NUR-590 Evidence-Based Practice Project Presentation

NUR-590 Evidence-Based Practice Project Presentation

NUR-590 Evidence-Based Practice Project Presentation

Introduction and Objectives

Achieving patient safety implores nurses and other healthcare professionals to develop interventions that improve quality care and reduces occurrence of hospital acquired infections (HAIs). The use of evidence-based practice interventions like hand hygiene protocols and measures that include handwashing with soap and water alongside sanitizers can prevent and reduce the prevalence of hospital acquired infections (Zhao et al., 2017). Nurses in pediatric care settings should set high levels of hygiene to minimize the occurrence of HAIs in these settings. The integration of EBP interventions mitigates the increasing prevalence of HAIs and their associated cost burden to patients, their families and the health care system (Akanji et al., 2017). Hospital acquired infections constitute a significant part of the increased mortality and morbidity and poor outcomes among pediatric patients. The purpose of this presentation is to detail the evidence-based practice project proposal on hand hygiene measures involving handwashing with soap and water alongside use of hand sanitizer by healthcare workers, especially nurses, in reducing and preventing the occurrence of hospital acquired infections in pediatric care settings.

EBP & PICOT Statement for EBP Project

Evidence-based practice continues to be a critical component of enhancing care delivery among patients in different settings. The use of EBP entails incorporation of research evidence together with patient preferences and clinician’s care experience. Evidence-based practice aims at optimization of provider and team behavior to support changes in patient conduct to attain quality care, and provides education to reduce the risks of hospital acquired infections and improve different aspects of care provision (Melnyk & Fineout-Overholt, 2019). EBP also encourages the use of resources and services, and improvement in patients and their families’ satisfaction (Zhao et al., 2018). The EBP project will also focus on enhancing patient safety, improving adherence to hand hygiene measures, and improving outcomes and quality management to reduce adverse events. The project also focuses on decreasing the overall cost of infections, length of stay, and readmissions, and ensure that providers can make better care decisions in managing adverse events resulting from HAIs. The PICOT Question for the project is

Among healthcare worker in pediatric settings (P), how does handwashing with soap and water alongside hand sanitizer (I), compared to handwashing with soap and water alone (C), reduce hospital acquired infections (O), with six months (T)?

Organizational Culture & Readiness

Organizational culture is an essential part of implementing change as it mirrors values, mission, and vision and employee perception to adopting new ways of doing things. A decentralized and hierarchical culture where employees get involved in decision-making and has robust values and norms leads to effective implementation of EBP project proposal. The proposed structure enhances employee motivation and diversification. Decentralization improves communication and ensures implementation of new approaches to doing things to enhance quality care (Melnyk & Fineout-Overholt, 2019).  Organizations ready to implement the proposed EBP interventions should focus on patient-centered care and health promotion to save lives in pediatric settings.

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The project uses the Organizational Capacity Assessment Tool (OCAT) developed by the United Nations Development Program (UNDP). The tool assesses overall readiness to enhance health interventions in organizations. The tool identifies substantive capacities and strengths that exist and the need for more to attain expected outcomes. Implementing the proposed EBP requires organizations to have capabilities and resources with a superb culture based on their mission, purpose and best values. Threats to readiness include need for resources to implement the project and technologies to reduce HAIs. Teamwork leads to effective flow of information to implement the project and attain expected outcomes.

Organizations that seek to implement the proposed EBP should enhance their patient-handling processes with a focus on improved quality care to reduce infections by better hand hygiene measures and protocols. Data-analysis tool using a collaborative approach will enhance dissemination of evidence to the entire care team. The deployment of Trans-theoretical model will allow the organizations to prepare for change by aligning their interventions with their needs. These include skills’ training and motivation policies to enact changes to focus on solutions (Melnyk & Fineout-Overholt, 2019). The integration of technology is also critical to enhancing organizations’ readiness since it improves gathering of intelligence.

The stakeholders include healthcare professionals in these settings comprising of nurses, physicians and other professionals and the management. External stakeholders comprise of patients and their familiescare (Melnyk & Fineout-Overholt, 2019). Further, the integration of the Project team and management highlights the importance of ensuring that the organization is ready while use of health information technologies like Telehealth leads to better understanding of the underlying issues to enhance patient safety based on existing deployment and their role in enhancing access and quality care.

Problem Statement

Hospital acquired infections are a concern in healthcare as they impact positive patient outcomes and patient safety. Healthcare workers, especially nurses, transmit infections to patients through poor hand hygiene measures and protocols in their practice environment. Pediatric patients have increased susceptibility to suffering from infections due to their low levels of immunity (Melnyk & Fineout-Overholt, 2019). Imperatively, nurses and other providers must develop interventions to prevent and control the prevalence of nosocomial infections and guarantee quality care by using evidence-based practice interventions like handwashing with soap and water alongside use of hand sanitizer(Khan et al., 2018). The initiative focuses on enhancing hand hygiene protocols by nurses to help reduce most prevalent infections like central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilator-associated pneumonia and surgical sites infections. 

Literature Review/Support

The proposed interventions must be effective by ensuring that existing literature consisting of previous research studies support its implementation and expected benefits to the target audience or population. In this case, through a comprehensive search of the literature, one can ascertain if the interventions meets the stakeholders’ goals and aspirations (Zhao et al., 2018). The literature review for the project entails defining and using terms related to hospital acquired infections, healthcare workers and hand hygiene measures. The review also used effective search engines and databases related to the nursing issues to ensure that the generated article represent the problem under study (Khan et al., 2018). The main inclusion criteria included article published within the last five years, articles that capture aspects of the PICOT question and support the EBP based on their findings or recommendations.

Synthesis of Literature: Review

The proposed project reviewed different research studies based on the inclusion and exclusion criteria to ascertain support for the interventions to enhance patient safety through hand hygiene measures. Two of the articles used demonstrate the significance of hand hygiene measures among nurses and other healthcare workers in reducing and preventing hospital acquired infections. The articles assert the need to implement evidence-based interventions to prevent infections and improve patient safety (Ni et al., 2020; Setty et al., 2019). Making hand hygiene attractive to nurses and other healthcare workers is essential. Zhao et al. (2017) and Staniford et al. (2020) demonstrate the need for behavioral change and ensuring that nurses accept the modifications to reduce infections. Compliance to hand hygiene measures requires changes in behavior, especially embracing handwashing with soap and water alongside the use of hand sanitizers. The literature articles illustrate that providing sufficient education to nurses and using evidence-based interventions increase the adoption of these measures leading to a reduction of hospital acquired infections in pediatric settings. Use of agile approach is effective in reducing a host of infections that include central line associated bloodstream infections (CLABIs). 

Comparison of the Articles & Future Research

The reviewed articles illustrate similar themes about the effects of HAUs and utilization of Hand Hygiene measures to reduce their prevalence and ensure that patients get quality care. The articles emphasize the use of evidence-based practice (EBP) interventions to reduce hospital acquired infections. All the article show that HAIs have negative effects on patient safety and health and are a public health issue (Staniford et al., 2018). Stakeholders play a critical part in implementation of interventions to reduce HAIs in pediatric setting through giving information and offering educational opportunities to nurses and other health care professionals to enhance their care delivery. The articles suggest the need for more studies to help evaluate the effectiveness of hand hygiene measure to control infections. 

Change Model/ Framework

The project selected the Iowa EBP model as its change framework. The Iowa model focuses on the whole healthcare system and its stakeholders that include patients, practitioners, and infrastructure. The model uses a problem-solving approach in EBP implementation and leads staff to question the current nursing practices and if they can enhance care through using current findings. The model is effective for the project as it focuses on promoting quality care using EBP interventions. The initials stage of the model is identification and selection of a health problem while the second stage involved determining if the issue is healthcare organization’s prioritycare (Melnyk & Fineout-Overholt, 2019). The third stage requires reflection about the issue of interest and engaging stakeholders while the fourth stage is to identify availability and merit of the chosen evidence. The fifth stage entails implementation of a pilot change based on the available evidence and its credibility. The sixth stage is to appraise the pilot practice change based on the degree of success and subsequent dissemination of findings to the providers and organizations. 

Implementation Plan

The project’s setting will be a pediatric hospital were nurse practitioners and clinical nurses leaders are involved in care delivery to young patients. The selected participants will be 20 healthcare staff having worked in the facility for at least the last 12 months. The team will get approval from the participants through signing a consent form to participate in the project. The implementation timeframe for the project will be 6 months and there will be different activities; right from the establishment of a multidisciplinary team, education, rolling out of pilot change, and reviewing the implementation (Rebekah & Ravindran, 2018). The project will require a host of resources that include human resources, funding, expertise and advice from stakeholders.

The project will use a qualitative design which effective in collecting data from participants as it deploys various approaches in getting opinions from healthcare workers on the issue. The monitoring instruments will include audit tool and satisfaction survey to gauge the level of implementation and satisfaction among the different stakeholders.

Delivery process for the intervention would include project team members that include nurse leaders and practitioners. Nurse leaders and practitioners will develop and implement requisite protocols like setting hand sanitizer stations at various points of care. Participants will also go through mandatory training on the suggested protocols and their significance to enhancing patient safety. Support from stakeholders is essential in EBP projects as they offer resources, input and suggestions and implement recommendations of such programs (Rebekah & Ravindran, 2018). Stakeholders in the project will include nurse leaders and nurse practitioners, project team and trainers, and the management of respective organizations.

Components of the project will include facilitators, challenges and development of effective strategies to overcome the inadequacies. Resource and time limitation, insufficient skills among nurses and negative attitude would be some of the potential challenges to the project. Successful strategies to overcome the challenges would include adhering to the timeframe, engagement of stakeholders and effective communication (Vandermouse et al., 2017). The project is feasibility based on the cost-benefit analysis as its implementation will cost less that expected long-term and short-term benefits.

Evaluation Plan

The expected outcomes from the problem include enhanced patient safety, quality care and use of better interventions by healthcare workers to reduce and prevent HAIs in pediatric settings. The project will also lead to knowledge dissemination among healthcare workers in the settings to reduce HAIs. The EBP project will enhance hand hygiene measures and protocols among healthcare workers (Vax et al., 2017). The project is expected to reduce the rate of HAIs and expand adoption of hand hygiene measures. The project will use a qualitative research design to understand ideas, thoughts and experiences of research subjects in connection to the proposed project and its importance to the target population (Rebekah & Ravindran, 2018). The project will use institutional interviews where the participants will fill questionnaires detailing their experiences and thoughts about the issue.  The statistical test for the project will be regression test as it has stringent requirement and make strong inferences based on the gathered data. The test will be use to measure the cause-and-effects of implementing the interventions in healthcare settings.

The study will employ personal interviews before, during, and after implementing the interventions among the target population. Outcome measures and evaluation will be based on collected data as the project team will analyze responses and feedback from the participants (Hunter, 2017). The project will use satisfaction surveys to evaluate the effectiveness of measures deployed to reduce the prevalence of HAIs. If the outcomes fail to offer the expected or positive results, the team will evaluate the cause of the failure and make necessary changes for better outcomes in the future (Kampstra et al., 2018). The team will recommend the incorporation of the various aspects of the project’s outcomes to form part of the organizational culture in the targeted settings. The second aspect will be to extend best practices and interventions in the selected settings as part of their overall culture.

References

Akanji, J., Walker, J. &Christian, R. (2017). Effectiveness of formal hand hygiene education and feedback on

  healthcare workers’ hand hygiene compliance and hospital-associated. JBI Database System

   Review and Implementation Repository, 15(5): 1272-1279. doi: 10.11124/JBISRIR-2016-003019.

Ni, L., Wang, Q., Wang, F., Ni, Z., Zhang, S., Zhong, Z., & Chen, Z. (2020). An interventional implementation

   project: hand hygiene improvement. Annals of Translational Medicine, 8(18). doi: 10.21037/atm-

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Setty, K., Cronk, R., George, S., Anderson, D., O’Flaherty, G., & Bartram, J. (2019). Adapting translational

  research methods to water, sanitation, and hygiene. International journal of environmental

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Stanford, L. J. & Schmidtke, K. A. (2020). A systematic review of hand-hygiene and environmental-

  disinfection interventions in settings with children. BMC Public Health, 20(195).

https://doi.org/10.1186/s12889-020-8301-0

Zhao, Q., Yang, M. M., Huang, Y. Y. & Chen, W. (2017). How to make hand hygiene interventions more

  attractive to nurses: A discrete choice experiment. PLoS ONE 13(8): e0202014.

https://doi.org/10.1371/journal.pone.0202014

Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology,

   prevention, control and surveillance. Asian Pacific Journal of Tropical

  Biomedicine, 7(5), 478-482. https://doi.org/10.1016/j.apjtb.2017.01.019

Real, K., Bardach, S. H., & Bardach, D. R. (2017). The role of the built environment:

  How decentralized nurse stations shape communication, patient care processes, and

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https://doi.org/10.1080/10410236.2016.1239302

Vax, S., Gidugu, V., Farkas, M., & Drainoni, M. (2021). Ready to roll: Strategies and actions to

  enhance organizational readiness for implementation in community mental health.

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https://doi.org/10.1177/2633489520988254

Albarqouni, L., Hoffmann, T., & Glasziou, P. (2018). Evidence-based practice educational

  intervention studies: a systematic review of what is taught and how it is measured. BMC medical

   education, 18(1), 1-8. https://doi.org/10.1186/s12909-018-1284-1

Hunter, S. (2017). Not All Evidence is Created Equal: Changes in practice require the highest

  possible level of statistical testing. EMS World, 46(10), 46-50.

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