INTRODUCTION Compliance with evidence-based Standard Precautions Guidelines (SPGs) among healthcare practitioners is essential to combat Healthcare Associated Infections (HCAI). However, it is widely understood that non-compliance with these precautions remains a common problem in paediatric nursing practice. Most existing studies into this problem have used quantitative methods. However, these studies have failed to explain noncompliant behaviour or address the issues that are specific to paediatric clinical areas. AIM This study is designed to investigate paediatric nurses' perceptions and experiences of infection control measures and to achieve a better understanding of the factors that influence nurses’ compliance with SPGs. METHODS This qualitative study used an adapted constructivist grounded theory approach. The study was conducted in five Jordanian hospitals. Thirty one (n=31) qualified paediatric nurses from different paediatric areas were reccruited to the study. Data were gathered using face-to-face semi-structured audio-taped interviews, which were transcribed and coded through constant comparative analysis. RESULTS This study identified causes of enduring failure by nurses to comply fully with SPGs. Four themes emerged (Children are different; Nurses are human first; Limited professional status; The challenges of the working environment). Paediatric nurses claim to be willing to comply with SPGs, but sometimes fail to achieve this. Risk of exposure to microorganisms was perceived as a major factor in compliance. Paediatric nursing practice was seen as different to adult practice and nurses construed the need for SPGs differently. DISCUSSION A key issue is the fact that nurses were reluctant to see themselves as change-agents to improve practice. This resulted in problems with SPGs being well understood but not acted on. Nurse’s prioritised compliance with the nursing culture in their specific clinical area, over more general principles of care, such as SPGs. Nurses did appreciate that compliance with SPGs was suboptimal and did sometimes criticise this situation. However, most nurses had a value system, which militated against the proper use of Standard Precautions and which served to diminish the influence of them. IMPLICATION The chief implication of this study is that infection control is unlikely to improve further until nurses feel empowered to initiate change. Nursing in this area of the world is essentially semi-professional in nature. Nursing needs to develop to become fully professional in its orientation so that nurses take full responsibility for their actions. Only when nurses see their actions and behaviour as fully their responsibility, will nursing issues such as this be properly addressed. Until this occurs, the imposition of rules and guidelines, documentation and policies, will not be sufficient to progress care in this important area of practice.

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University. Page 30 missing in numbering only

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

U.S. prisons are overextended, physically restrictive environments. Overcrowding in these facilities enhances the transmission of infectious, communicable diseases. At the same time, Staphylococcus aureus (S. aureus) colonization and infection rates are elevated in these settings. Moreover, HIV and sexually transmitted infections (STIs) are also prevalent. The purpose of this cross-sectional, correlational secondary analysis was to describe patterns of S. aureus co-infection with HIV and STIs in two New York State prisons and to identify risk factors for co-infection. Cultures were obtained from the anterior nares and oropharynx of a convenience sample of male (n = 383) and female (n = 373) prisoners in each facility. Descriptive and comparative statistics were used to accomplish the study aims. Overall S. aureus colonization rate was 53.8%. Among men, the rates of HIV-S. aureus and STI-S. aureus coinfection were 75% and 45.7%, respectively. Among women, the rates of HIV-S. aureus and STI-S. aureus co-infection were 47.4% and 59.1%, respectively. No statistically significant differences in S. aureus carriage rates were detected when comparing subjects with and without HIV or STIs. Multivariate logistic regression techniques were used to identify predictors of STIS. aureus co-infection in women. Insufficient numbers of subjects with HIV and men with STI-S. aureus limited regression modeling in these groups. After adjusting for age, race/ethnicity, and educational level, only taking more (10.1 vs 8.6) showers each week was significantly associated with increased risk of co-infection (p = .04). Results of this study suggested that rates of S. aureus carriage may be uniformly elevated across many risk groups in prisons. Suboptimal sample size limited interpretation of the study results.

Acute care hospitals function 24-hours-a-day, 7-days-a-week. A majority of that time is characterized as off-shifts (i.e., nights, weekends, and/or holidays). Researchers have found that patient outcomes are generally worse on off-shifts as compared to regular hours. However, the underlying mechanism of why these outcomes are worse remains unclear. This dissertation explores off-shift care including nurse staffing and human capital variables and their impact on patient safety in acute care hospitals. The importance of off-shift quality care in acute care hospitals is discussed in the first chapter. In the second chapter, findings from a systematic literature review are presented. The third chapter describes mixed methods and the theoretical framework that guided the development of an interview guide and the quantitative portion of the dissertation. The fourth chapter includes the qualitative study of off-shift nursing and the fifth chapter, is a quantitative study of testing variations in nursing inputs (i.e., staffing and human capital variables) by shift and their impact on length of stay. Finally, in the sixth chapter, the findings from Chapter 2, 4, and 5 are summarized and synthesized into a concluding chapter of the dissertation.

Shared decision making is considered to be a crucial component of high quality and safe patient-centered primary care treatment. Hispanics are the fastest growing minority group in the United States and they experience substantial health disparities. The aim of this study was to examine the factors that correlate with Hispanics' decision role preferences for participation in treatment decision making with their primary care clinician. Hispanic patients (n=772) were recruited from five zip codes in the Washington Heights/Inwood community of New York City and survey data were collected via interview by bilingual community health workers in four New York-Presbyterian Ambulatory Care Network clinics. Data were analyzed using multinomial logistic regression to investigate the association between sociodemographic and health factors and role preference in primary care treatment decision making (passive, shared, active); passive role as the reference range. Most survey respondents preferred to participate in medical treatment decisions in a shared or active role (90%) and also had inadequate health literacy (95%). The odds of wanting to participate in decision making in a shared role with a primary care provider significantly increased with younger age (OR=0.98, 95% CI [0.96- 0.99], p =0.01), less than 21 years living in the United States (OR=0.48, 95% CI [0.27- 0.88], p =0.02), more adequate health literacy (Newest Vital Sign) (OR=.46, 95% CI [0.25- 0.83], p =0.01), better ability to understand health instructions, pamphlets or written health materials (OR=0.55, 95% CI [0.31- 0.99], p =0.05), and higher social role performance (OR=0.97, 95% CI [0.94- 0.99], p =0.04). Statistically significant odds for preference for an active role were higher education (OR=3.11, 95% CI [1.20- 8.04], p =.02), less than 21 years living in the United States (OR=0.37, 95% CI [0.19- 0.73], p =0.004), and younger age (OR=0.98, 95% CI [0.95- 0.99], p =0.02). However, the overall models demonstrated poor fit with study data explaining 10% -14% of the variation of the dependent variable. Understanding the factors that influence Hispanic patients' role preference in primary care treatment decisions is crucial to providing higher quality patient-centered care and to possibly reducing Hispanics' health disparities. Our analysis suggested a number of patient specific factors that should be used to inform future informatics, clinical and public health primary care interventions for Hispanic patients. In addition, our analysis also underscores the need for more theoretical and analytical research to further characterize the factors that contribute to Hispanic patients' role preference in primary care treatment decision making.

This dissertation evaluates quality of care in the emergency department (ED), specifically with regards to crowding and infection prevention practices. Chapter One provides an overview of crowding, hand hygiene practices, and catheter-associated urinary tract infection (CAUTI) prevention in the ED, identifies gaps in science regarding these areas, and specifies the aims of this dissertation. Chapter Two reports a systematic review of the relationship between ED crowding and patient outcomes. Chapter Three reports a literature review of ED healthcare worker compliance with common infection prevention protocols. Chapter Four uses data collected from a single-site observational study to examine the relationship between crowding and hand hygiene compliance. Chapter Five uses data from a nationwide qualitative study to describe facets of high-performing ED CAUTI prevention programs. Lastly, Chapter Six synthesizes dissertation findings, specifies the implications of results, and makes recommendations for further study.