Improving Hand Hygiene in Developing Countries

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In order to focus on evidence-based practice in the sphere of nursing and providing healthcare services, it is necessary to be able to effectively evaluate articles representing the results of research studies. The article under assessment is titled Predictors of Hand Hygiene Behavior Among Nurses: A Theoretical Cross-Sectional Study, and it was written by Rahimi et al. (2019). The authors conducted a quantitative cross-sectional study, and the purpose of this paper is to review and evaluate the research article to determine its quality and validity.

Research Problem/Purpose

The researchers formulated the studys problem in the following way: poor compliance to hand hygiene (HH) norms is observed among Iranian hospital nurses because of certain personal views and organizational factors. The purpose of the study was to examine the role of the BASNEF (beliefs, attitudes, subjective norms, along with enabling factors) model in constructing nurses effective HH behavior and performance (Rahimi et al., 2019). The authors of the study discussed the problem of poor HH performance in the context of existing nursing knowledge with reference to the BASNEF model and evidence from other studies. While referring to the purpose of the study, it is possible to state that it can solve the problem of HH performance that is relevant to nursing. The reason is that the researchers determined the correlation between nurses age and experience at work and their HH behavior to prevent nosocomial infections in hospitals.

Review of the Literature

The authors assumptions are based on the previous studies on similar topics. The elements of the literature review are presented in the introduction section of the article to provide the background for the study and in the discussion section. The researchers explored such concepts as the HH behavior, HH compliance, and HH behavior predictors in their introductory part to support their formulation of the study problem and aim. In the discussion part, the references to other studies were actively used to compare and support the findings (Rahimi et al., 2019). Among 25 sources, only eight sources were published within the past five years, and the authors used the sources published more than 10-15 years ago although the original study was conducted in 2018 (Rahimi et al., 2019). Therefore, the researchers approach to selecting the literature to support findings can be discussed as inappropriate and can be caused only by the limited number of sources on nurses HH performance in Iran.

Theoretical Framework

The researchers organized their study as a quantitative theoretical work. However, in spite of referring to the BASNEF model as a framework for their research, Rahimi et al. (2019) did not explain a theoretical framework in their study effectively. One should state that the research is based on the BASNEF model actively applied not only in nursing but also in healthcare-related research (Matar et al., 2018; Schmidt & Brown, 2019). The article lacks a detailed description of assumptions and the nursing theory to be used in this research. The theory that can be applied in combination with the BASNEF model is Ajzens theory of planned behavior. The reason is that the theory of planned behavior explains how a persons beliefs, attitudes, and subjective views influence behaviors, including the HH behavior (Piras et al., 2017). Although this theory is not recognized as a nursing theory, it is directly linked to this study.

Variables/Hypotheses/Questions/Assumptions

The research question and hypotheses were not clearly stated by the researchers, and they can only be implied. Thus, the potential research question is the following: what is the relationship between the predictors of HH behavior and nurses actual HH performance? The variables used by Rahimi et al. (2019) were not clearly described in the article, but it is possible to assume that independent variables are nurses age, work experience, and the BASNEF model components, and a dependent variable is the HH behavior. Due to the fact that the authors did not present clear definitions of these variables, it is rather difficult to interpret the study results with reference to the research purpose and question. Furthermore, the provided dependent variable of HH behavior did not seem to be concrete or easily measurable.

Methodology

In the analyzed research, a quantitative descriptive and correlational research design was used. However, the problem is that Rahimi et al. (2019) provided different definitions for their research design as they named it a theoretical cross-sectional study and a descriptive analytical study. As the study is quantitative, deductive reasoning was applied by the researchers. The setting for the study covered hospitals in Ardabil and Khalkhal, Iran. The sample included 498 nurses, and they were selected with the help of a multistage sampling method, as it was reported by Rahimi et al. (2019). The probability sampling technique was applied as the researchers started from random sampling, and then they used inclusion and exclusion criteria to form their sample.

The independent variables were tested with reference to the questionnaire based on the BASNEF model, and the dependent variable in the study was also measured with the help of that questionnaire based on the Likert scale. The problem is that there were no clear descriptions of the variables measurement or their validity in the article although it was stated that the used questionnaire was a valid and reliable (Rahimi et al., 2019). Ethical considerations were mentioned by the researchers as the participants were required to provide their oral informed consent to participate in the study.

Data Analysis

The data collected with the help of the adopted questionnaire and a Likert scale were analyzed using statistical tests and SPSS software. The researchers conducted a t-test, an ANOVA test, a Pearsons correlation test, as well as multiple linear regressions, to determine the relationship between predictors of HH behavior and actual nurses behavior. The results of the study were presented with the help of tables to illustrate numerical data, and the findings were interpreted in the results section of the article. It was found by Rahimi et al. (2019) that nurses age and work experiences were negatively correlated with their HH behavior as a dependent variable. Nurses attitude toward HH was in a positive correlation with some of the BASNEF model components, including enabling factors. Still, the BASNEF model elements did not have a significantly high predictive power (3%) for influencing nurses HH behavior (Rahimi et al., 2019). It is possible to state that the interpretation of the results could be more detailed for guiding nurses and other researchers on the findings significance.

Summary/Conclusions, Implications, and Recommendations

The researchers concluded that the BASNEF model specific components could not predict nurses HH behavior although age and work experience served as critical factors in HH performance. The authors noted that the limitation of the study was associated with the lack of time to conduct a causal relationship study (Rahimi et al., 2019). However, it is important to state that the current study also has other limitations and weaknesses, such as problems with defining the variables and a research design. It is rather problematic to determine how the researchers measured nurses HH behavior as a dependent variable as no explanations were provided. The strengths of the research are associated with the application of several statistical tests to provide credible results on the relationship between the variables.

Still, it is rather problematic to generalize the studys results to other populations as the focus was only on nurses, and the discussed research design has weaknesses in its organization and realization. The significance of the presented findings is in drawing the attention to such factors as age and work experience that can predict nurses HH behaviors, and these factors need to be tested in clinical practice. It is important to note that the studys significance for nursing is in providing a new perspective on the effectiveness of the BASNEF model to explain nurses behaviors, including those related to HH.

Conclusion

The completed review and assessment of the research article indicate that the study presentation lacks details and explanations. When referring to the limited explanations presented in the article, it is possible to assume that the study had some weaknesses associated with the formulation of variables and its methodology. In spite of the studys weaknesses, the ideas that were presented in the article can be used by other researchers and nurses for testing similar hypotheses in other contexts and clinical settings.

References

Matar, M. J., Moghnieh, R. A., Awad, L. S., & Kanj, S. S. (2018). Effective strategies for improving hand hygiene in developing countries. Current Treatment Options in Infectious Diseases, 10(2), 310-329.

Piras, S. E., Lauderdale, J., & Minnick, A. (2017). An elicitation study of critical care nurses salient hand hygiene beliefs. Intensive and Critical Care Nursing, 42, 10-16.

Rahimi, G., Kamran, A., Sharifian, E., & Zandian, H. (2019). Predictors of hand hygiene behavior among nurses: A theoretical cross-sectional study. Journal of Medical Sciences, 39(6), 278-283.

Schmidt, N. A., & Brown, J. M. (2019). Evidence-based practice for nurses: Appraisal and application of research (4^th ed.). Jones & Bartlett Learning.

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