NUR-590 Topic 1: Evidence-Based Practice
The wellness of a population’s health using improved patient safety protocols implores healthcare workers (HCWs) especially nurses, to develop evidence-based practice interventions to reduce and prevent occurrence of adverse events like hospital acquired infections (HAIs) and medication administration errors (MAEs) among others. These adverse events lead to poor patient outcomes, increase the overall cost of care and disease burden, and lowers the quality of care delivered by healthcare professionals. Hospital acquired infections are some of the leading healthcare concerns that affect patient safety and quality of care. Many patients suffer from these infections that result into lengthened stays in hospitals, increased cost of care, and in extreme circumstances death.
Nurse practitioners and other healthcare professionals transmit infections to patients through poor hand hygiene measures and protocols (Alotaibi & Federico, 2017). As such, nurses and other providers should leverage evidence-based practice (EBP) interventions to reduce and prevent the occurrence of hospital acquired infections and guarantee quality care. The use of evidence-based practice interventions allows these providers to offer better services through increased quality, increased engagement of patients and their preferences, and leveraging clinical experience and expertise. The purpose of this evidence-based practice project proposal paper is to discuss how nurses in pediatric settings can integrate hand hygiene measures and protocols to reduce and prevent the occurrence of hospital acquired infections. These measures and protocols include handwashing using soap and water alongside hand sanitizers compared to handwashing with water and soap alone.
Hospital acquired infections or nosocomial infections are newly acquired infections that patients contract during their stay in hospital settings or facilities. The transmission of the nosocomial infections happens through healthcare workers, patients, hospital equipment like catheters and interventional procedures that include catheterization. Studies demonstrate that healthcare workers who include nurse practitioners infect patients when they fail to adhere to effective hand hygiene measures like handwashing with soap or using alcohol-based sanitizers and hand rubs when handling and interacting with patient in the care process (Liana 2021). The use of evidence-based practice interventions using PICOT question is important in assisting nurses to implement better practices to reduce the susceptibility of patients acquiring nosocomial infections that have adverse effects on overall care delivery and quality. These infections lead to increased length of stay in hospitals, a rise in cost of healthcare and cause deaths, especially in critical care settings like pediatric units (Setty et al., 2019). Hand hygiene measures that include handwashing with soap and water alongside sanitizer will improve patient safety among healthcare workers. The implication is that healthcare workers will adhere to these measures in pediatric settings to reduce hospital acquired infections within six months’ period and improve quality outcomes.
Population- Healthcare workers in pediatric settings
Intervention-Hand Hygiene using handwashing with soap and water and sanitizer
Comparison-Handwashing with soap and water alone
Outcome- Reduced Hospital acquired infections
Time- in Six months
Refined PICOT Question
The refined PICOT question for the EBP project is “Among healthcare workers in pediatric setting (P), does hand hygiene practices that include handwashing with soap and water alongside hand sanitizer (I) compared to handwashing with soap and water alone (C) reduce hospital acquired infections (O) within six months (T)?”
Organizational Culture and Readiness
The culture of an organization is essential in implementing changes and it impacts its overall vision, mission and values and employees’ perception in embracing new ways of executing tasks. A culture entails employees with strong norms and values, management and approaches to overall way of doing things. A culture that involves employees, possesses strong values and norms, and encourages an open-door policy with decentralized approach is important in achieving set change objectives in an organization (Real et al., 2017). To effectively implement this EBP project proposal, pediatric healthcare settings and practitioners should use a decentralized organizational and leadership structure. The model is effective in enhancing motivation of subordinates and enhancing growth and increased diversification. Decentralization in healthcare organizations leads to better communication and adoption of innovative practices, ideas and strategies to improve quality of care. Through decentralization, the management leads a transformational approach to enhance agility and respond to new and best practices in care delivery.
The implementation of this EBP project proposal requires organizational culture that focuses on patient-centered care delivery. Through being patient-centered, an organization can support change programs to improve patient safety, quality and access while minimizing the occurrence of hospital acquired infections (HAIs). Increasing patient engagement and promoting inter-professional collaboration leads to a competitive advantage for healthcare organizations.
The evaluation of an organization’s readiness for change based on its culture is essential in implementing evidence-based practice projects. Readiness demonstrates the level to which organizational members are prepared to implement and embrace change, behaviorally and psychologically. Dearing (2018) opines that readiness is a psychological state of the mind that shows commitment to certain course of actions. As such, this EBP project proposal will leverage the Organizational Capacity Assessment Tool developed by the United Nations Development Program (UNDP) that assesses an organization’s readiness in promoting and enhancing the use of global health interventions. Through the tool, organizations identify substantive capacities and strengths that are present and the required one to attain their set objective. In this case, pediatric settings that aim to implement this EBP recommendations should demonstrate exemplary capacities in their attributes, have a superb and influential culture based on their missions, purposes and better values (De la Perrelle et al.., 2020). The capacity assessment tool looks at the various capabilities that include human resources, processes, financial resources, and systems as critical components of readiness for change implementation. Ready organizations possess sufficient strengths that include having the best skills, effective communication and adequate resources, availability of sufficient nurse workforce and effective engagement of their stakeholders.
The organizational readiness also evaluates the process and systems that require improvement to effectively implement the requisite changes (Vax et al., 2021). For instance, the improvement that pediatric care settings require include their patient handling process, the need for healthcare workers to adhere to hand hygiene measures and protocols, and delivery of patient-centered quality care. The organization will need quality improvement and collaborative approaches to enhance implementation. These organizations will also require quality data assessment tools for better and accurate analysis of their respective data (Dearing, 2018). The readiness will also include engagement of stakeholders and integration of information and communication technologies to ensure that all components to implement the project proposal are present. Using selected technologies, the project team and practitioners will pursue outcomes based on patient needs through enhanced alerts, reminders, and notifications on the need to comply with set hand hygiene protocols and measures that include effective handwashing and use of hand sanitizers to reduce hospital acquired infections in the pediatric settings.
Several studies and existing literature supports the incorporation of hand hygiene improvement measures to reduce hospital acquired infections. In their study, Ni et al. (2020) demonstrates that implementation of hand hygiene measures leads to a reduction in hospital acquired infections transmitted by healthcare workers. Using a qualitative design, the authors discuss the outcomes of a research in a large teaching hospital in China about the incorporation of hand hygiene measures to prevent infections and improve patient safety. The authors demonstrate that using handwashing has the potential to reduce HAIs in different care settings, including pediatric units. The article is emphatic that healthcare workers should embrace these interventions as best practices to enhance quality of care and patient outcomes. The study by Setty et al. (2019) implores organizations and healthcare providers to establish hand hygiene measures as one of the evidence-based practices in care management. Using a narrative approach, the authors implore on healthcare workers to disseminate best information to manage and reduce the ever-rising cases of medication errors and adverse events that lead to longer stays in healthcare facilities and increased cost of medication.
Nurses as part of the healthcare workforce should embrace hand hygiene measures to reduce infections and guarantee patient safety and quality care as well as better outcomes. However, many do not embrace these measures. Therefore, it is essential for health organizations and other stakeholders to make the hand hygiene interventions more attractive to nurses since they are frontline care providers and interact more with patients than any other health and medical professionals. Zhao et al. (2017) emphasize the need to make hand hygiene interventions more attractive to nurses and other healthcare workers for effective integration. The study demonstrates that with requisite training and awareness, nurses can implement better practices and make informed choices and decisions on the incorporation of hand hygiene measures to enhance patient safety.
In her study, Liana (2019) explores the effectiveness of hand hygiene practices with the aim of reducing hospital acquired infections. The author notes that all patients hospitalized are at risk of contracting nosocomial infections with certain categories being at the greater risk than others. The study observes that children, the elderly and individuals with compromised immunity are more likely to get an infection while in hospitals. Longer stays in hospitals, use of indwelling catheters, overuse of antibiotics, and the failure by healthcare workers to wash their hands increase the risk for getting nosocomial infections. According to Centers for Disease Control and Prevention (CDC) hospital acquired infections (HAIs) account for close to 1.7 million infections with close to 100,000 individuals dying each year due to associated complications (Liana, 2019). The implication is that healthcare workers should practice proper hand hygiene based on the World Health Organization’s recommendations. These include before touching a patient, after touching them patient, after getting into contact with inanimate surfaces and objects in the patient’s environment, and after having exposure to bodily fluids. They should also have proper hand hygiene before cleaning and aseptic procedures.
Hand hygiene lowers the transmission of pathogens in healthcare settings and healthcare providers need to encourage patients, their families and visitors to regularly decontaminate their hands to reduce infections. The implication is that establishment of proper hand hygiene measures and protocols help reduce nosocomial infections. The study by Staniford et al. (2020) is a systematic review of literature on hand hygiene and environmental disinfection strategies that enhances hygiene standards in pediatric settings. The study emphasizes the need for healthcare workers to change their behaviors with the aim of embracing best practices in handwashing like using soap and water as well as alcohol-based products. nurse practitioners and other healthcare workers should have positive attitude toward hand hygiene measures, have information on protocols and procedures to integrate these interventions with the aim of enhancing patient safety.
In their study, Hillier et al. (2020) explore correct procedures needed for effective hand hygiene. The authors emphasize the significance of nurses possessing relevant knowledge and understanding about evidence-based guidelines like increased use of sanitizers alongside handwashing with hands and water. The authors are categorical that healthcare workers need sufficient knowledge, information and awareness to enhance and integrate the use of these interventions to reduce hospital acquired infections. Using hand hygiene measures, healthcare workers can control and stop the spread of emerging and re-emerging disease’ epidemics and pandemics like the Coronavirus disease of 2019 (COVID-19) in different healthcare settings. The study implores these providers to leverage evidence-based interventions in their care practice and settings to mitigate infections’ transmission.
Clean hands protect individuals from serious infections when they are hospitalized in any facility. The Center for Disease Control and Prevention (CDC) asserts that hand hygiene is the best way to prevent infection. However, many healthcare workers are hesitant to clean their hand leading to healthcare associated infections. In their study Akanji et al. (2017) emphasize the need to institutionalize formal hand hygiene education and feedback compliance among nurses to mitigate and prevent hospital acquired infections. The study shows the need to increase engagement of nurses and other healthcare workers to offer feedback on the most effective interventions to improve patient safety through reduce rate of nosocomial infections. The implication is that organizations and healthcare providers should develop and implement evidence-based practice interventions to reduce different types of infections associated with healthcare settings like central line-associated bloodstream infections that are among the leading types of HAIs.
The study by Azar et al. (2017) shows the need to use agile implementation model to mitigate HAIs among healthcare workers to reduce nosocomial infections. The authors are categorical that nurses and other healthcare workers can deploy various interventions to prevent and reduce the possibility of infections like central line associated bloodstream infections (CLABIs) and catheter-line associated urinary tract infections (CAUTIs) as well as ventilator-associated pneumonia. These studies show that hospital acquired infections are a major healthcare challenge that requires effective evidence-based interventions and best practices as demonstrated in this research proposal. Healthcare workers in pediatric settings have an obligation to reduce and prevent these infections through effective hand hygiene protocols and measures that include handwashing with soap and water as well as using sanitizer.
Discuss problems, issues, and concerns in the professional work setting that are amenable to a research based intervention using the PICOT format (i.e., population, intervention, comparison, outcomes, and time frame).
Examine the role of evidencebased practice (EBP) and change proposals in advanced registered nursing.
Review Chapters 1-3 in Advanced Nursing Research: From Theory to Practice.
Evidence-Based Practice in Nursing and Healthcare
Read Chapters 1 and 2 in Evidence-Based Practice in Nursing and Healthcare.
Striving for Evidence-Based Practice Innovations Through a Hybrid Model Journal Club: A Pilot Study
Read “Striving for Evidence-Based Practice Innovations Through a Hybrid Model Journal Club: A Pilot Study,” by Wilson, Ice, Nakashima, Cox, Morse, Philip, and Vuong, from Nurse Education Today(2015).
Effect of Online Journal Club on Evidence-Based Practice Knowledge, Intent, and Utilization in School Nurses
Read “Effect of Online Journal Club on Evidence-Based Practice Knowledge, Intent, and Utilization in School Nurses,” by Sortedahl, from Worldviews on Evidence-Based Nursing(2012).
6 Steps for Transforming Organizational EBP Culture
Read “6 Steps for Transforming Organizational EBP Culture,” by Ogiehor-Enoma, Taqueban, and Anosike, from
Nursing Management (2010).
About the CEBM
Read “About the CEBM?” located on the Centre for Evidence Based Medicine website.
Evidence-Based Practice Tutorial
Read the Evidence-Based Practice tutorial, located on the Duke University website.
Explore the Resources page on the Centre for Evidence Based Medicine website.
Evidence Based Medicine
Explore the Evidence Based Medicine page of the University of Illinois Library of the Health Sciences website. Use this website as a resource for your project.
The spirit of inquiry is defined as an insatiable curiosity that guides both learning and practice. Spirit of inquiry practices can have a significant positive impact on nurses. In nursing, the spirit of inquiry will prompt questions, challenge established and existing practices, and seek new solutions to problems. When using evidence-based practice (EBP) to address a clinical problem, it is critical to ask the right questions in the right way, obtain the best available evidence, and determine what practice changes are required (National League for Nursing, 2021). Developing nurses with an inquiry mindset within a culture that promotes a systematic approach to asking clinical questions is a critical component of the EBP journey. When conducting an evidence-based study or question, using the spirit of inquiry supports the ongoing curiosity of evidence that would dictate a clinical decision. As a nurse, it is your responsibility to determine whether an intervention is necessary, beneficial to the client, and supported by evidence-based practice. Clinical reasoning or judgment is used by nurses and members of collaborative teams to solve clinical problems. The spirit of greater exit will be established, and the first step of the evidence-based process will be launched. In predictable patient care settings, nurses will use evidence, tradition, and patient preferences to promote optimal health status in collaboration with other members of the health care team.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.