Beyond Basics: Embedded infection control in everyday practices of nurses in an intensive care unit

Author: Allison Roderick

Roderick, Allison, 2014 Beyond Basics: Embedded infection control in everyday practices of nurses in an intensive care unit, Flinders University, School of Nursing & Midwifery

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ABSTRACT Infection control is concerned with the control of infectious agents; that are defined socially as much as they are medically. Socially, germs are perceived as dirt, pollution and danger. Medically, they represent infection, illness, disease and risk. Symbolically, infectious agents engender fear, isolation and separating practices. In healthcare this fear, isolation and separation is located in infection control policies and practices that prevent cross-infection and the outbreaks widely discussed in scientific and tabloid papers. By focusing on infection control practices this research explores how nurses navigate their work in intensive care units (ICU), providing nursing care within infection control guidelines. Using ethnographic methodology, this study explored nurses' practice in ICU to discern infection control practices in the everyday. Nursing practices were explored by applying Bourdieu's theoretical approach to practice to ascertain how different forms of knowledge, such as policy or practice, were underpinned by knowledge embedded within that practice. Moreover, Bourdieu's concepts of field, knowledge and capital enabled exploration of the ethnographic data. Firstly, nursing practice was noted as constructed around objectified forms of knowledge such as standard precautions, accepted as doxa, to manage the risk of exposure to blood and bodily fluids. Nurses demonstrated what Bourdieu terms their cultural 'feel for the game' as they navigated between the distinct cultural fields of intensive care and infection control. This navigation was dominated by requirements of intensive care and the patient's critical status. Secondly, this study showed the subjective in the field of nursing through application of the idea of habitus as embodied practice to how nurses worked to identify matter out of place within their daily work. Finally, Kristeva's notion of abject and bodily boundaries enables nurses' infection control practice to be explained as containment within ambiguity. Infection control is aimed at controlling matter that is invisible. Current orthodoxy created confusion, fear and conflicts with infection control nurses. Nurses demonstrated that in trying to control out of place matter, they experienced infection control simultaneously as a subjective and abject space, locating nursing in-between the lived spaces between dirty/clean and infectious/non-infectious. By focusing on actual accounts of everyday nursing, infection control practices are understood as within nursing and not separate from nursing. They form the fabric of nursing within a context of intensive care work. Hence, nurses were often considered non-compliant with infection control policy because their infection control practices were intertwined with ICU knowledge, where patients' acuity dominated what ruled practice in each case. Infection control is often viewed as an activity that is added to keep nurses and their patients safe. Nursing practice across two fields threatens assumptions about the privileging of what infection control (in its forms of standard and additional precautions) are and should be. As such, accounts to date of non-compliance and surveillance of infection control practices fail to explore this incorporation and interplay of different forms of knowledge at work in nursing practice. Now the challenge is to not locate infection control outside of, or separate from, practice but to recognise and value infection control within practice.

Keywords: infection control,nurses,ethnography,everyday,intensive care,practice

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2014
School: School of Nursing & Midwifery
Supervisor: Professor Trudy Rudge