The two-headed monster at #IP2014

After a busy few weeks of holiday followed by personal quarantine, I thought it was time I put pen to paper and shared some of the thoughts I’ve been having whilst reflecting upon my time at Infection Prevention 2014…(#IP2014).

Being an “academic” in a “real-world” situation is a great privilege, it allows you to get a real sense of the current state – something which can be missed if you only rely on feedback from academic papers and conference discussions.

My new role within a medical setting has changed the way I interpret information. It is not that I am no longer optimistic – far from it, I am, and always will be, an optimist – but now I have a wider appreciation for the reality of infection prevention “as it is”. Day to day. On the front line. And this is not a negative, difficult reality view. Or one filtered through an anti-research, anti-forward thinking environment. On the contrary, as I have the pleasure of working with the 2013 IPS Team of the Year, noted for their continuous focus on engagement activities and involvement with research and development, both with IPS and the RCN.

However, it is certainly a different position to be in.  And it made my experience of #IP2014 very different from my previous ones.  Let me explain…

In 2012 and 2013 I experienced the IPS conference through the eyes of a “pure” researcher, eager to know what was “out there” in terms of new data, new approaches and concepts, and potential new technologies to appraise.  I felt optimistic because infection prevention seemed to be moving at such a pace, swept along by incredible passion, determination and enthusiasm.  The wealth of information produced, through conference papers, journal articles, webinars and seminars was mind-blowing, yet incredibly welcome to a researcher “new” to the field.  Now, having completed my thesis and with more experience under my belt, I am much more concerned about what impact all this information could have on the way we work within healthcare. As I see it, from paper to practice.

image from http://www.coloringcrew.com

So I felt very much like a two-headed monster through most of the conference sessions I attended – one brain very excited about recent findings, theoretical discussions and endless potential, whilst my “other” brain was much more pragmatic, continually asking the questions “how would this impact healthcare professionals on any given Tuesday?”, “is this feasible”, and sometimes just a rather pointed “Really?!”.

Team inf_con at #IP2014 (image from @allisoncbradley)

 

The saving grace (that prevented one or both of my heads exploding) was the delightful new experience of attending the IPS conference as part of a team. Each session we attended, together or individually, was followed by the opportunity to discuss implications for our Trust, our staff and our patients. This directly addressed my “paper to practice” dilemma, and kept the two headed monster calm.

Darren sharing one of our posters

As a team we were very excited to be presenting three posters (.pdf here: 1, 2, 3) outlining a diverse selection of our current activities, and also providing an oral presentation on how we won the inaugural IPS Team of the Year award (abstracts available here).  I could not have been more proud of the enthusiasm, excitement and energy displayed by my colleagues; something which I am sure did not go unnoticed by the rest of the #IP2014 community. 

A key aim of my role within the team is to ensure that research is conducted which not only involves healthcare professionals, but which is driven by them. Therefore I was particularly proud to be involved in delivering our posters which outlined research instigated, and conducted, by current active healthcare professionals. It’s exciting to know that this is just the start…

Wonderful memories of #IP2014 (image from @darrenwheldon)

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What am I…?

Identity Crisis

Emerging into sunlight!

After months spent as a virtual recluse battling against all manner of hurdles to complete my thesis it felt like a real treat to emerge out into the winter sunshine yesterday and wandered up to Warwick Medical School.   This was just a flying visit, to put last minute touches to some future plans, and now I am back in my regular haunt on main campus.   However, all being well I hope to be spending much more time “up there” in the future…

It was as I was wandering back down the hill that my thoughts turned back to a conversation I had a little while ago, on the topic of “identity”.  The common question of “What do you do?” often being an early probe in conversations, currently provides my first dilemma. I am no longer a student, having ceased to be registered with the University at the end of 2013.  However, my daily activities seem to have changed little, except that instead of writing my thesis I am now translating my work into journal papers, blog articles and future research proposals. But I am not a student.  Yet neither am I a Post-Doc, for I have to wait to have my viva before such exciting developments can occur. So prompts the question: “What am I?”

Identity Crisis

The answer to this question is further complicated from my seeming inability (reluctance?) to define myself under a traditional “discipline”.  In academia, as in life, one is often identified by a series of labels. People are “Historians”, “Mathematicians”, “Philosophers” and “Economists”.  Recently I was asked “What are you?” to which I explained that I saw myself as a researcher within Infection Prevention.

Apparently this was not the accepted approach…

I needed to “be” something. I explained I had a Psychology degree, but I refute that I am a “Psychologist”, although according to some definitions perhaps I am…  I have a business MA, but I do not see myself as exclusively in this field either.  Having spent a number of years in manufacturing I could define myself as an “Analyst”, but that isn’t solely what I do.  Finally, all being well, I will soon have a doctorate in “Engineering”.  But, looking at what I do, and where I see myself going, I don’t feel that the identity “Engineer” quite covers it either….

So, what am I?  And further, does it matter?  Answers on a postcard* please… Be kind.

*Tweets, comments, owls and smoke signals also accepted.

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Gloves Off….

When I started this blog, and thinking about how to discuss “my” area of research, I wanted to have an image that I could use to symbolise my work – perhaps a form of icon really – so that any related social media/dissemination outlets could follow the same theme.  Therefore both my Twitter feed, and all my presentations/posters have included the image (above), along with the phrase “exploringhandhygiene“.

Because that’s what I have been doing during my PhD really, exploring the concept of hand hygiene.

Whilst, due to the academic nature, I have had to be specific as to which areas I am particularly addressing (i.e. measurement, through researching auditing, technology, human behaviour), I have naturally been open to many other themes within the area during my research.  And that’s the point of today’s post.

One of the key additional themes that has come up time and time again, although not central to my current project, is the role of gloves within hand hygiene.   This was first pointed out to me during the interview phase of my Study 1, when participants were discussing their perceptions of barriers to hand hygiene.  Once it had been explained to me I was much more aware of it during my participatory observation sessions.  Further reading, and some excellent presentations at conferences, has shown me that this is a huge area of concern and research in the field of hand hygiene.  and aside from the clear implications for Patient Safety, it has left me more than a little uncomfortable about my originally chosen logo…..

Look at it again.

Indeed.  Why is the medical professional wearing gloves to touch the baby?  The infant has intact skin.  There appears to be no imminent bodily fluid risk.  It’s not a clinical setting where one would expect PPE to be required due to the infant being identified as being contaminated by some particular pathogen – indeed, the other hand we see holding them is not gloved….   So, barring the scenario that the medical professional is about to whip out a needle (possible) or other such ‘clutching-at-straws’ explanation, I have to say, I think this picture may be one for the archive now.

I may keep it until submission day, and launch a new picture for the next phase of my research life though.  That feels appropriate.  It’s been a comforting image through some pretty big events, like my first international conference, and my foray into social media, and so I’m not quite ready to dump it unceremoniously.   And to mark its passing with some style, I’m using it to launch my LinkedIn page.

Let it have one last hurrah out there in cyberspace!  And if it causes discussion about glove use, then perhaps that is a good thing.  We really should be thinking about the appropriateness of their use more…

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Hand Hygiene Technology – Quick Notes on Innovation

Today pages of notes swirl in my head like autumn leaves

 

Just a quick post whilst I let my head work out what to do with the pages of notes I’ve amassed whilst working on the structure of my PhD Dissertation ‘Background’ chapter….  I decided thinking about something else may allow it time to settle before I start adding in the next layer…

One of the key themes of my research is the potential for technology within the field of Healthcare Hand Hygiene, primarily to aid accurate monitoring, measurement and feedback – but through researching for such examples, all kinds of innovations have surfaced.  My interest lies in how these technologies are perceived by the Healthcare Professionals themselves, from a ‘fit for purpose’ aspect, and also how they may inspire different types of innovations or interventions themselves.  Thus, for a start, whilst examples shown to some participants in my research were judged not to be ‘fit for purpose’ they did inspire great discussion about how Hand Hygiene could be improved through better education, using a combination of technology and training.  The technology itself was seen as a tool for something entirely different from it was being marketed, yet the end goal – improving Hand Hygiene – may be the same.  A great example of the importance of the context, and allowing a wide range of thinking prior to implementing innovations.  sometimes, perhaps, it may be better to ignore what it says on the tin….

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A week in 3 easy chunks…(with a poster thrown in for free!)

Finally uploading the link to my IFIC Poster  – things have been a bit hectic since my last post, and whilst things are still very much ‘potentially interesting’ they are also very much intense!  Here I’ve split the week up into 3 chunks, the Successes, the Highs and the Lows (not too gloomy though!)….and then finish on my lingering issue of Where Next…..

Successes

This week I completed the final interview sessions for Study 1/2 – whilst it is tempting to continue collecting data along these themes, as it is enjoyable meeting new members of staff and discussing Hand Hygiene experiences and views on what could be done differently, the key (or one of them!) to successful qualitative research lies in knowing when to stop.  The legendary ‘Saturation Point’, whereby no new themes emerge from the data, is hard to categorically locate – there is always the fear that the next interview may provide something different…but you have to use your instinct, and also respect the time and resources available.

So after 6 months of data collection, using a mixture of deductive and inductive analysis, I am now confident that I can defend the process used to explore the phenomenon, and also the decision to stop at this stage.  Whilst every individual has unique experiences to share, due to differences in perceptions, memories and the very nature of life opportunities, the general themes now emerging are beginning to converge.  Thus I used the final group interview session to clarify issues I was still partially unclear on, and also to confirm some general themes that had emerged so far.  I now look forward to analysing the whole data set using the coding matrix established previously, and seeing the themes that fully emerge….

Highs

 This week I also had fun with a supplementary activity – comparing the emergent themes from my research with those which were raised during a live TwitterChat hosted by @WeNurses (see here for article). It was really interesting and encouraging to see so many other Healthcare Professionals raise the same themes as we have found at our case study site – issues such as the impact of Role Models, Habitual Hand Hygiene and the Challenges of Compliance.  It shows that the research is both relevant, and necessary!

Lows – but not all negative

This week I also said a sad goodbye to my Academic Supervisor, who has left WMG and Warwick to take up a new post as Leadership
Chair in eHealth Research at the Leeds Institute of Health Sciences (University of Leeds).  I have so much to thank Jeremy for, as even though I have only worked with him for 18 months, he has been instrumental in moulding my research into the project it is today, and helping me build both my skills and confidence as an early career researcher.  He has also shown a genuine interest in the topic area, despite it not being directly linked to any current research he is involved in, and thus it has taken additional time and resource for him to work on my PhD project – a fact he has never once complained about.  I cannot thank him enough for all his help and encouragement, and am delighted that we will be keeping in close contact as we both face our new future challenges.

It’s not all sad though – at our last meeting I was able to share with Jeremy my ideas for future research, and things looked good – I am very enthusiastic about his feedback and own enthusiasm.  The ‘Where Next’ question looms larger by the day then – questions such as ‘Is anyone else researching Hand Hygiene?‘, ‘Where?’, ‘In what context?‘…..

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Where do I go next….?

  So, now I have had time to let my thoughts settle/ferment since I returned from IPS 2012 I can write a little update about how I got on, and try and give a flavour of just how inspiring the whole event was. 

Yes, inspiring. Having thought long and hard, I think that is the best word to use as an overall theme.  Having been through a difficult few months with the PhD with various set-backs, not to mention the episode of quarantine immediately prior to the conference, it is fair to say I was a somewhat jaded character on the train north to Liverpool. Not so on the train home! I was brimming with new ideas, running thoughts over in my head, and with a bag full of notebooks, hand-outs and, naturally, hand-gel samples….

So what inspired me?  The answer is probably best split into 2 categories – my fellow delegates and the information presented.  

Fellow Delegates

The former was a great comfort, and a timely reminder that Infection Control is an area where people are hugely motivated towards moving forwards, and that to do so they understand that team work, multi-disciplinary collaboration and mutual support are crucial elements for success.  Having travelled to the conference alone it was a joy to meet with new people, to share stories, receive feedback on my work, and generally feel welcome in a room full of strangers. I was particularly made to feel welcome by some wonderful ladies from Bournemouth NHS Trust, Plymouth NHS Trust, St John’s Ambulance Head Office, and a Private healthcare provider in Sussex. It was also a perfect co-incidence to bump into one of my host ICT attending a fellow delegate – I was proud to see them there, knowing how hard they work helped me really relate the formal presentations to real-life, and it was great to debrief after a few of these sessions; relating them directly to ‘our’ NHS Acute trust.  A perfect balance of theory, experience and practice.

Information Presented

The formal presentations then, to sum up, were varied yet all thought-provoking.  Because of my focus on Hand Hygiene and Research I tended to attend sessions focused around these – although the session aimed at those new to Infection Control was a lovely way to start the Conference experience, really helped me feel less alienated as a ‘solo’ attendee.  It felt like there was a great emphasis in all of the sessions (I attended) to encourage empowerment in the delegates, to encourage the belief that change was possible, and that it could come from anyone, regardless of position, background or experience. I found that inspiring, as often it can feel like only ‘top’ people can make a difference – both in the academic and medical sectors; I’ve heard this a lot from those I’ve met during my studies, as well as from within my academic circle.  Great examples from Professor Judith Tanner helped illustrate how crucial research has often been born from the ideas of those on the ‘front-line’, continually perplexed or frustrated by a problem, and who took the step beyond fire-fighting to look for a more long-term solution.

Fire-fighting vs. long-term solutions

This was such a key theme in my decision to undertake a PhD; I felt it deserved a quick mention. Having worked in the private sector for 6 years, I had a great team there which was focused on this very topic, looking for, and implementing, long-term solutions rather than continually reverting to emergency work-arounds to get through a deadline; and repeating this again and again.  Doing a PhD allows an in-depth review of a particular issue or problem (for me, Hand Hygiene Auditing), using rigorous methodology, to produce a ‘unique contribution to knowledge’.  In this way it is hoped that the field moves forwards, and that others can benefit from another building block; rather than continually being stuck in a loop of emergency ‘make-do’s’.  

What the IPS Conference did was remind me of this initial excitement, the fact that so many people are stuck doing ‘work arounds’, and yet through rigorous research there is the potential to improve the situation in Infection Control; and for me, Hand Hygiene Auditing.

 Ending on a high

This idea, of being able to make a long-term difference, was firmly cemented during my final session at IPS – “Set me free – letting go of hand hygiene” presented by Julie Storr, (the new IPS President, WHO Consultant, Imperial College London) and Claire Kilpatrick (Consultant, World Health Oganisation Patient Safety).

An amazing presentation (you always know it’s going to a bit different, when the lights go down and Coldplay fills the speakers….), featuring an interview style debate on the future of Hand Hygiene.  Too much to jot down here (and I’m sure there would be some rules about plagiarism….), but the 5 ‘things to take away’, as outlined by Claire, were summarised a bit like this:

 Key points:

1. Hand Hygiene should be part of the natural workflow, embedded in daily tasks
2. Hand Hygiene interventions should be multipronged
3. We should all look for ‘one key step for tomorrow’ to improve Hand Hygiene where we are
4. Hand Hygiene is not that simple (but is should be….?)
5. We need to understand the complexities (to get back to the simple side….)

An interesting point mentioned was that we may be living under an illusion of a ‘Perception of Success’; infection rates have gone down, we have been used to hearing about Hand Hygiene campaigns, we have seen an increase in AHR use, and AHR dispensers seem abundant – but have we really moved forwards in helping people understand why Hand Hygiene is important? Do we believe it is too simple?  Jules had a great slide, demonstrating the journey from simple, through complex, back to simple – using a myriad of disciplines to navigate the complex stage; including psychology, neuroscience and ergonomics.  Thus, we need to move away from the belief that “It’s easy, everyone can wash their hands’, through to understanding why and how we can enable Hand Hygiene at the right moments, to a point where it really is easy for people to act appropriately and perform Hand Hygiene correctly.  Seriously, the slide explains this so much better….!

Finally, and of real interest to me, someone asked a question about the relevance of ‘Electronic Monitoring’ – a key theme of my research.  A stand in the exhibition (see image, right) was causing great interest; having a badge system that had the ability to track (some) Healthcare worker Hand Hygiene compliance within a set zone – still in a prototype stage, but worthy of investigation.  Issues such as price were definitely high on the agenda for delegates, and for me, issue relating to accuracy of data and, critically the relevance to the 5 Moments….  I was delighted to hear this was something that WHO was already taking active steps towards ensuring.

What I’ve taken away, and what next….

 Now my thoughts have settled, and I have almost finished deciphering my handwritten scrawl, I think my main output from the Conference is twofold.

Firstly, I am confident that the work I have been doing is worthwhile, that Hand Hygiene is still a crucial nut yet to be ‘cracked’ fully, and that the methods to complete this process is still hotly debated.

Secondly, though, I am confused, verging on worried. Where do I go from here?  I was really intrigued by the presentation by Julie and Claire, the concept of Simple/Complex/Simple, the involvement of Neuroscience, Psychology and Ergonomics (to name but a few elements), and the emerging field of electronic monitoring – but I feel I need further guidance as to where to apply my energies next.  My PhD is very ‘open’ at the moment, I feel it could still go in a number of directions, which is exciting, yet I need to start pulling it down, ready to write up into one cohesive ‘story’.  But I do not want it to be the only story. It doesn’t end at submission…!  So, I am now off to IFIC 2012 (Twelfth Congress of the International Federation of Infection Control) and what I’d really like to come away with is a clearer idea of how I could plan my Post-Doc future…..  Time will tell…..

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Migraine – Not “just” a Headache

A rather “off topic” post now, but one which has links to my work by the very nature that it is about a theme which is so linked in with my progress as to be impossible to disregard.  Last week it was Migraine Awareness Week, and as those who follow my Twitter account will now know, I suffer from Migraines.

I use the word “suffer” quite deliberately, as whilst I may also “get” headaches,  to me a Migraine is quite different, and is both debilitating and an event to be endured – quite often rendering me immobile and somewhat useless to the world around.  Hence I do tend to get rather annoyed at images such as the two below, used to illustrate articles on “Migraine”, where the model looks to me mildly irritated at best….

 

I think I am much more of the “may-not-now-move-for-an-indefinite-time” pose (below),

usually with my hand trying to push my brain back into my skull via an eye socket.

Yes, it is fun times indeed…  I have only been experiencing Migraines for about 6 years, having developed a Classical type (with aura) in 2006, quite suddenly and dramatically with a Hemiplegic Migraine phase, and now have quite a complex case history which features peaks and troughs of recovery/relapse, and rather a lot of treatment regimes.

Thus I wanted to add a post today to raise the awareness of the fact that Migraine is “not just a headache” – until this is clear in the minds of all then both treatment and understanding will be patchy at best, poor at worst.  I spoke with someone earlier this week at HPA2012 about this very topic, and we agreed it was worth trying to highlight this distinction as often as possible…so here we go….

I have been very lucky, being surrounded by very supportive family, co-workers, peers and two very good doctors who have worked hard to try to develop new treatment plans.  I know this is not always the case, and thus acknowledge that I am fortunate.  

The Migraine Trust explain the phases of a Migraine “event” well here – especially good to note that there is a Recovery “phase”; this is often one of the hardest things for me to deal with, because once the acute pain is gone I feel infinitely better, yet still like I have been hit by a truck, and this can last for a number of days. I find this hugely frustrating, because it is only time that can help restore full fitness, and when deadlines and other pressures are looming, this is the one resource we all could do with more of….

As I continue with my research into Hand Hygiene I will also be working, then, in the background on looking into ways to deal with sudden, unexpected, unexplained and unwelcome interruptions – and I am always interested in looking at new potential solutions. But most importantly, we need to make sure people understand that a Migraine is not just a headache – not even a “bad” headache…!

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Standing Still – Time to Think

My last post, just over two weeks ago, marked a low point in the research project – where a ‘Buckaroo Moment’ was dangerously close due to a myriad of issues cropping up in close succession.  Today marks my first day back after a well needed fortnight away from all things research, and thus I am happy to report the donkey has all four hooves firmly on terra firma this morning. So far, so good…

Whilst I may have been away from the active research for 2 weeks, it would be wrong to say that my thoughts have not turned to the project during this time.  However, both the geographical and time distance away from the work has allowed for a period of reflection, a time to stand still (literally…on rocks, on a beach, on a hill watching the sea….) and try to unpick some of the ‘knot’ that seems to have occurred within the work.  Prior to my holiday this knot felt very much like an impenetrable mass, with no discernible way past.  Now, with my mind and body rested I understand that, in the words of the Bear Hunt – if you can’t get round it, and you can’t get over it, then you just have to go through it. So that’s what I’m about to start doing….

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WMG Doctoral Conference – Debrief…

 My part in the WMG Doctoral Conference yesterday ended up going well – having had a weekend with no voice at all and having to stay somewhat horizontal for 48 hours, this was quite a relief!!

I got asked some great questions at the end of my Presentation, and this has given me plenty to think about, and research further.  I shall be uploading the Conference Abstract later this week.

What was excellent was that the themes of the questions coming out (e.g. Hand Hygiene Quality, Individual Differences in what is “Inherent” etc.) were all things we had touched upon during the course of planning this research, and underpin much of the investigative modes of research we plan to use – underpinning the need to really engage the Healthcare Workers in the debate.  

My next goal now that this Conference has passed is to continue planning for the active research stage, including recruitment which is now underway, and looking at attending two further Conferences later in the year – the Health Protection Agency (HPA) and the Infection Prevention Society (IPS).

I also need to get back out running, having had to miss the race on Sunday…however the weather here is a bit prohibitive at the moment, so tomorrow is looking like a better option.  For the record, tonight I shall be digging in to a rich luxury chocolate cupcake…rewards are essential in research!

Cake and Research - natural partners... (Photo credit: Wikipedia)

 

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How “Informed” is Participant Consent?

As part of my forthcoming research I am bound by ethical procedures to ensure that potential Participants provide informed consent before taking part in any of the 3 studies.  I have been fully passed by the relevant Ethical boards for my area, having produced various “Participant Information” documents and Consent Forms for sctutiny. 

 However, as part of another arm of my work (looking at Inherent/Elective Hand Hygiene Behaviour) I have recently been looking at “Readability” as a concept; specifically the Flesch-Kincaid scale (using a tool anyone can access on Microsoft Word).  Here, the level of “Readability” of any given text is analysed and given a rating based on the US Grade School system, which can then be translated into chronological years e.g. Grade 6 = 11 to 12 years.

It is through this research that I found that whilst a lot of literature has been published about enhancing the “readability” of Patient information (e.g. medical leaflets), there seems little literature regarding the information which is provided to non-patient research Participants…  Thus, whilst being passed by the relevant Ethical boards assures that research should do no harm to the Participant, whether an average person could fully understand the information provided appears not to have generated a “standardised” solution.    In regard to Patients, the recommendation is to aim for a reading age of 11-12 years, however there is no such recommendation for research Participants.  Now of course this could be due to the clear fact that all studies are different, thus all study Participants will potentially have different expected levels of comprehension….but it is still therefore hard to classify what exactly writing for the “lay” individual entails on a scale bases…..

 

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