NURSING INNOVATION PROJECT

NURSING INNOVATION PROJECT Order Description THIS IS THE 3RD ASSESSMENT OF THIS SUBJECT.I HAVE UPLOADED THE 1ST AND 2ND ASSESSMENTS WHICH YOU NEED TO GO THROUGH AND THEN U CAN DO THE 3RD ASSESSMENT. 1ST ASSESSMENT. . A. Project Description The prevalence of healthcare-related or associated infections are attributed to substantial direct and indirect costs. The development of nurses within an acute care setting in safe hand hygiene practices can significantly reduce health-related infections. The findings from different kinds of literature on intervention research are not clear enough in conclusively identifying components that are efficient or effective in spurring the use of best hand hygiene practices to reduce infections (PR, 2014). However, this project focused on a more descriptive analysis of practices rather than determining interpretive probes on how the perceptions of individuals on hygiene might impact practice. B. Projects Milestones In establishing the milestones of the project, it is essential to consider that the primacy of this proposal aims at integrating standard precautions that underpin routinely safe measures driven towards protecting both the staff members within an acute care setting and their patients from infections. The application of standard precautions for all patients and at all times denotes the need for programs and initiatives pegged on raising awareness on the inclusion of optimal hand hygiene to reduce infections (Trunnell & White, 2008). The project, therefore, aims at conducting a mass hygiene program on best hand practices in caring for patients in an acute care setting. Given this, the project developed a pool of typical milestones that will guide the processes of its implementation, and that includes: 1. Provide information on the project and the manner in which it will be implemented. 2. Establish the role of the community in the project 3. Assessment of the patients’ needs 4. Communication and facilitating the participation of caregivers 5. Awareness creation on hand hygiene practices C. Implementation of the Project The implementation of this project will follow a healthcare based approach that will be adopted as the most efficient means of empowering the acute care nurses and patients, on the need to undertake standard precautions and safety measures against infections. The acute care nurses will be observed for a duration of four weeks i.e. all shifts will be included. The mass education program is anticipated to have acute care nurses and their patients aware of the need to embrace hand hygiene to reduce infections (Collins et al, 2009). To maximize the impact of the project, an integrated approach that combines safe and adequate hand hygiene practices and the promotion of sanitized environment will run hand in hand, efforts that will help the care providers to minimize the risks that come across with infections. D. Evaluation of the Project In a bid to ensure the timely and efficient implementation of the project, the collected data will be evaluated using Joanna Briggs clinical audit template. This will help in finding out the degree of non-compliance with best hand hygiene practices and offer suggestions in what should be done to seal the gap. Below are the steps which will be adopted to facilitate the evaluation of the project: 1. A review of the clinical audit work plans and the achievements of the project. 3 . Bed-to-bed visitation on patients to determine the effectiveness of the project 4 Collection of case studies and impact assessments to determine the benefits of the delivered project. 5 The project will ensure all the health care professionals within an acute setting and holding a clinical responsibility for their patients need to be trained on the inclusion of infection prevention and control procedures, practices that need to be performed every day. 6 The acute care nurses and the patients will additionally receive mandatory infection control education and training on an annual basis. E. Project Reporting The results of the project will be given to the director of nursing, nursing unit managers and all the acute care nurses. The clinical audit findings will help in realizing the extent of non-compliance and thus educate the staff so that optimal adherence is achieved. F. Ethical Considerations Given that this project seeks to enhance patient safety activities, the project will ensure minimal risks are applied to patients and care providers (Abdelaziz, Hany, Atwa, Talaat, & Hosny, 2016). This is attributed to the fact that the project involves human subjects and requires an assessment of predicted burdens and risks of the subjects involved in comparison with the benefits of the project. Confidentiality will be applied during the implementation phase of the project. Studies have shown that if the subjects being assessed, are aware of being monitored, they act in a way that is not genuine, but if they aren’t aware the results tend not to be biased. References Abdelaziz, A., Hany, M., Atwa, H., Talaat, W., & Hosny, S. (2016). Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources. Medical Teacher, 38(3), 272-279. Collins, C., Harshbarger, C., Sawyer, R., & Hamdallah, M. (2009). The Diffusion of Effective Behavioral Interventions Project: Development, Implementation, and Lessons Learned. AIDS Education & Prevention, 185-20. PR, N. (2014, June 5). Study Proves Accuracy of DebMed® Group Monitoring System™ in Measuring Hand Hygiene Practices of Healthcare Workers. PR Newswire US. Trunnell, E., & White Jr., G. (2008). Using Behavior Change Theories to Enhance Hand Hygiene Behavior. Education For Health: Change In Learning & Practice (Taylor & Francis Ltd), 18(1), 80-84. APPENDIX A Innovative Project Plan for the NSG5NPI. Name: XX Student ID -XX Project Summary Statement: Proper hand hygiene practices by the acute care nurses play a pivotal role in infection transmission control. Despite adherence, literature shows that compliance with hand washes by the acute care nurses is still moderate. This project aims at conducting a mass education program on initiatives pegged on raising awareness on the inclusion of optimal hand hygiene to reduce infections in an acute care setting. Project Title: Do acute care nurses in xx hospital comply with the best hand hygiene practices while delivering nursing care. Action Commencement Date Completion Date Reflection To clarify with xx hospital’s ethical committee whether the project requires ethical approval. 12th 09 2017 14th 09 2017 Confirmed that this project doesn’t require ethical approval. Meet with the Director of nursing and the nursing unit manager. 15th 09 2017 15th 09 2017 DON and the NUM are aware of the project and have approved it. Have a meeting with the clinical nurse consultant and clinical nurse educator. 17th 09 2017 17th November This is to help in gaining more support in the process of conducting my project. To submit assessment 1 End of week 3 End of week 3 Review the literature in terms of the factors that hinders best hand hygiene practices in an acute care setting. 16TH OCTOBER 2017 26th October 2018 Project commences Evaluate the literature 27th October 2017 30th October 2017 Review and evaluate the current evidence based practice in regard to the factors hindering compliance with hand hygiene practices by acute care nurses. Ensure hand hygiene policy is available. 1st november2017 1st November 2017 To help in guiding the acute care nurses on the expected hand hygiene practices. Educate the acute care nurses through in-service about best hand hygiene practices 3rd november2017 5th november2017 Acute care nurses are familiar with the world health organization(WHO)’s established 5 moments of hand wash. To implement the best hand hygiene practices in the acute care setting. 6th November 2017 8th November 2017 To analyze the finding of the clinical audit project. 10th November2017 15th november2017 Do a comparison between the clinical audit project findings with the best hand hygiene practices Examine the reasons as to why the current practice failed to meet the expected standards. To communicate the findings to the Nursing unit managers. And submit to XX UNIVERSITY. 20th November 2017. 20th November 2017. Provide a copy to the Director of nursing and the Nursing Unit Manager. 2ND ASSESSMENT. INNOVATION NURSING PROJECT. Do Acute Care Nurses in XXX Hospital Comply with The Best Hand Hygiene Practices While Delivering Nursing Care? 1. Project description: The prevalence of healthcare-related or associated infections are attributed to substantial direct and indirect costs. According to Shang, Stone, & Larson (2015), Health care associated Infections (HAIs) are those infections which a patient gets while in hospital, receiving medical treatment. Universally, this is a serious patient safety issue (p. 1). Principally speaking, the health care system must provide safe care to all their patients. This is due to the fact that the expectations of proper health care is on the increase. Padoveze & Figueiredo (2014) have explained that primary health care is a vital part of treatment and must be provided to the people with safety. Moreover, the WHO states that unsafe care provisions is one of the five common and major limitations of healthcare service. Hence, minimizing the HCAIs is the priority for assuring safe health care to all (p. 1132). Shang, Stone, & Larson, (2015) estimate that every year approximately 75000 hospitalized patients die due to health care associated infections. Additionally, the cost that is associated with these infections is 9.8 billion dollars annually. However, most of the HAIs are preventable (p. 2) according to Bruce. He further explains that the ratio of the HCIs is estimated in the millions but with proper hand hygiene measures these infections would be minimized. Nurses are the heart and soul of all health care systems around the globe. As such, their performance and practice are directly related to the prevention and spread of infections. With proper training in safe practices and consistent updating on their performance, these infections can be limited. According to Shang, Stone, & Larson, (2015), Nursing is the largest profession globally and it is essential in preventing and controlling the HAIs. Thus, the nurses are not only responsible for prevention of infections but also they look out for and provide advocacy. So, it is very important to learn about the relationship among nurses and health care associated infections (p. 2). The development of nurses within an acute care setting in safe hand hygiene practices can significantly reduce health-related infections. According to PR Newswire, the findings from different kinds of literature on intervention research are not clear enough in conclusively identifying components that are efficient or effective in prompting the use of best hand hygiene practices to reduce infections (2014). Correct hand hygiene procedures are one of the best ways to reduce and prevent the hospital acquired infections however, according to WHO less than 40% of the health care providers comply with this method. Therefore, it has been found that the proper hand hygiene practices by the acute care nurses play a pivotal role in infection transmission control. Despite being aware of the benefits, statistics show that compliance with hand washes by the acute care nurses is still moderate. The aim of this project is to focus on a more descriptive analysis of practices rather than determining interpretive probes on how the perceptions of individuals on hygiene might impact practice. In short this project looks ahead, conducting a mass education program on initiatives pegged on raising awareness on the inclusion of optimal hand hygiene to reduce infections in an acute care setting. The project details including the ethical approval were added upon feedback. The ethical considerations were included in the appendix A. Henceforth; data for the project will be collected and assessed through Joanna Briggs clinical audit template. This will help in finding out the degree of non-compliance with best hand hygiene practices and offer suggestions in what should be done to seal the gap. Similarly, the ethical approval was not needed as it was discussed with the Ethical Committee. I also met with the Director of nursing and Unit nurse managers. They were aware about this project and approved it. The Projects details are as; provision of information on the project and the ways in which this will be conducted, to prepare the community to establish their roles in the project, assessment of the patient’s needs, communications with the care givers and provision of education and awareness programs on hand hygiene and follow up to see the sustainability. 2. Literature review: Hand hygiene is the process of using the hand rubs, soap and water or any antiseptic to clean the hands and in so doing removing the transient germs. So, any action that is taken to keep the hands and skin condition free from germs and removal of micro-organisms from the skin is known as hand hygiene. This step is of utmost importance in the prevention of the infections. However, about 50% of the health care associated infections are due to the unclean hands of the health care professionals and particularly the nurses. Though the nurses are thought to be the back bone of the health care settings around the globe they are also considered the persons with the most microorganisms, thus spreading infections. Efstathiou, Papastavrou, Raftopoulos, & Merkouris, (2011) aggrandized that health care professionals and particularly the nurses are exposed to the micro-organisms. Additionally, the organisms are lethal in nature for patients as well as for themselves. As nurses are more exposed with this issue, it is therefore necessary to explore the causes of their noncompliance (p. 1). A number of methods are used to prevent the transmission of the micro-organism however, the most commonly used is hand hygiene or hand washing. Teker et al., (2015) has explored that among different methods for prevention, the most commonly used method is proper hand washing because this is very easy to follow, economical and effective. Thus, it helps in prevention of community and hospital acquired infection by breaking the chain of cross contamination (p. 2). Coupled with this, Abdella et al., (2014) explained that the hands of the care workers are the most feasible source of infection transmission in the health care settings. Moreover, the pathogens remain for 2-60 minutes on the hands of the care workers (p. 1). There are many reasons for which the health care workers don’t follow the standard precautions and methods of hand hygiene. The most common reasons are that the nurses don’t develop a routine of hand washing, not enough knowledge which leads to confusion among the use of hand wash and hand sanitizers. 3. Implementation: The project, therefore, aims at conducting a mass hygiene program on best hand practices in caring for patients in an acute care setting. The implementation of this project will follow a healthcare based approach that will be adopted as the most efficient means of empowering the acute care nurses and patients, on the need to undertake standard precautions and safety measures against infections. The acute care nurses will be observed for a duration of four weeks i.e. all shifts will be included. To maximize the impact of the project, an integrated approach that combines safe and adequate hand hygiene practices and the promotion of a sanitized environment will run hand in hand, efforts that will help the care providers to minimize the risks that come across with infections. The factors will be traced out that hinder the nurses to adhere with the hand hygiene procedure. For the ethical approval the meeting was done with the ethical committee of the concerned hospital on 12th September 2017 however, the committee confirmed that this project doesn’t require ethical approval on 14th September 2017. On 15th September 2017 the meetings were arranged with the Director of Nursing (DON) and Unit Nurse Manager to inform them that the project had been approved and to involve them in the plan. On 17th September 2017 I had a meeting with the Clinical Nurse Educator and Clinical Nurse Consultant. From 16th October 2017 till 26th October 2017 the project was carried out. From 27th October to 30th October 2017 the literature review was done and the practices of the nurses were examined in the light of evidence based practices. The current practices say that the health care professionals must use Standard precautions to treat all the patients and the patients should be considered as infectious whatever their status is. Hand hygiene is one of the components and it must be regarded as the major component of prevention. On the 1st November 2017 the nurses of acute care facility were guided about the expected outcome of hand hygiene. From 3rd to 5th November 2017 the nurses were educated by in service about the best hand hygiene practices. It was observed that the nurses were aware about the 5 moments of hand wash. From 6th to 8th November 2017 the findings of the clinical audit project were analyzed and recorded. From 10th to 15th November a comparison between the clinical audit project findings with the best hand hygiene practices was done. Furthermore, it was examined as to what makes the practices fail and then the findings were communicated to the unit nurse manager. The project report will be submitted to the Latrobe University. Lastly, the copy of the report will be given to the Director of Nursing of the hospital. The results of the project will be given to the director of nursing, nursing unit managers and all the acute care nurses. The clinical audit findings will help in realizing the extent of non-compliance and thus educate the staff so that optimal adherence is achieved. 4. Challenges: During the project implementation a number of challenges were faced. Firstly, the handling of the different age groups was a challenge. The old age nurses prefer soap and water over all other methods and this is the best way to have hand hygiene. According to Chatfield, Nolan, Crawford, & Hallam, (2016) the result of a qualitative study had shown that the old nurses think that soaps are better than any other sanitizer or gel. It is due to the reason that; the production of foam is the source of extra protection for them (p. 3). The challenge was addressed by the involvement of the senior persons who are aware about the nurses and hygiene. Secondly, the ethical approval and consents have to be taken before any project or research work. However, in this study, there was no need for this. This was a challenge to tell the people about this study and it’s also necessary to assess the nurses without informing them otherwise the results can be changed and pure results cannot be achieved. Thirdly, there was a need to train the nurses and patients and to educate them regarding hand hygiene and infection control prevention. For patients it is difficult to communicate to them, concerning hand hygiene, and to tell them how to prevent the infections to spread from them to other persons. So, this challenge was addressed by involving the community persons and the attendants of the patients. Lastly, the nurses need training on an annual basis about the hand hygiene and infection prevention methods. This challenge was met by planning with the DON and preparing a schedule of training regarding hand hygiene and infection control trainings. The evaluation of the project will be done by performing bed to bed visits and providing education to the nurses and patients related to hand hygiene. The factors that are hindering the nurses from using the hand hygiene methods will be looked at. Reflection Undoubtedly, the nurses are the main power of the hospital settings and they are involved in the care of patients from arrival to departure. The nurses care for the patients and families and spend most of the time with them in the clinical area. Although, impute of care goes to nurses, they are also seen as the main source of spreading infection in the hospitals. They care for a number of patients at the same time so; they can transfer the germs from one patient to the other. Health care related infections are the major cause of death in the hospitals. Health care associated infections also known as health care related infections are those which a patient gets when he/she comes to hospital for the treatment of other medical issues(WHO,2009). The importance of nursing in prevention of health care infections cannot be underestimated. Although this is a difficult task, yet it can be made possible through making particular policies and proper observations. Hand washing is the best method that helps in the reduction of heath care associated infections. According to Mathur, Hand hygiene is one of the most important elements of infection control program. Furthermore, the importance of this has been shown in the early 19th century. Similarly, it has been clarified that hand hygiene is the single most important step in reducing the health related infections and spread of antimicrobial resistance (2011). Coupled with these facts WHO has stated that hand hygiene is the primary preventive measure for HCAIs and it also minimizes the resistance of the microbes against antimicrobials. Contrary to its importance, the health care workers are not complying with this at different levels (2009). According to Malliarou, Sarafis, Zyga, & Constantinidis, (2013), adequate hand hygiene among the healthcare professionals can prevent approximately 15-30% of the health care associated infections. Additionally, this is the simplest and easiest way that can prevent diarrhea and pneumonia which causes death to patients (p.328). So the hand hygiene which is one of the standard precautions can prevent the spread of infections in the hospital care settings. It was observed that if nurses comply with the proper hand hygiene process, the infections can be reduced. It was a situation that evoked me to think. I was thinking about, what are the factors that block acute care nurses to perform proper hand hygiene. Why they are abdicating? What were the reasons of the spread of infections other than the nurses in hospitals? So, I felt bad for the patients and families. The health care settings are those places where a lot of money is spent. According to Malliarou, Sarafis, Zyga, & Constantinidis, (2013) in USA and UK the deaths due to HCAIs are 99000 and 55000 per year which can be minimized if the health care professionals comply with the proper hand hygiene methods (p. 327). On the other hand, Kavanagh, Cimiotti, Abusalem, & Coty, (2012) have explained that the cost is increasing on the health care facilities whereas, the quality of care is falling due to unsatisfactory practices among health care professionals. The nurses are at risk for financially because of the cost driven health care systems (p. 386). Therefore, I felt that this is an issue that needs prompt attention and this act can be inuring in health care settings. Thus, I planned to run a project on the aforementioned issue. I planned to observe the nurses and their compliance towards proper hand hygiene. For this I planned to involve the Director of nursing, Unit managers and hospitals management. My aim was to get and evaluate the data gathered through the observation and I remained as only an observant in the execution of this project. The project was good and it went well. It was necessary to check the compliance of the nurses towards the hand hygiene methods used in the patient care. The good thing was that some nurses were following the proper hand hygiene methods and they were aware about the importance of proper hand hygiene. They were utilizing the five moments of hand hygiene as established by WHO. According to WHO (2009), the routine of hand hygiene of health care workers is different depending upon the intensity and nature of work. Nurses wash hands from 5 to 42 times per shift however, in an hour their hand washing performance is 1.7 to 15.2 times (WHO,2009). On the other hand, the bad thing that was present in this project was that some nurses were not following the proper hand hygiene methods. Although the nurses were aware of the importance of hand hygiene, they still did not follow the guideline for various reasons. They had different sorts of excuses. Lack of time, emotional exhaustion, lack of supervision, lack of equipment and skin conditions (skin irritations due to the use of different kinds of hand rubs and gels). So, I assessed and educated the nurses according to the current practices related to hand hygiene and its importance. After taking all these factors into account, the situation seemed to me to be one different viewpoint. The work burden (lack of time) is the strongest reason that hinders the nurses from this practice. Moreover, the nurses also have skin irritation and allergies related to different types of soaps and gels which deter them from proper hand hygiene habits. So my project helped to find out the reasons of not complying with the hand hygiene practices. These findings will be helpful for the nurses to find some other ways to comply. In my point of view just analysis and education is not enough for this project. The sustainability should be measured. The correct policies and easy guidelines can be made to achieve the compliance. Refresher courses should be done in this project to help the nurses to know the most recent method and guidelines about hand hygiene. Reminders can be included to the nurses who are in acute care as they go from one patient to another patient. In future, whenever, I would have a chance to run such a project I would like to introduce more convenient sink locations which can minimize the skin irritation. Additionally, I will use Feedback, policy reviews, memo, and posters in the area that can be used to assess the sustainability of my project. Lastly, In-service first, then group feedbacks and verbal reminders to the nurses can be included so that the nurses can comply and the project will be successful. References Abdella, N. M., Tefera, M. A., Eredie, A. E., Landers, T. F., Malefia, Y. D., & Alene, K. A. (2014). Hand hygiene compliance and associated factors among health care providers in Gondar University Hospital, Gondar, North West Ethiopia. BMC Public Health, 14(1), 1-7. doi:10.1186/1471-2458-14-96 Bruce, N. (2013). Improving Compliance with Healthcare Associated Infection (HAI) Practice Guidelines to Reduce the Acquisition of HAIs (Unpublished doctoral dissertation). University of Massachusetts Amherst, Amherst, MA. Chatfield, S. L., Nolan, R., Crawford, H., & Hallam, J. S. (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE Open Medicine,4, 205031211667509. doi:10.1177/2050312116675098 Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care–associated infection. American Journal of Infection Control, 40(6), 486-490. doi:10.1016/j.ajic.2012.02.029 Efstathiou, G., Papastavrou, E., Raftopoulos, V., & Merkouris, A. (2011). Factors influencing nurses' compliance with Standard Precautions in order to avoid occupational exposure to microorganisms: A focus group study. BMC Nursing, 10(1), 1-12. doi:10.1186/1472-6955-10-1 Haile, T. G., Engeda, E. H., & Abdo, A. A. (2017). Compliance with Standard Precautions and Associated Factors among Healthcare Workers in Gondar University Comprehensive Specialized Hospital, Northwest Ethiopia. Journal of Environmental and Public Health,2017, 1-8. doi:10.1155/2017/2050635 Kavanagh, K. T., Cimiotti, J. P., Abusalem, S., & Coty, M. (2012). Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing. Journal of Nursing Scholarship,44(4), 385-395. doi:10.1111/j.1547-5069.2012.01469.x Malliarou, M., Sarafis, P., Zyga, S., & Constantinidis,, T. C. (2013). The Importance of Nurses Hand Hygiene. International Journal of Caring Sciences, 6(3), 327-331. Retrieved from https://www.internationaljournalofcaringsciences.org/docs/5.%20Malliarou.pdf Mathur, P. (2011). Hand hygiene: Back to the basics of infection control. The Indian Journal of Medical Research, 134(5), 611. doi:10.4103/0971-5916.90985 Padoveze, M. C., & Figueiredo, R. M. (2014). The role of primary care in the prevention and control of healthcare associated infections. Revista da Escola de Enfermagem da USP, 48(6), 1137-1144. doi:10.1590/s0080-623420140000700023 PR, N. (2014, June 5). Study Proves Accuracy of DebMed Group Monitoring System in Measuring Hand Hygiene Practices of Healthcare Workers. PR Newswire US. Shang, J., Stone, P., & Larson, E. (2015). Studies on nurse staffing and health care–associated infection: Methodologic challenges and potential solutions. American Journal of Infection Control, 43(6), 581-588. doi:10.1016/j.ajic.2015.03.029 Teker, B., Ogutlu, A., Gozdas, H. T., Ruayercan, S., Hacialioglu, G., & Karabay, O. (2015). Factors Affecting Hand Hygiene Adherence at a Private Hospital in Turkey. The Eurasian Journal of Medicine, 47(3), 208-212. doi:10.5152/eurasianjmed.2015.78 WHO Guidelines on Hand Hygiene in Health Care: a Summary. (2009). Retrieved from https://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf. AFTER READING ABOVE.NOW HERE ARE THE INSTRUCTIONS FOR THE 3RD ASSESSMENT. Your final assessment is to report on your project as a whole. You should address the following aspects in your submission: What you hoped to achieve (your objectives) Why you thought this topic was important (background/rationale) How you went about this (your methods) What you found (results and discussion) Limitations and Consequent future recommendations The actual format of your final report will be presented as previously negotiated, depending on the type of project you undertake. For some projects, such as a clinical audit, it might be appropriate to prepare a report to senior management of an organisation.....NOTE MINE IS UNDER CLINICAL AUDIT SO PREPARE A REPORT TO SENIOR MANAGEMENT OF AN ORGNISATION.