Evidence-Based Practice Proposal.
Roger\’s diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck\’s change curve model or the transtheoretical model of behavioral change. Other conceptual models, such as a utilization model (Stetler\’s model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based proposal in clinical practice. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.Evidence-Based Practice Proposal.
In 500-750 words (not including the title page and references page), discuss applying one of the change models to the implementation plan:
Identify the selected model or theoretical framework and discuss its relevance to your project.
Discuss each of the stages in the change model/framework.
Describe how you would apply each stage in your proposed implementation.
In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 4 with the narrative, you will include the conceptual model in the appendices for the final paper.Evidence-Based Practice Proposal.
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not 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.
Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.Evidence-Based Practice Proposal.
Identify the selected model or theoretical framework and discuss its relevance to your 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 reducingthe rate of hospital acquired infections becomes 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 the use of 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 so that the spread of the new behavior presents as adoption. Another principle aspect of the model is that adoption process occurs in stages, and not simultaneously (Brixey, J., Brixey, E. & McCormick, 2015).Evidence-Based Practice Proposal.
Discuss each of the stages in the change model/framework, and Describe how you would apply each stage in your proposed implementation.
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 first to try the new idea. They do not require much convincing, except to understand that the idea is logical. The second stage is early adopters, identified as the nurses who are able to influence others as leaders and opinion makers.Evidence-Based Practice Proposal. 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 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 results of the change in terms of statistical analysis showing reductions in incidence of hospital acquired infections and other evidence of success. The fourth stage is late majority, identified as the skeptical nurses who 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 a significant number of nurses have adopted the new idea with positive results. They would be brought on board with the change by showing that the majority of 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 changes in workflow and procedures 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).Evidence-Based Practice Proposal.
Various factors determine the activities and operations of healthcare organizations. Organizational culture is one of these variables. The adopted organization culture guides the actions of the management and other healthcare staff. This paper will assess the organizational culture implemented in the organization, its readiness to support the proposed changes, barriers, and the facilitators of the new change, and the clinical inquiry.Evidence-Based Practice Proposal.
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.
Therefore, the organization is ready to implement the proposed change that involves the use of 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. Evidence-Based Practice Proposal.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 overall performance of the organization, which will, in turn, attract more potential clients, increasing the level of revenue.Evidence-Based Practice Proposal.
Clinical inquiry can be integrated by questioning the patients about how they feel concerning HAIs. The inquiry response will facilitate the implementation of change, 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.Evidence-Based Practice Proposal.
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 topic for the proposal states that “The effectiveness of hand hygiene measures in reducing the rate of HAIs.”Evidence-Based Practice Proposal.
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.Evidence-Based Practice Proposal.
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.Evidence-Based Practice Proposal.
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 is effective in reducing 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.Evidence-Based Practice Proposal.
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 accuracy of the results.Evidence-Based Practice Proposal.
Finally, a study conducted by Wang et al. (2019) focused on evaluating the risk factors associated with cases of nosocomial infection (NI) that are 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 by 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 outcomes in other medical facilities.Evidence-Based Practice Proposal.
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 the cases of healthcare-associated infections significantly. This intervention was also proposed by McLaws (2015), who argued that healthcare-associated diseases can 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 is required to buy hand washing detergent and ensure the taps always have clean running water. Therefore, the implementation of this intervention in the organization is realistic.Evidence-Based Practice Proposal.
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 ability of the organization to implement the recommended practice into its daily operations. Practitioners should practise hand hygiene to kill bacteria and other disease-causing microorganisms, thus lowering the spread of HAIs in the organization.Evidence-Based Practice Proposal.
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 the implementation of hand hygiene intervention.Evidence-Based Practice Proposal.
Method to Achieve the Outcomes
The high rate of HAIs among adult patients hospitalized in the healthcare organization will be reduced through the implementation of 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 be used to 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.Evidence-Based Practice Proposal.
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-centred 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.Evidence-Based Practice Proposal.
In conclusion, the proposed change involves the implementation of hand hygiene measures. The intervention consists of the use of soap and water to wash hands and alcohol-based hand rubs. These measures will prevent the spread of pathogens, thus reducing the high rate of hospital-associated infections. The healthcare organization is ready to implement the change to lower the rate of these infections. However, the implementation process will be affected by the reluctance of nurse practitioners to adopt the change. On the contrary, the management will facilitate the implementation process by educating the nurses on the significance of embracing hand hygiene measures.Evidence-Based Practice Proposal.