WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

PART V. PATIENT INVOLVEMENT IN HAND HYGIENE PROMOTION
3.
Components of the empowerment process
3.1 Patient participation
<strong>WHO</strong> recognizes that the primary responsibility for the delivery
of safe care is with the health-care system. Nevertheless, there
are now many ways in which patients can become involved in
the process of their own health care. Lyons 1102 identifies three
key contributions patients can provide: 1) historical background
about their health; 2) self-interest and motivation for a
beneficial outcome; and 3) being physically present at all times
during care and treatment. Their age, culture, background,
personality, and level of intelligence have been identified as key
characteristics when engaging patients in participation. 1102
To sum up, the opportunity for patients to be involved
in their health care has evolved over the last decades from
passive to more active. An understanding of this new role by
both patient and HCW is the foundation of an empowerment
programme.
3.2 Patient knowledge
Patients can be empowered only after having gathered enough
information, understanding how to use the information, and
being convinced that this knowledge gives them shared
responsibility with their HCWs. In their review of materials
given to patients, Coulter and colleagues 1103 found that relevant
information was often omitted, many doctors adopted a
patronizing tone, and few actively promoting a shared approach.
Studies have also shown that patients prefer information that
is specific, given by their HCWs, and printed for use as prompt
sheets if necessary. 1103,1104
3.3 Patient skills
3.3.1 Self-efficacy
Self-efficacy is defined as an individual’s belief that he/she has
the capabilities to produce an effect or reach a certain goal. 1105
Individuals with high self-efficacy regarding a given behaviour
are more inclined to undertake this behaviour, have greater
motivation, and usually undertake more challenging tasks than
individuals with low self-efficacy. 1106
Promoting self-efficacy among patients is fundamental in order
to bring them to the stage where they will feel confortable to
ask HCWs about hand hygiene. Bandura identified four major
ways (dubbed “sources”) to improve one’s self-efficacy: mastery
experiences; vicarious experience; verbal persuasion; and
physiological responses. Mastery experiences, considered
as the most important, relate to the fact that previous
successes will raise self-efficacy. Vicarious experience refers
to the increase in one’s self-efficacy upon witnessing other
individuals completing successfully a task. The third source,
verbal persuasion, relates to the impact of encouragement on
an individual’s perceived self-efficacy. Finally, physiological
responses such as moods, emotional states, physical reactions,
and stress levels also influence one’s perception of self-efficacy.
These skills can be applied to the behaviour of empowering
patients to ask about hand hygiene. Knowledge will give
mastery experience of the behaviour, role modelling by HCWs
will provide vicarious experience, and patients asking their
providers to perform hand hygiene will give verbal persuasion. It
is likely that the high self-efficacious person will have the skills to
invest more effort. 1106
3.3.2 Health literacy
Health literacy is the ability to understand health information
and to use that information to make good decisions about
health and medical care. Lower health literacy has been
reported among people who are elderly, less educated, poor,
and members of minority groups 1107 and is associated with
lower health outcomes, increased rates of hospitalization, and
higher costs for care. 1101,1108 Health literacy is fundamental to
patient empowerment. 1109 However, authors of health education
material often attempt to encourage health literacy by simply
rewriting existing materials in lay language and fail to recognize
that “information” is only one piece of the literacy process. 1110 To
solve this problem, an action plan has been set forth to improve
literacy in the USA. 1111
In summary, the skills of self-efficacy and health literacy
have been linked to the performance of a task that requires
a change in behaviour. High levels of self-efficacy appear
to be a motivating factor to perform a task. Health literacy
and community partnership provide the structure required
by champions of empowerment to deliver the message of
engagement to their communities.
3.4 Creation of a facilitating environment and
positive deviance
The creation of a facilitating environment can be defined as
the process in which patients are encouraged to develop
and practise open communication about their care in an
environment free of barriers. There are three prerequisites that
HCWs require if they are expected to help patients be seen as
partners and to facilitate an environment for empowerment. 1112
These are: a) a workplace that has the requisite structure to
promote empowerment; b) a psychological belief in one’s
ability to be empowered; and c) acknowledgement that the
relationship and communication of HCWs with patients can be
powerful.
An individual cannot create personal empowerment in another
individual, but the partnership of HCWs and patients can
facilitate the process of empowerment. If patients are given
knowledge and resources in an environment of mutual respect
and support, then a facilitating environment for empowerment
will develop.
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