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Table 3 Thematic analysis of the practice demonstrations by healthcare workers documented in the retrospection videos

From: Motivating healthcare professionals (nurses, nurse assistants, physicians) to integrate new practices for preventing healthcare-associated infections into the care continuum: turning Positive Deviance into positive norms

Central theme


1. General evaluation of the model

“As far as I’m concerned, the use of the videos came just in time. It empowered the staff and validated tips that are not present in the regular guidelines.”

“Actually, since we made this video it went (viral) to everyone, and I noticed that me and my unit staff have been stricter. Especially, the order we decided on became a habit.”

“It’s amazing to see how with simple actions are when the staff member explains what they are doing, it makes it applicable and accessible and I suggest that we disseminate these films to the other departments, so that the teaching will continue to spread.”

“To see a video today is more practical and interesting than reading a boring procedure and I can already see that people are starting to implement it during their shifts.”

2. Data processing by the analytical route

(Effective assimilation of the practice)

“When you see in the video how doctors peform, and you understand the risk of introducing contamination through the central-line, it is definitely an assimilation process that probably really doesn’t happen in any other way, and I can tell you that even though we have great relations with the staff, it’s been years since we’ve seen such an assimilation process, and it was received in a way that you don’t see using other techniques.”

“We asked an orderly to demonstrate on a doll how she washes the patient, with all the knowledge and tips she brings from working in the field... Then other staff members demonstrated again with her, and you can see that they really assimilated the actions and it’s amazing.”

“When we made the video it got me focused 100% and I gave it my best, even though these are things I do every day. Definitely there are things that were added in the video that I would not have necessarily done before, but since we made the video now I imitate the way I did it in the video.”

3. The contribution of filming:

The contribution of filming is that it:

 a. Promotes the assimilation of practices more effectively than reading a procedure

 b. Actively involves the staff

 c. Empowers and increases sense of professionalism

“It’s amazing to see how this process serves as a mirror to each other of how the staff approaches things. At the end you could see the shift in how people assimilated and implemented things and talked about it.”

“It was amazing to see in the process how there are things everybody is used to doing, the ‘norms,’ and then there are the exceptional tips that came up during the research, and how the rest of the staff started to implement them because of the videos.”

“Even though we perform this procedure every day, the video gave us a kind of ‘back up,’ it also gives you a good feeling to keep doing it, and since then I’ve had more confidence that I’m doing the right thing.”

“Merely documenting the practice in a video got me to be more organized... To make sure that I have the full and tidy equipment in advance and that I will not have to stop in the middle and ask somebody for help... It makes you feel more professional, and when you’re being filmed it forces you to meet the standards, especially if you want other people to learn from you. Simply by filming, it gives you the feeling that it’s your mission to pass the information on to younger nurses and students and that this will serve us going forward.”

4. Bringing up difficulties on the care continuum nd filling out the gray area

“We saw that precisely in the simple and basic practices we perform dozens of times a shift, like a peripheral venous catheter, drug dilution – there are so many gaps, and filming and watching the videos created a photographic memory that is much stronger than skimming over a written procedure.”

“It made things clearer in my mind, when you talk about something, I used to do it spontaneously, and after the film I started to think about each and every stage, and to separate the stages, the disinfection stage, the stage of carrying the medication to the patient, I didn’t think about the process itself in this way before, the little details. Such as how to carry a medication from the medication room to the patient’s room. We used to say that you have to prepare the drugs sterilely, and the thing is, there’s a correct way to transfer the drug sterilely and not just to take the bag and hang it by the patient.”

“These videos completely refresh what we do all the time, and sometimes there are little tips that help in the places we miss and where we do things wrong out of pressure...”

“During your daily work sometimes you miss things, and when we made the video it got me to focus 100% and give it my best, even though these are things I do daily. For instance, before, when I changed the patient’s dressing and brought a garbage bag for the waste, I would put it on the floor. Today I say to myself, why on the floor? Why not hang it close to the patient?”

“There are a lot of nurses who slip on the issue of decontamination, moving from inward to outwards. Everybody knows you’re supposed to do it that way but they don’t do it, and demonstrating the procedure with a short video is ideal.”

5. The contribution of TA

“I think the fact that you talk and explain while performing the actions makes you aware of everything you do, of every small details. It clarifies all kinds of points in your mind, things you already know.”

“Saying out loud what I’m about to do gives me of a sense of confidence and it is sort of a control of myself because it makes you think about the next stages and not just work on auto pilot and it really helps.”

“I think talking out loud... It also helps to share with people, to get ideas... For instance, the demonstration of taking blood, we didn’t do it like that before but now we do it like in the video.”

“Because of the video we learnt to talk to each other about how to prepare what we need to do, to plan what we do, and say it out loud one step at a time, and say what we are going to do in the next step. Now our actions are synchronized and coordinated with each other.”