To follow a rule? On frontline clinicians’ understandings and embodiments of hospital-acquired infection prevention and control rules
Clinicians were filmed performing everyday activities using infection control practices according to the rules of the hospitals where they worked. The clinicians then watched the videos of themselves so they could reflect on their adherence to the rules. While viewing the videos, their responses and discussions about issues were also recorded. This method is called video-reflexive ethnography.
The process helped clinicians to improve their learning about infection control practices and strengthened their appreciation and interpretation of the hospitals’ infection control standards.
This article reports on a study of clinicians’ responses to footage of their enactments of infection prevention and control. The study’s approach was to elicit clinicians’ reflections on and clarifications about the connections among infection control activities and infection control rules, taking into account their awareness, interpretation and in situ application of those rules. The findings of the study are that clinicians responded to footage of their own infection prevention and control practices by articulating previously unheeded tensions and constraints including infection control rules that were incomplete, undergoing change, and conflicting; material obstructions limiting infection control efforts; and habituated and divergent rule enactments and rule interpretations that were problematic but disregarded. The reflexive process is shown to elicit clinicians’ learning about these complexities as they affect the accomplishment of effective infection control. The process is further shown to strengthen clinicians’ appreciation of infection control as necessitating deliberation to decide what are locally appropriate standards, interpretations, assumptions, habituations and enactments of infection control. The article concludes that clinicians’ ‘practical wisdom’ is unlikely to reach its full potential without video-assisted scrutiny of and deliberation about in situ clinical work. This enables clinicians to anchor their in situ enactments, reasonings and interpretations to local agreements about the intent, applicability, limits and practical enactment of rules.