CAPITULO 2. MARCO TEÓRICO
2.2 Bases Teóricas
2.2.4 La Evaluación Formativa basada en competencias
2.2.3.1 Enfoques de la evaluación formativa
Our study showed that overall as well as in the subgroups of nurses and physicians, a considerable increase in the HH knowledge (about 1 point increase at post-strategy and at follow-up) and in HH compliance (about 50% increase at post-strategy and at follow-up) was achieved.
In line with Naikoba and Hayward’s conclusion,8 we developed a multifaceted
strategy. It is impossible to conclude which components were – to what degree – responsible for our achieved improvement. However, there was only a relatively small increase in HH knowledge – knowledge was already rather high at baseline (>7), relative to the low initial compliance and the large increase in compliance. Based on this information, one might conclude that only providing education on the indications for HH would have been insufficient.
Our study showed that our strategies were highly effective for the nurses as well as the physicians. In contrast to other studies,4;18 the overall compliance in
our study was significantly higher in physicians than in nurses. Possibly differences in observed HH indications have influenced the HH compliance results among the subgroups.
Although the HH improvement program in our study was mostly focusing on the nurses and staff physicians, and not on the residents, there was no significant difference between the staff physicians’ and residents’ compliances. Probably, the staff physicians functioned as role models for the residents.19;20
For measuring the HH compliance, we used unobtrusive observations: the gold standard as defined by the World Health Organization.7 By mentioning the
observation of patient safety-related items and their own learning experience as explanations for their observations and by performing observations during the researchers’ daily practice, the nurses and physicians were unaware of the true reason for the observations. Nevertheless, observation bias and the Hawthorne effect cannot be excluded.
Some possible limitations of our study must be considered. Sixty-eight nurses and staff physicians anonymously received the HH questionnaire. Approximately
there could be a matter of selection bias. Moreover, the HH compliance was anonymously observed. Although all participants were equally likely to have been selected for observation during the study periods, selection bias cannot be ruled out.
The effectiveness of HH on the prevention of HAIs depends not only on compliance but also on the HH technique.21 Although HH technique training was
part of the program, it was not evaluated in this study.
Finally, the physicians’ HH compliance in the outpatient clinic was not observed. Sladek et al. concluded in their study that the observational setting had an effect on HH compliance: HH was significantly more likely during ward rounds than during clinics.22 Therefore, we highlighted during our improvement program
that HH is important with inpatients just as with outpatients. However, the effect on the HH compliance in the outpatient clinic remains unclear.
In conclusion, our HH improvement program for nurses and physicians had large positive effects on the HH knowledge and HH compliance, and these positive effects sustained after 6 months follow-up. This multifaceted HH improvement program will be tested in a multicenter controlled trial.
References
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