Posted: June 21st, 2020

Evidence-Based Practice and Applied Nursing Research | Nursing Assignment: I need help writing a research paper.

Evidence-Based Practice and Applied Nursing Research
A. Write a summary of the significance and background of a healthcare problem by doing the following:

1. Write a page paper – Describe a healthcare problem that can be used to develop a PICO question.

Note: You may use the same topic and the same research articles that were used in Task 1 provided they support the proposed intervention. Or you may choose a different topic and select articles focusing on one of the following topics: falls and fall prevention, pain management in children, opioid abuse, hepatitis C, catheter-associated urinary tract infections, and hand hygiene and infections in hospitals.

2. Explain the significance of the problem from part A1.

3. Write a page paper – Describe the current healthcare practices related to the problem from part A1.

4. Discuss how the problem affects the organization and patients’ cultural background (i.e., values, health behavior, and preferences).

B. Complete a literature review by searching for a total of seven articles consisting of five research articles and two non-research articles related to the healthcare problem from part A1, and describe the search strategy you used to conduct the literature review by doing the following:

1. Discuss two research evidence sources and two nonresearch evidence sources that you considered.

Note: Please do not use the same primary author for more than two articles. Articles must not be more than five years old.

C. Use your research articles to develop a PICO (patient/population, intervention/indicator, comparison/control, and outcome) question based on the topic.

D. Complete the attached “Evidence Matrix,” using the five research evidence sources from scholarly journal sources you located during the literature review in part B. For each article, address the following points:

Note: You may submit your completed matrix as a separate attachment to the task, or you may include the matrix within your paper, aligned to APA formatting standards.

Note: Upload a copy of the full text of the articles with your submission.

• author, journal name, and year of publication

• research design (e.g., quantitative, qualitative, mixed design, systematic review)

• sample size (e.g., numbers of study participants, number of articles, number of control group participants)

• outcome variables measured (e.g., identify what the research is measuring)

• quality (using the following scale: A, B, C)

• results/author’s conclusions (e.g., briefly summarize the outcome)

E. Recommend a practice change that addresses the PICO question, using the evidence collected in the attached “Evidence Matrix.” You must use all five research articles from the “Evidence Matrix” attachment to support this recommendation via in-text citations.

F. Write a page paper – Describe a process for implementing the practice change from part E in which you do the following:

1. Explain how you would involve three key stakeholders in the decision to implement the recommendation from part E.

2. Write a page paper – Describe two specific barriers you may encounter when implementing the practice change from part E in the nursing practice setting.

3. Identify two strategies that could be used to overcome the barriers described in part F2.

4. Identify one indicator to measure the outcome (the O in PICO question) of the recommended change practice from part E.

G. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

H. Demonstrate professional communication in the content and presentation of your submission.

PICO EVIDENCE MATRIX
Authors Journal Name Year of Publication Research Design Sample Size Outcome Variables Measured Quality (A, B, C) Results/Author’s Suggested Conclusions
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– Sample Answer Solution, Paper Writing Guide, Free Essay Assignment

Evidence-Based Practice and Applied Nursing Research

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Evidence-Based Practice and Applied Nursing Research
Healthcare Problem
The selected healthcare problem is the increasing rate of hospital-acquired infections caused by bacterial, viral, and fungal pathogens. The challenge is associated with poor hand washing among healthcare workers. Research studies indicate that infections lead to longer hospital stays, readmissions, and complications (Ay et al., 2019). In some cases, it leads to lawsuits that cost hospitals huge amounts annually. Healthcare workers should thus maintain high levels of hygiene to protect patients from various diseases. For example, diseases associated with poor hand washing include gastrointestinal and respiratory infections. Although the rate of hospital-acquired infections is high among geriatric and pediatric patients, it is important to take precautions to avoid infections among all patients. Research shows that handwashing compliance among healthcare workers is suboptimal (Hor et al., 2017).
Significance
Improving compliance with handwashing is important in healthcare since it creates a healthy and safe environment for both patients and providers. If providers fall sick, they will not come to the hospital and when patients fall sick, providers will be overwhelmed. It prevents avoidable conditions such as diarrhea and intestinal illnesses (Mu et al., 2016). If the condition is not resolved, it will lead to chronic intestinal bacteria. It helps avoid common eye problems such as conjunctivitis, keratitis, stye, and blepharitis. Washing hands prevents respiratory conditions including running nose, sneezing, nasal congestion, and coughing (Quilab et al., 2019). Cleanliness is also important since it raises trust among patients that their providers are free from any infection.

Current Healthcare Practices
Poor handwashing practices among healthcare workers account for 40% of nosocomial infections (Haque et al., 2018). Healthcare workers fail to wash their hands regularly thus exposing their patients to infections. Noncompliance occurs due to misinformation or poor perception about cleaning hands. A study shows that some wash hands when they perceive to be dirty and not when they should (Haque et al., 2018). Other reasons include high workload, lack of sufficient resources like soap, poorly located sinks, and understaffing. Lack of a culture of washing hands is another practice that has led to noncompliance. Healthcare workers also perceive that they have a low risk of contracting diseases or disagree with the guidelines (Haque et al., 2018). Providers also perceive that wearing gloves will obviate the need for handwashing.
Effect of the Problem on Organization and Patients
The health problem affects organizations by putting them at risk of infecting their patients with hospital-acquired infections. Organizations that do not observe the recommended protocols are at risk of losing patient’s trust and spending more resources treating patients (Trampuz & Andreas, 2020). They can also create a culture of further spread of diseases. The problem affects patients since when they get infected they will spend more time in hospital. They are also at risk of readmissions or other health complications that will delay their recovery.
Literature Reviews
Evidence Sources
The search strategy involved searching for peer-reviewed articles and studies on the university library and the internet. Ay et al. (2019) carried out a qualitative study on the impact of handwashing among healthcare workers in intensive care units. The study indicates that the handwashing levels are still at suboptimal levels. It also indicates that healthcare workers can expose themselves and patients to various risks if they fail to maintain hand hygiene. Therefore, it emphasizes that healthcare facilities should train providers on the importance of handwashing to improve compliance levels. Similarly, Quilab et al. (2019) carried out a study on the impact of education on handwashing compliance among healthcare workers. The findings indicate that misinformation trigger high levels of non-compliance and recommend that healthcare facilities should train their staff.
According to John Hopkins Medicine (2002), states that handwashing can prevent the spread of germs. It states that providers and visitors should wash their hands. It encourages staff to always encourage their colleagues to wash hands or speak up if they notice non-compliance. On the other hand, an article by Trampuz and Andreas (2020) from Mayo Clinic states that to reduce hospital-acquired infections, providers need to make hand washing an everyday part of caring for patients.
PICO
The selected PICO question is does hand washing among healthcare workers reduce hospital-acquired infections? The question is developed to address various components of PICO. The problem is a hospital-acquired infection, the intervention is hand washing, the comparison failure to wash hands, and the outcome is a reduction in infections.
Evidence Matrix
Authors
Journal Name Year of Publication Research Design Sample Size Outcome Variables Measured Quality (A, B, C) Results/Author’s Suggested Conclusions

Ay, P., Teker, A. G., Hidiroglu, S., Tepe, P., Surmen, A., Sili, U., … & Karavus, M. The Journal of Infection in Developing Countries 2019 Qualitative study 25 Hand hygiene and compliance A Compliance is still at suboptimal levels.
Hor, S. Y., Hooker, C., Iedema, R., Wyer, M., Gilbert, G. L., Jorm, C., & O’Sullivan, M. V. N. BMJ Quality & Safety 2017 Qualitative 177 Hand hygiene and infections A Hospitals should improve efforts to improve handwashing
Mu, X., Xu, Y., Yang, T., Zhang, J., Wang, C., Liu, W., … & Yang, H. The Brazilian Journal of Infectious Diseases 2016 Quantitative 27,852 Hand washing and compliance A Training enhances compliance
Quilab, M. T., Johnson, S., & Schadt, C. Hos Pal Med Int Jnl, 2019 Quantitative 120 Handwashing compliance B Education can improve compliance
Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. Infection and drug resistance 2018 Qualitative 78 Healthcare-associated infections C Healthcare workers have a poor handwashing compliance

Implementing Practice Change
The process of implementing the change is to improve training among healthcare workers to emphasize the need for handwashing. Training should be carried out regularly using various modes to ensure all the providers are aware of the changes they should make in their daily routine (Quilab et al., 2019). Facilities should also implement the necessary facilities for handwashing to boost compliance. They should also develop policies that will create better hygiene policies. For example, some of the case studies indicate that facilities without hygiene policies or culture have poor compliance. Providers should also support each other to ensure they develop peer-support similar to a culture adopted in John Hopkins Medicine. Peer support involves ensuring all the providers are complying with handwashing practices. During the change implementation, various stakeholders should participate to ensure successful practice change (Ay et al., 2019). The involvement should also be maintained for a long period to enhance consistency and change of old traditions that may hinder the adoption of change. Change implementation also requires support from the management.
Key Stakeholders
The key stakeholders for the implementation of change include healthcare workers at different levels of care including nurses, physicians, and technologists. The providers should include all staff working across all departments in a healthcare system (Ay et al., 2019). The management is also critical in implementing the change.
Barriers
The challenge of implementing change in healthcare is a lack of effective communication with all the staff. Another challenge is resistance to change which can undermine the implementation of handwashing culture (Ay et al., 2019). Lack of support from the management, nurse leaders or supervisors will also lead to failure. Providers should develop healthy and sustainable practices to improve the ability to overcome the challenges.
Strategies to Overcome Barriers
The strategies include timely and elaborate communication with all the stakeholders. They should also participate in giving ideas on how the change will be implemented to enhance acceptance (Hor et al., 2017). To avoid resistance, the management should provide information on why the change is necessary using data and peer-reviewed research. They should also show the effectiveness of the handwashing culture in other facilities. The management should deal with the barriers to promoting successful change implementation in all departments. Healthcare facilities should improve their culture and policies to enhance a long-term plan of overcoming the challenges.
Indicator to Measure Outcome
The indicators of care include an increase in compliance rates, reduced number of hospital-acquired infections, a change of attitude, reduced readmissions, and complications. For example, a reduction in hospital-acquired infections such as gastrointestinal and respiratory diseases will be a great milestone in the change initiative (Hor et al., 2017). The management should ensure they are keen on identifying the outcomes to ensure they track if the change is successful. The practices are also effective in ensuring that patients can develop trust when they know their health is taken care of through high hygiene standards.

References
Ay, P., Teker, A. G., Hidiroglu, S., Tepe, P., Surmen, A., Sili, U., … & Karavus, M. (2019). A qualitative study of hand hygiene compliance among health care workers in intensive care units. The Journal of Infection in Developing Countries, 13(02), 111-117. DOI: 10.3855/jidc.10926
Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Healthcare-associated infections–an overview. Infection and drug resistance, 11, 2321. DOI: 10.2147/IDR.S177247
Hor, S. Y., Hooker, C., Iedema, R., Wyer, M., Gilbert, G. L., Jorm, C., & O’Sullivan, M. V. N. (2017). Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ Quality & Safety, 26(7), 552-558.
John Hopkins Medicine (2020). Infection Prevention: Hand Hygiene. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Retrieved from https://www.hopkinsmedicine.org/patient_safety/infection_prevention/hand_hygiene.html
Mu, X., Xu, Y., Yang, T., Zhang, J., Wang, C., Liu, W., … & Yang, H. (2016). Improving hand hygiene compliance among healthcare workers: an intervention study in a Hospital in Guizhou Province, China. The Brazilian Journal of Infectious Diseases, 20(5), 413-418.
Quilab, M. T., Johnson, S., & Schadt, C. (2019). The effect of education on improving hand hygiene compliance among healthcare workers. Hos Pal Med Int Jnl, 3(2), 66-71.
Trampuz, A., & Andreas F. W. (2020). Hand Hygiene: A Frequently Missed Lifesaving Opportunity During Patient Care. Mayo Clinic, 79(1), DOI:https://doi.org/10.4065/79.1.109 PlumX Metrics