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Title: Exploring the use of protocols and guidelines in the management of healthcare-associated infection : a case study
Author: Rasmussen, Julie
ISNI:       0000 0004 2739 939X
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2012
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Implementation of protocols and guidelines is an important strategy used by hospitals in their fight against healthcare-associated infections (Pratt et al., 2007), yet their use remains a challenge (Boaz et al., 2011; Grimshaw et al., 2001). This thesis addresses the topic of behavioural change through exploring how protocols and guidelines are used on hospital wards to manage the risk from Clostridium difficile infection, the difficulties ward staff faced with their use and what happened in practice as difficulties were experienced. A qualitative study was conducted using a single case study methodology (Yin, 2009) with one acute NHS hospital in the UK. Methods used included nonparticipant observation (184 hours), informal conversation, interviews (49) and document review. An adapted version of the topic guide developed by Michie et al. (2005) based on their theoretical framework of behavioural change was used in the interviews. Data collected was analysed inductively using NVivo 8 and compared against Michie et al’s (2005) framework. The findings illustrate that nurses and doctors were detached from protocols and guidelines. Instead they relied heavily on informal sources of knowledge to guide their practice. Examples include experiential knowledge, common sense, intuition, ‘‘rules of thumb’’ and “mind lines’’ (Gabbay and le May, 2004, 2011). They also took account of preferences, their perceptions of risk, social norms and other contextual issues. Four emergent themes illustrate the complexity of factors hindering and assisting the use of protocols and guidelines into practice. These are ambiguity, organisational issues, professional frustrations and perceptions of contamination. Variations in practice were widespread as protocols and guidelines were ‘worked around’ and improvisations were made as ward staff struggled against a tide of organisational constraints, unrealistic conflicting priorities and difficulties with protocol ambiguity. The way that difficulties were being solved on the ward means that the underlying causes were not being addressed as concerns were not brought to the surface. Professional frustrations such as feeling overwhelmed and powerless acted as barriers to nurses’ reflection. The study has empirically expanded Michie et al’s (2005) behavioural framework whilst exploring the dynamics and complexity of categories influencing the use of protocols and guidelines through a ‘thick’ description of the study findings. This study has made a conceptual contribution to the literature by identifying that Michie et al’s (2005) framework does not seem to take into account tacit and experiential knowledge, professional knowledge, how sense is made of information from the local context or the process of reflection as part of learning. Recommendations are made to address the findings from this study.
Supervisor: Not available Sponsor: NHS Institute for Innovation and Improvement (Great Britain)
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA0421 Public health. Hygiene. Preventive Medicine ; RC Internal medicine