title: Infection prevention as "a show": a qualitative study of nurses' infection prevention behaviours.
abstract: BACKGROUND
  Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers' practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned "How can nurses' infection prevention behaviour be explained?" This paper presents one of three identified themes 'Rationalising dirt-related behaviour'.
  
  
  METHODS
  This interpretative qualitative study uses vignettes, developed from nurses' accounts of practice, to explore nurses' reported infection prevention behaviours.
  
  
  METHODS
  Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University.
  
  
  METHODS
  Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method.
  
  
  RESULTS
  The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a 'show' or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny.
  
  
  CONCLUSIONS
  This study contributes to the identification and explanation of nurses' infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely 'scientific' understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection.
authors.affiliation: Department of Postgraduate Research, Florence Nightingale School of Nursing and Midwifery, King's College London, Room 1.21a, James Clerk Maxwell Building, Waterloo Campus, 57 Waterloo Road, London SE1 8WA, United Kingdom. Electronic address: carole.jackson@kcl.ac.uk.
authors.forename: Carole
authors.initials: C
authors.lastname: Jackson
authors.affiliation: Institute of Gerontology, Department of Social Science, Health & Medicine, King's College London, Strand, London WC2R 2LS, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Lowton
authors.affiliation: Chair of Health Services Research, Faculty of Health Sciences, University of Southampton, Room E4015, Building 67, Highfield Campus, SO17 1BJ, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
mesh_terms: D002983:Clinical Competence; D006801:Humans; D017053:Infection Control; D009736:Nursing Process; D009740:Nursing Staff; D036301:Qualitative Research
keywords: Compliance; Goffman; Healthcare associated infection; Infection prevention; Nurse; Qualitative research