Healthcare-Associated Infections that patients acquire when hospitalized are among the most intractable and widely studied health concerns across the globe. While infections are a threat to the lives of millions of people across the globe, approximately seventy percent of healthcare-associated infections can be prevented. HAIs are still a burden to public health despite increased efforts to reduce their incidence. The infections also cost the United States economy billions of money in excess of planned healthcare expenses. Among the most common HIAs is Central Line-Associated Blood Stream Infections (CLABSIs). This infection is prevalent in intensive care units where invasive procedures are common. CLABSI is an infection in the bloodstream among patients who have a central line in a period of 48 hours prior to developing the bloodstream infection, and when the infection is not secondary to a different infection. Although strategies and guidelines meant to prevent CLABSIs were developed, the infections are still high, mainly because of non-compliance with proposed practices. In this paper, the social cognitive theory is applied to Central Line-Associated Blood Stream Infections. Social cognitive principles can in preventing CLABSIs among hospitalized patients, and there exists a relationship between the theory and the health issue discussed in this essay.
Background
CLABSIs account for substantial morbidity, deaths, prolonged hospital stays, and more expenses to health care facilities. They are accountable for approximately one hundred thousand deaths and an estimated $40 billion more costs in the United States healthcare system every year (Cohen et al., 2019). Strategies meant to prevent CLABSIs in healthcare facilities were developed for the first time in 2008. Since then, the guidelines have been updated, and the last update was in 2017. Both the current and past guidelines were considered components of strategies to improve adherence to proposed evidence-based practices to promote the safety of patients. These components include hand hygiene before conducting an insertion, optimal selection of location, precautions for the maximal barrier, daily assessment of line necessity, and chlorhexidine skin antisepsis (Cohen et al., 2019). Existing literature indicates that there exists a significant relationship between the use of the components and reduction in the occurrence of Central Line-Associated Blood Stream Infections in intensive care units. According to Gurses et al. (2008), compliance with guidelines is the main problem that has caused the continued prevalence of CLABSIs. Although there are evidence-based practices that can prevent CLABSIs, making sure that adherence to the practices is sustained is sometimes a challenge hence the prevalence of the infections.
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Relationship and Application of Cognitive Social Theory to CLABSI
Social cognitive theory, developed by Albert Bandura, focuses on the dynamic association between people, their conduct, and their surroundings. The theory explains how a person’s behavior is influenced by personal encounters, actions of other people, and the environment. The social cognitive theory provides an opportunity for social support by developing expectations, self-efficacy, and application of learning through observation and other types of reinforcement to change behavior. The main components of social cognitive theory linked to behavior change in individuals are self-efficacy, behavioral ability, expectations, self-control, learning through observation, expectancy, and reinforcement.
Self-efficacy refers to the belief that a person possesses control over and can implement a behavior while the behavioral ability is defined as the understanding and skills needed to execute a behavior. Expectations are related to the outcomes of changing behavior, while expectancy is assigning values to the results of changing behavior. Learning through observation entails watching the outcomes of other people who perform or model the desired conduct. Reinforcement refers to giving rewards that promote change in behavior. Association between these components is demonstrated through a construct referred to as reciprocal determinism. According to this construct, individual, environmental, and behavioral factors interact by influencing and being influenced by one another (Bandura, 2012). Reciprocal determinism can be applied in different ways among nurses to enhance the prevention of CLABSI. Through this construct, their behaviors related to adherence to guidelines can be changed by targeting their knowledge and attitudes as well as implementing changes in hospital environments.
The reciprocal determinism model can be applied by educators to improve the learning experience and enable learners to implement changes that can guide their learning experience (Bandura, 2012). Social cognitive theory can be implemented to the learning needs of nurses regarding the prevention of Central Line-Associated Blood Stream Infections in hospital settings. Changing or influencing factors in every determinant can enhance the self-efficacy of learners. For instance, the learning environment is controlled by social persuasions, observing, instructing, and modeling. Therefore, a chance to observe and model practices related to CLABSI prevention can increase the self-efficacy of nurses. The main appeal of self-efficacy in changing health behaviors is that behavior can be changed because it comes from an individual’s experiences, motivations, and persuasion offered by modeling other people. It is not enough that guidelines on CLABSI prevention are developed and made available. For behavior change to be realized, a person has to believe that his/her present behavior is undesirable and changing the behavior would be beneficial. Nurses too, should feel that they have the competence needed to overcome barriers and begin the desired behavior. It means that the more a person makes an effort, the higher the possibility of achieving a behavior goal. According to Bandura, (2012), people who lack faith that they can produce the expected outcomes have less motivation to realize them.
In preventing CLABSI based on social cognitive theory, learning is adjusted in a way that improves nurses’ self-efficacy by enhancing the nurses’ environment, individual, cognitive and behavioral factors. The provision of standardized learning can modify the nurses’ or healthcare staff’s environment by offering structure and consistency in educators and incorporate modeling prevention practices skills. Observation of proper CLABSI prevention practices performed by others at the patient’s bedside can also improve the learning environment for nurses. Nurses model the skills learned by re-demonstrating and observing in a repeated manner to ensure that learning becomes a continuous social encounter. Social persuasion may include nurses learning the ability to master the skills effectively. Individual and cognitive factors can be handled by offering nurses the appropriate motivation required to learn CLABSI prevention practices and implement them in their units. Offering motivation needed for learning and positive emotions influence individual and cognitive factors and, ultimately, strong self-efficacy (Glanz et al., 2015). Based on Bandura’s argument, self-efficacy has a significant impact on success in learning and human achievement. Individuals with a strong sense of personal self-efficacy are able to set high goals and value their outcomes.
In situations where mastery is linked to preventing the infection and patient hospitalization, healthcare staff will develop strong motivation, learn, and implement the proposed practices. Mastering experience is a critical factor in achieving self-efficacy because achieving goals has the greatest impact on improving a person’s confidence ( Sreeramoju et al., 2019) . Nurses’ behavior can then be improved by understanding the expected outcome, which is preventing CLABSI. As a consequence, self-efficiency can be promoted by confirmed mastery of the practices. Implementing social cognitive theory can modify and enhance nurses’ education, which can, in turn, promote patient outcomes.
Social cognitive theory is applauded by researchers and other theorists because of its comprehensiveness. An important strength of this theory in the context of CLABSI prevention is that it puts into consideration multiple levels of the social-ecological model in behavior change among nurses. However, the theory is criticized for its assumption that alterations in the environment always cause changes in an individual. Some researchers claim that this is not always the case. It is also argued that the theory is organized loosely because it interplays between individuals, conduct, and the immediate environment. There lacks clarity on the level to which the factors lead to actual behavior changes related to CLABSI prevention practices. Furthermore, this theory does not recognize the role that might be played by biological factors that can affect behavior regardless of experiences in the past or expected results.
Conclusion
CLABSI is among the most common hospital-acquired infections. Mortality and morbidity related to this infection is high even though it is preventable. Evidence indicates that the implementation of proposed preventive practices and guidelines reduce the infection’s incidence. However, the lack of adherence to preventive guidelines provided is a major setback to reducing the infection. Social cognitive theory can be applied in understanding the factors that affect adherence/motivation to the measures and provide ways through which effective strategies can be formulated. The theory of social cognitive theory is of significance to CLABSI prevention and can be applied in understanding what motivates or does not motivate nurses and doctors to apply evidence-based guidelines in CLABSI. Social cognitive theory has seven main components, which are self-efficacy, ability to change behavior, self-control, observation, expectation, and reinforcement. From a social cognitive perspective, behavior and beliefs are linked to the intention of a nurse to use CLABSI preventive practices. Different factors, such as rewards, among others, motivate nurses to adhere to CLABSI prevention practices and guidelines. Although the theory is comprehensive hence explains the issue of CLABSI prevention extensively, it is limited in that it does not explain the possible role played by hormones and other biological factors and its proposal that environmental changes always make a person change his/her behavior.
References
Bandura, A. (2012). On the functional properties of perceived self-efficacy revisited. Journal of Management, 38, 9-44. doi:10.1177/0149206311410606
Cohen, R., Gesser-Edelsburg, A., Singhal, A., Benenson, S., & Moses, A. E. (2019). Deconstruction of central line insertion guidelines based on the positive deviance approach—Reducing gaps between guidelines and implementation: A qualitative ethnographic research. PLOS ONE , 14 (9), e0222608. https://doi.org/10.1371/journal.pone.0222608
Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health behavior and health education: Theory, research, and practice . John Wiley & Sons.
Gurses, A. P., Seidl, K. L., Vaidya, V., Bochicchio, G., Harris, A. D., Hebden, J., & Xiao, Y. (2008). Systems ambiguity and guideline compliance: A qualitative study of how intensive care units follow evidence-based guidelines to reduce healthcare-associated infections. Quality and Safety in Health Care , 17 (5), 351-359. https://doi.org/10.1136/qshc.2006.021709
Sreeramoju, P. (2019). Reducing infections “Together”: A review of Socioadaptive approaches. Open Forum Infectious Diseases , 6 (2). https://doi.org/10.1093/ofid/ofy348
