Interdisciplinary Journal of Acute Care

Interdisciplinary Journal of Acute Care

The Effect of Educational Interventions Based on Theory of Planned Behavior on Nurses' Intention to Perform Hand Hygiene

Document Type : Research

Authors
1 Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
2 Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
3 Kermanshah University of Medical Sciences. Kermanshah, Iran
Abstract
Considering the importance of hand hygiene in the nurses, this study has aimed to determine the effect of educational interventions based on Theory of Planned Behavior on nurses' intention to perform hand hygiene. In this randomized controlled clinical trial, subjects including 60 nurses were selected by using the convenience sampling method and then were located in the intervention or control groups by the simple random sampling. The intervention group received educational interventions based on the Theory of Planned Behavior through a four-session workshop. Instrument was Theory of Planned Behavior questionnaire with four subscales including attitudes, perceived behavioral control, subjective norms and hand hygiene intention. The questionnaire was filled in the two groups before, immediately after, and one month after intervention. The mean score of attitude, subjective norms, perceived behavioral control, and intention in the baseline of intervention group were 1.96 ± 0.62, 1.87 ± 0.68, 1.84 ± 0.72, and 3.96± 0.64 respectively.  Immediately after the intervention the mean score of these constructs changed to, 2.88 ± 0.68, 2.79 ± 0.79, 3.82 ± 0.69, and 3.78± 0.71 respectively, and the changes were statistically significant (P<0.001). Also education performed in the intervention group increased the scores of attitude, subjective norms, perceived behavioral control and intention in comparison with the control group and changes were significant statistically(P<0.001). The use of educational models could improve the nurses' intention to perform hand hygiene behaviors; therefore, it is necessary to consider this model by modifying the training patterns.
Keywords

1. Challenge FG. WHO Guidelines on Hand Hygiene in Health Care. Retrieved from: whqlibdoc who int/publications/009 pdf. 2009.
2. Raffa RB, Pergolizzi JV, Taylor R, Choudhuri S, Rodenbeck R. Persistence of healthcare-associated (Nosocomial) infections due to inadequate hand hygiene: part 1—biological and treatment factors. Pharmacology & Pharmacy. 2018 Aug 9;9(08):293.
3. Edwardson S, Cairns C. Nosocomial infections in the ICU. Anaesthesia & Intensive Care Medicine. 2019 Jan 1;20(1):14-8.
4. Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2015 Jan;19(1):14.
5. Fox C, Wavra T, Drake DA, Mulligan D, Bennett YP, Nelson C, Kirkwood P, Jones L, Bader MK. Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal of Critical Care. 2015 May 1;24(3):216-24.
6. Öncü E, Vayısoğlu SK, Lafcı D, Yıldız E. An evaluation of the effectiveness of nursing students' hand hygiene compliance: A cross-sectional study. Nurse education today. 2018 Jun 1;65:218-24.
7. Brunner LS. Brunner & Suddarth's textbook of medical-surgical nursing. Lippincott Williams & Wilkins; 2010.
8. Luangasanatip N, Hongsuwan M, Lubell Y, Limmathurotsakul D, Srisamang P, Day NP, Graves N, Cooper BS. Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis. Journal of Hospital Infection. 2018 Oct 1;100(2):165-75.
9. Nazari R, Haji Ahmadi M, Dadashzade M, Asgari P. Study of hand hygiene behavior among nurses in Critical Care Units. Iran J Crit Care Nurs. 2011;4(2):95-8.
10. Nouri B, Hajizadeh M, Bahmanpour K, Sadafi M, Rezaei S, Valiee S. Hand hygiene adherence among Iranian nurses: A systematic review and meta-analysis. Nursing Practice Today. 2021;8(1):11-24.
11. Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, Van Beeck EF. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infection Control & Hospital Epidemiology. 2010 Mar;31(3):283-94.
12. Alp E, Altun D, Cevahir F, Ersoy S, Cakir O, McLaws ML. Evaluation of the effectiveness of an infection control program in adult intensive care units: a report from a middle-income country. American journal of infection control. 2014 Oct 1;42(10):1056-61.
13. Al-Tawfiq JA, Pittet D. Improving hand hygiene compliance in healthcare settings using behavior change theories: reflections. Teaching and learning in medicine. 2013 Oct 1;25(4):374-82.
14. Weijers RJ, de Koning BB, Paas F. Nudging in education: From theory towards guidelines for successful implementation. European Journal of Psychology of Education. 2021 Sep;36:883-902.
15. Conner M. Theory of planned behavior. Handbook of sport psychology. 2020 Apr 14:1-8. 
16. Mostafazadeh-Bora M, Bahrami M, Hosseini A. A survey of nurses' compliance with hand hygiene guidelines in caring for patients with cancer in a selected center of Isfahan, Iran, in 2016. Iranian journal of nursing and midwifery research. 2018 Mar 1;23(2):119-24.
17. Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes. 1991;50(2):179-211.
18. Sheppard BH, Hartwick J, Warshaw PR. The theory of reasoned action: A meta-analysis of past research with recommendations for modifications and future research. Journal of consumer research. 1988 Dec 1:325-43.
19. Ajzen I. Perceived behavioral control, self‐efficacy, locus of control, and the theory of planned behavior 1. Journal of applied social psychology. 2002 Apr;32(4):665-83. 
20. Mullan BA, Wong C, Kothe EJ. Predicting adolescents' safe food handling using an extended theory of planned behavior. Food Control. 2013 Jun 1;31(2):454-60.
21. Sax H, Allegranzi B, Chraïti MN, Boyce J, Larson E, Pittet D. The World Health Organization hand hygiene observation method. American journal of infection control. 2009 Dec 1;37(10):827-34. 
22. Srigley JA, Corace K, Hargadon DP, Yu D, MacDonald T, Fabrigar L, Garber G. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. Journal of Hospital Infection. 2015 Nov 1;91(3):202-10.
23. EL Hajjar ST, Alkhanaizi MS. Exploring the factors that affect employee training effectiveness: A case study in Bahrain. Sage Open. 2018 Jun;8(2):2158244018783033.
24. Safety WP, World Health Organization. Hand hygiene technical reference manual: to be used by health-care workers, trainers and observers of hand hygiene practices. InHand hygiene technical reference manual: to be used by health-care workers, trainers and observers of hand hygiene practices 2009.
25. Piras SE. The Effect of Social Influence on Nurses’ Hand Hygiene Behaviors. December, 2016.  Submitted to the Faculty of the Graduate School of Vanderbilt University in partial fulfillment of the requirements for the degree of Phd in Nursing Science.  Avilable from: https://etd.library.vanderbilt.edu/available/etd-11282016-170413/unrestricted/SPiras.pdf. Access: 10 sept 2017. 
26. Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975 Dec 1;28(4).
27 Baghaei R, Sharifian E, Kamran A. Can theoretical intervention improve hand hygiene behavior among nurses?. Psychology research and behavior management. 2016 Jun 16:133-8.
28. Yuan CT, Dembry LM, Higa B, Fu M, Wang H, Bradley EH. Perceptions of hand hygiene practices in China. Journal of Hospital Infection. 2009 Feb 1;71(2):157-62.
29. Najafighezeljeh T, Abbasnejad Z, Rafii F, Haghani H. Nurses' knowledge, beliefs and practices towards hand hygiene.
30. Arshadi Bostanabad M. Asdollahi M. jebrailli M, Mahallei M, Abdolalipuor N. Nurses attitudes towards hand hygiene barriers in the neonatal unites of tabrize. Iranian Jornal of pediatric Nursing. 2014.
31. Piras SE, Minnick A, Lauderdale J, Dietrich MS, Vogus TJ. The effects of social influence on nurses' hand hygiene behaviors. JONA: The Journal of Nursing Administration. 2018 Apr 1;48(4):216-21.
32. Perkins MB, Jensen PS, Jaccard J, Gollwitzer P, Oettingen G, Pappadopulos E, Hoagwood KE. Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know?. Psychiatric Services. 2007 Mar;58(3):342-8.
33. Carroll CM, Gladson SW, Camins BC. “Your hands touch many lives”: a hand hygiene compliance improvement campaign. American Journal of Infection Control. 2006 Jun 1;34(5):E27-8.
34. Schot E, Tummers L, Noordegraaf M. Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. Journal of interprofessional care. 2020 May 3;34(3):332-42. 
35. Akyol AD. Hand hygiene among nurses in Turkey: opinions and practices. Journal of clinical nursing. 2007 Mar;16(3):431-7.
36. White KM, Jimmieson NL, Obst PL, Graves N, Barnett A, Cockshaw W, Gee P, Haneman L, Page K, Campbell M, Martin E. Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses. BMC health services research. 2015 Dec;15:1-9.
37. Reason FP. Improving hand hygiene compliance for the reduction of nosocomial infections: recommendations for behaviour change in a health care setting: Faculty of Health Sciences-Simon Fraser University; 2008.
38. Labrague LJ, McEnroe‐Petitte DM, Van de Mortel T, Nasirudeen AM. A systematic review on hand hygiene knowledge and compliance in student nurses. International nursing review. 2018 Sep;65(3):336-48.
39. Gould DJ, Chudleigh J, Drey NS, Moralejo D. Measuring handwashing performance in health service audits and research studies. Journal of Hospital Infection. 2007 Jun 1;66(2):109-15.
40. Staines A, Vanderavero P, Duvillard B, Deriaz P, Erard P, Kundig F, Juillet C, Clerc O. Sustained improvement in hand hygiene compliance using a multi-modal improvement programme at a Swiss multi-site regional hospital. Journal of Hospital Infection. 2018 Oct 1;100(2):176-82.
 
Volume 2, Issue 1
June 2021
Pages 12-20

  • Receive Date 06 November 2020
  • Revise Date 12 July 2020
  • Accept Date 08 April 2020