Ethnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Ireland

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dc.contributor.authorAgreli, Heloise
dc.contributor.authorBarry, Fiona
dc.contributor.authorBurton, Aileen
dc.contributor.authorCreedon, Sile
dc.contributor.authorDrennan, Jonathan
dc.contributor.authorGould, Dinah
dc.contributor.authorMay, Carl R.
dc.contributor.authorSmiddy, Maura P.
dc.contributor.authorMurphy, Michael
dc.contributor.authorMurphy, Siobhan
dc.contributor.authorSavage, Eileen
dc.contributor.authorWills, Teresa
dc.contributor.authorHegarty, Josephine
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2019-09-24T10:27:27Z
dc.date.available2019-09-24T10:27:27Z
dc.date.issued2019-08
dc.date.updated2019-09-19T08:39:22Z
dc.description.abstractObjective: The aim of this study was to explore how infection prevention and control (IPC) guidelines are used and understood by healthcare professionals, patients and families. Design: Ethnographic study with 59 hours of non-participant observation and 57 conversational interviews. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework. Setting: Four hospitals in Ireland. Participants: Healthcare professionals, patient and families. Results: Five themes emerged through the analysis. Four themes provided evidence of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring). Our findings revealed the existence of a ‘dissonance between IPC guidelines and the reality of clinical practice’ (theme 1) and ‘Challenges to legitimatize guidelines’ recommendations in practice’ (theme 3). These elements contributed to ‘Symbolic implementation of IPC guidelines’ (theme 2), which was also determined by a ‘Lack of shared reflection upon IPC practices’ (theme 4) and a clinical context of ‘Workforce fragmentation, time pressure and lack of prioritization of IPC’ (theme 5). Conclusions: Our analysis identified themes that provide a comprehensive understanding of elements needed for the successful or unsuccessful implementation of IPC guidelines. Our findings suggest that implementation of IPC guidelines is regularly operationalised through the reproduction of IPC symbols, rather than through adherence to performance of the evidence-based recommendations. Our findings also provide insights into changes to make IPC guidelines that align with clinical work.en
dc.description.sponsorshipDepartment of Health, Irelanden
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide029514en
dc.identifier.citationAgreli, H., Barry, F., Burton, A., Creedon, S., Drennan, J., Gould, D., May, C. R., Smiddy, M. P., Murphy, M., Murphy, S., Savage, E., Wills, T. and Hegarty, J. (2019) 'Ethnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Ireland', BMJ Open, 9(8), e029514 (8pp). doi: 10.1136/bmjopen-2019-029514en
dc.identifier.doi10.1136/bmjopen-2019-029514en
dc.identifier.eissn2044-6055
dc.identifier.endpage8en
dc.identifier.issued8en
dc.identifier.journaltitleBMJ Openen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/8601
dc.identifier.volume9en
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urihttps://bmjopen.bmj.com/content/bmjopen/9/8/e029514.full.pdf
dc.rights© 2019, the Authors (or their employer(s). Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/en
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/en
dc.subjectInfection prevention and controlen
dc.subjectIPCen
dc.subjectClinical practiceen
dc.subjectSymbolsen
dc.titleEthnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Irelanden
dc.typeArticle (peer-reviewed)en
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