NUR 590 Evidence Based Practice Project Week 8 Discussion
NUR 590 Evidence Based Practice Project Week 8 Discussion
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.
Share Common Themes on HAIs and use of Hand Hygiene Measures
Application of evidence-based Practice Interventions
HAIs as public health Concern
Stakeholders’ Role is essential in Mitigating HAIs
Need for More Studies to assess the effectiveness of hand hygiene Measures on Infection Control
Findings show that religious engagement among students declines during college, but their spirituality shows substantial growth. “Students become more caring, more tolerant, more connected with others, and more actively engaged in a spiritual quest.” (“Cultivating the Spirit – Spirituality in Higher Education”) The authors also found that spiritual growth enhances other outcomes, such as academic performance, psychological well-being, leadership development, and satisfaction with college. The study also identified a number of college activities that contribute to students’ spiritual growth. Some of these–study abroad, interdisciplinary studies, and service learning–appear to be effective because they expose students to new and diverse people, cultures, and ideas. Spiritual development is also enhanced if students engage in “inner work” through activities such as meditation or self-reflection, or if their professors actively encourage them to explore questions of meaning and purpose. (“Cultivating the Spirit – Spirituality in Higher (Alexander W, 2010)”). By raising public awareness of the key role that spirituality plays in student learning and development, by alerting academic administrators, faculty, and curriculum committees to the importance of spiritual development, and by identifying strategies for enhancing that development, this work encourages institutions to give greater priority to these spiritual aspects of students’ educational and professional development.
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.
Problem Statement
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.
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PICOT Statement
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.
Literature Review
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.
Change Model or Framework
Evidence-based practice change models are essential as they offer guidelines on the implementation of effective interventions to enhance quality care and patient outcomes. The need to improve patient safety among healthcare workers in pediatric settings through interventions like hand hygiene measures that include washing hands with soap and water alongside sanitizers to prevent and reduce hospital acquired infections is essential. The selected model for this EBP project proposal is the Iowa model. The Iowa model is an effective EBP framework that focuses on the entire healthcare network that comprises of patients, practitioners, infrastructure and all stakeholders to enhance the application of best practices to improve care.
The model helps and guides the project team to execute practice decisions using accessible research evidence (Collaborative et al., 2017). The Iowa model is suited for this project as it is detailed and applies a pragmatic problem-solving perspective in the implementation of EBP and takes an organizational system approach to generate the desired results to the clinical problem at hand. The Iowa model allows the staff to use the EBP process to question and critically evaluate current nursing practices and if they can enhance care provision by using current evidence. The model suits this EBP project proposal as it is focused on promoting quality care among the target patient populations.
Stages of the Iowa Model
The Iowa Model of EBP has seven stages that focus on the problem at hand which to reduce the rate of hospital acquired infections (HAIs) in pediatric settings in six months. The first step is to identify the problem that required change. For example, the project team or organization should identify if the issue is problem-based or knowledge-focused trigger that can lead to the need for changes in the practice or nursing setting. In this case, the issue is to reduce the rate of HAIs among pediatric patients by instituting hand hygiene measures among healthcare workers. The second step in the Iowa Model is to demonstrate if there is a priority for the healthcare organization or facility to implement the new practice change. In this case, the level of priority for hand hygiene measures and protocols is high with the aim of reducing HAIs among the healthcare workers in the setting. Studies are categorical that HAIs threaten patient safety and quality care because of their adverse effects like longer stays in hospitals and complications.
The third step is to develop a team that will form, implement, evaluate and integrate the EBP change. The created team should include all interested stakeholders whose role would to appraise the project, synthesize existing literature and evidence, present the findings and implement recommendations to solve the problem at hand. The team should include nurse practitioners, project team manager, administrative representatives and other critical stakeholders to assist in designing the infrastructure for the project’s implementation.
The fourth stage of the change model is to gather and analyze research related to the desired change. The team should evaluate the level and merit of existing evidence. In case the evidence and its merit are not present, the team should conduct a fresh literature search. The team should also formulate and reframe the PICOT question and statement to effectively conduct evidence search for related studies through literature review. The fifth step of the Iowa Model is to review and analyze the obtained literature and ensure that the evidence supporting the EBP is scientifically sound. When the team ascertains the credibility and reliability of the available evidence, it can implement a pilot change to assess its effectively in addressing the practice issue, in this case, reducing HAIs among healthcare workers through hand hygiene measures. The sixth step is to appraise the pilot practice change based on its level of success in addressing the identified issue in the practice setting. The last step is to implement changes realized through the pilot program and evaluate the outcomes, whether they are cost-effective and should be sustained, or if factors requires more changes or should be canceled altogether.
The evaluation of the project’s implementation will demonstrate if the program will impact the target patient population and lead to behavioral change among the healthcare workers to reduce the rate of HAIs. The assessment will be based on real transformation as evidenced through reduced cases of infections and integration of hand hygiene protocols and measures. The implication is that the need to reduce the rate of HAIs is essential in healthcare settings, especially for pediatric care, and implementing interventions using the Iowa model will be important. The Iowa model is based on planning an action process and includes research evidence to translate it into bedside implementations. While there are other models and theoretical frameworks that can be used for this project, the Iowa model makes sense the most as it not only straight forwards to adopt but also the most appropriate for the practice setting.
Implementation Plan
Execution of any changes in an organization or facility comprises of different components that require a project team to develop a plan. Implementation entails the actualization of the ideas developed in the proposed EBP project that are divided into several identifiable steps. The implementation plan will entail integrating hand hygiene measures in pediatric setting among healthcare workers to mitigate hospital acquired infections. The implementation plan has several steps or components that include setting, timelines and resources, methods and instruments, intervention of delivery process and data collection model. The plan also entails management of various aspects of the project like challenges, facilitators and feasibility of the project.
Setting of the Project and Subjects
The setting for the project will be a pediatric hospital with the different cadres of healthcare workers (HCWs) being involved in service delivery to patient population that will be the primary subjects taking part in the proposed project. The chosen participants should have been in the unit for 12 months. The project will choose 20 healthcare workers to be part of the implementation process. The second aspect of the project is attaining consent or approval from participants and the Institutional Review Board (IRB). Participants’ consent is important as it demonstrates their willingness to participate in the project willingly. The project will attain authorization from the review board and comply with ethical requirements to protect the subjects.
Timelines for the Implementation
The project’s implementation duration is six months when different activities will take place as indicated in the time schedule in appendix. The activities include establishing a multidisciplinary team in the first two weeks, and collection of resources and experts for the process in the last two weeks of the first month. The second month will have activities that include training of nursing staff for three weeks to ascertain that they have sufficient knowledge and skills based on available resources to execute hand hygiene measures aimed at reducing hospital acquired infections. In the first week of the third month, the project team and manager will identify possible barriers which may impact or influence implementation. The duration will also be leveraged to enhance stakeholder engagement and participation and gathering of their views and input for final implementation. The remaining duration will be used to implement the proposed with the pilot change initiative taking place in the first week of the period. The project team will conduct a review of the project in the fifth month to ascertain if there are any changes and modifications needed in the project. The evaluation of the project will occur simultaneously to ascertain its effectiveness to the target population and goals of reducing infections in pediatric settings.
Resources
Studies show that success of EBP projects mainly depend on the existence of required resources (DeNisco, 2019; Luciano et al., 2019). Implementing the project needs human resources that will consist of competent trainers who will impart the team with necessary skills and knowledge. The most appropriate resource for this EBP project proposal are nurse practitioners and clinical nurse leaders. Engagement of nurse practitioners and nurse leaders having the appropriate skills enhance the success of quality improvement projects. Apart from human resources, the project will need financial resources to fund its implementation. The financial resources as captured in the appendix will be used for compensating different stakeholders that include trainers and purchasing of the required stationeries like the training manuals. Changes needed in the implementation of the solution will entail more education and awareness among caregivers as most of pediatric patients do not understand protocols proposed to mitigate hospital acquired infections.
Design in Data Collection and Effectiveness
The EBP project proposal will use a qualitative design as it is effective in understanding thoughts, concepts and experiences of participants through techniques that include interviews, focus groups, and a literature review. The design is effective because it entails collecting opinions from healthcare workers on the need to improve hand hygiene measures to prevent and reduce the prevalence of hospital acquired infections (DeNisco, 2019). The design is effective as it encourages healthcare workers in the chosen settings to comply with hand hygiene measures for effective care delivery and quality patient outcomes.
Monitoring Methods and Instruments
The implementation process will use an audit tool and satisfaction survey to assess the success of progress of the plan. The satisfaction survey will evaluate the effectiveness of the measured implemented to reduce the prevalence of HAIs in pediatric settings. The team will use the audit tool to complete the project audit process to ensure that all tasks and activities mentioned are implemented well. The tool will improve the auditing of collected data on certain hand hygiene interventions and their overall outcomes. The project will also use questionnaires to collect data from participating nurses as they will provide the requisite information on the effectiveness of hand hygiene measures and protocols.
Delivery of the Intervention
The delivery process will entail project team members consisting of nurse practitioners and leaders in different capacities who will develop and execute these interventions like setting hand sanitizer stations at various points of care. These points will include nursing stations and places within the pediatric wards and other key points to improve hand hygiene protocols. The participants will be trained to allow them execute their tasks and duties. Training will comprise of offering information to nurse leaders concerning aspects of the proposed solution to supervise the practitioners and ensure that they implement their mandate effectively.
Stakeholders to Implement the Plan
Stakeholders are important in implementing the EBP project as they offer resources, inputs, support, and execute the recommendations. The EBP project will involve several stakeholders that include clinical nurse leaders, nurse practitioners, organizations’ management, patients and their families, and suppliers who will ensure that all aspects of the EBP project are attained. The protect team and trainers will also be essential stakeholders as they will offer direction on the overall implementation of the interventions.
Components of the Implementation: Challenges, Barriers and Proposed Strategies
The overall success of this project will depend in the team’s management of various components that include facilitators, barriers and development of effective strategies to respond effectively to all circumstances that may hinder overall implementation (Melnyk & Fineout-Overholt, 2019). Organizational managers and leaders will play a critical role as they will offer the requisite support and allocate resources once they embrace the project and approve it. Critical challenges that may arise include time and resource limitations, insufficient knowledge and skills among healthcare workers, and negative attitude that may fuel resistance. These challenges will hamper effective implementation and should be addressed well by the concerned stakeholders. Again, mitigating these challenges and barriers will require use of effective strategies like sticking to the timelines to avoid scope creep, and engaging all stakeholders for resource allocation and deploying effective communication modalities.
A core aspect of the implementation plan is the feasibility of the project. In this case, the project manager and team will assess the feasibility using a cost-benefit analysis approach (Vandermause et al., 2017). The cost of implementing the project will be evaluated against the overall benefits that it shall have on the target population. The cost of the EBP will include funds to compensate different stakeholders like the trained and purchase of the required project implementation materials. The pediatric units of the organizations should implement the plan as its cost-benefit analysis will lead to a positive effect on the organization.
Evaluation Plan
Evaluation is a critical aspect of project management’s implementation as it assesses if the project’s execution is successful, what needs to be altered and if the work provide is sufficient to offer proof for funding and being supported by stakeholders (Albarqouni et al., 2018). In this case, the evaluation of the EBP project proposal to reduce HAIs in pediatric setting by healthcare workers, will entail assessing the expected outcomes, review of data collection tools, selection of an appropriate statistical test and methods to collect date and measure outcomes.
Expected Outcomes for the EBP Project Proposal
The EBP project is about improving outcomes that will lead to patient safety, quality of care and better intervention by healthcare workers in pediatric settings to reduce and prevent the occurrence of HAIs. The anticipated outcomes from the project comprise of dissemination of knowledge among healthcare workers to reduce HAIs, improvement of patient safety measures and establishing organizational frameworks and polices to integrate hand hygiene protocols and culture among healthcare workers. The proposals will reduce the prevalence of HAIs and expand the adoption of hand hygiene measures that include handwashing with soap and water alongside use of hand sanitizers and alcohol-based hand rubs.
Data Collection Tools Based on Research Design
The selected research design for the project is qualitative as it is an effective approach that leads to understanding of participants’ thoughts, idea and experiences in relation to the proposed interventions and its effectiveness to the selected population (Hunter, 2017). The project’s chosen data collection tool is institutional interviews where the participants will fill questionnaires to detail their experiences and thoughts on the topic. These will include views and opinions and best practices on hand hygiene to enhance quality care and patient safety in pediatric settings by the healthcare workers. Interviews are appropriate tools to collect data since they are flexible, and enhance validity and reliability. Collected data through interviews capture original sentiments, views, and opinions of healthcare workers in pediatric settings. Interviews improve confidentiality, accuracy and information precision as it comes from participants with experience based on their work settings.
Statistical Test for the EBP Project & Outcome Evaluation
Statistical tests offer a framework for making effective decisions concerning a certain study sample. Statistical tests evaluate the hypothesis concerning the significance of observable sample. Tests also evaluate the interactions between predictor variables and outcome variables and estimate the variance between two or more groups. The proposed EBP project will deploy regression test which demonstrate the cause-and-effect model to the issue under study. The project will use a qualitative research design and interviews to collect data (Rebekah & Ravindran, 2018). Regression test is the most appropriate tools for the project as it provides information on the cause and impact of the interventions.
Outcome measurements and evaluation will use the collected data through analyzing the responses and feedback from the population sample. The project will deploy satisfaction survey to assess the effectiveness of measures used to reduce the occurrence of HAIs. A reduction of the number of reported HAIs among the pediatric patients will demonstrate positive outcomes. If the outcomes fail to produce the expected or positive results, the team will analyze aspects that may have led to the failure of the project and correct them (Melnyk & Fineout-Overholt, 2019). For instance, they may have to alter the approach or methodology to attain expected outcomes.
The sustainability of the project will entail having the team create plans to maintain, extend, review or end the proposed solutions after overall execution. Plans to maintain the project will include integration of the recommended practice standards as part of best practices and organizational culture in all areas of the facility, especially in the pediatric unit. The team or organization will continually review and revise the practices and components of the project to align with new scientific evidence, especially translational research findings, to reduce hospital acquired infections (Schirm et al., 2018). They should also align these aspects with organization’s goals, best practices and quality improvement initiatives and policies.
Conclusion
The proposed EBP project shows that nurses and other healthcare workers in pediatric settings can reduce hospital acquired infections (HAIs) through hand hygiene practices. The existing evidence as captured by the review of literature shows that handwashing interventions alongside sanitizing using alcohol-based products are effective in reducing the occurrence of nosocomial infections in pediatric settings as children are among the population groups with increased susceptibility to infections. The EBP’s change model, Iowa model, will be appropriate in its implementation based on the steps required to execute the project. The model requires integration of a learning environment that will encourage implementation of best evidence to improve patient safety and guarantee quality outcomes. Implementing these interventions will lead to better patient outcomes, especially patient safety, that will enhance overall quality of care among the targeted population. As such, pediatric care nurses and healthcare workers should embrace these recommendations to reduce susceptibility of children to nosocomial infections to enhance best outcomes and care interventions.
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Week 8 Discussion
DQ1 Post a rough draft of your “Evidence-Based Practice Presentation.” The purpose of this draft is to get feedback from your peers. Identify at least two areas you would like specific feedback for improvement.
Peers are encouraged to also comment on anything they feel is successful or could be further improved. Review all of the presentations, but provide critical commentary for at least one other posted presentation.
DQ2 The EBP process is a powerful way of advancing improvements in health care. Identify three strategies that you will now incorporate into your practice based on this course. Explain your rationale.
The dissemination of evidence-based practice (EBP) information is an important part of effective care delivery for providers as it allows stakeholders to implement different changes to meet patient expectations. Dissemination involves the spread and sharing of clinical, research, and theoretical findings with goals of transitioning new knowledge to points of care (DeNisco, 2019). Dissemination requires organizations to have effective culture and be ready for change as well as selection of the best EBP model to implement new change. The use of Fall TIPS to reduce falls in medical-surgical units reduces the adverse effects of fall, improves patient safety and overall satisfaction. The purpose of this presentation is to disseminate the outcomes of the proposed EBP project for effective implementation in the medical-surgical unit to reduce the prevalence of patient falls.
The evidence-based practice process involve the integration of research findings, clinician’s care experience and patient preferences. EBP projects focus on optimizing providers and team conduct to support changes for patients to get quality care and reduce adverse effects of falls like injuries and associated complications and costs. Patient satisfaction and engagement are important while implementing EBP in health care settings. In this case, the need to reduce falls through tailoring interventions for patient safety (TIPS) is essential to offering quality care and considering the concerns that patients may have and critical to improving their response to safety measures by providers
Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls by 20%(O) within 6 months (T)?
Organizational culture which entails values, mission, vision and operational efficiencies is important on implementing or introducing changes to nursing units or workplace. The implementation of EBP project proposal to reduce falls through Fall TIPS approach requires organizations to have a change-oriented culture and values. Evaluation is essential as it allows project team to determine the level of readiness and acceptance of change. In this case, the organizational structure in the medical-surgical unit is positive. The findings from the Organizational Capacity Assessment Tool (OCAT) created by the United Nations Development Program (UNDP) shows that the unit has decentralized structure that allows engagement and participation of nurses to implement changes to improve the quality of patient care (Ratnapalan, 2019.
The OCAT tool assesses overall readiness and highlights organizational capacities and strengths. Based on the model, the overall organizational culture and readiness for change is positive since the unit as part of the entire facility has capacities and strengths. These include having effective teamwork to improve communication, integration of providers’ perspectives when implementing new approaches to care, and better communication and effective collaboration among the internal stakeholders. Data analysis tools are also essential to improving overall efficacy of the proposed solution (DeNisco, 2019). The organizational culture also focuses on health promotion and saving lives through involvement of all stakeholders at different levels of care delivery.
Falls are a major concern and public health issue because they affect quality of care and patient safety. The Centers for Disease Control and Prevention (CDC) (2021) observes that one in every four older people experiences falls. Close to 800,000 individuals are hospitalized each year due to falls, especially in critical care settings. more than 95% of hip fracture occur due to falls and falls are the most prevalent cause of traumatic brain injuries (Heng et al., 2020). The Centers for Medicare and Medicaid Services (CMS) categorize falls as never events since a majority of them are preventable. Falls also increase hospital stays and increase cost of care. Therefore, reducing falls is a critical part of improving patient safety ad overall care delivery (PSNet, 2019). Existing literature supports the use of Fall TIPS as an EBP intervention to reduce and prevent falls.
The proposed interventions should be appropriate through a review of existing literature consisting of previous research studies to support implementation and expected benefits to the targeted 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 involved the definition and use of terms associated with Fall TIPS and its benefits for patients, especially in medical-surgical settings. The review also employed appropriate search engines and databases associated with the nursing issue to ensure that the generated articles focus on the problem under investigation (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 focus on effective interventions to reduce falls and efficacy of Fall TIPS implementation.
The proposed project reviewed several research studies based on the inclusion and exclusion criteria to ascertain support for the intervention to enhance patient safety and quality of care through fall prevention using the Fall TIPS model. Literature synthesis and critical analysis show increased support for the intervention of using Fall TIPS model to reduce falls. Studies by LeLaurin et al. (2019); Xia et al. (2022); Kelly (2022), and Dykes et al. (2020) agree that fall prevention bundles through the TIPS model reduce incidences of falls and improve overall patent safety. The studies show that Fall TIPS is effective and should be implemented on diverse settings that include medical-surgical units because of their benefits like being customized to meet patient needs and situations. The studies also emphasize the need for effective guideline for providers to enhance their adoption of fall TIPS in their practice settings.
The selected model is the Iowa EBP framework. The Iowa model focuses on the entire healthcare system and stakeholders who comprise of patients, practitioners, and infrastructure. The framework uses a problem-solving and implores staff to question the current nursing practices and if they can improve care through using current evidence. The model is effective for the project as it focuses on promoting quality care using EBP interventions (DeNisco, 2019). The initial 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 priority areas for patient care (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 (Cullen et al., 2020). 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.
The project will be set in the medical-surgical unit/ward with the patients as the main participants. They will have informed consent and voluntary accept to participate in the study. The implementation timeline would be six months. The timeline will have different aspects as defined by the project scope and activities. Nurse training and requirement definition as well a project schedule will be part of these activities. Resources needed will include both financial and human for the implementation of the project. The project will employ a qualitative approach in collecting data. The qualitative approach is appropriate as it allows the use of different techniques like interviews, observation, review of literature and even focus groups (Tang, 2019). The implementation team will use an audit tool and a patient survey. The survey tool will collect feedback and opinions from participants on the effectiveness of the fall TIPS framework. Using these tools will help determine the overall effects of the Fall TIPS
The delivery of the intervention will entail having an inter-professional team consisting of different healthcare providers in the medical-surgical unit. The interventions will entail staff training on all components of the TIPS bundles, development of safe toileting, effective communication and patient education. The project will have different stakeholders who would include nurses and nurse leaders, nurse managers, project team and manager, trainers and patients as well as their families (Amit-Aharon et al., 2019). Others will be organizational management and health information technology vendors. The implementation plan will encounter barriers and challenges like resistance to change, limited resources to implement the plan, and insufficient knowledge and skills by nurses on Fall TIPS (Pop et al. (2020). There will also be facilitators like sufficient resource allocation. The project’s overall feasibility is high due to its cost-effectiveness and associated benefits to patients and the healthcare system.
The main outcome is to reduce patient falls in the medical-surgical unit by 30% in six months of its implementation. The Fall TIPS will enable nurses and other providers to customize fall prevention intervention based patient’s conditions and preferences and not a one-fits-all approach. The EBP project will employ qualitative design implying that it will use questionnaires and focus groups to collect data. It will also observation to determine the level of implementation (Grove et al., 2019). The statistical test in this case would be the t-test because of its suitability to the project.
Using data collected through semi-structured questionnaires, the researchers will measure patient outcomes and experiences (Lengnick-Hall et al., 2020). They will then tabulate the data to determine if there are changes after the implementation of the Fall TIPS. The research will the deploy computation tools to determine rates of improvement based on the reduction of falls within the unit. Strategies to improve outcome will include re-examination of the implemented intervention through analyzing the process and all associated components at each level. The team will also formulate timelines and explore corrective measures to improve outcomes . The sustenance of the EBP will entail training, continuous monitoring of quality care, and creating teams that will review areas of concern and ensure that Fall TIPS integrate patients and concerns.
References
Amit-Aharon, A., Melnikov, S., & Warshawski, S. (2020). The effect of evidence-based
practice perception, information literacy self-efficacy, and academic motivation
on nursing students’ future implementation of evidence-based practice. Journal of
professional nursing, 36(6), 497-502. DOI: 10.1016/j.profnurs.2020.04.001.
Centers for Disease Control and Prevention (CDC) (2021). Facts About Falls.
https://www.cdc.gov/falls/facts.html
Grove, S. K., & Cipher, D. J. (2019). Statistics for Nursing Research-e-book: A workbook for evidence-based
practice. Elsevier Health Sciences.
Lengnick-Hall, R., Willging, C. E., Hurlburt, M. S., & Aarons, G. A. (2020). Incorporators, early investors, and
learners: A longitudinal study of organizational adaptation during EBP implementation and
sustainment. Implementation Science, 15(1). https://doi.org/10.1186/s13012-020-01031-w
Melnyk, B. M. & Fineout-Overholt, E. (2019). Evidence-based Practice in Nursing &
Healthcare: A Guide to Best Practice. Wolters Kluwer.
Rebekah, G., & Ravindran, V. (2018). Statistical analysis in nursing research. Indian Journal of Continuing
Nursing Education,19(1), 62-70. https://www.ijcne.org/text.asp?2018/19/1/62/28649
Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., … & Bates,
- W. (2020). Evaluation of a patient-centered fall-prevention tool kit to reduce
falls and injuries: a nonrandomized controlled trial. JAMA network open, 3(11),
e2025889-e2025889. doi:10.1001/jamanetworkopen.2020.25889
DeNisco, S. M. (2019). Advanced Practice Nursing: Essential Knowledge for the Profession:
Essential Knowledge for the Profession. Jones & Bartlett Learning.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital
falls prevention with patient education: a scoping review. BMC Geriatrics, 20, 1-12. DOI:
https://doi.org/10.1186/s12877-020-01515-w
Pop, H., Lamb, K., Livesay, S., Altman, P., Sanchez, A., & Nora, M. E. (2020). Tailoring a
comprehensive bundled intervention for ED fall prevention. Journal of emergency
nursing, 46(2), 225-232. DOI: 10.1016/j.jen.2019.11.010.
Ratnapalan, S. (2019). 37 Leading and managing change in healthcare organizations. BMJ
Leader, 3(Suppl 1), A14-A14. http://dx.doi.org/10.1136/leader-2019-FMLM.37
Kelley, R. J. (2022). Preventing Falls in the Surgical Setting by
Implementing a Fall Prevention Bundle.
http://hdl.handle.net/10713/18736
Xia, L., Zheng, Y., Lin, Z., Chen, P., Mei, K., Zhao, J., … & Gu, Z.
(2022). Gap between risk factors and prevention strategies? A
nationwide survey of fall prevention among medical and
surgical patients. Journal of Advanced Nursing, 78(8), 2472-
- https://doi.org/10.1111/jan.15177
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized
patients: state of the science. Clinics in geriatric medicine, 35(2),
273-283. doi: 10.1016/j.cger.2019.01.007
Patient Safety Net (2019). Falls. https://psnet.ahrq.gov/primer/falls
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Also Read: NUR 590 Evidence Based Practice Project Week 7 Discussion
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
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Communication
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Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
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