Benchmark – EBP Proposal Final Paper
Throughout this course, you have developed a formal, evidence-based practice proposal. The proposal is the plan for an evidence-based practice project designed to address a problem, issue, or concern in the professional work setting. Although several types of evidence can be used to support a proposed solution, a sufficient and compelling base of support from valid research studies is required as the major component of that evidence. Proposals must be submitted in a format suitable for obtaining formal approval in the work setting. Proposals will vary in length depending upon the problem or issue addressed (3,500 and 5,000 words). The cover sheet, abstract, references pages, and appendices are not included in the word count. Section headings for each section component are required. Evaluation of the proposal in all sections will be based upon the extent to which the depth of content reflects graduate-level critical thinking skills. This project contains seven formal sections: Section A: Organizational Culture and Readiness Assessment Section B: Proposal/Problem Statement and Literature Review Section C: Solution Description Section D: Change Model Section E: Implementation Plan Section F: Evaluation of Process Each section (A-F) will be submitted as a separate assignment in Topics 1-6 so your instructor can provide feedback (refer to applicable topics for complete descriptions of each section). The final paper submission in Topic 7 will consist of the completed project (with revisions to all sections), title page, abstract, compiled references list, and appendices. Appendices will include a conceptual model for the project, handouts, data and evaluation collection tools, a budget, a timeline, resource lists, and approval forms, as previously assigned in individual section assignments. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.Benchmark – EBP Proposal Final Paper
Cases of Healthcare-associated infections (HCAIs) have increased significantly in healthcare facilities. These infections occur during care delivery in hospitals. In most cases, they are experienced within the ﬁrst 48 hours after hospitalization. HCAIs are ranked among adverse events impacting on hospitalized patients. According to the US Center for Disease Control and Prevention, HCAIs cases are identified among 1.7 million patients admitted to various hospitals annually. Additionally, these infections are attributed to the death of one in 17 patients who are treated for other medical conditions. An increase in the morbidity rates in healthcare facilities is also associated with high cases of HAIs. Increased length of stay in hospitals is another impact of HAIs. Besides, these infections tend to increase the rate of resistance to antimicrobials. Furthermore, HAIs expose patients to excess health costs. Therefore, prevention and control measures are required to lower the high cases of HAIs. The implementation of the EBP project (hand hygiene measures), including cleaning hands with water and soap and the use of an alcohol-based hand rub, will prevent the HCAIs, thus lowering morbidity and mortality rates. These measures will also reduce health care costs. The implementation process will involve healthcare practitioners, including nurse leaders and practitioners. Roger’s Diffusion of Innovation Theory will guide the whole process. It will take eight weeks for the implementation process to be completed. Human resources and finances will be required to enhance the implementation of the proposed EBP project.
Benchmark – EBP Proposal Final Paper
Section A: Organizational Culture and Readiness Assessment
Healthcare organizations have different and unique cultures. The results of the conducted cultural survey indicate that the healthcare organization has adopted the adhocracy culture. Energy and a high level of creativity form the basis of this culture. The leaders encourage the employees to take risks. Additionally, leaders are entrepreneurs who focus on innovation. Experimentations hold the organization together. However, individual freedom and ingenuity are emphasized to enhance the success of the entire organization.Benchmark – EBP Proposal Final Paper
Therefore, the organization is ready to implement the proposed change that involves using alcohol hand rubs to reduce the rate of HAIs. However, the success of the project will be compromised by some barriers. The most common obstacle is the lack of personal initiative by the nurses to implement the new project. Most practitioners consider washing hands with water and soap as the most effective way of killing pathogens, thus preventing HAIs. Therefore, it is challenging to implement the change since the nurses encounter patients during care delivery. On the contrary, the management will facilitate the project. The organization’s leadership focuses on entrepreneurship and innovation. Thus, it will support the change as a new way of reducing the cases of HAIs. This move will facilitate the organization’s overall performance, which will, in turn, attract more potential clients, increasing the level of revenue.
Clinical inquiry can be integrated by questioning the patients about how they feel concerning HAIs. The inquiry response will facilitate change implementation, thus improving the quality of care offered to the patients. The organization’s weaker areas, specifically the nurses’ reluctance to implement the changes, will be strengthened by educating them on the benefits of using alcohol-hand rubs to kill pathogens.
Section B: Proposal/Problem Statement and Literature Review
Refining the PICOT Question into a Proposal
The initially developed PICOT question states, “Among hospitalized adult patients (P), does the use of alcohol-hand rubs (I), when compared to hand washing using water and soap (I), help in reducing the rate of HAIs (O), within a period of 4 months (T)?” This PICOT question can be refined into a proposal that can be easily studied. The proposal’s topic states that “The effectiveness of hand hygiene measures in reducing the rate of HAIs.”
Summary of the Conducted Research
The conducted research indicates that hand hygiene measures are effective in reducing the rate of HAIs.
According to Musu et al. (2017), the high morbidity and lower quality of life in healthcare facilities are associated with infections (HAIs). Additionally, these infections are attributed to the high costs incurred in healthcare facilities. Therefore, measures should be implemented to prevent high cases of HAI in healthcare facilities.
The study conducted by Musu et al. (2017) focused on assessing the availability of procedures for regulating the high rate of infections in healthcare facilities. Specifically, the researchers focused on evaluating the effectiveness of hand hygiene (HH) measures in lowering the rate of these infections. The study focused on providers who were offering care in six ICU units. The researchers conducted a prospective observational study in the selected six ICU units. They assessed how healthcare workers adhered to the set standard precautions and hand hygiene measures.
This study established that adherence to hygiene measures reduced the rate of infections in the assessed healthcare units. Thus, these measures should be implemented in other departments in healthcare facilities to reduce the rate of infections. However, this study is associated with some limitations. First, the sample population (six ICUs) was relatively small, limiting the generalization of the study’s findings. More so, the study was limited to the ICU unit, making it hard to predict results for other departments in healthcare facilities.
Another study conducted by Vermeil et al. (2019) indicates that hand hygiene effectively reduces HAI cases. The researchers aimed at evaluating the evolution from the use of soap and water to clean their hands to the use of alcohol-based hand rubs. The authors reviewed the documented literature regarding the use of soap and water. They also studied how chlorine was discovered during Babylon civilization as an effective hand-rub for killing pathogens.
Their study’s findings indicate that washing hands with soap and water killed pathogens, thus preventing the spread of HAIs. However, it was not very effective in killing germs necessitating the introduction of alcohol-based hand rub. This hand hygiene measure was supported by the World Health Organization and other key stakeholders in the healthcare sector due to its effectiveness. The major limitation of this study is that it was not based on experiments but findings of previously conducted studies limiting the results’ accuracy.Benchmark – EBP Proposal Final Paper
Finally, a study conducted by Wang et al. (2019) focused on evaluating the risk factors associated with nosocomial infection (NI) experienced in the ICU units for patients struggling with respiratory conditions. The researchers conducted observational surveillance in the ICU unit between 2013 and 2015. Specifically, they investigated the overall rate of infection and their distribution in the ICU units.
The findings of this study indicate that the rate of NI in the ICU unit is relatively high. 102 out of 1347 patients in the ICU units were diagnosed with NI. Approximately 87 of these infections were associated with the device that was being used by the patients. Other cases of infections were associated with poor hand hygiene. Therefore, the rate of these infections could be reduced by improving hand hygiene, specifically by washing the hands with soap and water or using alcohol-based hand rubs. One of the study’s significant limitations is being conducted on a single unit in the healthcare facility. Thus, it is difficult to predict the results in other departments. Additionally, the research was conducted in an only healthcare organization, making it difficult to predict other medical facilities’ outcomes.
Section C: Solution Description
The Proposed Solution
The proposed solution involves the implementation of hand hygiene in the healthcare organization. Hand hygiene is observed by washing hands with water and soap regularly or using alcohol-based hand rubs to sanitize the hands. This practice kills disease-causing microorganisms, thus reducing the rate of HAIs. According to Sickbert-Bennett et al. (2016), observing hand hygiene strictly lowers healthcare-associated infections significantly. This intervention was also proposed by McLaws (2015), who argued that healthcare-associated diseases could be prevented by complying with hand hygiene measures. McCalla et al. (2017) also support the effectiveness of hand hygiene in preventing HAIs. The cost of this intervention is relatively low. Specifically, its implementation in the healthcare organization does not require the care providers to be given special training or new equipment and machines to be purchased. Instead, the organization must buy handwashing detergent and ensure the taps always have clean running water. Therefore, the implementation of this intervention in the organization is realistic.
The Consistency between Hand Hygiene and the Organization’s Culture
The proposed intervention of hand hygiene is consistent with the organization’s culture. The healthcare organization has adopted the adhocracy culture. This organizational culture involves the ability of a corporate to adapt to the changing conditions quickly. Organizations with this culture are relatively flexible and empower their employees to cope with the changes. Therefore, the consistency between the proposed intervention and the organization’s culture involves the organization’s ability to implement the recommended practice into its daily operations. Practitioners should practice hand hygiene to kill bacteria and other disease-causing microorganisms, thus lowering the spread of HAIs in the organization.
The implementation of hand hygiene aims at lowering the high rate of HAIs among adult patients hospitalized in the healthcare organization. Thus, the cases of HAIs in the medical facility are expected to reduce significantly following hand hygiene intervention implementation.
Method to Achieve the Outcomes
The high rate of HAIs among adult patients hospitalized in the healthcare organization will be reduced by implementing hand hygiene measures. Specifically, care providers and other healthcare staff who encounter these patients will start washing their hands regularly using soap and running water. Additionally, alcohol-based hand rubs will sanitize hands, thus killing pathogens, which cause infections among this patient population. Therefore, observing these hand hygiene measures will reduce the high rate of HAIs among adult patients in the healthcare facility. The achievement of these outcomes requires the management to ensure that the organization has a regular supply of hand cleaning detergents, including soap, alcohol-based hand rub, and running water.
The Impacts of the Outcome
The outcomes of hand hygiene practice have an impact on various aspects of care. First, hand hygiene will improve the overall quality of care by reducing the possibility of acquiring HAIs while receiving services at the healthcare organization. Additionally, patient-centered quality care will be enhanced by ensuring that patients struggling with other conditions are prevented from HAIs. Acquiring HAIs is likely to complicate their conditions further, thus delaying the recovery process. The outcome also impacts the efficiency of the processes. The cases of HAIs compromise the processes of delivering quality care to patients. Finally, the practice of hand hygiene will enhance the professional expertise of care providers. Practitioners seem to be more professional if they can regulate the cases of HAIs in the healthcare organization.Benchmark – EBP Proposal Final Paper
Section D: Theoretical Framework
Identification of the Selected Model Suitable for this Project
The proposed project intends to introduce alcohol hand rubs as a strategy for reducing the rate of hospital-acquired infections. Roger’s Diffusion of Innovation Theory will be applied to guide the change process. Developed by E. M. Rogers in 1962, the theory is considered appropriate since it explains how, over time, the use of alcohol hand rubs will gain momentum and spread/diffuse through the facility as its positive effects in reducing the rate of hospital-acquired infections become more apparent (Melnyk & Fineout-Overholt, 2015). The expected result of the diffusion is that nurses and other medical personnel, as a unique social system, will adopt alcohol hand rubs as a new behavior/idea. The theory perceives adoption as implying that nurses will increasingly use alcohol hand rubs than they had previously used them. A principal aspect of the adoption is that nurses will first perceive the use of alcohol hand rubs as a new or innovative behavior/idea to spread the new behavior presents as adoption. Another principle aspect of the model is that the adoption process occurs in stages and not simultaneously (Brixey et al., 2015).
The Stages in the Change Model and their Application to the Proposed Project
As earlier indicated, the adoption process, as presented by Roger’s Diffusion of Innovation Theory, occurs in five stages determined by the extent to which the new behavior appeals to the nurses. The first stage is innovators, identified as the nurses who are willing to take risks and try a new idea. They do not require much convincing, except to understand that the concept is logical. The second stage is early adopters, identified as the nurses who can influence others as leaders and opinion-makers. They adopt the behavior after becoming aware of its need as a strategy for reducing the rate of hospital-acquired infections. They would be brought on board with the change by highlighting the need for change. The third stage is the early majority, identified as subordinate nurses who require evidence before adopting a new behavior. They are convinced by success stories and evidence of the idea being effective before they adopt it. They would be brought on board with the change by presenting the change results in terms of statistical analysis showing reductions in the incidence of hospital-acquired infections and other evidence of success. The fourth stage is the late majority, identified as skeptical nurses. They would only adopt the new behavior after it has turned into a popular idea, with most other nurses having adopted it. They are convinced by success stories, showing that many nurses have adopted the new idea with positive results. They would be brought on board with the change by showing that most nurses have adopted the new idea. The final stage is laggards, identified as conservative nurses who would only adopt the new idea when there is no other option. They are very skeptical of any change and require pressure from workflow and procedures changes before they adopt the new idea. They would be brought on board with the change by pressuring them, fear appeals, and statistics (Dang & Dearholt, 2018; Grinspun & Bajnok, 2018).
Section E: Implementation Plan
This EBP proposal will be implemented in the healthcare unit dealing with adult inpatients. Therefore, nurse practitioners and clinical nurse leaders involved in delivering services to this patient population will be involved during the implementation process. The selected participants must have served in this unit for the last 12 months. Providers serving in other healthcare organization departments and those that have served in this unit for less than 12 months will be excluded. Specifically, 50 healthcare staff will be involved during the implementation process. A consent or approval form will be prepared before the implantation process. The healthcare staff participating in the process will be required to sign the forms to indicate that they have willingly agreed to participate in the project’s implementation. The form will indicate that participants are allowed to leave at any point during the implementation process. Additionally, the consent form will indicate that the project’s primary purpose is to decrease the rate of HAIs within four months by introducing hand hygiene measures, specifically the use of alcohol-hand rubs and washing hands using water and soap.Benchmark – EBP Proposal Final Paper
The implementation of this evidence-based project will take eight weeks. Distinct activities will take place in each of the eight weeks. The formation of a multidisciplinary team is a significant activity that will take place in the first week. The second week will be spent gathering all the resources required for the implementation process. Staff training is a critical activity that will be undertaken in week three to ensure the participants are equipped with the required knowledge and skills. Week four will involve the identification of any potential barrier that might interfere with the implementation process. The actual implementation will be undertaken from week five to week seven. Week 8 will be spent making any necessary modifications to the project. Therefore, the implementation process will be successful if the eight weeks will be spent as anticipated in the proposed time to plan.
The success of this evidence-based project will mainly depend on the availability of the required resources. Human resources are necessary for the implementation process. This resource will include competent trainers who will impart the project team with the required knowledge and skills. The most suitable project for this team includes nurse practitioners and clinical nurse leaders. According to Lavallée et al. (2019), engaging nurse practitioners and clinical nurse leaders with the required skills enhances quality improvement projects’ success. Thus, equipping the team members with this knowledge will enhance the success of the implementation process. Additionally, the team members’ performance will be improved by defining each one’s roles and responsibilities. The assigned duty should be in line with one’s qualifications and competence (Padula et al., 2016). In addition to human resources, financial resources will be required to fund the implementation process. The funds will compensate the trainers and purchase any stationeries as are necessary for the implementation process, such as training materials.
Methods and Instruments
The implementation process will involve various methods and instruments. First, an audit tool and a satisfaction survey will be utilized during the implementation process. The project team will use the satisfaction survey to assess the effectiveness of the measures implemented to reduce the high rate of HAIs in the healthcare unit. The audit tool will be used to complete the auditing process. Specifically, it will enhance the auditing of the collected data on specific hand hygiene interventions and their outcomes. Furthermore, questionnaires will be utilized to gather the required data from the participants. Young (2016) considers questionnaires as effective data collection tools. Nurse leaders and practitioners will fill the questionnaires and provide data regarding the effectiveness of hand hygiene measures in reducing the high rate of HAIs among the selected patient population. This information will guide the project implementation team during the process.
Intervention Delivery Process
The process of delivering the proposed measures will involve the project team members, including nurse leaders and practitioners. Training will be required to enable the participants to perform their respective duties effectively. Training the nurse leaders about the proposed measures’ components will allow them to supervise nurse practitioners to ensure they perform their tasks as expected. Additionally, it is essential to train the practitioners to implement the proposed measures as planned, thus meeting the project’s set goals.
Data Collection Plan
Data will be collected in stages during the implementation process. The first set will be gathered before the implementation to assess the rate of HAIs among the selected patient population. Secondly, data will be gathered during the monitoring process to evaluate if the project is progressing as anticipated. The last set of data will be collected upon the completion of the implementation process. The implementation team will use this data to evaluate the success of the project.
The Management of Barriers, Facilitators, and Challenges
The project’s success will mainly depend on how the team members will manage the facilitators, barriers, and challenges. The leaders and the healthcare organization’s management are critical facilitators since they will provide the necessary support. Healthcare management considers supporting new projects to improve the overall quality of care (Parand et al., 2015). Therefore, establishing a good relationship with the management will facilitate the success of the project. Additionally, addressing barriers and challenges is key to the success of the project. Time limitation and the healthcare staff’s negative attitude towards the proposed measures are significant barriers to the project’s success. Time limitation can be addressed by adhering to a set time plan strictly. Staff’s negative attitude can be addressed by communicating the impact of the proposed measures on improving the overall quality of care. According to McLaws (2015), hand hygiene measures prevent healthcare-associated infections among inpatients.Benchmark – EBP Proposal Final Paper
The feasibility will be used to assess the proposed project will be practical. The cost incurred during the implementation process will be relatively lower than the benefits the project will accrue to the patients and the entire healthcare organization. The funds will be used to compensate the trainers and purchase the required and project implementation materials and stationeries.
Maintenance of the Plan
Maintenance of the plan will be essential to enhance its success. It will be done in stages. The changes and moderation will mainly depend on the outcomes of the previous step.
Section F: Evaluation of Process
Techniques used to Gather the Outcome Data
The project team relied on surveys and audit tools during the data collection process. Surveys will be preferred due to their effectiveness during data collection. It is relatively easy to develop surveys depending on the required data. Additionally, it is easy to get feedback on time from the participants, particularly healthcare staff, when using surveys as a data collection method. According to Young (2016), the survey enables the researcher to obtain feedback from a large population. Additionally, the project team will make the use of an audit tool to gather outcome data. Just like surveys, audit tools will be utilized since they are easy to use. Also, data captured through these tools can be easily edited by the audit departments, supporting implementing the proposed change in the healthcare organization. This change improves the quality of care (Esposito & Dal Canton, 2014).
How does the Outcome Measures Assess the Extent to which the Project Team has Attained the Set Objectives?
The project team will utilize quantitative measures to evaluate the extent to which the set objectives have been achieved. The primary outcome that will be measured is the decline in the rate of HAIs in the healthcare organization. The decrease in these infections indicates the success of the proposed change project.Benchmark – EBP Proposal Final Paper
The Basis for Measuring and Evaluating the Outcomes
The validity, reliability, and applicability of the project outcomes will be assessed using statistical tests, particularly Paired T-Test. This test evaluates the difference between two variables that have been obtained from a similar population. According to Xu et al. (2017), paired t-test are widely used in comparing the results of clinical research due to its effectiveness. In this case, the test will assess HAIs among adult inpatients before and after implementing the proposed hand hygiene measures.
Strategies to Adopt in case the Outcomes Fail to give Positive Results.
Sometimes a project might fail to give positive results due to various reasons. The project team might experience a similar incident after the implementation of the proposed change project. If that will be the case, corrective measures should be adopted to get the desired results. In this case, the project will have failed to give positive results if the claims of HAIs will not reduce following the implementation of the proposed hand hygiene measures. Under such circumstances, the project team will assess whether the implementation process was done as planned. Additionally, they will strive to understand other spreading pathogens’ strategies, causing infections rather than hands. According to McLaws (2015), the relationship between HAIs and hand hygiene is complicated.
Implications for the Practice and Future Research
The proposed change project reveals that healthcare practitioners can implement hand hygiene measures to lower HAIs among adult inpatient in a healthcare organization. Future scholars can conduct further research to assess if the proposed rules would give similar results if implemented among other patient populations rather than inpatient adults.
Brixey, J. J., Brixey, J. E., & McCormick, K. A. (2015). Essentials of Nursing Informatics Study Guide. McGraw Hill Professional communication.
Dang, D., & Dearholt, S. (2018). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines (3rd ed.). Sigma Theta Tau International.
Esposito, P., & Dal Canton, A. (2014). Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World journal of nephrology, 3(4), 249.
Grinspun, D., & Bajnok, I. (2018). Transforming Nursing Through Knowledge: Best Practices for Guideline Development, Implementation Science, and Evaluation. Sigma Theta Tau International.
Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in A practical guide, 165 community, 27(4), e417-e427.
McCalla, S., Reilly, M., Thomas, R., & McSpedon-Rai, D. (2017). An automated hand hygiene compliance system is associated with improved monitoring of hand hygiene. American journal of infection control, 45(5), 492-497.
McLaws, M. L. (2015). The relationship between hand hygiene and healthcare-associated infection: it’s complicated. Disease and drug resistance, 8, 7.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice (3rd ed.). Wolters Kluwer Health.
Musu, M., Lai, A., Mereu, N. M., Galletta, M., Campagna, M., Tidore, M., Piazza, M. F., Spada, L., Massidda, M. V., Colombo, S., Mura, P., & Coppola, R. C. (2017). Assessing hand
Benchmark – EBP Proposal Final Paper