Perceptions of the nursing team during the covid-19 pandemic: cross-sectional study

Percepções da equipe de enfermagem durante a pandemia por covid-19: estudo transversal

Percepciones del equipo de enfermería durante la pandemia de covid-19: estudio transversal

Esta obra está bajo una Licencia Creative Commons Atribución 4.0 Internacional.

Since the onset of the global crisis caused by Covid-19, 663,640,386 deaths have been recorded worldwide, with Brazil being the fifth country with the most deaths (36,677,844).¹ Covid-19 is caused by SARS-CoV-2, manifested by respiratory symptoms that can progress to death, transmitted by the respiratory route.² The survival of SARS-CoV-2 on human skin is 9 hours.³

Therefore, the exposure of nursing during the pandemic is undeniable, due to the use of hands as an instrument to perform care, which are vehicles for the transmission of microorganisms⁴, as well as being on the front line of care.⁵

Hand hygiene (HH) refers to the action of cleaning hands in order to remove dirt and microorganisms.⁶ HH inactivates SARS-CoV-23, as well as being a low-cost and effective protocol for breaking the pathogen transmission cycle.⁶ After improvements at HH, there was a reduction in Healthcare-Related Infections (HAIs), which worsen the patient's condition.⁷The transmission of HAIs depends on the contamination of the hands of the professional who omits or improperly performs HH.⁸ HAIs increase length of stay, mortality and hospital costs.⁹Despite initial efforts to improve HH in 2020, effectiveness was not sustained, with a drop in 2021.¹⁰ There has been a significant increase in HAIs in the pandemic, demonstrating that the practice should be reinforced.¹¹

HH is influenced by cultural and behavioral factors.^4,6Therefore, it is crucial to evaluate the perception of nurses in relation to HH, considering the influence of these differences. The lack of knowledge is a barrier to adherence to HH, so the aim is to delineate participants' perceptions and impacts on professional behavior.⁴ This study covers nursing professionals who work at different levels of care, which differs from the majority of studies, which focus on health professionals who work at more complex levels of care.

The aim of this study was to identify the perceptions of nursing professionals who worked during the covid-19 pandemic about HAIs and HH, classifying them by profession and Brazilian regions.

This study was conducted using a cross-sectional observational design.¹²The presentation of the results followed the Reporting of Observational Studies in Epidemiology (STROBE) and Checklist for Reporting Results of Internet E-Surveys (CHERRIES).

The sample consisted of nursing professionals (assistants, nursing technicians and nurses) in different regions of Brazil (South, Southeast, Midwest, North and Northeast). Recruitment was voluntary, through invitations published on the social networks Facebook®, Instagram®, LinkedIn® and WhatsApp®, during November/2020 to December/2021. The sample size was defined by convenience, comprising the maximum number of participants who accepted voluntarily. The inclusion criteria were: working in health care during the covid-19 pandemic, age ≥18 years and agreement to participate.

We used the "Basic questionnaire on the perception of healthcare professionals regarding healthcare-related infections and hand hygiene", developed by the World Health Organization (WHO), validated by the National Health Surveillance Agency (ANVISA) and the Pan American Health Organization (PAHO) and applied online using Google Forms®. It is self-administered, with 18 multiple-choice questions on a Likert scale.^13-15

The results were analyzed using descriptive statistics and presented in absolute and relative frequencies, broken down by group of nursing professionals and by region. Pearson's chi-squared test (X²) and Fisher's exact test were used to verify the association between the variables, with a significance level of α = 5%. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) version 23 and the Reporting of Observational Studies in Epidemiology (STROBE) and Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklists were used to present the results.

The study was approved by the Research Ethics Committee of the Ribeirão Preto School of Nursing of the University of São Paulo (CEP-EERP/USP), CAAE No. 38623520.6.0000.5393, and followed the regulatory standards for research involving human beings, in accordance with Resolution CNS 466/12 of the National Health Council. Participants were informed about the objectives and methods and their right to withdraw. The study was conducted in accordance with the required ethical standards (resolutions 466/2012 - 510/2016 - 580/2018, of the Ministry of Health).

Sociodemographic data was collected from 493 nursing professionals. The majority were female (75.8%), from the Southeast region (74.6%) and the state of Sao Paulo (66.8%). Of the nurses, 244 (68.2%) had postgraduate degrees. The majority worked in just one place (79.3%), with 44.3% working in general care institutions in the private sector. While 27.1% of NUR had been working for less than a year, only 15.6% of nursing assistants and technicians had been working for less than a year. Only the South and North regions had more TECs than NUR. The sociodemographic description was published in a previous journal.¹⁶ Below is the sociodemographic characterization with absolute and relative frequency subdivided into NUR and NUR.

Table 1
Absolute (n) and relative (%) sociodemographic characterization of the sample grouped by professional category. Brazil, 2023.

Source: Author data.

Below are data by professional category and Brazilian regions. While 43.9% of nurses (NUR) said that the impact of HAIs on the patient's clinical evolution is very high, only 26.7% of nursing technicians and assistants (TEC) said the same. While 50.8% of NUR said that it takes a lot of effort to perform HH properly, only 68.9% of TECs said the same.

Table 2
Absolute (n) and relative (%) frequency of perception of HAIs and HH by nursing professionals in the regions of Brazil and grouped by professional category. Brazil, 2023.

Source: Author data

The sociodemographic and occupational characteristics of the participants in this study are in line with the literature. Most of the participants (374; 75.8%) were female, aged between 30 and 39 (157; 31.8%), and were nurses (358; 72.6%).^17,18

Most nursing professionals in this study had a high perception of HH and HAI. A study carried out in Iran showed that most nursing professionals had a good perception of HH and HAI.¹⁷In this study, 157 (43.9%) of the nurses recognized that the impact of HAIs is very high and only 36 (26.7%) of the nursing assistants and technicians said the same. While 93 (68.9%) of the assistants and technicians said that a great deal of effort was needed to carry out a good HH, 182 (50.8%) of the nurses reported the same.

The professionals’ perception is related to the level of training they have had access to.¹⁷Therefore, the greater effort to perform a good HH and the level of perception observed in this study can be justified, given that 249 (50.4%) have postgraduate degrees.

It was observed that 222 (44.9%) of the participants reported that only 0% to 10% of the patients admitted to the institution where they work develop HAIs. Although there is evidence that higher levels of perception contribute to better adherence to protocols,¹⁹in contrast to the 374 (75.7%) who recognize the efficacy of HH in reducing HAIs, 288 (58.41%) do not perform HH in 100% of the recommended cases. Therefore, there is a contradiction between the high level of perception, the lower adherence to HH and the low development of HAIs within the institution where they work.

There is evidence that patient feedback improves professionals’ HH.²⁰In agreement, 277 (56.1%) participants said that patients attach great importance to HH and 224 (45.3%) considered it effective to encourage patients to remind health professionals to perform it. In addition, only 78 (15.8%) said that colleagues in the institution carry out HH in 100% of recommended cases, showing a possible lack of encouragement and example among peers, due to the influence of other professionals on their own clinical practice.²¹

Most of the participants in this and another study¹⁸pointed to several strategies as very effective for permanently increasing HH in institutions, such as support from leaders, reminders and HH education. This is because these strategies provide reflections and improvements on HH itself.²²Authors emphasizes that physical structure and the availability of materials are essential for adequate HH, although studies point to a lack of resources.²³

The perceptions of HAIs and HH described collaborated to identify possible facilitators in the practice of HH, from the perspective of nursing professionals. Considering the fundamental role of HH and nursing in reducing HAIs, the results may contribute to the development of future strategies aimed at improving HH practices in nursing care in global emergencies, such as the COVID-19 pandemic. No association was found between region and level of perception in this study, which only included nursing professionals working during the pandemic. It is worth noting that most of the participants were from the southeast and the state of São Paulo. Although the purpose of the study was to reach all Brazilian regions, some states did not respond to the questionnaire and the other regions had few responses. Although this limitation of the sample is not representative, it offers an initial view of how these aspects may be reflected in the different states and regions. In this context, it suggests the need to carry out similar studies with larger and more representative samples. The data collection period was justified by the difficulty in keeping up with new evidence and changes in the face of outbreaks of infectious diseases, such as COVID-19.¹⁹The remote modality overcame geographical barriers. The instrument used for data collection is easy to apply and could be reproduced in other studies. However, daily reminders were necessary to ensure the volunteers' participation, and the use of an online, self-administered questionnaire compromised the veracity of the answers.

In addition, it should be noted that most nursing professionals had a high perception of HH and HAI, considering their profession and geographical region. These results may contribute to the development of future strategies aimed at improving HH practices in nursing care, especially during outbreaks of infectious diseases such as COVID-19.

redalyc-journal-id: 5704