The sample size was small at ten preregistration nurses taking part. However the research was qualitative and wanted to look into perceptions of nursing students and therefore a small sample size is more beneficial as the researchers can look more in-depth at each participant.
Student from all three branches of nursing, adult; child and mental health were selected making it consistent and valid. Not knowing the sample size makes it more difficult to assess the appropriateness of the sample for the target population and it is difficult to know whether it can be generalise to the wider population. Furthermore the target population is not mentioned in the research which makes it even more difficult to tell whether the study can be generalised at all. The age and the sex of the participants are also not known which could be a factor which affects the results. Further research could be provided into different subgroups of age and sex and how this could affect perceptions of student hand hygiene.
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. Open-ended questions were asked in the semi-structured interview, an advantage of this is that although the key questions have already been devised there is potential for the researcher to ask further questions following the response the interviewees give.(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-analysed until no new themes were identified. Recording the interview is important as it allows the researcher to analyse 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 clear whether notes were made about the interviewee’s body language and other non-verbal communications, as these are important and provide further information and can provide context for analysis.
The themes identified in the data analysis are filtered down so that the less important ones can be discarded, it is important to look at the themes where participants feel strongly about, it is not evident in the research what themes were discarded and were kept and the degree of certainty and credibility of process. In the research there doesn’t seem to be rigorous 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 direct quotes from the interviews supporting the different themes are shown in the research.
The researchers were both nurses which could have had an influence of the data and there could be some researcher bias as they could have shifted the data in order to meet the results they wanted. This could have also been problematic if the nurses conducted the interviews and they could have also been an interviewer bias where the questions were phrased in order to achieve the answers they wanted. However this is not as they is no example of the questions, but as there was a pilot study making the questions less-structured and more open ended this should of alleviated any bias. One way that would have ensured no researcher bias would have been to employ an independent person to analyse the data and then further compare notes later.
This type of research takes the phenomenology approach which identifies phenomenon and gathers “deep” information through inductive, qualitative methods. Phenomenology has roots in philosophy. It is concern with experience from the perspective of the individual. Phenomenological research has overlaps with other qualitative approaches such as ethnography. (Lester,S 1999).
Ethnical issues have been considered in the research and the study was approved by “The medical school ethical committee”. Researchers follow ethical rules such as confidentially to all participants and that they can withdraw at any time from the study.( I 2009) Participants were fully informed and a consent form was signed. Ethical controls are important, and the close relationship held in qualitative research between researcher and participant enables the researcher to focus closely on ethical issues to achieve empathy with the participants.
The rigour in the research could be improved by using triangulation; triangulation tests the internal validity by using more than one method of data collection (Popay J 1998), in this study, this could have been improved by holding a group interview and having the transcripts checked by an independent party. However this is difficult to make sure it is achieved accurately as data collected using different methods can make to it difficult to directly compare such as comparing individual and group interviews and even more so for comparing qualitative and quantitative data. However contradictions to data compared in the qualitative approach do not necessarily threaten in the integrity of the data but can provide room for further research. Rigour is also concern with transferability which is comparable with external validity. Transferability refers to how findings can be transferred or applied to a similar group of individuals in a similar context. This study lacks transferability as the sampling method which was convenience sample result in small sample; another point to consider is the Hawthorne effect in the qualitative interview used to collect the data. The Hawthorne effect is where the validity of the investigation is threatened through bias. The participants might have modified an aspect of their behaviour which was being measured in response to the fact they know they are being studied. It is unclear whether this happen in the study as no evidence has been given about this.
One way to improve the study would have been to employ an audit trail; this is the method of keeping a description of the research steps taken from the start until the findings of the research (Lincoln Y.S. 1995). These records are kept as reference, and this can compared with internal validity. In the research it is no evident that an audit trail has been taken and this would have been beneficial to see whether the researcher deviated from the starting protocol. Another way which could of improved the study is to use triangulation to analyse the results, the study was analysed be the researchers and this could of lead to bias which would of made the results invalid.
The key points of the study are to present nursing student perceptions of hand hygiene and factors which affect this. It also seeks to make recommendations which would increase hand hygiene compliance. Findings shown that nurses thought lack of time and that nurses perceived that it was not always necessary to follow hand hygiene procedures in certain tasks such as taking a temperature. The researchers discuss that glove are often substitute in place of hand hygiene which other research has shown. This is not explored in this research and could be furthered explore the use of gloves and to what extent this effects hand hygiene. Another factor found was that nurses “fitting in” also effect hand hygiene practices and students identified saying that wanted to fit in as part of a team. It’s suggested that be doing this will be easier and stops the fear of retaliation. However this is a point that haven’t been evaluated by the researchers, participants may not of given their true viewpoints due to the fact they didn’t want to “rock the boat” and wanted to comply with others, leading to the findings being inaccurate. This is a concern as hand hygiene should be known to help the care of the patient and to prevent infections; however as nursing student stated one of the reasons that kept up with hand hygiene is to “fit in”. This is a concern and shows the next step is to provide further training as it appears that participants do not fully understand the implications of hand hygiene. These shows a key factor EBP where evidence needs to be collected regularly in order to provide the highest level of care and practice.
Other research has noticed this and because of this an infection control nurse has been developed to emphasis clinical effectiveness, however this is still problematic with a big workload making less time for ward-based activities meaning in one way or another care will be comprised. In the findings it is not clear whether the nursing students liaise with an infection control nurse; however this is an area for further research as to the effectiveness and whether time and money could be better spent somewhere else to achieve higher standards of care.
There is no clear cut answer to the factors that affect compliance of student hand hygiene which is shown in the research by several factors identified. It is impossible to determine ones sole cause and this makes it more difficult to make recommendations of how to improve hand hygiene compliance.
The participants are similar to those in podiatry and in fact all healthcare professions as hand hygiene is an essential role in providing high quality care to all patients showing this research could be applicable in many different health professions (Heneghan C, 2002). In applying the results it could be possible that patients are at risk and could be likely to get infections, therefore it is important to carefully consider views given by the participants. This will therefore maximise patient healthcare (Williams, Hywel C 2003).
Qualitative research is important in healthcare as it provides a person-centred and holistic perspective. This approach helps understanding of people which is important in podiatry and all other health professions to be caring and communicating in approach to treatment. This piece of research helps understand the nurses in a social and cultural context, which can understand issues that may not be understood from quantitative research. This can lead to more successful care to the patient which is essentially what evidence based practise tries to achieve.
In applying the results from this study it is clear that hand hygiene practices could be improved. When trying to improve hand hygiene practice it is important that to consider the individual perception of the nurses to ensure that hand hygiene is effective and to ensure that the nurses will comply. These perceptions could be generalised to other healthcare workers within a health care setting and would be an insight into views of hand hygiene and how these could be improved in order to achieve a higher level of care.
Many factors were found that affect compliance and it would be impossible comply to every one of these factors. Also the fact that is the perception of individuals means that every person will have different views and therefore different compliance rates. There is many confounding research and views to hand hygiene which is another reason why student nurses have different ideas of acceptable hand hygiene. Therefore is it impossible that hand hygiene compliance will be 100%.
In conclusion, findings cannot be fully generalised and 100% reliable due to limitations in the design previously discuss. The sample method could have affected validity of results, as it is not stated the sex and age of the participants in the study it can’t be generalised to different sub-groups and further research needs to be carried out in this area to generate more findings. Furthermore participants were employed through opportunity sampling; a disadvantage of this is that it can produce a biased sample, as it unknown whether the researcher picked people from their own social group. This sample would therefore not be representative of the target population showing bias.
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