Engaging Nurses In Impelementation Strategies And Evidence-Based Practice Guidelines For Infection Prevention And Control To Support Ebola Preparedness In Sierra Leone

ENGAGING NURSES IN IMPELEMENTATION STRATEGIES AND EVIDENCE-BASED PRACTICE GUIDELINES FOR INFECTION PREVENTION AND CONTROL TO SUPPORT EBOLA PREPAREDNESS IN SIERRA LEONE Background: Nurses are at increased risk of infection during epidemics. During the 2014 Ebola Viral Disease (EVD) epidemic in Sierra Leone, over half of the 293 healthcare workers infections were in nurses. Despite infection prevention and control (IPC) evidence-based practices (EBP) to minimize the transmission of disease, limited literature exists on what strategies are used to promote IPC during epidemics, and even less literature exists on what strategies nurses desire to better prepare them for epidemics. The purpose of this dissertation was to engage nurses about implementation strategies and EBP guidelines for IPC to support EVD preparedness at the onset of an epidemic in Sierra Leone. Methods: For aim one, a systematic review was conducted to synthesize and critique what is known about implementation strategies used to promote IPC for nurses in Sub-Saharan Africa. For aims two and three, ethnography was used. For aim two, observations and interviews were conducted to assess nurses’ perceptions of implementation feasibility and appropriateness of the 2015 national IPC guidelines for healthcare workers in Sierra Leone. For aim three, focus group discussions that included free-listing and pile sorting activities were conducted. Using NVivo and Anthropac software, thematic analysis and nominal group technique were utilized to analysis data. Results: For aim one, a total of 61 articles met the inclusion criteria for final review. The most frequent implementation strategies reported were education (n=59, 97%), quality management (n= 39, 64%), planning (n=33, 54%), and restructure (n= 32, 53%). For aim two, five themes emerged from data: resources, practice changes, them versus us, innovations, and education. For aim three, trainings, incentives, and policies were listed as strategies nurses desired for an IPC intervention for an EVD epidemic. Conclusions: The following conclusions were produced: 1.) IPC and the development of an IPC culture within nursing evolves during an epidemic, 2.) IPC innovations that are introduced during the epidemic need to be de-implemented post-epidemic if they are no longer appropriate for the context, and 3.) implementation science theories and frameworks are currently limited in scope to explain some of the complexities related to IPC EBP implementation in low-middle income countries.