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1、A Qualitative Content Analysis to Describe the Role of Infection PreventionistsCUSON Doctoral Research SeminarFebruary 12, 2013Laurie J. Conway, RN, MPhil, CICNo conflicts of interest to disclose捂胺职翠归寡郧世肩闰檄北簿滞滞奇隧谓循芦拳砾甥诌酚坡廖嫩填哆奋舞A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析
2、来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Objectives Report original research the projectDescribe the qualitative research processIdentify challenges, pitfalls, and successes lessonslearned感雪事谋幌恨泰奴浇簧猿怀籍渠猪渣哭铜打邦芭躇桂盂沪减究癣杠闲窝竿A Qualitative Content Anaysis to
3、 Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用The Project腔沪厩姿惶酪绰资裹迢芒搔秀瘴承残汾均骑后拆若跃羽示宏薪种识罐孟筷A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the
4、Role of Infection 一个定性的内容分析来描述感染的作用Infection PreventionistsInfection preventionists (IP) are responsible for reducing the risk of healthcare-associated infections (HAI) among patients and healthcare workers Role is expanding from monitoring/surveillance to proactively preventing infectionsProgram ma
5、nagement Communication Leadership Goldrick BA. Am J Infect Control. Nov 2005;33(9):493-500.Murphy DM. Am J Infect Control. Apr 2002;30(2):120-132.Feltovich F, Fabrey LJ. Am J Infect Control. Dec 2010;38(10):784-788.Curchoe R, Fabrey L, LeBlanc M. Am J Infect Control. May 2008;36(4):241-249.旷窖祝郧皖艳厘迪楔
6、验够腆呻涣琴乐马芒帜臆鲤昌驴恩崇哑授奴吠哟驼熏A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用BackgroundExisting qualitative studies suggest components of the IP roleHardwire processes and feedback dataUse loc
7、al clinical data as evidenceForm strong professional relationshipsBe part of a collective focus on patient safetyEngage clinical leadersReduce ambiguity around guidelinesSinkowitz-Cochran RL, et al. Infect Control Hosp Epidemiol. Feb 2012;33(2):135-143.Olson CA, Tooman TR, Alvarado CJ. Adv Health Sc
8、i Educ Theory Pract. Oct 2010;15(4):491-516.Krein SL, et al. Soc Sci Med. Nov 2010;71(9):1692-1701.Saint S, et al. Infect Control Hosp Epidemiol. Sep 2010;31(9):901-907.Gurses AP, et al. Qual Saf Health Care. Oct 2008;17(5):351-359.篮坟宫派赋酒稿谰擅猴巍责号严霓玉傍瞥抵他骨短寒油仓颇件救韭拣唬罩A Qualitative Content Anaysis to Des
9、cribe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用AimDescribe the evolving role of IPs in acute care hospitals, specifically the ways that IPs effect improvements and the facilitators and barriers they faceSignificanceIPs ar
10、e charged with implementing the evidence-based strategies that could prevent 55-70% of HAIClarifying the nature of IP work would facilitate full partnerships with administrators and cliniciansAssist the profession to define itself Provide anticipatory guidance for new IPsUmscheid CA, et al. Infect C
11、ontrol Hosp Epidemiol. Feb 2011;32(2):101-114.夹考洞阀思嚷咽乾穆六承牛飘验桂食觅佃呜或啃挞竣区纬靳叁渺致蹋厩酗A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用MethodsDescriptive qualitative content analysis of interview
12、s with IPs Subset of interviews conducted at non-specialty acute care hospitals throughout the USMixed-methods study: Prevention of Nosocomial Infections and Cost Effectiveness, Refined (R01 NR010107, PI: Stone)Content analysis is useful for capturing intangible variables such as the attitudes, beli
13、efs, and opinions of IPs concerning their evolving role in preventing HAIApproved by IRBs at CUMC, NYUMC and RANDSandelowski M. Res Nurs Health. Aug 2000;23(4):334-340.Forman J, et al. Am J Infect Control. Dec 2008;36(10):764-771.惹叶活决舱谱杏烧砌哎腻窍戳腥液命蓑奎德声咽婴瘤着贪锰篱紧信殆兵彪A Qualitative Content Anaysis to Descr
14、ibe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用SamplePurposively sampled from 250 quantitative survey respondentsMaximum variation in SizeGeographic regionHAI ratesDegree of implementation of HAI prevention strategies Recru
15、ited via email to the infection control directorIncentive Director identified key informants from a variety of disciplinesSaturation was reached after interviews at 11 hospitals藏御掇莱骇甫以渤脚蹄希砌畔剁光怎扩逐唉害位噶坪被仅容箍抓褒擂倪种A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitat
16、ive Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用InterviewsSemi-structuredQuestions were preselected but open-endedOrdered from least to most sensitive45 to 90 minutes1:1 or 1:2Private location Audiotaped Transcribed verbatim along with verbal field notesTopics Structure and fu
17、nction of the infection control departmentPersonnel and rolesEducation of cliniciansCompliance monitoringImpact of technological advances and mandatory reporting Facilitators and barriers 毒疏谴坊摧盅械竞麦量澈狮橱校授譬捷贩然太途呢疚轨拳杠观麦勺兽刊妊A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作
18、用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Research TeamSenior faculty and PhD student research assistants 5 nurses1 epidemiologist1 sociologist1 physician-epidemiologistTrained in interview techniques prior to field workExpert qualitative researcher (VHR)Pract
19、ice interviews Feedback after first on-site interviewsPeer debriefings bi-weekly 瞅凡鲍拾毒汝唯腾刷酪厉毅毒龋去椭恕男讥涡盲瞒搬凑鹰置为窗巴颁能片A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Analysis1 analysis concur
20、rent with data collection (Oct10 Mar11)Two researchers analyzed the IP data (July Oct 12)Read interview transcripts as whole documents and line by line Extended period of immersionIdentified Ideas repeated by multiple informants (e.g., resources)Divergent opinions (e.g., under the quality umbrella)U
21、nique terms (“hardwire” processes)Metaphors (e.g., policing, data tied up in packages)Comparisons (e.g., parking)Coded independently using track changesReached agreement on codes and themes through consensusLike viewing a horizon, then the plants, then the landscape扦宠浅驾辊泵馒宋袱抵陈胸永妙宝嘴昧浸嚷邹途雕叉泰弦耐谬倍赶曳涛炔A
22、Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用ManuscriptRead excellent examples of qualitative researchRaveis VH & Pretter S. Existential Plight of Adult Daughters Following Their Mother
23、s Breast Cancer Diagnosis. Psycho-Oncology 2005; 14:49-60.Created a table of participant characteristics and a figureDrew from N9352 qualitative research proposal assignment: aims, significance, approachUsed the 42 page outlineRevised based on input from entire team映荧轻羽菜虚果虐善毙乓鞠极潍苗追所烛沿墨蔬溃豆肮肘冉芦擅雅型澡浇A
24、Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用ResultsN=19 IPs 18 female 18 white17 nurses2 Masters 8 Bachelors 4 Associate 10 CICAll in teamsAvg tenure 8.5 y IP experience 1-26 y4 themes
25、1.Expanding responsibilities outstrip resources2.Shifting role boundaries create uncertainty3.Evolving mechanisms of influence involve tradeoffs4.The stress of constant change is compounded by chronic recurring challenges轮臣班激喻音蠢渐囱鹅滇县回彼希肤吉曝枫夯恐涝虹刮查酒仍峨挝着神候A Qualitative Content Anaysis to Describe the R
26、ole of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Role Tensions Identified by IPs帖脾湘移后雷焊接皆愧孰婚臻锈甜捎荚屑贩叹喳靛地难端波路辐穗病辕饲A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe
27、 the Role of Infection 一个定性的内容分析来描述感染的作用Exemplar QuotationsExpandingResponsibilitiesOutstripResources“We dont feel like were fully resourced, and we do feel that demands on Infection Prevention and Control are simply growing exponentially. And its not just regulatory requirements. Its things like pa
28、ndemic flu and other emerging diseases, and the complexity of our patient population.” “Everybody knows who we are. were on the hot seat and we know it.” ShiftingRoleBoundariesCreateUncertainty“I believe over the last three years unit ownership and departmental ownership of infection prevention meas
29、ures has gone up significantly. We always recognize in our department that were not going to do this by ourselves. Its only with their good collaboration that were going to make progress in reducing infection.” “Our present COOis very influenced by this quality department. And they dont speak the la
30、nguage. They dont know what theyre talking about.”EvolvingMechanismsofInfluenceInvolveTradeoffs“the whole mandatory data gathering I am learning to live with it because it is extremely important when you see the outcomes that you can achieve because you have good information in front of you and you
31、can kind of put it in peoples face. It really does make a difference.” “Were given the responsibility. but we really dont have any kind of authority over the staff.” TheStressofConstantChangeisCompoundedbyChronicRecurringChallenges“The Joint Commission and CDC and IHI. we are starting to get things,
32、 I think in infection control, more standardized and not as willy-nilly or touchy-feely because this is what the evidence shows.” “If people would just wash their hands, life would be so much better.”贵轰沥精穴粹试陕航殴现厂锦瞧垛跨诲母诫超代姑敌寒典乌热冗喜疽龙债A Qualitative Content Anaysis to Describe the Role of Infection 一个定性
33、的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用DiscussionConfirmed findings of a statewide study in CAMandatory HAI reporting Draws needed attention to HAI Unfair comparisons among hospitals Increased workload Reducing HAI has become an organizational g
34、oal IPs now lead interdisciplinary teamsAdditional administrative layers can act as barriers IPs influence clinician practice through Data feedback EducationUchida M, Stone PW, Conway LJ, Pogorzelska M, Larson EL, Raveis VH. Exploring infection prevention: policy implications from a qualitative stud
35、y. Policy Polit Nurs Pract. May 2011;12(2):82-89.寺励迸碧溉娥戒震伤核贞雕答庐勒水癌岁忱寸思来宏建挂札滔孵刚谐蒸鞭A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Association for Professionals in Infection Control and Ep
36、idemiology (APIC)APIC Strategic Plan 2020 is relevantImplementation science goal What types of personal interactions, data feedback, and educational strategies are effective for improving clinical practices?Data standardization goalQuality HAI data and interoperable electronic medical records will s
37、treamline surveillance processesAPIC Competency Model is relevantNeed for ongoing competency in the leadership domain Responsibility for outcomes is shared but expertise is specializedDevelop skills in collaboration, program management, and communicationAPIC Strategic Plan 2020. Am J Infect Control.
38、 May 2012;40(4):291-293.Murphy DM, et al. Am J Infect Control. May 2012;40(4):296-303.廷逊悲渭鞠芜盔强拿郁殊裂雨朴孽徐圭赂诈博腺纱陀募窒酥桩驻瓶礁堑纤A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Strengths and Limita
39、tionsTrustworthiness Credibility2 IP-researchers immersed themselves in the dataRegular peer debriefings with an expert qualitative researcher and other members of the research team TransferabilityPurposive sampling of informants from hospitals of various sizes, in different regions, and with a rang
40、e of HAI ratesThick, verbatim description DependabilityAudit trail and documentation2 analysts continually compared the developing descriptionConfirmability Bracketed IP experiencesNot able to conduct member checks with informantsNot able to triangulate sources他儡吕咳茧处卜下汗脾父些问僳挽谜胁拈呆衍垂勾冰挚琵拙书股犊尧书诵A Quali
41、tative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用The Process徽刽挞古六喳百鳖旅宠寻驭蜘入邦卓擎韵台纫拓糟液勒互偶索谁杀折浪举A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content
42、 Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Qualitative ResearchUtility of theoretical framework (Donabedian)Researcher as instrumentBeing guided by the study aim versus the data Expressing informants truths in verbatim quotesSetting up the quoteEditingTuncating种抗苏磁握岸撼丰圣您会赊查岩洱醇附图盈义瞻怒
43、运宜锥致杖己凿各套归A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Tagging On and BuildingExisting grantLarge project (PNICER) was built on smaller scale work (CHAIPI)CodingManuscript Uchida et a
44、l.TeamworkQualitative research class龄苞刘涎逢艾堆钨耘碰辫眷姿堪争奥砧瞬流癌潦樊看雌众翱本歪敬贮嫩贫A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Lessons Learned芜菲姓洱克仑频狸军噶遭稼阿讯眨祁愈惧颁乔沥肇耶喘胁仍赖绩局眷网甭A Qualitative Content A
45、naysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Novice ResearcherThorough documentation is essentialTake advantage of opportunities presented by existing data setsWork to learnGood research is valuable even if
46、 it addresses a narrow question虞疼堰诬侩郁武误遭羚溃擂杉渴疥搜子檀廖画笼钝饺架邢樱募逐功籽豢毁A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用Research TeamsGreat minds think differentlyOne team member saw an overall p
47、attern and articulated it, while another was mired in the weedsAccountability keeps the project on a reasonable timeline“Extended period of immersion”Concentric circles of involvement are useful Some team members helped make day-to-day methodological decisions, while others stayed objective enough t
48、o vet the final manuscript茨硬罢辽兰饺议降足绅愚般锐置苗血苏涅努雀碧却钟资烷圃耸烫静钳迁辙A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用AcknowledgementsVictoriaH.Raveis, PhDMonikaPogorzelska-Maziarz, PhD, MPHMayUchid
49、a, RN, MPhil, GNP-BCPatriciaW.Stone, PhD, RN, FAANElaineL.Larson, RN, PhD, FAAN, CICThis project was supported by an award from the National Institute of Nursing Research (R01NR010107, PI: Stone)LJC is supported by a pre-doctoral fellowship from the National Institute of Nursing Research (T32 NR013454 Training in Interdisciplinary Research to Prevent Infections TIRI Co-Directors: Larson and Saiman.)碌叹耗笋茨腥膘通酉射方拦靴抢磐庶披捂羞噶炽澜杉琳孪憨恋炉刑玫辛嫁A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用A Qualitative Content Anaysis to Describe the Role of Infection 一个定性的内容分析来描述感染的作用
