Barriers to Learning Healthcare-Associated Infections Prevention and Control during Clinical Practicum among Nursing Students in Korea: A Focus Group Study
Abstract
:1. Introduction
Research Question
2. Materials and Methods
2.1. Design
2.2. Participants and Setting
2.3. Data Collection
2.4. Analysis
2.5. Ethical Considerations
3. Results
3.1. Limited Learning Opportunities
3.1.1. Not Many Learning Opportunities
You know, in our classes, we primarily learned about diseases… because we focused so much on diseases during our studies, I forgot everything about infection control, like standard precautions, and by the time I went to clinicals, I just kept saying to myself, “Oh right, we learned about this.”(Participant 5)
I think seeing the patient in person helps to learn more about the particular disease. So, I think that is why I could not learn more about infection control… The clinicals are usually structured as case studies, and because it involves talking to the patients to get more subjective data, for their case studies, everybody tends to choose patients, whom they encounter as much as possible. So, I think that is why I could not choose patients with an infection, for my case study.(Participant 12)
I had my rotation in an infectious diseases unit so I was able to see a lot of cases of patients with infections, but you know not everyone gets to do their rotations at such units. So, I think not everyone has such opportunities to learn about preventing… such infections during their clinicals.(Participant 4)
3.1.2. Limited Face-to-Face Interactions with Patients with an Infection
In the case of COVID-19, patients come up to the general med-surg floors where we are placed only after their test is negative… the hospital tells us not to go into rooms of patients with contact precautions, the single-person rooms… We had no chance of wearing N95 masks or AP gowns and I have never done it before… So, even after COVID started, we did not really do much during our clinicals. Students have to wear a face mask and goggles during clinicals; so, we just wore those.(Participant 3)
When I was placed in an infectious diseases unit, there were patients with MRSA… and VRE… but I was told not to go into those rooms at all… So, I just knew that we had those patients and I did not go into those rooms… The hospital excludes… I think, they kept students away from patients with airborne or droplet precautions, as far as possible.(Participant 8)
Even if we learn it at school or they talk about it in the unit and our preceptors teach us about it, we cannot actually see these patients; so, it just flies by us… so, I think nothing was really rememberable.(Participant 5)
3.1.3. Inability to Be Proactive in Clinical Practicum Settings
Honestly, I think the preceptors did not really like us coming in at all… because we might make things worse… what they always said is, that students do not sufficiently practice hand hygiene and they blamed the infections on students… so, I was very careful about being proactive to do anything.(Participant 11)
You know, ever since COVID-19, wearing a face mask and other PPE has become a sensitive issue… However, there were a lot of patients using contact precautions at my rotation site. Then, I had to wear gloves too. There are gloves in every room, but I saw that a lot of the preceptors did not wear gloves when providing patient care, especially when they quickly do things and stuff… but when I wear gloves to take vitals, the caregivers kind of give us this look. At first, I really did try to put gloves on… but they kept giving us weird looks; so, I just stopped wearing gloves when taking vitals. That was a bit of a challenge.(Participant 1)
I went to take vital signs, and you know the sign is up there on the bed, “contact precautions.” After I saw that, I was going to don the gown, but the patient told me that the nurses do not wear it, and only the students try to wear it. So, I was kind of embarrassed and did not wear it, although I know that it is to be worn not only to protect ourselves, but also other patients. However, the patients do not like that. And, that was kind of hard… The patients hated it so much; so, we were debating whether to do it and decided not to… We just took care of that patient last and washed our hands really thoroughly after that.(Participant 2)
At first, there was a time when I did not know, but found out later, during the handoff, that a patient had a communicable disease … My reaction was like “Uh oh,” when I heard about it. I was so concerned and thought to myself, why did she not tell me? … I just touched that patient without any protection… She did not also tell us about other patients with contact precautions; so, we just looked through the electronic medical records.(Participant 5)
Even before COVID, it was a bit hard to go in… I just stood outside the room, even during the rounds… If we go in without the preceptors, then too, we have to use supplies, and we were concerned about whether it is okay for us to use them. We have to use the gowns or face masks and stuff available in front of the rooms, and as these are disposable, we have to throw them away after use. But we are students; so, we were thinking whether it was okay for us to keep using them. Would it not affect the supply?(Participant 3)
3.2. Lack of Knowledge about Infection Control
3.2.1. Lack of Specific Knowledge about Transmission Routes
Even if it is an emerging infectious disease… it is something we have been learning; so, instead of something new… it wasn’t like I knew that content (or had already learned it before)… in depth or extensively, but I just had shallow knowledge about it, like hand hygiene and use of PPE… I just had a broad sense of knowledge like that… I did not know that in detail… like what is required for each, and what makes it up. I did not know; so, I could not do anything because I did not know what to observe.(Participant 2)
You know, standard precautions are basic. Even during the pandemic, such basic knowledge is what I had already learned before; so, it did not feel like something new. However, I needed to know these well… like know exactly what the standard precautions are… what are the things on standard precautions… I just knew about hand hygiene and PPE, and did not know the rest.(Participant 6)
There was a patient suspected of measles in our unit, and at that time, I did not exactly know that measles involves airborne precautions… I had limitations about what diseases take each route of transmission.(Participant 11)
3.2.2. Fading Memories of Learned Knowledge over Time
I learned theory in my second year, and it was taught when I had rotations in surgery during the first semester… the head nurse in the hospital once taught us… but I could not remember it that well during clinicals in the following semester. I think it did not come to me quickly because I had not been hands on for a long time since then and I had never tried that after learning about it.(Participant 2)
3.3. Inadequate Training Experience
3.3.1. Inadequate Infection Management Skills
I think I kept forgetting at first. I have to perform hand hygiene after touching every patient, but I wasn’t aware of that, and I was nervous, and it was my first rotation… Sometimes, I just forgot performing hand hygiene and remembered later… and it was my first time wearing an N95 mask during my internal medicine rotation. When wearing the mask, it should cover my entire face, but I felt like the mask was not fitted well, and there were empty spaces and stuff.(Participant 4)
We learned about it, but when it was actually time to use it, I could not remember what I had learned… I think I did not perform it correctly because of nervousness and stuff…I had practiced it a couple of times when we had learned about it… but even if I knew it, I could not really apply it during my rotations… it does not come to mind quickly… I think I really felt that knowing something and applying it are two different things… I did not know the exact protocol, so I just kind of kept pretending to have done it.(Participant 2)
3.3.2. School-Based Skills Training Not Reflecting Real-Life Clinical Settings
What I should do when I am actually exposed to infection?… Ṭhe patient had an IV, and after removing the line, one has to apply pressure to stop the bleeding, but the patient’s bleeding had not completely stopped. So, when I went to take the patient’s blood pressure, the blood was still oozing. As I was in a hurry, I held onto that part with my bare hands, and called my nurse.(Participant 1)
I know, but when I actually do it, I sometimes miss out and forget about it… I think we should actually practice nursing skills, like trying to put on PPE and stuff … In a simulation, one is aware of the activities and performs them when given a situation… but in other labs, we are supposed to just visualize the situation when we practice… and I think that makes it harder to become aware of the activities.(Participant 12)
3.4. Passive Learning Attitude
3.4.1. Hesitancy about Learning about Patients with an Infection
At first, I was a little scared during the orientation. Would it be okay to go into this room? Would wearing only a gown and gloves be enough? So, at first, I was a little hesitant to go in… When I checked the vital signs of a patient with tuberculosis, I had so many concerns and I was a little hesitant to go in at that time. So, I think I tried to avoid the situation, rather than face it…(Participant 2)
I already knew that the patient had tuberculosis… so, I did not want to go in because I was scared.(Participant 10)
3.4.2. Lack of Interest
There were no instances when I had to think deeply about infection control; so, that may have been the reason why I did not attempt to search for things. If I had been exposed to such situations frequently, I would have tried to learn more about it, but that wasn’t the case. So, I think that is why I was not interested.(Participant 2)
I have come across CDI on electronic medical records, but I did not see those patients in detail; so, I did not intensively study infection control.(Participant 7)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Cardoso, T.; Almeida, M.; Friedman, N.D.; Aragão, I.; Costa-Pereira, A.; Sarmento, A.E.; Azevedo, L. Classification of Healthcare-associated Infection: A Systematic Review 10 years after the First Proposal. BMC Med. 2014, 12, 40. [Google Scholar] [CrossRef] [Green Version]
- Topçu, S.; Emlek Sert, Z. Turkish Nursing Students’ Compliance to Standard Precautions during the COVID-19 Pandemic. PeerJ 2023, 11, e15056. [Google Scholar] [CrossRef]
- Parreira, P.; Santos-Costa, P.; Pardal, J.; Neves, T.; Bernardes, R.A.; Serambeque, B.; Sousa, L.B.; Graveto, J.; Silén-Lipponen, M.; Korhonen, U.; et al. Nursing Students’ Perceptions on Healthcare-Associated Infection Control and Prevention Teaching and Learning Experience in Portugal. J. Pers. Med. 2022, 12, 180. [Google Scholar] [CrossRef] [PubMed]
- Ahsan, A.; Dewi, E.S.; Suharsono, T.; Setyoadi, S.; Soplanit, V.G.; Ekowati, S.I.; Syahniar, N.P.; Sirfefa, R.S.; Kartika, A.W.; Ningrum, E.H.; et al. Knowledge Management-Based Nursing Care Educational Training: A Key Strategy to Improve Healthcare Associated Infection Prevention Behavior. SAGE Open Nurs. 2021, 7, 23779608211044601, Erratum in SAGE Open Nurs. 2022, 8, 23779608221109367. [Google Scholar] [CrossRef] [PubMed]
- Baker, M.A.; Sands, K.E.; Huang, S.S.; Kleinman, K.; Septimus, E.J.; Varma, N.; Blanchard, J.; Poland, R.E.; Coady, M.H.; Yokoe, D.S.; et al. The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections. Clin. Infect. Dis. 2022, 74, 1748–1754. [Google Scholar] [CrossRef] [PubMed]
- Fakih, M.G.; Bufalino, A.; Sturm, L.; Huang, R.H.; Ottenbacher, A.; Saake, K.; Winegar, A.; Fogel, R.; Cacchione, J. Coronavirus Disease 2019 (COVID-19) Pandemic, Central-line-associated Bloodstream Infection (CLABSI), and Catheter-associated Urinary Tract Infection (CAUTI): The Urgent Need to Refocus on Hardwiring Prevention Efforts. Infect. Control Hosp. Epidemiol. 2022, 43, 26–31. [Google Scholar] [CrossRef]
- Kim, E.J.; Lee, E.; Kwak, Y.G.; Yoo, H.M.; Choi, J.Y.; Kim, S.R.; Shin, M.J.; Yoo, S.Y.; Cho, N.H.; Choi, Y.H. Trends in the Epidemiology of Candidemia in Intensive Care Units from 2006 to 2017: Results from the Korean National Healthcare-Associated Infections Surveillance System. Front. Med. 2020, 7, 606976. [Google Scholar] [CrossRef] [PubMed]
- Jeong, S.Y.; Choi, J.; Kim, J.Y.; Ga, H. Development and Application of a Surveillance Method for Healthcare-Associated Infections in Long-Term Care Hospitals in Korea. Ann. Geriatr. Med. Res. 2020, 24, 274–281. [Google Scholar] [CrossRef] [PubMed]
- Chiang, C.H.; Pan, S.C.; Yang, T.S.; Matsuda, K.; Kim, H.B.; Choi, Y.H.; Hori, S.; Wang, J.T.; Sheng, W.H.; Chen, Y.C.; et al. Healthcare-associated Infections in Intensive Care Units in Taiwan, South Korea, and Japan: Recent Trends Based on National Surveillance Reports. Antimicrob. Resist. Infect. Control 2018, 7, 129. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kim, K.M.; Oh, H. Clinical Experiences as Related to Standard Precautions Compliance among Nursing Students: A Focus Group Interview Based on the Theory of Planned Behavior. Asian Nurs. Res. (Korean Soc. Nurs. Sci.) 2015, 9, 109–114. [Google Scholar] [CrossRef] [Green Version]
- Park, H.; Kim, Y. Infection Control Education Programs for Nursing Students: A Systematic Review. J. Korean Acad. Fundam. Nurs. 2021, 28, 237–248. [Google Scholar] [CrossRef]
- Appiah, E.O.; Appiah, S.; Menlah, A.; Baidoo, M.; Awuah, D.B.; Isaac, N.B. Experiences of Infection Prevention and Control in Clinical Practice of Nursing Students in the Greater Accra Region, Ghana: An Exploratory Qualitative Study. SAGE Open Med. 2021, 9, 20503121211054588. [Google Scholar] [CrossRef] [PubMed]
- Barisone, M.; Ghirotto, L.; Busca, E.; Diaz Crescitelli, M.E.; Casalino, M.; Chilin, G.; Milani, S.; Sanvito, P.; Suardi, B.; Follenzi, A.; et al. Nursing Students’ Clinical Placement Experiences during the COVID-19 Pandemic: A Phenomenological Study. Nurse Educ. Pract. 2022, 59, 103297. [Google Scholar] [CrossRef]
- Dempsey, L.; Gaffney, L.; Bracken, S.; Tully, A.; Corcoran, O.; McDonnell-Naughton, M.; Sweeney, L.; McDonnell, D. Experiences of Undergraduate Nursing Students who Worked Clinically during the COVID-19 Pandemic. Nurs. Open 2023, 10, 142–155. [Google Scholar] [CrossRef]
- Gómez-Moreno, C.; García-Carpintero Blas, E.; Lázaro, P.; Vélez-Vélez, E.; Alcalá-Albert, G.J. Challenge, Fear and Pride: Nursing Students Working as Nurses in COVID-19 Care Units. Int. J. Qual. Stud. Health Well-Being 2022, 17, 2100611. [Google Scholar] [CrossRef]
- Dziurka, M.; Machul, M.; Ozdoba, P.; Obuchowska, A.; Kotowski, M.; Grzegorczyk, A.; Pydyś, A.; Dobrowolska, B. Clinical Training during the COVID-19 Pandemic: Experiences of Nursing Students and Implications for Education. Int. J. Environ. Res. Public Health 2022, 19, 6352. [Google Scholar] [CrossRef]
- Kaveh, O.; Charati, F.G.; Kamali, M.; Mojarrad, F.A. Clinical Nursing Education during the COVID-19 Pandemic: Perspectives of Students and Clinical Educators. BMC Nurs. 2022, 21, 286. [Google Scholar] [CrossRef]
- Nabavian, M.; Rahmani, N.; Alipour, H. Experiences of Nursing Students in the Care for Patients Diagnosed with COVID-19: A Qualitative Study. J. Patient Exp. 2021, 8, 23743735211039925. [Google Scholar] [CrossRef]
- Casafont, C.; Fabrellas, N.; Rivera, P.; Olivé-Ferrer, M.C.; Querol, E.; Venturas, M.; Prats, J.; Cuzco, C.; Frías, C.E.; Pérez-Ortega, S.; et al. Experiences of Nursing Students as Healthcare Aid during the COVID-19 Pandemic in Spain: A phemonenological research study. Nurse Educ. Today 2021, 97, 104711. [Google Scholar] [CrossRef]
- Salifu, D.A.; Heymans, Y.; Christmals, C.D. Teaching and Learning of Clinical Competence in Ghana: Experiences of Students and Post-Registration Nurses. Healthcare 2022, 10, 538. [Google Scholar] [CrossRef] [PubMed]
- Kwon, S.; Kim, Y.; Bang, M.; Ryu, M. Nursing Students’ Experiences of Adapting to Clinical Practice in the COVID-19 Pandemic. J. Korean Acad. Soc. Nurs. Educ. 2022, 28, 57–69. [Google Scholar] [CrossRef]
- Kitzinger, J. Qualitative Research: Introducing Focus Groups. BMJ 1995, 311, 299–302. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated Criteria for Reporting Qualitative Research (COREQ): A 32-item Checklist for Interviews and Focus Groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gould, D.; Drey, N. Student Nurses’ Experiences of Infection Prevention and Control during Clinical Placements. Am. J. Infect. Control 2013, 41, 760–763. [Google Scholar] [CrossRef]
- Graneheim, U.H.; Lundman, B. Qualitative Content Analysis in Nursing Research: Concepts, Procedures and Measures to Achieve Trustworthiness. Nurse Edu. Today 2004, 24, 105–112. [Google Scholar] [CrossRef]
- White, M.D.; Marsh, E.E. Content Analysis: A Flexible Methodology. Libr. Trends. 2006, 55, 22–45. [Google Scholar] [CrossRef] [Green Version]
- Sandelowski, M. The Problem of Rigor in Qualitative Research. Adv. Nurs. Sci. 1986, 8, 27–37. [Google Scholar] [CrossRef]
- Ayele, D.G.; Baye Tezera, Z.; Demissie, N.G.; Woretaw, A.W. Compliance with Standard Precautions and Associated Factors among Undergraduate Nursing Students at Governmental Universities of Amhara Region, Northwest Ethiopia. BMC Nurs. 2022, 21, 375. [Google Scholar] [CrossRef]
- Xiong, P.; Zhang, J.; Wang, X.; Wu, T.L.; Hall, B.J. Effects of a Mixed Media Education Intervention Program on Increasing Knowledge, Attitude, and Compliance with Standard Precautions among Nursing Students: A Randomized Controlled Trial. Am. J. Infect. Control 2017, 45, 389–395. [Google Scholar] [CrossRef]
- Kang, M.; Nagaraj, M.B.; Campbell, K.K.; Nazareno, I.A.; Scott, D.J.; Arocha, D.; Trivedi, J.B. The Role of Simulation-based Training in Healthcare-associated Infection (HAI) Prevention. Antimicrob. Steward Healthc. Epidemiol. 2022, 2, e20. [Google Scholar] [CrossRef] [PubMed]
- Kuzel, A.J. Sampling in qualitative inquiry. In Doing Qualitative Research; Crabtree, B.F., Miller, W.L., Eds.; Sage Publications: Thousand Oaks, CA, USA, 1999; pp. 33–45. [Google Scholar]
- Patton, M.Q. Designing qualitative studies [excerpt: Purposeful sampling]. In Qualitative Research and Evaluation Methods; Sage Publications: Thousand Oaks, CA, USA, 2002; pp. 230–247. [Google Scholar]
|
|
|
|
Participant Number | School Year | Sex (Age) | Courses in Which Students Recalled Having Learned Infection Control | Clinical Placement Units * |
---|---|---|---|---|
1 | 3 | F (21) | Fundamentals of Nursing | CV, PED, OBGY, OS, OS |
2 | 3 | F (21) | Fundamentals of Nursing | INF, PED, OS, OBGY, OR |
3 | 3 | F (21) | Fundamentals of Nursing | CV, PED, OBGY, OS, OS |
4 | 3 | F (21) | Fundamentals of Nursing | INF, PED, OR, GS, OBGY |
5 | 3 | F (22) | Fundamentals of Nursing Adult Health Nursing | On, NICU, OS, OBGY, OR |
6 | 3 | M (23) | Fundamentals of Nursing | INF, PED, OR, OS, OBGY |
7 | 4 | M (25) | Fundamentals of Nursing | ICU, PED, GER, PSY, OS, On, NICU, ER, TS, OBGY |
8 | 4 | F (22) | Fundamentals of Nursing Microbiology | TICU, CNCU, GER, PSY, NR, PED, CV, OR, OS, OBGY |
9 | 4 | F (22) | Fundamentals of Nursing | GI, GER, TICU, PSY, CNCU, TS, OBGY, ER, PED, On |
10 | 4 | F (22) | Fundamentals of Nursing | PED, GER, ICU, PSY, PU, OBGY, OR, GS, NICU, On |
11 | 4 | F (23) | Fundamentals of Nursing | GER, ICU, PED, PSY, CNCU, IDM, NICU, OR, GS, OBGY |
12 | 4 | F (22) | Fundamentals of Nursing Adult Health Nursing | GER, ICU, PED, PSY, CNCU, OBGY, OR, OS, CV, NICU |
Categories | Sub-Categories | Frequencies * | Participant Number |
---|---|---|---|
Limited learning opportunities | Not many learning opportunities | 4 | 4, 5, 11, 12 |
Limited face-to-face interaction with patients with an infection | 11 | 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12 | |
Inability to be proactive in a clinical practicum setting | 6 | 1, 2, 3, 5, 6, 11 | |
Lack of knowledge about infection control | Lack of specific knowledge about transmission routes | 12 | 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 |
Fading memories of learned information over time | 5 | 1, 2, 3, 4, 8 | |
Inadequate training experience | Inadequate infection management skills | 7 | 2, 3, 4, 6, 8, 10, 11 |
School-based skills training not reflecting real-life clinical setting | 9 | 1, 2, 3, 4, 5, 6, 10, 11, 12 | |
Passive learning attitude | Hesitant about learning about patients with an infection | 4 | 1, 2, 7, 10 |
Lack of interest | 2 | 2, 4, 7 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Park, E.; Park, H.-R.; Lee, J.-H. Barriers to Learning Healthcare-Associated Infections Prevention and Control during Clinical Practicum among Nursing Students in Korea: A Focus Group Study. Int. J. Environ. Res. Public Health 2023, 20, 6430. https://doi.org/10.3390/ijerph20146430
Park E, Park H-R, Lee J-H. Barriers to Learning Healthcare-Associated Infections Prevention and Control during Clinical Practicum among Nursing Students in Korea: A Focus Group Study. International Journal of Environmental Research and Public Health. 2023; 20(14):6430. https://doi.org/10.3390/ijerph20146430
Chicago/Turabian StylePark, Eunyoung, Hyung-Ran Park, and Ji-Hye Lee. 2023. "Barriers to Learning Healthcare-Associated Infections Prevention and Control during Clinical Practicum among Nursing Students in Korea: A Focus Group Study" International Journal of Environmental Research and Public Health 20, no. 14: 6430. https://doi.org/10.3390/ijerph20146430
APA StylePark, E., Park, H. -R., & Lee, J. -H. (2023). Barriers to Learning Healthcare-Associated Infections Prevention and Control during Clinical Practicum among Nursing Students in Korea: A Focus Group Study. International Journal of Environmental Research and Public Health, 20(14), 6430. https://doi.org/10.3390/ijerph20146430