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Methicillin-resistant Staphylococcus aureus (MRSA) an Unclear and Untoward Issue: Patient-Professional Interactions, Experiences, Attitudes and Responsibility
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to investigate experiences of living with multidrug-resistant bacteria (MDRB), using methicillin-resistant Staphylococcus aureus (MRSA) colonization as an illustration, and to develop and validate a tool to describe healthcare personnel’s attitudes towards patients with MDRB. A further objective was to study MRSA-colonized persons’ and healthcare personnel’s experiences of patient-professional interactions and responsibilities for infection prevention.

Four empirical studies were conducted. A total of 18 MRSA-colonized persons and 20 healthcare personnel were interviewed regarding their experiences, and a total of 726 RNs responded the MDRB Attitude Questionnaire.

The findings revealed the difficulties associated with living with MRSA colonization, which was described as something uncertain, and as an indefinable threat that has to be managed in both everyday life and in contacts with healthcare. Interactions with healthcare personnel were described as unprofessional owing to personnel’s inappropriate behaviour and insufficient information provision. According to the personnel, achieving adequate patient-professional interactions required having knowledge and experiences of MRSA. They also experienced difficulties in providing tailored information to patients. The MRSA-colonized persons described their unwanted responsibility to inform healthcare personnel about the colonization, but also felt responsible for limiting the spread of infection to others. Furthermore, responsibility for infection control was regarded as shared between healthcare personnel and patients. The personnel described such responsibility as a natural part of their daily work, although it was not always easy to adhere to hygiene precautions. The MRSA-colonized persons felt that healthcare personnel have insufficient knowledge of the bacteria and of hygiene precautions. The MDRB Attitude Questionnaire showed that registered nurses do have knowledge deficiencies. The MDRB Attitude Questionnaire has adequate psychometric properties.

In conclusion, MRSA colonization constitutes a psychological strain for carriers, and interactions with healthcare personnel resulted in feelings of stigmatization. The present thesis indicates that there is a need to improve healthcare personnel’s knowledge, behaviour and emotional response in relation to patients with MDRB, in order to ensure patient safety and address patients’ needs. The heads of department is responsible for such improvements, and the MDRB Attitude Questionnaire is useful in identifying areas in need for improvement.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2012. , 74 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 741
Keyword [en]
Attitudes of health personnel, colonization, hygiene, infection control, mixed-methods approach, MRSA, nursing care, patient-professional interaction, quality of healthcare, responsibility, The MDRB Attitude Questionnaire
National Category
Nursing
Identifiers
URN: urn:nbn:se:hig:diva-18925ISBN: 978-91-554-8273-2OAI: oai:DiVA.org:hig-18925DiVA: diva2:786029
Public defence
2012-03-27, Universitetshuset, sal IX, Biskopsgatan 3, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2015-02-05 Created: 2015-02-04 Last updated: 2015-09-22Bibliographically approved
List of papers
1. Suffering from meticillin-resistant Staphylococcus aureus: experience and understanding of colonisation
Open this publication in new window or tab >>Suffering from meticillin-resistant Staphylococcus aureus: experience and understanding of colonisation
2009 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 73, no 3, 271-277 p.Article in journal (Refereed) Published
Abstract [en]

The objective was to explore individuals' experiences and understandings of meticillin-resistant Staphylococcus aureus (MRSA) colonisation. Thirteen interviews were performed and processed using content analysis, resulting in the theme ‘Invaded, insecure and alone’. The participants experienced fears and limitations in everyday life and expressed a need to protect others from contagion. Moreover, they experienced encounters with, and information from, healthcare workers differently: some were content, whereas others were discontent. The described fears, limitations and inadequate professional–patient relationship generated unacceptable distress for MRSA-colonised persons. Thus, the healthcare sector should assume responsibility for managing MRSA, and healthcare workers must improve their professionalism and information skills, so as to better meet MRSA-colonised persons' needs

Keyword
Colonisation; Content analysis; MRSA; Qualitative research; Quality of healthcare
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hig:diva-5334 (URN)10.1016/j.jhin.2009.07.002 (DOI)000272033800012 ()19783322 (PubMedID)2-s2.0-70349819880 (ScopusID)
Available from: 2009-09-07 Created: 2009-09-07 Last updated: 2016-10-26Bibliographically approved
2. Attitudes toward patients with multidrug-resistant bacteria: scale development and psychometric evaluation
Open this publication in new window or tab >>Attitudes toward patients with multidrug-resistant bacteria: scale development and psychometric evaluation
Show others...
2011 (English)In: Journal of Infection Prevention, ISSN 1757-1782, Vol. 12, no 5, 196-203 p.Article in journal (Refereed) Published
Abstract [en]

There is a need for validated assessment tools for measuring attitudes towards patients with multidrug- resistant bacteria. Such an assessment tool was developed and psychometrically evaluated in the present study. A literature review and discussions with experts and key informants were used to develop the questionnaire. To ensure item adequacy and interpretability, face validity and pre-tests were performed. Item validity, content validity and internal consistency reliability were evaluated in a non-random sample of 329 hemodialysis nurses. The psychometric properties were satisfactory, indicating good item validity. The content validity revealed three appropriate factors with good internal consistency reliability. The haemodialysis nurses’ knowledge about multidrug-resistant bacteria was not suf. cient, and their intentional behaviour was unsatisfactory with respect to infection control precautions. The multidrug-resistant bacteria Attitude Questionnaire would be a valuable tool, in nursing practice and nursing education, in promoting quality improvements in patient safety with regard to healthcare associated infections.

National Category
Nursing Infectious Medicine
Identifiers
urn:nbn:se:hig:diva-10037 (URN)10.1177/1757177411411122 (DOI)2-s2.0-80053104580 (ScopusID)
Available from: 2011-09-06 Created: 2011-09-06 Last updated: 2015-09-22Bibliographically approved
3. The Multidrug-Resistant Bacteria Attitude Questionnaire: validity and understanding of responsibility for infection control in Swedish registered district, haematology and infection nurses
Open this publication in new window or tab >>The Multidrug-Resistant Bacteria Attitude Questionnaire: validity and understanding of responsibility for infection control in Swedish registered district, haematology and infection nurses
2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 3-4, 424-436 p.Article in journal (Refereed) Published
Abstract [en]

Aim. To assess the discriminative and construct validity of the Multidrug-Resistant Bacteria Attitude Questionnaire and to study registered nurses knowledge of, behaviour toward and emotional responses to patients with multidrug-resistant bacteria in relation to how they understand their own, managers and politicians responsibility for adherence to preventive measures for infection control. Background. Multidrug-resistant organisms are a global problem and an essential topic in healthcare regarding patient safety improvement. Design. Descriptive and correlational cross-sectional survey. Method. Data were collected in a non-random sample consisting of 397 registered nurses; district, haematology or infection registered nurses. One-way analysis of variance and independent t-tests were used for comparisons and a principal component analysis was performed. Results. Discriminative and construct validity were supported, as the infection registered nurses generally had higher scores on knowledge, behaviour and emotional response, compared with district registered nurses and haematology registered nurses and the three-factor solution was confirmed. Registered nurses with higher scores on knowledge and emotional response attributed greater responsibility to themselves and to politicians. The Multidrug-Resistant Bacteria Attitude Questionnaire was translated using a forward-back translation process. Conclusion. The questionnaire has adequate psychometric properties. Insufficient knowledge of, behaviour toward and emotional response to patients with multidrug-resistant bacteria were described, but the registered nurses did estimate their own responsibility for adherence to preventive measures for infection control as being great or very great. Relevance to clinical practice. There is a considerable need to improve knowledge, behaviour and emotional response regarding infection prevention measures among healthcare workers. The hospital management are responsible for such improvements and the Multidrug-Resistant Bacteria Attitude Questionnaire is useful in identifying such needs, as it has adequate psychometric properties and is able to discriminate between groups. Evaluation among healthcare workers may indicate where to situate additional training, as this is of clinical significance for safe care.

National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-10038 (URN)10.1111/j.1365-2702.2011.03914.x (DOI)000298793400015 ()22150887 (PubMedID)2-s2.0-84855352106 (ScopusID)
Available from: 2011-09-06 Created: 2011-09-06 Last updated: 2015-09-22Bibliographically approved
4. MRSA-colonized persons’ and healthcare personnel's experiences of patient-professional interactions in and responsibilities for infection prevention in Sweden
Open this publication in new window or tab >>MRSA-colonized persons’ and healthcare personnel's experiences of patient-professional interactions in and responsibilities for infection prevention in Sweden
2014 (English)In: Journal of Infection and Public Health, ISSN 1876-0341, Vol. 7, no 5, 427-435 p.Article in journal (Refereed) Published
Abstract [en]

Background: Patient-professional interactions and adherence to infection control measures are central to the quality of care and patient safety in healthcare. Persons colonized with methicillin-resistant Staphylococcus aureus (MRSA) describe insufficient support and unprofessional behavior among healthcare personnel. Methods: A descriptive qualitative study was conducted to investigate managers', physicians', registered nurses' and MRSA-colonized persons' experiences of patient-professional interactions in relation to and responsibilities for infection prevention in the care of colonized patients. Five persons with MRSA colonization and 20 healthcare personnel employed within infection, hematology, nephrology or primary healthcare settings participated. The data were collected using open-ended semi-structured individual interviews with the MRSA-colonized persons and semi-structured focus group interviews with the healthcare personnel. Results: The participants perceived MRSA as an indefinable threat and described that the responsibility for infection prevention is important, but such adherence was a neglected and negotiable issue. The described actions that were acknowledged as unprofessional and inappropriate adherence to infection prevention resulted in stigmatized patients. Conclusion: Colonized persons' and healthcare personnel's understanding of MRSA determines whether the personnel's behavior is perceived as proper or improper. Individual responsibility for patient-professional interactions in relation to MRSA colonization and adherence to infection control measures should be more stringent.

Keyword
Infection prevention, MRSA, Patient-professional interaction, Responsibility
National Category
Nursing Infectious Medicine
Identifiers
urn:nbn:se:hig:diva-18433 (URN)10.1016/j.jiph.2014.02.004 (DOI)000354964000009 ()24888790 (PubMedID)2-s2.0-84926247521 (ScopusID)
Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2015-09-22Bibliographically approved

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