Health care workers' perceptions and reported use of respiratory protective equipment: A qualitative analysis
Health care workers' perceptions and reported use of respiratory protective equipment: A qualitative analysis
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DOI：
10.1016/j.ajic.2019.04.174
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发表时间：
2019-10-01
影响因子：
4.9
通讯作者：
McInnes, D. Keith
中科院分区：
文献类型：
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作者：
Fix, Gemmae M.;Reisinger, Heather Schacht;McInnes, D. Keith
背景：卫生保健工作者（HCW）对呼吸防护设备（RPE）的认知或使用经验知之甚少。我们试图描述他们的看法，并确定护理不当使用的原因。方法：我们对4个医疗中心的护士和护理员进行了12个焦点小组的调查。我们分析了焦点小组参与者讲述的73个离散“故事”的主题内容。结果：我们确定了围绕RPE使用的5种故事类型：1)在日常工作中已知和看到的策略；2)在协议失效期间，通过社会规范加强使用；3)临床经验有时取代方案的遵守；4)当风险感知较高时，我们发现对获取RPE的关注；5)急诊科的卫生保健工作者被视为不遵守协议，因为风险始终存在。讨论：医护人员意识到RPE和使用RPE的协议的重要性，并支持在协议失效时使用RPE。然而，临床经验、感知风险和急诊科的独特背景削弱了协议的依从性，在急诊科，患者不断被诊断不完整或延迟。结论：协议、视觉提示和社会规范有助于安全文化。当卫生保健工作者经历诊断的不确定性，或者他们不信任协议，转而依赖他们的临床经验时，这种文化就会被破坏。由爱思唯尔公司代表感染控制和流行病学专业人员协会出版。
Background: Little is known about health care workers' (HCW) perceptions of, or experiences using, respiratory protective equipment (RPE). We sought to characterize their perceptions and identify reasons underlying Nursing inappropriate use.Methods: We conducted 12 focus groups with nurses and nursing assistants at 4 medical centers. We analyzed the thematic content of 73 discrete "stories" told by focus group participants.Results: We identified 5 story types surrounding RPE use: 1) policies are known and seen during work routines; 2) during protocol lapses, use is reinforced through social norms; 3) clinical experiences sometimes supersede protocol adherence; 4) when risk perception is high, we found concern regarding accessing RPE; and 5) HCWs in emergency departments were viewed as not following protocol because risk was ever-present.Discussion: HCWs were aware of the importance of RPE and protocols for using it, and these supported use when protocol lapses occurred. However, protocol adherence was undermined by clinical experience, perceived risk, and the distinct context of the emergency department where patients continually arrive with incomplete or delayed diagnoses.Conclusions: Protocols, visual cues, and social norms contribute to a culture of safety. This culture can be undermined when HCWs experience diagnostic uncertainty or they mistrust the protocol and instead rely on their clinical experiences. Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.