to the site where they were collected. In research, philosophy is a multi-fold grouping that includes pragmatic, positivists, participatory, and social constructivist (Wu, 2014). Considering the subject of thus research, which is hand hygiene compliance among healthcare workers, the research methodology is aligned to the comprehension of respondents, evidence, reality, practicality, and ethnography. Hence, this study will be directed by the philosophical framework of epistemological views of ontology of positivist empiricism, realism, and pragmatism. This philosophical framework requires that reality be considered objectively in a direct manner, and truth should always override human subjectivity (Wu, 2014). Subsequently, this study will be approached based on truth reinforced by evidence that is adequately acquired and analysed. People have traditions, beliefs and traits that are aligned to their culture. As such, it justifies the reason why compliance in developed countries is estimated at 40% while in developing countries is significantly low estimated at 2.1% (Schmitz et al., 2014). Consequently, it is important to comprehend this perspective for a realistic and practical outcome of the study. However, realism is founded on the view that knowledge is a fundamental factor in the comprehension of truth in a study phenomenon. This is because truth can only be substantiated when there is adequate knowledge on the subject under enquiry. This ideology will guide the research on healthcare workers’ compliance to hand hygiene in Saudi Arabia through mining knowledge from sets of empirical processes. Qualitative research involves social interactions, observation of behaviours and perceptions that exist within these social groups. Thus, ethnography was identified as the best research approach for this study. Ethnography has the ability to immerse the researcher in the lives of participants so as to develop a deeper understanding of what the respondents are doing as well as what they say they are doing (Reeves, Kuper and Hodeges, 2008). As this study seeks to investigate the behaviours, views, and culture of nursing staff in Saudi Arabia, ethnography will be useful in accounting for descriptive and interpretive observations. Sample Sampling is the process of selecting representative part of a group so as so determine the group characteristics (Gentles, Charles, Ploeg, & McKibbon, 2015). The data will be collected from the nurses employed at hospital at Al-Albaha city using random sampling. A carefully selected sample will ensure data representative of the nursing population in Saudi Arabia. This study will use non-probable and purposive sampling. When using non-probability sampling, the researcher uses his/her discretion to identify subjects to take part in the study (Cresswell & Plano, 2011). The rationale for choosing this method is that the study requires nurses to provide their views on hand hygiene, which they would do using their experience. Thus, only nurses who are eligible will be used for the study. Purposive sampling is advantageous because it is useful when resources are limited; it selects subjects with experience and knowledge of the subject matter; and the subjects are able to communicate their views and experiences in an expressive, reflective, and articulate manner (Palinkas, et al., 2015). However, the non-probability nature of this technique means that it can be difficult to justify the representativeness of the sample and it is also prone to bias (Palinkas, et al., 2015). Study population is the source of the study sample normally referred to respondents or participants. This study will focus on nurses who are important medical professionals and should practice good hand hygiene within hospitals in order to prevent hospital-associated infections. This group was chosen because nurses are the majority of healthcare workers in any hospital facility. Secondly, they are mostly involved in handling patients right from admission, assessment, care and even discharge and follow ups. Thirdly, it would be good to have a clear picture of how nurses practice hand hygiene in the chosen hospital in order to put measures or intervention in addressing the issue specific to the target group (Avwokeni, 2006). In designing a study, it is important to use an appropriate sample size for ethical and methodological reasons, as well as for financial and human resources (Faber & Fonseca, 2014). Monette et al. (2011) posit that a researcher, when confronted by constraints that could lead to inadequate sample size, should report both the sample size and the appropriate ample size in the final report. In most cases, these constraints include factors such as personnel, budget, and time. This research will use a sample size of 40 respondents. The researcher will work in collaboration with the management in choosing participants based on the amount of experience they have working at the hospital. Inclusion and Exclusion Criteria Exclusion and inclusion criteria are both statistically and ethically important in the research proves as they help identify qualities that are undesirable or desirable for the study (Broomfeld, 2014). The study will include nurses who are willing to participate and available during the study period. They will sign an informed consent before they are recruited to the study to protect their confidentiality. All other healthcare workers in the facility will be excluded from the study and any nurse who fail to sign the informed consent will also be excluded. Data collection As noted by Cresswell (2009), a research study requires a compressive research strategy to be successful. This study will incorporate various stages of collecting and analysing data. Thus, it is important to develop an extensive plan to ensure that data is collected appropriately, analysed adequately and reported. The study will therefore run for a period of six months and will involve two phases that will involve data collection and observation. The first phase will involve interviews with the study subjects where responses will be recorded in research book and taped for future analysis. The second phase will involve observations of how the study subjects behave during their normal practice and important data will be recorded systematically. According to Parahoo (2006), qualitative research tends to describe people’s behaviours and seeks to examine a sample’s beliefs, concepts, world views and values. This will be achieved by studying feelings and thoughts and drawing interpretations to explanations using theoretical approach. Qualitative studies apply several methods of the data collection. They include individual interviews, focus groups, observations and action research methods. This study will use interviews in the form of open-ended questions. Interviewees will be contacted periodically interspersed with observations that will allow the passive monitoring of respondents to verify their patterns and perceptions (Folkestad (2008). The interviews to be conducted will take many forms, depending on the participants’ organisation. Therefore, a combination of open-ended unstructured and structured interviews will be conducted in an attempt to collect the required data that will help answer the research question in depth. The collection of data from the participants is intended to last a period of 2 months in a progressive manner. The integrity of the collected data is critical for the relevance and validity of the research study (Cai & Zhu, 2015). This study will use a combination of interviews and observation. The interviews will last for approximately 20 to 25 minutes where participants will be allowed to share their feeling, opinions, views and perception about the study topic. The researcher will prepare a comfortable, private, well-ventilated room for interviews. The questions will be variable depending on the observations made and open for the nurses to share their opinions and feelings. Lastly, questions will be repeated and clarification made for any unclear questions before the nurse will be allowed to respond. Interviews will be videotaped and transcribed and responses will be recorded in a note book for analysis. Data analysis The purpose for analysing data is to understand or uncover the bigger picture by use of the collected data to describe the phenomenon under investigation. The data analysis will be undertaken in accordance with the research question. Qualitative data analysis will also be used to interpret the results. Qualitative data analysis is used due to its strength of focusing on specific situations or people and its emphasis on words through its inductive approach (Maxwell, 2005). In qualitative analysis, the transcripts should be read several times until content of the transcript is understood extremely well (Parahoo, 2006). Thematic analysis will be used to condense raw data into themes based on valid interpretation and inference. By use of inductive reasoning, emerging themes will be identified through careful examination and repeated comparison. Thus, the coding categories will be derived inductively and directly from the raw data. Because qualitative interviews will be the main method of data collection regarding the barriers to hand hygiene among healthcare workers in Saudi Arabia, thematic analysis offers the best analysis approach. According to Folkestad (2008), qualitative interviews provide a new insight into a social phenomenon because they enable respondents to reason and reflect on a variety of issues in a different way. Consequently, carrying out interviews with registered nurses would provide better insight into the matter under investigation. NVivo, a Computer Assisted Qualitative Data Analysis Software will be used for data analysis. NVivo is recommended for qualitative data analysis because it helps manage data and ideas, query data, create visual models, and finally in reporting the data. Thus, it ensures that the research analysis is methodical, thorough, and attentive (Hilal & Alabri, 2013. Braun and Clarke (2006) describe thematic analysis as a method of identifying and reporting patterns in a given data set. The advantage of this method is that it can yield an insightful analysis that provides responses to the research question. In addition, this approach will complement the research questions by enabling an enquiry of the interview data. The main consideration would be to identify consistent themes throughout the whole process. Deductive analysis will allow for the emergence of research findings from frequent, central, or substantial themes. Additionally, the researcher will employ generic analysis of data from the interviews and observation. The research will do this by identifying and describing similarities such as point of views (of each respondent) and looking at this in terms of available literature both historical, personal, environmental and technological factors to avoid deviations (Folkestad (2008). However, since the interview is expected to generate specific answers from the participants will simplify the analysis process. In this view, the researcher will first generate responses (interviews) from the respondents by reading the responses and categorize them to identify connections. This will help establish links between the summary of findings obtained from the raw data and the research questions (Folkestad (2008). Responses will be understood in-terms of; a) Barriers to hand hygiene b) Factors hindering hand hygiene The final step will be to answer the research questions comparing the findings with literature. Ethical issues Ethical issues should be considered in order to protect the study subject from any physical and psychological harm (Farley, 2014). This study will be undertaken in adherence to certain ethical standards. Firstly, the participants will be guaranteed of their privacy and the confidentiality of any information that they provide. As the study will require participants to provide their personal views, recording and storage of such information may be a concern. This is related to the possibility of sensitive information being divulged. Actually, the nurse name or personal identification details will not be included in the series of records collected. Since it is an inquiry and observation study, there is little risks expected on the study participants but in case of any abnormal outcome during interviews such as fainting, the nurse will be attended by other nurses on duty (Elliott, Aitken, & Chaboyer, 2012). The procedure of the interview will be laid out clearly so that the participants understand what is required of them. The questions will also be asked in simple, understandable language appropriate for the study population. This will help avoid misunderstandings that may lead to ethical risks. Observational research is one of the data collection methods that will be used in this study and as such, it may face subtle ethical issues that can easily be missed. The researcher will interact with nurses during the observation process and this may lead to invasion of personal space and privacy. While there is a need to collect data covertly so that the credibility of the data is not impugned, there is a need to not interfere with the privacy of the participants as well (Elliott, Aitken, & Chaboyer, 2012). Consequently, the participants will sign informed consent in advance but they will not be informed when the observation is taking place. Is recording observed data, confidentiality will be maintained as there will be no photos, videos, or any other personal recordings of the participants. only the action of the nurses will be recorded without any accompanying personal information that may help identify the participant. The researcher will be a passive participant and will not intervene in any process that does not present an ethical risk to the research study (Elliott, Aitken, & Chaboyer, 2012). In addition, ethical approval will be secured from the University Research Ethics Panels and will be presented to the Hospital’s management for verification and documentation. Any research procedure proposed will be conducted professionally and in accordance to the Hospital’s code of practice. CONCLUSION Existing literature has identified various factors that influence adherence to hand hygiene among healthcare workers in various settings. These factors can be categorised as either organisation or professional. one of the major challenges that has been identified is lack of scientific knowledge. Any training on standard infection controls are taught during the early days of the training module and thus, by the time they get to practice, they can no longer associate with the processes they were trained on. Nurses are also limited by their cultural perceptions and attitudes regarding hand hygiene. The hospital environment is a rather busy area, and most nursing mentors lack the time to engage in proper hand hygiene. This could be brought about by the lack of adequate nursing staff, rendering the existing workforce extremely engage with saving lives. This culture is continually passed down to newly recruited nurses and their actions become rather imitational than rational. Another issue that literature has cited is lack of continued training on hand hygiene during the nursing practice. There are various methods used in hand cleaning to ensure proper hand hygiene is maintained in hospitals. However, evidence has shown that most hospitals lack adequate hand hygiene materials such as soaps, water, or even enough hand washing sinks. In addition, personnel lifestyle such as use of jewellery, maintaining long finger nails, and other body enhancements act as barriers to hand hygiene. The purpose of this study is to examine the barriers that nursing personnel at hospital at Al-Albaha city face with regards to hand hygiene compliance. The study aims to find any correlation with previous research findings and provide solutions to address the identified barriers. If this study is successful, it is expected to establish the challenges the nurses face in adherence to hand hygiene. These challenges are expected to correlate with those described in literature review from previous findings. However, any new findings from the research will also be given adequate consideration. These findings will help inform the implementation of specific strategies to encourage and ensure compliance to hand hygiene among nurses in all hospitals in Saudi Arabia as the sample size used will be representative of the entire country. The report will be used by both policy makes and hospital managers to ensure that there are laws as well as tools that help in effecting hand hygiene policies. Research Time Table Ethics approval Recruitment Data collection Data analysis Report writing Month 1 2 3 4 5 6 Resources This study will take at least six months without factoring in the preparation stages. The study will also need financial resources for materials. Other expenses expected include those associated with traveling for data collection. Dissemination The report of this study will be peer-reviewed to enhance its credibility and objectivity. The report of this study is meant for academic publication and to inform policy decisions. 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