A Exploration of the Theory of Planned Behaviour in Nursing Care

The influence of the theory of the planned behaviour on the nursing behavioural intentions of using Physical protection equipment for infection prevention and control

Research gaps

The theory of planned behaviour presents a theoretical explanation of the decision-making process that is applicable in clinical settings by nurses in the provision of care. In their job, nurses interact with a wide variety of medical conditions among the patients seeking therapeutic attention. It is necessary to explore the decision-making mechanisms of the nurses before and during the encounter with such patients.

Studies have examined the theory of planned behaviour, which has presented promising findings in the explanation of intentional behaviour exhibited by the nurses. This theory explains the human behaviour to be driven by behavioural beliefs, normative beliefs and control beliefs which interplay together to contribute to the decision making by the nursing practitioner. In this case, behavioural beliefs produce the attitude towards the action, and normative beliefs result in perceived social pressure, also known as the subjective norm. The control belief breeds perceived behavioural control.


However, despite the promising nature of the theory in the explanation of the human behaviour, there are fundamental gaps in the research that should be addressed to ensure that the findings based on this theory are generalised to the behaviour in the nursing practitioner. First, there is minimal evidence, and the studies that have been conducted have highlighted the limitation of the available research to back their findings. Kim and Oh (2015) explain that few studies have been conducted to explore the applicability of the theory of planned behaviour as a guide in exploring the specific barriers and facilitators of standard precaution (SP) compliance which includes the use of Personal Protective Equipment (PPE). In the nursing practise the limitations of the literature and congruent research findings concerning the planned behaviour as a critical pillar to understanding the adoption of precautions, specifically on the use of the protective physical equipment when handling the patients (Kim and Oh 2015). There is minimal evidence examining the influence of the theory of planned behaviour on the nurse’s decision to using the PPEs.

Secondly, limited literature and research findings are examining the applicability of the theory of planned behaviour in clinical settings. Considering the explanation of the theory of planned behaviour, the perceived control in decision making that can be applied in the nursing practice is reliant on the nature of the normative belief and the favourable beliefs ((Kim and Oh 2015). In this case, therefore, the theory assumes that the individual beliefs coupled with the social norms determine their control and the subsequent decision in a particular setting and this applied in the construction of questionnaires involving the theory (Ajzen 2006). In this case, therefore, it can be argued that the nurse’s decision to use the PPEs for prevention and control of infections when handling the patients is determined by their behavioural attitude and the available norms and social guidelines. However, there is little available evidence to support this assertion making it challenging to pinpoint the theory to its applicability in the specific clinical setting (Efstathiou 2011).

The third crucial research gap associated with this study is the generalisation of the theory to account for intended behaviour in different settings. In this case, this study focuses on the clinical settings, particularly the decision to use physical protective equipment by the nurses when handling the patients. In general, the theory of planned behaviour explains that all intentional behaviour can be explained through the theory, and this too lacks substantiation from the supporting research. Studies have tended to conflict on the main determinants of behavioural decisions in line with the theory concerning the primary determinant of decision making between the normative beliefs and personal behavioural beliefs (Ajzen 2006; Kim and Oh 2015).

The other research gap identified is the difficulties in the applicability of the theory of human behaviour in the explanation of the decisions made by the nursing practitioners in the provision of care. It is undoubted that nurses play crucial decisions and are tasked with decision making, some of which is quickly made upon the encounter with the patients. The limited available research evidence has not fully explored the applicability of the theory of human behaviour in the nursing practice when handling patients during the emergencies (Ko et al. 2004; Kim and Oh 2015). There is a difference in the decision-making approach adopted by nurses when encountering different kinds of patients bearing in mind the various institutionalised decision-making procedures that have been documented to guide the medical practitioners in the decision making (Ko et al. 2004). However, in instances of emergencies and the nurses have to make swift decisions, as in life and death situations, nurses may occasionally rely on their instincts to make the decisions compared to the use of a structured theory of human behaviour.

Despite these highlighted gaps in the research, the theory of planned behaviour will still be used as the guide in the examination of the nursing decision making in Saudi hospitals. Although there is little evidence, if any, of a related study being conducted in Saudi hospitals, this study will be guided by crucial research questions highlighted in the methodology. It will also consider aspects such as multicultural diversities and their influence in the decision making of the nursing practitioners in clinical settings. In this case, the key research questions that will be answered by this study include: what nurses’ beliefs underpin their behavioural intentions to comply with the use of PPEs? What are the influences of the attitudes, subjective norms and PBC on the nurse’s plans to comply with the use of PPEs? What factors relate to the nurse’s behavioural intentions to follow the use of PPEs when handling patients? These research questions will explore in detail the influence of the theory of planned behaviour on the nurses’ decisions in the use of PPE’s as precautionary standards in handling the patients to prevent and control the infections that could otherwise occur in the absence of this equipment.

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Ko, N. Y., Feng, M. C., Chiu, D. Y., Wu, M. H., Feng, J. Y., & Pan, S. M. (2004). Applying theory of planned behavior to predict nurses' intention and volunteering to care for SARS patients in southern Taiwan. The Kaohsiung journal of medical sciences, 20(8), 389-398.

Ajzen, I. (2006, January).Constructing a TPB questionnaire: Conceptual and methodological considerations (Rev.), Retrieved from https://people.umass.edu/aizen/tpb.html

Efstathiou, G., Papastavrou, E., Raftopoulos, V., & Merkouris, A. (2011). Factors influencing nurses' compliance with Standard Precautions in order to avoid occupational exposure to microorganisms: A focus group study. BMC nursing, 10(1), 1.

Kim, K. M., & Oh, H. (2015). Clinical Experiences as related to standard precautions compliance among nursing students: a focus group interview based on the theory of planned behavior. Asian nursing research, 9(2), 109-114.

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