49 - A Grounded Theory Study Exploring Surgical Attire Guideline Adherence Decision Making
Description: Surgical site infections (SSIs), which occur in over 160,000 patients annually (Magill et al., 2014), create negative effects including increased financial burdens such as $3.2 to $10 billion in additional expenses for healthcare facilities (Magill et al., 2014) and physical disabilities, psychosocial sequelae, and a 3% increased mortality risk (CDC, 2016) faced by patients. While the Association of periOperative Registered Nurses developed guidelines aimed at minimizing the SSI risk, the failure of intraoperative team members’ adhering to surgical attire guidelines (SAGs) places patients at a greater risk of acquiring postoperative SSIs. Following the qualitative positivist classic grounded theory method, this study explored the decision making of intraoperative team members from New England, not-for-profit hospitals related to the use of SAGs. A theoretical sample of 17 intraoperative team members from New England was recruited through direct mailings of recruitment flyers and introductory letters to 189 facilities’intraoperative leaders and posting on e-Chapter’s communication board. The resulting semi-structured interviews were conducted by phone and recorded electronically from November 2018 through April 2019. The constant comparison process began with the primary investigator reviewing the audio recordings and the transcripts and comparing data from each interview to the previous ones. During the analysis, the PI bracketed personal thoughts to allow the data to speak for themselves. Data collection stopped after 17 interviews due to achieving theoretical saturation. The resulting Decision Making Theory of Surgical Attire Guideline Adherence (DTSAGA) explains intraoperative team members’ SAG decision making related to critically evaluating and responding to multiple factors. These factors included personal identity needs, adherence anchoring activities, evaluating SAG awareness, influence of authority figures and organizations, guideline evidence strength, and resource availability. After weighing the influence of each factor, the team members decided to adhere or not adhere to the various components of the SAGs. Additional research to validate the DTSAGA beyond New England and obtain input from a wider sample of intraoperative team members should occur. Upon further validation of DTSAGA, nurses can use these results to lead interdisciplinary efforts aimed at addressing the factors adversely affecting intraoperative team members’ SAG adherence decisions in support of SSI risk reduction.