Nurses’ Perception of Privacy in the NICU and GCU: A Qualitative Descriptive Study

Mitsuki Yoshimoto^1*, Rie Wakimizu²

¹Master Program in Nursing Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
²Department of Child Health Care Nursing, Division of Health Innovation and Nursing, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.

DOI: 10.4236/ojn.2023.132008                

Abstract

Purpose: The purpose of this study was to identify the perceptions that determine the nursing practices of nurses working in NICU and GCU to protect the privacy of the affected children and their families, and the perceptions that arise in relation to their practices. Further to obtain information on current issues and future suggestions for nursing practice. Method: Semi-structured interviews were conducted with six nurses of Clinical Ladder I or higher currently working in the NICU and GCU, and content analysis was conducted. Result: The study identified five categories, 16 subcategories, and 63 codes: “keeping in mind to act in accordance with the characteristics of the NICU and GCU”, “trying to secure a space only for the affected children and families depending on the situation”, “feeling the need for consideration for the affected children and families”, “feeling puzzled and frustrated through the relationship with families”, “having a dilemma between the environment they want to realize for the affected children and families and the fact that it cannot be realized”. Conclusion: In considering nursing care in NICU and GCU, including consideration for privacy, the need to reflect on daily nursing care and share it with other staff members was suggested.

Keywords

Privacy, Family Nursing, Neonatal Intensive Care Unit, Growing Care Unit, Environment

1. Introduction

Both neonatal and infant mortality rates in Japan have remained very low in international comparisons due to advances in neonatal and perinatal care [1] . While medical advances have saved many lives that were once unsalvageable, in recent years, the percentage of low birthweight (<2500 g), very low birthweight (<1500 g), and extremely low birth weight infant has been increasing as the number of births has remained flat or declined [2] . Furthermore, in recent years, there has been an increase in the number of specific pregnant women and young pregnant women as well as an increase in older births due to later marriages, resulting in an increase in social high-risk pregnant women in addition to medical high-risk [3] . Thus, the number of newborns requiring treatment and systemic management immediately after birth is increasing, and the importance of Neonatal Intensive Care Units (NICUs) and Growing Care Units (GCUs) is growing.

In healthcare, nurses are responsible for protecting patient privacy, as the Code of Ethics for Nurses clearly states that they must maintain patient confidentiality and handle personal information appropriately [4] . Nurses’ protection of patients’ privacy is also a matter of protecting patients’ dignity and is considered a component of their social responsibility as nurses [5] [6] . Furthermore, since it has been reported that nurses consider not only patients but also their families as objects of care and practice nursing acts to protect the privacy of the families [7] , nurses play a role in protecting the privacy of patients and their families in hospital wards and other medical settings. However, privacy-conscious words and actions can vary depending on the situation in which the nurse is placed, and furthermore, they rely heavily on judgment based on the nurse’s personal values and experience. Therefore, depending on the nurse’s actions, patients may perceive that their privacy has been violated [8] [9] .

Privacy-conscious nursing practice is required, given that the privacy of patients and their families admitted to NICU and GCU can be easily violated by the open floors environment and the words and actions of nurses. However, few studies have focused on privacy in NICU and GCU [10] and it is unclear what nurses are doing to ensure patient and family. It is not clear what nursing practices nurses use to protect the privacy of patients and their families. Since moral sensitivity and perceptions are associated with nurses’ nursing practice [11] , and furthermore, the difference between nursing or work is whether the act is a practice guided by perceptions [12] , it is important to grasp and understand nurses’ perceptions in order to clarify their practice.

2. Method

2.1. Aim

The purpose of this study is to identify the perceptions that determine the nursing practices of nurses working in NICU and GCU to protect the privacy of the affected children and their families, and the perceptions that arise in relation to their practices.

2.2. Study Design and Setting

This study is a qualitative descriptive study using semi-structured interviews. And this was conducted from October 2022 to November.

2.3. Subject of Study

The subjects were nurses who were currently working in NICU and GCU and had completed Clinical Ladder I. After obtaining approval from the University of Tsukuba Medical Ethics Committee (Notice No. 1816), we requested research cooperation from one facility, the Comprehensive Perinatal Maternal and Child Health Center in Ibaraki Prefecture. At the same time as recruiting the target facilities, a poster inviting subjects was posted on the website of the University of Tsukuba’s Graduate School of Developmental Nursing. The poster clearly indicated the contact information for the study and asked eligible subjects to contact the reference if they wished to participate.

2.4. Survey Contents

2.4.1. Subject Attributes

Before the interview began, the subjects were asked to fill out a face sheet. The questions on the face sheet included the following items: age, years of nursing experience, years of experience in NICU and GCU, current ladder, and number of beds in the NICU and GCU where they work.

2.4.2. Interview Contents

The interviews were semi-structured interviews lasting about 30 minutes, following an interview guide. Prior to the start of the interview, the interviewer was asked to recall the pre-infectious disease epidemic, given the current situation in hospitals with visitation restrictions. The interview guide consisted of a set of items asking how they perceived privacy in the NICU and GCU, with supplementary questions as needed.

2.4.3. Conducting Interviews

The interviews were conducted based on the interview guide and face sheet. And the interviews were conducted one-on-one between the researcher and the subject. The method of implementation was adjusted according to the subject’s preference, with the subject choosing either face-to-face or online (ZOOM). The interviews were recorded and videotaped only when the subject agreed to be recorded on an IC recorder or on ZOOM.

2.5. Analysis Method

This study was based on the method of Krippendorff, K. (1980) and content analysis [13] .

For content analysis, a verbatim transcript was first created from the narratives obtained from the interviews. From the verbatim transcripts, the subject’s statements were extracted verbatim and coded after marking the content statements related to “the perception that determine the nursing practice that nurses perform to protect the privacy of the affected children and their families, and the perception that arise in relation to their practices”. Subcategories were then created by grouping together codes with similar semantic content from among the codes. After naming the subcategories, the similarity of the codes comprising each subcategory was checked, and similar subcategories were grouped together to create a category. After naming the categories, we checked the similarity of the subcategories that make up each category.

In analyzing the data, I was supervised by a faculty advisor who is well versed in qualitative research and worked to ensure accurate interpretation of the data. In addition, we asked the subjects to confirm the results of the analysis as member checking, and all six subjects responded. Based on the comments and feedback from the subjects, we made modifications as necessary to ensure the reliability and validity of the data.

2.6. Ethical Consideration

This study was conducted with the approval of the University of Tsukuba Medical Ethics Committee (Notice No. 1816).

It was clearly stated in the explanatory statement that participation in the study was voluntary and that no disadvantage would be incurred by not giving consent to the study. And if the subject became ill during the 30-minute interview, we decided whether or not to continue the interview, and we ensured that we did not force the subject to answer any questions that the subjects were not comfortable answering or did not want to answer. IDs were assigned to each subject, and data such as recorded data and verbatim transcripts were managed by creating a consolidated anonymization correspondence table. Information containing personal information was deleted, and management and analysis were conducted with sufficient care so that individuals could not be identified.

3. Result

The subjects were six nurses of Ladder I or higher currently working in NICU and GCU. When six subjects had been interviewed, the date reached the point of saturation. So, we did not interview further subjects.

Table 1 describes Attributes of the subjects. From this table, it can be seen that the average number of years of nursing experience was 13.1 (4.5 - 24) years, and the average number of years in the NICU and GCU was 7.0 (4 - 16) years. The wards where the subjects worked had an average of 9.5 NICU beds and an average of 13.3 GCU beds.

Table 1. Attributes of the subjects.

Interviews were conducted for an average of 30.5 minutes (25 - 34 minutes), and the interview methods were three face-to-face and three online using ZOOM.

After analyzing the verbatim transcripts obtained from the interviews, 63 codes, 16 subcategories, and 5 categories were extracted regarding the perception that determine the nursing practice that nurses perform to protect the privacy of the affected children and their families, and the perception that arise in relation to their practices.

3.1. Keeping in Mind to Act in Accordance with the Characteristics of the NICU and GCU (Table 2)

The category “keeping in mind to act in accordance with the characteristics of the NICU and GCU” indicates that nurses are mindful of privacy in accordance with the different environment of the NICU and GCU from that of general wards, such as open floors with no partitions and close bed distances due to the presence of medical equipment and monitors.

Table 2. Keeping in mind to act in accordance with the characteristics of the NICU and GCU.

This category was generated from two subcategories: , and .

“If there is a bit of invasive care, you know…if there is a wound or bowel protrusion or something that is a bit difficult to do or see when other patients (family members) are present, I pull back the partitions before I care for them.” (ID1)

“Sometimes during family visits, there are a bit busy with other babies being treated or hospitalized, and the nurses and doctors sometimes get flustered, but at those times I think the family members inevitably look at me as if I am having a hard time, so I use curtains to separate them.” (ID4)

3.2. Trying to Secure a Space Only for the Affected Children and Families Depending on the Situation (Table 3)

The category “trying to secure a space only for the affected children and families depending on the situation” indicates that the subjects were aware of the need to provide space for only the affected children and families depending on the situation with each family, such as sometimes creating space for only the family and sometimes intentionally engaging in an open floor.

Table 3. Trying to secure a space only for the affected children and families depending on the situation.

This category was generated from three subcategories: , , and .

“I am conscious of trying not to say anything that could identify the specific name of the disease. Try not to mention anything that could identify the disease. (Some omitted.) With so many babies in the hospital, sometimes there is a mix of different families coming to the ward to visit and participate in care, so it is natural to wonder what kind of babies are around, not just your own child. It also means that there may also be desire not to provoke such feelings or to let other people know about some of the things you do.” (ID3)

3.3. Feeling the Need for Consideration for the Affected Children and Families (Table 4)

The category “feeling the need for consideration for the affected children and families” indicates that there are situations in daily work where subjects feel that the privacy of affected children and their families is not protected, or that the words and actions of staff, including themselves, lack consideration for privacy, and that they perceive the need for consideration.

This category was generated from the following five subcategories: , , , , .

“Since it is an open floor and the bed itself is very small, there are many times when I feel that privacy is not protected in the environment. Especially in the presence of many family members, there are times when I feel that the physical space is not protected. “ (ID3)

“I thought at the time that since we work so hard to cope with sudden changes, the degree to which we are aware of the privacy of children on a daily basis is a major factor in whether or not we are able to give consideration to their privacy. “ (ID2)

3.4. Feeling Puzzled and Frustrated through the Relationship with the Families (Table 5)

The category of “feeling puzzled and frustrated through the relationship with the families” indicates that the subjects feel difficulty in dealing with the families in a privacy-conscious manner and that they feel frustration and resistance in dealing with the families of the patient due to their consideration of the surroundings.

Table 4. Feeling the need for consideration for the affected children and families.

Table 5. Feeling puzzled and frustrated through the relationship with the families.

This category was generated from the following three subcategories: , , and .

“If the mothers are talking to each other, I don’t know…hmmm…until attention…is it ok? No, but…I might consult with my senior once and get advice from that senior. Well, I might not be able to judge alone what level is acceptable….” (ID1)

“When you feed a child directly, you add milk to the bottle, because sometimes one of the patients is not able to drink at all and another is able to drink. But in reality, we both want to be happy when one of us is able to drink, don’t we? I want to say to the mother, ‘You were able to drink,’ but if the other child is unable to drink, I have no choice but to keep my voice down.” (ID4)

3.5. Having a Dilemma between the Environment They Want to Realize for the Affected Children and Families and the Fact That It Cannot Be Realized (Table 6)

In the category of “having a dilemma between the environment they want to realize for the affected children and families and the fact that it cannot be realized”, although the subjects believe that it is not easy to realize an ideal environment given the role of NICU and GCU, where the first priority is to save the life of the patients, they indicated that they have some points to improve and hope to make the environment of the NICU and GCU where they are currently working better for the affected children and their families, including in terms of protecting their privacy.

Table 6. Having a dilemma between the environment they want to realize for the affected children and families and the fact that it cannot be realized.

This category was generated from three subcategories: , , and .

“Rather than having the parents do various things in a small environment, if we can create a space that is a little closer to their home environment, such as a GCU where they can experience a simulated baby bed here and diapers there, the environment will be even better. I think it would be a better environment.” (ID3)

4. Discussion

In order to protect the privacy of the affected children and their families, the nurses were aware that they should “keeping in mind to act in accordance with the characteristics of the NICU and GCU” and “trying to secure a space only for the affected children and families depending on the situation” in their nursing practice. On the other hand, the nurses felt “feeling the need for consideration for the affected children and families” in their daily work, and that they felt “feeling puzzled and frustrated through the relationship with the families” due to privacy concerns. Furthermore, it became clear that each nurse was aware of “ having a dilemma between the environment they want to realize for the affected children and families and the fact that it cannot be realized”.

Therefore, the following sections will be divided into three themes based on the generated categories: 1) privacy in NICU and GCU, 2) nursing care for families in NICU and GCU, and 3) the environment of NICU and GCU.

4.1. Privacy in NICU and NICU

The subjects in this study were aware that NICU and GCU are different environments from general wards, such as open floors without partitions and narrow distances between beds due to the presence of medical equipment and monitors, and they tried to protect the privacy of the affected children and their families by “trying to act in accordance with the characteristics of the NICU and GCU”. On the other hand, they were aware that, in the course of their daily work, and that This is due to the fact that NICU and GCU are environments where the treatment of the patient should be the top priority, and care and treatment must be provided regardless of the family’s visiting status or time. In such situations, it is not always possible to completely block the eyes of other families who come to visit or to prevent them from seeing or hearing information about the children. Therefore, it can be said that although the nurses themselves were consciously acting to protect privacy, sometimes there were tasks that should be prioritized over privacy considerations, and they recognized situations in which privacy was not adequately protected and “feeling the need for consideration for the affected children and families”. This interpretation is consistent with the results of a previous study [14] , which found that, as in the NICU and GCU, nurses in ICUs that provide advanced intensive care to patients questioned the treatment-first ICU environment and the lack of patient privacy, while recognizing the need for that environment.

Furthermore, some of the subjects considered that children’s privacy was not protected in response to situations where care was provided without covering them with towels. The perception that human dignity should be protected even for newborns who cannot express themselves verbally indicates that privacy protection is one of the ethical issues to be considered in NICU and GCU. NICU nurses face a variety of ethical challenges beyond the primary ethical issue of life-or-death decision making [15] , and some previous studies report that care for the affected children is one of the dilemmas, as was the case for the subjects in this study [16] . Therefore, it is important to reaffirm that protecting the privacy of the children is the key to preserving the children’s dignity, and it is important for the ward staff to be united in this recognition.

The subjects also recognized that they felt “feeling puzzled and frustrated through the relationship with the families” related to privacy and consulted senior nurses as a way to cope with this situation. Prior research has shown that when new nurses encounter ethical dilemmas, they only respond to them privately by consulting their supervisors or colleagues, and not systematically in public settings such as hospital-wide or ward conferences [17] . As with ethical dilemmas, it is difficult to make a judgement about family’s involvement on the spot alone, since the acceptable level of privacy varies from person to person. Therefore, as an organizational effort, it is necessary to set up ward conferences to share awareness of problems and confusions held through everyday work and involvement with families.

Furthermore, one of the subjects recognized that and . If nurses can raise their awareness of ethical issues, dilemmas, and sensitivity to privacy through the previously mentioned conferences, and if they can reflect on their daily nursing care on a case-by-case basis, it can be expected to improve the quality of nursing care in the ward as a whole.

4.2. Nursing Care for Families in NICU and GCU

The results of this study showed that the subjects were conscious of in an environment where the words and actions of other patients, family members, and sometimes medical staff could be easily observed, and that they made “trying to secure a space only for the affected children and families depending on the situation” by using a stand to partition the space and talking to the families to prevent unnecessary information from entering the space. For mothers, the NICU is a “different space” where they do not belong, and it has been reported that they are always tense and aware of the presence of instruments through visual and auditory senses [18] , so it is necessary for families to be aware of their children and to create a family-only space including them.

However, this study also revealed that open floors are not necessarily a negative aspect for families. In other words, the nurses themselves recognized the advantages of the NICU and GCU for the families, such as the sense of security of having more staff watching their children and the ability of mothers and fathers to build relationships with each other because of the open floors, and they made use of these strengths in their interactions with the families. In a previous study, it was reported that mothers of children admitted to the NICU “wanted to hear about the experience of raising a child born small” [19] , which is consistent with the perceptions of the subjects in this study. Furthermore, it was revealed that the mothers of the affected children felt that there was an atmosphere in the NICU where they were not allowed to talk to other mothers, and they felt lonely because they could only have a space to face their children [18] .

Therefore, in order to secure space for the affected children and families, it is important to consider appropriate considerations for the families, recognizing that excessive partitioning in terms of privacy considerations may cause the families to feel isolated and that the NICU and GCU can be a place for peer support among family members when open floors are available.

4.3. Environment of NICU and GCU

The subjects of this study recognized that the NICU and GCU in which they currently worked had areas that could be improved to create a privacy-conscious environment for affected children and their families. Therefore, it can be said that they had the desire to and in the current NICU and GCU. On the other hand, the fact that they suggests that they were aware of the difficulties in overcoming these points for improvement and creating an ideal environment, considering the role of NICU and GCU, which should place the highest priority on saving the life of the patient.

Although each subject had a different image of the environment they wanted to create for the affected children and families, they had a common ideal of an environment where the children and families could spend time together, in keeping with the wishes of the family, who would normally have to spend their precious time with their children in the NICU and GCU immediately after the birth. The environment of NICU and GCU is under constant examination to achieve the optimal environment for the affected children and families, including the promotion of developmental care [20] and the comparison of the effects of open floors and semi-private room types [21] . In the future, further study is needed to add the perspective of privacy considerations to such optimal environment items, and the narratives from the subjects in this study are very significant.

In addition, the environment of the NICU and GCU made the subject resistant to dealing with the affected children and their families. This resistance may have arisen from the fact that the subject wanted to protect the children’s privacy by referring to the children’s name by their bed number, but also wanted to call the children by their name, which were gifts from their parents. The environment in which the nurses’ words and actions could be seen and heard by those around them made the nurses hesitant to respond honestly, leading to a sense of frustration and resistance. Therefore, it can be said that nursing care in the NICU and GCU is related to the ward environment, and it is desirable to have a system that allows staff to share and consult with each other, given that not only the individuals involved but also other staff may feel the same frustration and resistance.

Furthermore, while it has been reported that nursing practice in private wards is difficult to see among nurses [22] , the NICU and GCU can be viewed as an environment where nurses can easily observe and learn from each other’s nursing practice because of the open floor. Since the presence of senior nurses is one of the factors that improve skill acquisition and practical skills [23] [24] , an environment where nurses can easily observe nursing practices performed by other nurses is thought to have a positive effect on nurses in terms of their personal growth. So, these findings suggest that the environment of the NICU and GCU, although difficult to protect privacy, may have a positive impact on families and nurses.

Finally, the results of this study indicate that the environment of the NICU and GCU has a significant bearing on the perception that determine the nursing practice that nurses perform to protect the privacy of the affected children and their families, and the perception that arise in relation to their practices.

NICU and GCU is a place where intensive care is provided with the highest priority of saving the life of newborn babies, and at the same time, that is a place where parents accept their children and form families, creating a very special environment in which normally conflicting aspects must be balanced. On the other hand, nurses in the critical care area have the role of advocating for those who receive medical care in a condition where they are unable to make self-determination and to maintain a basic life respected as a person in any condition [25] . Therefore, even in the special environment of NICU and GCU, nurses are required to protect the life safety of affected children and provide nursing care that is close to the affected children and their families. This study showed that consideration for privacy is an important underlying factor.

In the NICU and GCU, there are many situations that require consideration for privacy, such as responding to sudden changes, caring for affected children, and interacting with families, but these are often left to the judgment of individual nurses and passed off as casual situations. Prior research has shown the importance of discussing ethical issues that arise in the unique environment of the NICU [26] , suggesting the need for staff to share not only ethical issues but also privacy-related awareness and confusion with each other in the future. By sharing information among staff with different experiences and values, privacy can be viewed from a new perspective, leading to clues for better nursing care. This will lead to the practice of privacy-conscious nursing care in the entire ward.

5. Limitations of the Study and Future Challenges

The small number of subjects in this study six and the limited interview time may have prevented us from eliciting sufficient narratives from the subjects, making it difficult to generalize the results as the perceptions of nurses working in the NICU and GCU. Furthermore, it cannot be denied that the results obtained in this study lacked accuracy in terms of memory and perception, since the subjects were speaking in retrospect before the infectious diseases outbreak. In addition, given the situation where there are still restrictions on visits in hospital wards, it is not appropriate to apply the findings of this study to current nursing practice, and further investigation is needed. Specifically, we believe that by obtaining narratives from subjects at a larger number of facilities and by investigating changes in perceptions based on whether or not visitation restrictions are in place, we can gain a clearer understanding of nurses’ perceptions of the current situation.

6. Conclusions

Five categories were identified as perception that determines the nursing practice that nurses perform to protect the privacy of the affected children and their families, and the perception that arise in relation to their practices. The following five categories were identified: “keeping in mind to act in accordance with the characteristics of the NICU and GCU”, “trying to secure a space only for the affected children and families depending on the situation”, “feeling the need for consideration for the affected children and families”, “feeling puzzled and frustrated through the relationship with the families”, and “having a dilemma between the environment they want to realize for the affected children and families and the fact that it cannot be realized”.

In considering nursing care in the NICU and GCU, including consideration for privacy, it was suggested that it is necessary to reflect on daily nursing care and share it with various staff members.

Funding

This study was funded by Grant-in-Aid for Scientific Research (Grant Number: 22H00490).

Conflicts of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

1. 1. Drame, G. (2008) Hygiène des mains dans les services à haut risque infectieux du CHU du point «G». Thèse, Université de Bamako, Bamako, 74 p. https://www.keneya.net/fmpos/theses/2008/med/pdf/08M172.pdf


2. 2. Ribeiro Pinto, V., Rodiguez Gonzalez, A. and Silva, I. (2015) Quels sont les principaux facteurs influençant l’hygiène des mains chez les infirmiers/infirmières dans les milieux de soins. Haute école de santé Genève, Genève, 86 p. https://sonar.ch/global/documents/315265


3. 3. Muyulu, N. (2016) Perceptions et croyances relatives à l’hygiène des mains chez les infirmières de deux hôpitaux de la République démocratique du Congo. Mémoire, Université de Montréal, Montréal, 127 p. https://papyrus.bib.umontreal.ca/xmlui/handle/1866/16295


4. 4. Gbenou, E., Hossou, N. and Ahoyo, T. (2019) Audit de l’hygiène des mains dans les services de maternité et de médecine-pédiatrie de l’hôpital de zone d’Adjohoun au Bénin en 2019. EPAC/CAP/UAC, Cotonou, 38 p. http://biblionumeric.epac-uac.org:8080/jspui/handle/123456789/3825


5. 5. Diallo, A. (2015) Connaissances, attitudes et pratiques liées au lavage des mains à Djicoroni-Para. Thèse, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, 69 p. https://www.bibliosante.ml/handle/123456789/766


6. 6. Minata, K. (2009) Connaissances, attitudes et pratiques liées au lavage des mains en milieu formel, informel et domestique à Yirimadio en 2009 (commune VI-district de Bamako-Mali). Thèse, Université de Bamako, Bamako, 58p. https://www.keneya.net/fmpos/theses/2009/med/pdf/09M500.pdf


7. 7. Guemning Watchueng, V.L. (2014) Ethnographie du lavage des mains au centre de santé de référence de la commune II du district de Bamako. Thèse, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, 85 p. https://www.keneya.net/fmpos/theses/2014/med/pdf/14M220.pdf


8. 8. Musangu, M.S., Umba, F.M., Bope, M.B., Bora, G.K., Kalwaba, S.K., et al. (2020) Observance of Hand Hygiene in Hospitals: A Requirement for Patient Safety in Health Structures in Lubumbashi, Democratic Republic of Congo. Revue de l’Infirmier Congolais, 4, 36-42.


9. 9. (2009) Loi N° 2009-007 du 15 mai 2009 portant code de la sante publique de la République togolaise. Journal Officiel De La République Togolaise, 25, 1-57. https://faolex.fao.org/docs/pdf/tog93366.pdf


10. 10. Boutolleau, G., Brangier, M.-T., Brochard, M.T., Cadot, C., Cante, Y., Da Cunha, E., et al. (1996) Recommandations pour les bonnes pratiques d’hygiène dans les services d’accueil des urgences. CCLIN Sud-Ouest, Toulouse. p. 18. https://www.sfmu.org/upload/consensus/cclin_hygiene_sau.pdf


11. 11. Nina N’Diaye Johanne Samson (2013) Hygiène des mains en milieu hospitalier: Stratégies de promotion et de formation Note informative préparée par l’UETMIS du CHU Sainte-Justine, Montréal. https://www.chusj.org/getmedia/b634151e-850c-4a79-8004-61aa0622ca89/UETMIS_hygiene-des-mains_fr.pdf.aspx


12. 12. Gouvi, A.W., Koudokpon, C.H. and Dandjlessa, O. (2019) Evaluation des connaissances sur l’hygiène des mains du personnel des centres de santé publics de Houéyogbé (commune de Houéyogbé) Bénin. EPAC/CAP/UAC, Cotonou, 50 p. http://biblionumeric.epac-uac.org:8080/jspui/handle/123456789/3277


13. 13. Hounsa, S.N., Cakpo, P., Dougnon, V.T., Klotoe, J.R. and Kougnimon, E. (2019) Evaluation de l’hygiène des mains et du risque infectieux au centre médicale d’Oganla (commune de Porto Novo). EPAC/CAP/UAC, Cotonou, 43p. http://biblionumeric.epac-uac.org:8080/jspui/handle/123456789/3646


14. 14. Capo-Chichi, E.N. (2018) Evaluation de l’observance de l’hygiène des mains par le personnel soignant du service de pédiatrie du chud-op au Bénin en 2018. EPAC/ UAC/CAP, Cotonou, 43 p. http://biblionumeric.epac-uac.org:8080/jspui/handle/123456789/979


15. 15. Hossou, N. (2018) Audit de l’hygiène des mains en milieu hospitalier: Cas des services de maternité et de medecine-pédiatrie de l’hôpital de zone d’Adjohoun au Bénin en 2018. EPAC/UAC/CAP, Cotonou, 38 p. http://biblionumeric.epac-uac.org:8080/jspui/handle/123456789/645


16. 16. Organisation mondiale de la Santé. (2010) Résumé des recommandations de l’OMS pour l’hygiène des mains au cours des soins. Organisation mondiale de la Santé Sante. https://apps.who.int/iris/handle/10665/70469


17. 17. Tsuji, I. and Koyama, H. (2021) Simple Hygiene and Public Health 2021. Nankodo, Tokyo. (In Japanese)


18. 18. Ministry of Health, Labor and Welfare (2015) Current Status of the Perinatal Medical System. (In Japanese)https://www.mhlw.go.jp/file/05-Shingikai-10801000-Iseikyoku-Soumuka/0000096037.pdf


19. 19. Ministry of Health, Labor and Welfare (2019) Current Status and Challenges in the Medical Treatment of Pregnant and Nursing Women. (In Japanese)https://www.mhlw.go.jp/content/12401000/000488877.pdf


20. 20. Japan Nursing Association (2021) Code of Ethics for Nursing Profession. https://www.nurse.or.jp/home/publication/pdf/rinri/code_of_ethics.pdf


21. 21. Lin, Y.-P. and Tsai, Y.-F. (2011) Maintaining Patients’ Dignity during Clinical Care: A Qualitative Interview Study. Journal of Advanced Nursing, 67, 340-348. https://doi.org/10.1111/j.1365-2648.2010.05498.x


22. 22. Yamada, E. and Nakajima, M. (2021) Components of Social Responsibility as Perceived by Nurses. Japanese Journal of Nursing Education, 30, 13-25. (In Japanese)


23. 23. Yamasaki, C. and Nagato, K. (2010) Nursing Practices for Respecting and Protecting the Privacy of Inpatients and Their Family Members. Kochi Women’s University Bulletin, Faculty of Nursing, 59, 39-50. (In Japanese)


24. 24. Marin, C.R., Gasparino, R.C. and Puggina, A.C. (2018) The Perception of Territory and Personal Space Invasion among Hospitalized Patients. PLOS ONE, 13, e0198989. https://doi.org/10.1371/journal.pone.0198989


25. 25. Valizadeh, F. and Ghasemi, S.F. (2020) Human Privacy Respect from Viewpoint of Hospitalized Patients. European Journal of Translational Myology, 30, 1-8. https://doi.org/10.4081/ejtm.2019.8456


26. 26. Ikeda, N., Hirotani, R., Kamio, K., Fukutani, M., Marumo, Y. and Shimokawa, C. (2013) A Survey on Privacy Awareness among Nurses and Mothers in NICU and GCU. Research Collection of Nursing, Department of Nursing, Yamaguchi University Hospital, 22-25. (In Japanese)


27. 27. Maeda, Y. and Katsuno, T. (2021) Factors Related to Nursing Practice for Elderly Patients with Cognitive Impairment with the Aim of Person-Centered Care on Acute Wards. Gerontological Nursing, 25, 71-79. (In Japanese)


28. 28. Jinda, Y. (2006) Invitation to Nursing Field Science Expert Nurses Grow up in the Field. Igaku Shoin, Tokyo. (In Japanese)


29. 29. Krippendorff, K.H. (1980) Content Analysis: An Introduction to Its Methodology: Beverly Hills. SAGE Publications, Thousand Oaks.


30. 30. Kiriyama, K., Hayashi, K., Matsui, Y., Sugawara, T. and Mizutani, Y. (2022) Ethical Issues and Responses of Nurses in ICU. Bulletin of Asahi University School of Health Sciences, School of Nursing, No. 8, 10-19. (In Japanese)


31. 31. Strandås, M. and Fredriksen, S.-T.D. (2015) Ethical Challenges in Neonatal Intensive Care Nursing. Nursing Ethics, 22, 901-912. https://doi.org/10.1177/0969733014551596


32. 32. Mizusawa, N., Endo, R. and Inoue, M. (2005) Dilemma as Told by NICU Nurses. Pediatric Nursing, 36, 152-154. (In Japanese)


33. 33. Ito, C. and Ota, K. (2008) A Case Study of Ethical Dilemma for Novice Clinical Nurses and Their Educational Need for Nursing Ethics. Journal of Japanese Society of Nursing Education, 18, 41-49. (In Japanese)


34. 34. Nishida, S. (2006) Experience of Mothers Whose Babies Are Continually Hospitalized from NICU to the Pediatric Ward. Japanese Journal of Nursing Science, 26, 64-73. (In Japanese) https://doi.org/10.5630/jans.26.4_64


35. 35. Nagai, T. (2022) Hope for Support for Mothers of Low Birth Weight Infants in the Process of Rebuilding Their Lives. Journal of St. Luke’s Nursing Society, 26, 11-19. (In Japanese)


36. 36. Santos, J., Pearce, S.E. and Stroustrup, A. (2015) Impact of Hospital-Based Environmental Exposures on Neurodevelopmental Outcomes of Preterm Infants. Current Opinion in Pediatrics, 27, 254-260. https://doi.org/10.1097/MOP.0000000000000190


37. 37. O’Callaghan, N., Dee, A. and Philip, R.K. (2019) Evidence-Based Design for Neonatal Units: A Systematic Review. Maternal Health, Neonatology and Perinatology, 5, Article No. 6. https://doi.org/10.1186/s40748-019-0101-0


38. 38. Hayashi, Y., Teraoka, T. and Ikebe, T. (2007) Nurses’ Hesitation and Awareness of Nursing Practice in Psychiatric Wards That Consists of Private Rooms. Japanese Journal of Mental Health Nursing, 16, 67-74. (In Japanese)


39. 39. Imai, T., Takase, M., Nakayoshi, Y., Kawamoto, M. and Yamamoto, K. (2019) Factors Indispensable for Improving Practical Nursing Competence: A Text Mining Analysis of Descriptive Questionnaire Date from Nurses with under Five Years of Clinical Experience. Labour Science, 95, 41-55. (In Japanese)


40. 40. Watanabe, M. (2018) Experiences That Influence the Physical Assessment Skill Acquisition of Clinical Nurses—Focus on the Acquired Clinical Experience. Mejiro University Health Science Research, No. 11, 77-87. (In Japanese)


41. 41. Ikematsu, Y. (2011) Critical Care Nursing I: Patient Understanding and Basic Nursing Skills. Medical Friend Inc., Tokyo. (In Japanese)


42. 42. Furukawa, I. and Tamagami, A. (2022) Literature Review on Ethical Issues of NICU Nurses. Osaka City University Journal of Nursing Science, 18, 27-33. (In Japanese)

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Tsuji, I. and Koyama, H. (2021) Simple Hygiene and Public Health 2021. Nankodo, Tokyo. (In Japanese)
[2]	Ministry of Health, Labor and Welfare (2015) Current Status of the Perinatal Medical System. (In Japanese) https://www.mhlw.go.jp/file/05-Shingikai-10801000-Iseikyoku-Soumuka/0000096037.pdf
[3]	Ministry of Health, Labor and Welfare (2019) Current Status and Challenges in the Medical Treatment of Pregnant and Nursing Women. (In Japanese) https://www.mhlw.go.jp/content/12401000/000488877.pdf
[4]	Japan Nursing Association (2021) Code of Ethics for Nursing Profession. https://www.nurse.or.jp/home/publication/pdf/rinri/code_of_ethics.pdf
[5]	Lin, Y.-P. and Tsai, Y.-F. (2011) Maintaining Patients’ Dignity during Clinical Care: A Qualitative Interview Study. Journal of Advanced Nursing, 67, 340-348. https://doi.org/10.1111/j.1365-2648.2010.05498.x
[6]	Yamada, E. and Nakajima, M. (2021) Components of Social Responsibility as Perceived by Nurses. Japanese Journal of Nursing Education, 30, 13-25. (In Japanese)
[7]	Yamasaki, C. and Nagato, K. (2010) Nursing Practices for Respecting and Protecting the Privacy of Inpatients and Their Family Members. Kochi Women’s University Bulletin, Faculty of Nursing, 59, 39-50. (In Japanese)
[8]	Marin, C.R., Gasparino, R.C. and Puggina, A.C. (2018) The Perception of Territory and Personal Space Invasion among Hospitalized Patients. PLOS ONE, 13, e0198989. https://doi.org/10.1371/journal.pone.0198989
[9]	Valizadeh, F. and Ghasemi, S.F. (2020) Human Privacy Respect from Viewpoint of Hospitalized Patients. European Journal of Translational Myology, 30, 1-8. https://doi.org/10.4081/ejtm.2019.8456
[10]	Ikeda, N., Hirotani, R., Kamio, K., Fukutani, M., Marumo, Y. and Shimokawa, C. (2013) A Survey on Privacy Awareness among Nurses and Mothers in NICU and GCU. Research Collection of Nursing, Department of Nursing, Yamaguchi University Hospital, 22-25. (In Japanese)
[11]	Maeda, Y. and Katsuno, T. (2021) Factors Related to Nursing Practice for Elderly Patients with Cognitive Impairment with the Aim of Person-Centered Care on Acute Wards. Gerontological Nursing, 25, 71-79. (In Japanese)
[12]	Jinda, Y. (2006) Invitation to Nursing Field Science Expert Nurses Grow up in the Field. Igaku Shoin, Tokyo. (In Japanese)
[13]	Krippendorff, K.H. (1980) Content Analysis: An Introduction to Its Methodology: Beverly Hills. SAGE Publications, Thousand Oaks.
[14]	Kiriyama, K., Hayashi, K., Matsui, Y., Sugawara, T. and Mizutani, Y. (2022) Ethical Issues and Responses of Nurses in ICU. Bulletin of Asahi University School of Health Sciences, School of Nursing, No. 8, 10-19. (In Japanese)
[15]	Strandås, M. and Fredriksen, S.-T.D. (2015) Ethical Challenges in Neonatal Intensive Care Nursing. Nursing Ethics, 22, 901-912. https://doi.org/10.1177/0969733014551596
[16]	Mizusawa, N., Endo, R. and Inoue, M. (2005) Dilemma as Told by NICU Nurses. Pediatric Nursing, 36, 152-154. (In Japanese)
[17]	Ito, C. and Ota, K. (2008) A Case Study of Ethical Dilemma for Novice Clinical Nurses and Their Educational Need for Nursing Ethics. Journal of Japanese Society of Nursing Education, 18, 41-49. (In Japanese)
[18]	Nishida, S. (2006) Experience of Mothers Whose Babies Are Continually Hospitalized from NICU to the Pediatric Ward. Japanese Journal of Nursing Science, 26, 64-73. (In Japanese) https://doi.org/10.5630/jans.26.4_64
[19]	Nagai, T. (2022) Hope for Support for Mothers of Low Birth Weight Infants in the Process of Rebuilding Their Lives. Journal of St. Luke’s Nursing Society, 26, 11-19. (In Japanese)
[20]	Santos, J., Pearce, S.E. and Stroustrup, A. (2015) Impact of Hospital-Based Environmental Exposures on Neurodevelopmental Outcomes of Preterm Infants. Current Opinion in Pediatrics, 27, 254-260. https://doi.org/10.1097/MOP.0000000000000190
[21]	O’Callaghan, N., Dee, A. and Philip, R.K. (2019) Evidence-Based Design for Neonatal Units: A Systematic Review. Maternal Health, Neonatology and Perinatology, 5, Article No. 6. https://doi.org/10.1186/s40748-019-0101-0
[22]	Hayashi, Y., Teraoka, T. and Ikebe, T. (2007) Nurses’ Hesitation and Awareness of Nursing Practice in Psychiatric Wards That Consists of Private Rooms. Japanese Journal of Mental Health Nursing, 16, 67-74. (In Japanese)
[23]	Imai, T., Takase, M., Nakayoshi, Y., Kawamoto, M. and Yamamoto, K. (2019) Factors Indispensable for Improving Practical Nursing Competence: A Text Mining Analysis of Descriptive Questionnaire Date from Nurses with under Five Years of Clinical Experience. Labour Science, 95, 41-55. (In Japanese)
[24]	Watanabe, M. (2018) Experiences That Influence the Physical Assessment Skill Acquisition of Clinical Nurses—Focus on the Acquired Clinical Experience. Mejiro University Health Science Research, No. 11, 77-87. (In Japanese)
[25]	Ikematsu, Y. (2011) Critical Care Nursing I: Patient Understanding and Basic Nursing Skills. Medical Friend Inc., Tokyo. (In Japanese)
[26]	Furukawa, I. and Tamagami, A. (2022) Literature Review on Ethical Issues of NICU Nurses. Osaka City University Journal of Nursing Science, 18, 27-33. (In Japanese)