Chia-Jung Wu Thesis (PDF 1MB)
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Queensland University of Technology Institute of Health and Biomedical Innovation School of Nursing Effectiveness of a specific infection control education program for Taiwanese nursing students Chia-Jung Wu RN, BN, MN This dissertation is submitted to fulfil the requirement for the award of the Doctor of Philosophy at School of Nursing, Queensland University of Technology. 2007 SUPERVISORY TEAM Principal supervisor: Professor Glenn Gardner Professor of nursing research, Queensland University of Technology Director, Centre for Clinical Nursing, Royal Brisbane & Women's Hospital Associate supervisor: Professor Anne Chang Professor of nursing research, Queensland University of Technology Director, the Queensland Centre for evidence-based nursing & midwifery, Mater Health Service i STATEMENT OF ORIGINALITY The work contained in this dissertation has not been previously submitted for a degree at any other tertiary education institution. To the best of my knowledge and belief, the dissertation contains no material previously published or written by another person, except where due reference is made. Signed by Date: 24/08/2007. ii KEYWORDS Infection Control Standard and Additional Precautions Infection Control Precautions Severe Acute Respiratory Syndrome (SARS) Infection Control Education Program Nursing Curriculum Nursing Education iii ABSTRACT The purpose of the study The purpose of this research project was to develop and test an educational program for preparing Taiwanese nursing students for clinical practice. Study background The SARS outbreak revealed that health care professionals were ill-prepared for coping with the disease epidemic in terms of the rapid transmission of the infection, the high mortality and morbidity rate among health care workers, and the significant impacts on the public and health care personnel. Frontline nurses were the group at highest risk of becoming infected, as they are the health care personally that provide direct health care to infected patients. However, to date the ability of Taiwanese frontline nurses to respond to such a disease epidemic has not been examined. Study design This research project incorporated a three phase design, presented in the form of two separate studies. A small qualitative exploratory study was undertaken to validate the assumptions emerging from international literature regarding the preparedness nurses in managing an infection outbreak. The information gained was used to construct an infection control education program (Study I). A quasi-experimental design, using pre- and post-tests and experimental and control groups was then used to test the effectiveness of the education intervention (Study II). iv Participants A purposive sampling technique was used in the qualitative exploratory study, whereby six Taiwanese nurses who had provided direct nursing care to patients with SARS were interviewed. A convenience sampling approach was utilised in the quantitative study, which aimed to test the effectiveness of educational intervention. This, second study, had 175 participants in total, 80 in the experimental group and 95 in the control group. All participants were enrolled in the first semester of their fourth year in a five-year nursing program in two selected junior nursing colleges. The education intervention The purpose-designed standard and additional precautions (SnAP) program was the intervention. The experimental group received a SnAP program which consisted of 16 hours of classes over 16 weeks. The control group received a conventional education program. Data collection and instrument Data were collected at three time points during the study (baseline, four months, six month) using validated instrument. The reliability and validity of the instrument was established in a pilot study with a Taiwanese population prior to the present study. Data analysis t-tests and chi-square analyses were performed to assess any differences across demographic variables and baseline outcome variables between the experimental and control groups. Two-way repeated measures ANOVAs were used to examine the scores of the intervention and control groups across three time points. v Results The data revealed that, at six months following the education program, there was a statistically significant improvement in the knowledge (F [2,180] =13.53, p=0.001) and confidence (F [2,94] =4.88, p= 0.01) of infection precautions in the intervention group compared to the control group. Also, the means of knowledge and confidence in intervention group showed a consistently increased across three time points; whereas, the mean of confidence relating infection control management in the control group resulted a drop at time 3. Although the application skills relating to infection control procedures did not show a statistically significant change during this period (F [2, 174] =2.54, p=0.081), there were minor improvements in these scores at the six-month follow-up assessment. Conclusion The SnAP program had a positive impact on Taiwanese nursing students’ readiness for clinical placement and potential outbreak of disease epidemics. Participation increased their knowledge about infection control precautions, their ability to properly use these specific precautions, and their confidence in solving infection- related issues in clinical practice. vi LIST OF PUBLICATIONS RELATED TO THIS THESIS TAIWANESE JOURNALS Wu, C. J., & Chen, S. L. (2005). Interpretive research: an assessment and relevance in nursing, Tzu Chi Nursing Journal (Taiwan), 4(4), 8-13. Wu, C. J., & Yang, M. L. (2006). A lookback on the SARS outbreak: a qualitative examination of Taiwanese nurses’ clinical practice, Tzu Chi Nursing Journal (Taiwan), 5(3), 81-92. CONFERENCE PRESENTATIONS *denotes presenter *Wu, C. J., Gardner, G., & Chang, A. (20-22 Sep 2006). A study evaluating the effectiveness of a specific infection control education program for preparing Taiwanese nursing students for clinical practice. in Australian Infection Control Association, Fourth Biennial Conference 2006: the Key to Success, Sheraton on the Park, Sydney, Australia vii DECLARATION OF ENROLMENT I, Chia-Jung Wu, a candidate for the degree of Doctor of Philosophy at Queensland University of Technology, have not been enrolled for another tertiary award during the term of my PhD candidature without the knowledge and approval of the Research degrees Committee. Candidate’s Signature Date: 24/08/2007. viii ACKNOWLEDGEMENTS I would like to express my appreciation to all the people who have kindly given me support and encouragement during my Ph.D learning journey. Firstly, I would like to thank my supervisors, my principal supervisor Professor Glenn Gardner and associate supervisor Professor Anne Chang. Their crucial comments, input and continued support which were invaluable in the completion of my study. I also wish to express my deep thanks to the director of Nursing, Taipei Municipal Gan-Dau Hospital (during 2004), the Rector of Tzu-Hui Institute of Technology, and the director of the Nursing Faculty (during 2005-2006) who gave me the opportunity to conduct my study in their facilities and supported me throughout the period of data collection. I also appreciate panel members who participated in evaluating and assessing the instrument and education program. Furthermore, many thanks to all participants/students involving in this research project for providing invaluable information and contribution to this research. I wish them success in their future. To me, it was not possible to complete this dissertation without my family support and understanding; here especially, I appreciate my beloved parents, my mother, PH. Huang and my father SY. Wu who always supported and prayed for my success. Moreover, I thank my brother and sister-in-law who gave me their supports and shared my responsibilities of filial piety while I was studying. ix Lastly, thanks to all my dear friends for their supports and encouragements, and especially to Cherrie and Rebecca for their help in transcription of interview data. Many thanks to my lovely associates at QUT for their companionship, support, and encouragement throughout the whole period. Herein, I would like to appreciate two significant persons to me, W.Y. and Jeffy, without them, I would never have a chance to study aboard and see the world in a global perceptive. I do appreciate all the people listed above. Without them, this dissertation would not have been completed, thank you all very much. I will remember all your kindnesses and support, particularly the good days living in Australia, which I will always treasure. x TABLE OF CONTENTS SUPERVISORY TEAM..............................................................................................i STATEMENT OF ORIGINALITY ..........................................................................ii KEYWORDS .............................................................................................................iii ABSTRACT ...............................................................................................................iv LIST OF PUBLICATIONS RELATED TO THIS THESIS.................................vii DECLARATION OF ENROLMENT....................................................................viii ACKNOWLEDGEMENTS......................................................................................ix TABLE OF CONTENTS ...........................................................................................1 LIST OF TABLES ......................................................................................................5