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Table 3 Key Concepts, Themes (including number of times theme expressed), and Example Quotations of Beliefs across the Full Sample (N =27) identified by Focus Group Number (FG 1–5)

From: Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses

Concept

Key themes

Example quotations

Behavioural Beliefs –Advantages

Patient protection

“Yeah, our poor patients who can pick up an infection at the drop of a hat and we're the ones walking in with a cold and stepping over them and touching them.” (FG2)

(n = 11)

Self protection

“If more people think selfishly and it's like ‘I have touched that patient and I don't want their germs,’ then you will wash your hands more often. Because you don't know what your patients have got.” (FG2)

(n = 8)

Infection control

“Because people are sick in hospital, you tend to think of the individual being germy; where it's not the actual individual that is germy. We all have different bacteria that live on our skins. If you touch something of somebody's, even if it's just their handbag which they touch every day, and then you sort of plonk it back down and move on to something else, the bacteria that would normally reside on that individual's skin, it could potentially move to another.” (FG2)

(n = 7)

Behavioural Beliefs -Disadvantages

Hand damage

“You don't realise until the end of the day how many times you have washed your hands and how sore and cracked they end up.” (FG2)

(n = 9)

Time

“If you are busy, it adds quite an extra bit of time onto what you are actually doing.” (FG3)

(n = 5)

Normative Beliefs -Supportive

Colleagues

“I actually have seen people say, ‘Can you wash your hands?’, or something like that. So I have actually heard that question being asked of colleagues or, ‘Can you wash your hands and come give me a hand?’” (FG2)

(n = 17)

Supervisors

“And because our professor, he's the senior person and the head of the unit, everyone abides by it… because he's enforcing it so diligently.” (FG4)

(n = 7)

Patients

“Seems like the patients approve, that they appreciate it.” (FG2)

(n = 6)

Infection control staff

“Well, yeah, they [infection control] are good. They sort of lead by example as well, but they are not sort of on your back all the time or anything. But we did know when they were doing the audit. They were walking around, looking.” (FG5)

(n = 4)

Family

“Our family members, so we are not taking it back to them.” (FG1)

(n = 2)

Normative Beliefs -Unsupportive

Doctors/consultants

“There's even doctors who challenge the fact that hand washing actually prevents - like, they ask you, “Oh, where’s the study that proves it?” (FG1)

(n = 10)

Patients

“…they get really offended. If you have just gone and touched them on the shoulder and you just go and wash your hands, they are like, “I don’t have any germs. Rah, rah, rah, I had a shower.”” (FG1)

(n = 2)

Control Beliefs -Facilitators

Availability of sinks/hygiene products

“Yes, with everything that we have put into place, like they are mounted on the outside of rooms just as you leave the wards, outside of every room, then you have got pumps at the end of the bed plus your wash basin in every room.” (FG2)

(n = 21)

Education/training programs

“I just remember being a student in my crew, what they did, they broke us into sections and got some of us to do a 30-second wash, some of us a surgical scrub and then we all touched agar plates and then three days later had a look at our growths and I think that was a really good thing to just make it really real and show us how many bugs we could be carrying.” (FG1)

(n = 17)

Infection outbreak/infectious patients

“When we get MRSA [Methicillin-resistant Staphylococcus aureus] or VRE [Vancomycin-resistant Enterococci], we always have a meeting and the manager re-enforces everything and tries to make sure that there's soap in every - at every sink and stuff like that. So they really up the infection control.” (FG1)

(n = 13)

Auditing/infection control unit

“On a hospital level, they do a lot. They have got auditors on each ward. There's at least some staff - there will be at least two staff members that you can go to and ask questions, if you need to ask questions about hand washing. There’s knowledgeable people everywhere about infection control.” (FG5)

(n = 11)

Verbal/visual reminders

“I guess putting up signs as well saying ‘wash your hands.’ I mean, just that picture.” (FG4)

(n = 7)

Access to dermatologist

“They (nurse unit managers) keep on reminding us, ‘There's available help, just in case you need that cream/medication, we can help you to repair with the dermatologist.’” (FG1)

(n = 4)

Control Beliefs - Barriers

Emergencies

“If someone falls then you are not going to walk to the sink first… I guess you might forget to in that situation because your focus is basically off your hand hygiene and it's more on the patient.” (FG1)

(n = 7)

Skin irritations

“I remember once on night shift I washed my hands so much that they were just - they were almost irritated from me washing them and all I had was alco wipe stuff and the sting - it was horrible.” (FG4)

(n = 7)

Product/sinks not readily available

“Sometimes certain areas they are not - especially in the long-term facilities, it's hard to get to the sink sometimes because not every patient’s site has got a sink or alcohol rub.” (FG1)

(n = 7)

Lack of education

“I guess you don't think of yourself as having germs either”. (FG4)

(n = 7)

Distraction/forgetting

“The thing is I guess, a lot of times, you are not even aware that you have forgotten. Especially when you enter an area you might have forgotten to wash your hands and then you don't. I wouldn't know unless somebody is watching me and tells me, ‘Well, you just haven't washed your hands now.’” (FG1)

(n = 6)

Lack of time/too busy

“Or that someone else has come in and opened your curtain and you are in the midst of a wash/turn, and then you have to go and close the curtains and then again, you don't have time to wash your hands - take your gloves off and wash your hands and do that.” (FG3)

(n = 5)

Practical constraints

“Because it's impractical to ask the wardsman to hold your patient up, particularly if they weigh upwards to 180/200 kilos while you go and wash your hands and put on a fresh set of gloves.” (FG3)

(n = 5)

Sensor taps/wasting water

“That people will turn it off and wash their hands, they are only sort of half clean but then they are unwilling to start them again because they run for too long/too little and there's thoughts of wasting water.” (FG2)

(n = 3)