Healthcare worker mental models of patient care tasks in the context of infection prevention and control

Abstract

Objective: Understanding the cognitive determinants of healthcare worker (HCW) behavior is important for improving the use of infection prevention and control (IPC) practices. Given a patient requiring only standard precautions, we examined the dimensions along which different populations of HCWs cognitively organize patient care tasks (ie, their mental models).

Design: HCWs read a description of a patient and then rated the similarities of 25 patient care tasks from an infection prevention perspective. Using multidimensional scaling, we identified the dimensions (ie, characteristics of tasks) underlying these ratings and the salience of each dimension to HCWs.

Setting: Adult inpatient hospitals across an academic hospital network.

Participants: In total, 40 HCWs, comprising infection preventionists and nurses from intensive care units, emergency departments, and medical-surgical floors rated the similarity of tasks. To identify the meaning of each dimension, another 6 nurses rated each task in terms of specific characteristics of tasks.

Results: Each HCW population perceived patient care tasks to vary along 3 common dimensions; most salient was the perceived magnitude of infection risk to the patient in a task, followed by the perceived dirtiness and risk of HCW exposure to body fluids, and lastly, the relative importance of a task for preventing versus controlling an infection in a patient.

Conclusions: For a patient requiring only standard precautions, different populations of HCWs have similar mental models of how various patient care tasks relate to IPC. Techniques for eliciting mental models open new avenues for understanding and ultimately modifying the cognitive determinants of IPC behaviors.

Figure 1.

Stress of the best-fitting configuration obtained in 1 through 6 dimensions. Lower values of stress indicate a better fit to the rating data, with 0 corresponding to a perfect fit. The PROXSCAL algorithm minimizes a variant of stress called “normalized raw stress.”

Figure 2.

Plot of patient care tasks along Dimensions 1 and 2. See supplemental material for complete descriptions of the 25 tasks. Note: pt = Patient; NG = Nasogastric; NP = Nasopharyngeal; BF = Body fluid; SQ = Subcutaneous; IM = Intramuscular; IV = Intravenous line; PIV = Peripheral intravenous line; CL = Central line.

Figure 3.

Plot of patient care tasks along Dimensions 3 and 1. See supplemental material for complete descriptions of the 25 tasks. Note: pt = Patient; NG = Nasogastric; NP = Nasopharyngeal; BF = Body fluid; SQ = Subcutaneous; IM = Intramuscular; IV = Intravenous line; PIV = Peripheral intravenous line; CL = Central line.