Understanding how infection prevention influences nurses' task sequencing using a mixed-methods, simulation-based approach

Abstract

Objective: Better understand how and why nurses sequence their patient care tasks. Background: Workflow mitigation strategies, such as working clean to dirty, could help reduce cross-contamination. However, the extent to which priorities, other than infection prevention concerns, influence the sequence of patient care tasks is poorly understood. Methods: We had nurses perform high fidelity simulations of patient care tasks that incorporated common barriers to practicing infection prevention, such as time pressure, high workload, and interruptions. We assigned nurses patient care tasks that were either high or low in patient-infection risk and either high or low in dirtiness; a two-way repeated measures ANOVA was used to analyze the effect of these two factors on the order in which nurses completed the tasks. We used a cued-retrospective think-aloud to elicit why participants sequenced the tasks the way they did; open and closed card sorts were used to analyze this data. Results: On average, participants completed low patient-infection risk, high dirtiness tasks first followed by low dirtiness tasks (regardless of patient-infection risk) and then finally high patient-infection risk, high dirtiness tasks. Analysis of the think-alouds suggest patient stability and patient comfort were, on average, higher priorities for task sequencing than infection prevention. Conclusion: Healthcare workers have to balance competing priorities such as patient stability, patient comfort, and infection prevention concerns with the limited resources (e.g., staff, supplies, time) available to them. Future research examining how different task sequence approaches might affect these priorities would help inform how healthcare workers could sequence their tasks.