Dear Editor,
We would like to thank professor Hallberg (2022) for her interest and thoughtful comments on our paper on exploring infection prevention practices in home-based nursing care (Wendt et al., 2022) and thank the editor for the opportunity to respond to these comments. We would like to take advantage of this opportunity in the form of a short reply.
In our paper we concluded that “the daily practice of infection prevention in home-based nursing care appears to be suboptimal” (Wendt et al., 2022). Professor Hallberg summarised the findings as an illustration of “poor practice, both at the level of the nurses and at the level of the organisations[…], through a “violation of knowledge, regulations and laws” and “harsh criticism” in the discussion would have been – in her view - appropriate. While we do feel professor Hallberg raises a fair and valid point; it is nevertheless complex and deserves further exploration.
One point that was raised is what could be considered the concept of ‘patient safety culture’; defined as “the product of individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the commitment to and the style and proficiency of, an organization's health and safety management” (Health and Safety Commission, 1993). The presence of a ‘patient safety culture’ is related to patient and healthcare worker safety (Hessels and Larson, 2016); however, a quick literature search suggests that it might not get the attention it deserves in the context of home-based nursing care (Gallego et al., 2012; Olsen and Bjerkan, 2017). Being an understudied topic may – in part – explain why it has been underexposed in the discussion and indicates that this is an important issue for further research.
A second point concerns the role or perspective of the researcher. If the goal of research is to generate or develop ‘knowledge’; for example, provide a description of practices and experiences, one can argue that the researcher should play the role of ‘intermediary’ between the practices and experiences of the participants and the reader, and therefore the researcher needs to have a certain ‘neutrality’ and leave the ‘judgment’ up to the reader. Another perspective is that the researcher is morally obliged take a stand or even be the ‘patients’ advocate’ when he or she is witness of a poor practice or harm. This question is further complicated if the researcher is also a healthcare provider and research principles and the well-being of clients need to be balanced, or else it might lead to a role conflict (Orb et al., 2001). We think that there are no easy answers to these ethical concerns as they originate from different ontological and epistemological backgrounds. Therefore we warmly invite the international nursing community to further explore the topic and participate in the ‘debate’.
On behalf of the research team,
Sincerely,
Declaration of Competing Interest
There is no conflict of interest related to the submitted response to commentary.
References
- Gallego B., Westbrook M.T., Dunn A.G., Braithwaite J. Investigating patient safety culture across a health system: multilevel modelling of differences associated with service types and staff demographics. Int. J. Qual. Health Care. 2012;24(4):311–320. doi: 10.1093/intqhc/mzs028. [DOI] [PubMed] [Google Scholar]
- Hallberg I.R. Comment on Wendt et al (2022) “Exploring infection prevention practices in home-based nursing care: a qualitative observational study.” (Wendt et al. 2022) Int. J. Nurs. Stud. 2022 doi: 10.1016/j.ijnurstu.2022.104190104190. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Health & Safety Commission . HMSO; London: 1993. ACSNI Human Factors Study group: Third report. Organising for Safety. [Google Scholar]
- Hessels A., Larson E. Relationship between patient safety climate and standard precaution adherence: a systematic review of the literature. J. Hosp. Infect. 2016;92(4):349–362. doi: 10.1016/j.jhin.2015.08.023. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Olsen R.M., Bjerkan J. Patient safety culture in Norwegian home health nursing: a cross-sectional study of healthcare provider's perceptions of the teamwork and safety climates. Saf. Health. 2017;3(1):1–8. [Google Scholar]
- Orb A., Eisenhauer L., Wynaden D. Ethics in qualitative research. J. Nurs. Scholarsh. 2001;33(1):93–96. doi: 10.1111/j.1547-5069.2001.00093.x. [DOI] [PubMed] [Google Scholar]
- Wendt B., Huisman-de Waal G., Bakker-Jacobs A., Hautvast J.L., Huis A. Exploring infection prevention practices in home-based nursing care: a qualitative observational study. Int. J. Nurs. Stud. 2022;125 doi: 10.1016/j.ijnurstu.2021.104130. [DOI] [PubMed] [Google Scholar]