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Positive deviance and hand hygiene of nurses in a Quebec hospital: What can we learn from the best?

  • Josiane Létourneau
    Correspondence
    Address correspondence to Josiane Létourneau, MPH, 8595 Ave André-Grasset, Montréal, QC H2M 2M5, Canada. (J. Létourneau).
    Affiliations
    Faculté des sciences infirmières, Université de Montréal, Montréal, QC, Canada

    Quebec Nursing Intervention Research Network, Montréal, QC, Canada

    Institut de recherche en santé publique, Université de Montréal, Montréal, QC, Canada
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  • Marie Alderson
    Affiliations
    Faculté des sciences infirmières, Université de Montréal, Montréal, QC, Canada

    Quebec Nursing Intervention Research Network, Montréal, QC, Canada

    Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
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  • Annette Leibing
    Affiliations
    Faculté des sciences infirmières, Université de Montréal, Montréal, QC, Canada

    Quebec Nursing Intervention Research Network, Montréal, QC, Canada

    Institut de recherche en santé publique, Université de Montréal, Montréal, QC, Canada

    Research group Meos (Le médicament comme objet social), Geneva, Switzerland

    CREGÉS (Centre de recherche et d'expertise en gérontologie sociale), Montréal, QC, Canada
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Published:November 21, 2017DOI:https://doi.org/10.1016/j.ajic.2017.10.005

      Highlights

      • The mobilizing leadership of a head nurse can instigate social cohesion in a care team.
      • Sharing a philosophy of care based on humanism in a care team can lead to social cohesion.
      • Social cohesion can generate positive deviance regarding hand hygiene practice.
      • Positive deviance can equally be applied to care teams and to individuals.

      Background

      Although it is well known that hand hygiene is the most effective measure to prevent health care–associated infections, hand hygiene adherence is low in Quebec, as it is elsewhere. For this study, an innovative framework was used to explore the clinical practice of nurses regarding hand hygiene and the factors that influence it: positive deviance, or the idea that there are people who find better solutions to problems than their peers. This study investigated positive deviance at the level of the care team to shed light on group dynamics.

      Methods

      We conducted focused ethnographies on 2 care units—a medical-surgery unit and a palliative care unit—at a Montreal university hospital. Data collection consisted mainly of systematic observations and individual interviews with nurses.

      Results

      The results show that positive deviance related to hand hygiene is instigated by social cohesion within a care team, created, in this study, by the mobilizing leadership of the head nurse in the medical-surgery unit and the prevailing humanist philosophy in the palliative care unit.

      Conclusions

      In health care, it can be useful to apply the positive deviance approach to care teams instead of individuals to better understand the ideologic and structural differences linked to better hand hygiene performance by the nurses.

      Key Words

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