|Practice Immersion Clinical Evaluation Tools Submission
Submit the completed “Practice Immersion Clinical Evaluation Tool” to your course faculty by the end of the course, as it is required to successfully pass ***
I did my practices hour at divine home health care agency in Tampa Florida
I attached what I was doing there
you has to to do student evaluation part.
Hygiene is crucial in any medical environment. In clinical practice, people are educated on the value of maintaining personal hygiene as a mean of avoiding contamination and risking their health. Nurses’ hygiene is paramount in protecting the wellness of patients through minimizing the spread of infection or causing infection among uninfected patients and staff members. In this study will focus on nurses working in the Intensive Care Unit (P) using alcohol-based hand wash solution (I) compared to soap and water hand wash (C) to help reduce hospital-acquired infection (HAIs) among patients in the ICU within a period of 3 months (T)
The PICO focuses on the significance of maintaining hand hygiene through hand wash using an alcohol-based hand wash solution. According to a study by Maher(2007) indicated that compliance with hand hygiene ensures a majority of the people get to wash their hands for the safety of the patients. The author concentrates on the value of clinical hygiene especially in the ICU to maintain patient safety through avoiding the spread of infectious disease through handwashing with compliance to the patient’s care. Hand washing usingan alcohol-based hand wash solution is beneficial in killing microorganisms compared to basic water and soap handwash. The article by Srigley, Furness, Baker and Gardam (2014) conducteda study that uses an electrical system to monitor whether nurses who use alcohol-based hand wash solution to wash their hands before and after handling patients eliminated any possibility of infecting others. The study observed that soap and water are not very effective in eliminating germs especially microscopic germs. In ICU there is a high risk of patient infection especially due to contact with contaminated suffers such as nurses’ hands. As such, the study by Bolton, Rivas, Prachar, andJones (2015) recommend thorough hand cleaning before and after visiting the ICU as a strategic measure of reducing hospital-acquired infections.It is confirmed that the participation by healthcare workers was suboptimal and hence could increase the chances of transmitting hospital-acquired infection (Srigley, Furness, Baker,&Gardam, 2014). The main aim of the research entailed ensuring that a proper strategy is determined to meet the concerns of health care workers.
The process of advocating for hand wash hygiene is considered as part of nursing intervention. The PICOT statement fulfills the process of nursing intervention through educating nurses on the value of handling patients with the clean hand using appropriate hand wash solution that effectively removes germs and reduces the chances of infection within the hospital. Nurses are urged to regularly clean their hands before they are in contact with a patient and after handling any patient to reduce the chances of putting other people within the health facility at risk. Hand wash intervention is important in promoting patient wellness and safety. It guides nurses on the appropriate mechanism to help reduce hospital infection especially when handling patients who are sick with communicable diseases. These nursing interventions proved that then Hawthorne effect that patients tend to have their hands watched if they have the feeling that they are being watched. Hence, the act of having an observer means that more hands will be washed, leading to minimized cases of hospital infections.
The PICOT statement is patient cantered through ensuring nurses protect and provide safety of the patient by protecting them from hospital-acquired infections. Hand washes hygiene involves patient care by establishing a clean environment for the patient to thrive without In the study by Srigley et al. (2014), It was determined that anytime an individual went to the dispenser, he or she washed the hands. The action of handwashing is confirmed through the use of RTLS placed on the faucets that audit any time a person visits the dispenser.Proper code of nurses should be instilled that will ensure that adequate hygiene techniques have been maintained as well as ensure that minimal infections are to be made through the hospital-acquired infections.
Health Care Agencies
According to the PICOT statement, health care agencies involved in the process of reducing hospital-acquired infections are agencies such as insurance companies that protect the welfare of patients. Agencies such as the CDC have conducted research on the dangers of poor hygiene in hospitals especially in the ICU department where nurses get in conduct with patients with critical conditions. Washing hands with an alcohol-based hand wash solution help reduce such risk that can affect the health of other people within the hospital and even causes an outbreak of a disease or virus.
Patients have been helped to have a recovery from the illness, which could have resulted in harming through the transmission of pathogens that could have been from the nurses or even failure of the patients to clean hands. There is a need to ensure that hands are washed, and proper education should be made to both nurses and patients on the need for washing hands to prevent HAIs. Hand washing has a significant impact on an individual if not adequately done, and it can lead to adverse outcomes, especially on patients. Health Care Agencies are advocating for a campaign on handwashing by both nurses and patients with the belief that if hands are properly washed, the results expected will be improved health on patients. Hence, there is a need for policy changes to ensure that the outbreaks from HAIs are reduced.
The use of alcohol-based hand wash solution over soap and water is effective in reducing HAIs and protecting patients and other members of the hospitals. As such, proper education should be created for all individuals concerning hand hygiene, especially to nurses. Quality care is achieved through proper clinical hygiene and nurses must demonstrate proper hygiene when it comes to appropriate hand wash intervention using alcohol-based hand wash solution rather than simple soap and water solution.
Practice Immersion Clinical Evaluation Tool – Agency/Site
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Excels: Agency/site meets this criterion and further a teaching point opportunity or expanded information, guidance, or other element to further enhance student learning.
Agency/site – strengths:
Agency/site – areas of improvement needed:
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Practice Immersion Clinical Evaluation Tool – Mentor
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Practice Immersion Clinical Evaluation Tool – Student
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Benchmark – Capstone Project Change Proposal
Millions of patients across the world experience hospital-acquired infections (HAIs), which reduces the likelihood of having better health outcomes. According to Oyapero and Oyapero (2018), 1.4 million patients in the world experience these infections at any point in time, leading to an increased risk of patient morbidity and mortality. In developing economies, the rate of preventable HAIs as a result of medical care is at least 40% because of the risk factors such as low levels of awareness, multiple trauma, and the lack of effective preventive mechanisms (Asadollahi et al., 2015). Primarily, direct contact between healthcare workers with transient contamination of their hands with nosocomial pathogens and patients is the main route of infection transmission leading to patients getting infected (Luangasanatip et al., 2015). Fortunately, hand hygiene is considered one of the most critical interventions to reduce the menace of HAIs in admitted patients. However, it is necessary to understand whether or not washings hands with soap and water is more effective than the use of alcohol-based wash solution in reducing HAIs.
Microbial pathogens mainly contaminate healthcare workers’ hands, yet these providers do not frequently wash their hands with water and soap or alcohol-based solution. Awoke et al. (2018) explain that the hands of these workers are the vehicle of healthcare-associated pathogen transmission because they continuously touch body fluids, patients’ skin and mucous membranes, surfaces, and their own bodies while performing a myriad of healthcare activities.Awoke et al. (2018) defines hand hygiene as the transient removal of microbial organisms by killing or removing them from dirty hands through the use of handwashing agents and different techniques. Unfortunately, hand hygiene is less practiced by these workers (Sharif et al., 2016). It is worse than healthcare workers do not practice handwashing with the use of soap after touching potentially contaminated surfaces.
Purpose of the Change Proposal
This change proposal purpose of fostering the execution of hand hygiene measures through hand hygiene as the most effective intervention to prevent or reduce the occurrence of HAIs in intensive care units (ICUs). Therattil et al. (2015) explain that there is no difference between the counts of hand bacteria when using ethyl alcohol-based sanitizer or soap-and-water hand washing. Planned behavior to inspire hand hygiene by educating and motivating healthcare workers to abide by the hand hygiene protocols and evidence-based guidelines are fundamental to improve the practice of this therapeutic intervention (White et al., 2015). According to Zhao et al. (2018), nurses prefer adopting or implementing interventions in which they participate during the planning and formulation phases. Besides, these interventions should be simple and easy to execute, which makes hand hygiene to be an appropriate solution for adoption in the ICU. Therefore, purposing to engage the healthcare workers and inspiring them to implement appropriate hand hygiene practices as well as soliciting and providing the necessary hand hygiene resources, such as water, soap, or alcohol-based sanitizer, is crucial.
This change proposal is based on the knowledge or evidence obtained to answer the PICOT question: in nurses working within the ICU (P), does the use of alcohol-based hand wash solution (I) compared with soap-and-water handwashing (C) reduce HAIs (O) in patients within three months (T)? Already, Therattil et al. (2015) reveal that both the intervention and the comparison are effective in mitigating HAIs after establishing that alcohol-based and soap-and-water hand washing does not depict any significant variations in hand pathogen count. However, nurses can effectively participate in the formulation of clinical solutions to existing problems for the interventions to be executed and sustained (Zhao et al., 2018). Therefore, healthcare workers should use scientific evidence to answer the PICOT question and formulate an evidence-based solution to the problems of HAIs in ICUs.
Literature Search Strategy
The search for evidence from scholarly, peer-reviewed sources relied on the use of different databases. Some of the most critical databases used to access these sources comprised Google Scholar and PubMed. Important search terms from the PICOT statement, as well as those related to the problem of HAIs in hospitalized patients, were used to help in accessing the sources through the databases. The search terms included “nurses,”“healthcare workers,”“hand hygiene,”“handwashing,”“alcohol-based hand hygiene,”“healthcare-associated infections,”“alcohol sanitizer,” and so forth. After completing the search, many sources were identified. However, it was the duty of the research to select only those that met the inclusion criteria. Only peer-reviewed journal articles published in English from 2015 to date were selected. Besides, these articles were to have relevant information concerning the PICOT statement with much focus on HAIs and hand hygiene. Eight articles were selected after meeting the inclusion criteria.
Evaluation of the Literature
Fundamentally, the literature from the eight sources was evaluated for reliability, validity, and credibility of the evidence. It was established that these evidence-based, peer-reviewed sources contained the necessary information to answer the PICOT question and address different aspects of the change proposal. For example, Asadollahi et al. (2015) discussed the levels of knowledge of nurses concerning the concept of hand hygiene and the need for training while Awoke et al. (2018) addressed the issue of hand hygiene compliance, which was found to be poor leading to the need for adopting measures aimed at improving the adherence levels. Conversely, Luangasanatip et al. (2015) examined the efficacy of different interventions to promote hand hygiene, while Oyapero and Oyapero (2018) assessed hand hygiene perceptions among nurses, which is similar to Sharif et al.’s (2016), which explored hand hygiene perceptions and attitudes in nurses. Therattil et al. (2015) had credible evidence on different hand hygiene methods as White et al. (2015) sought to assess the determinants of hand hygiene decisions in nurses, while Zhao et al. (2018) provided evidence on how to improve the attractiveness of hand hygiene interventions. Therefore, this credible evidence revolves around promoting hand hygiene to mitigate HAIs.
Application of the Change Theory
Kurt Lewin’s theory of planned change is appropriate for this change proposal. Its details are indicated in Appendices A and B. Batras et al. (2016) explain that this change theory aims at destabilizing the status quo by creating room for change where stakeholders such as clinicians are engaged to overcome the tendency to implement routine practices by adopting evidence-based interventions. During unfreezing, which is the first phase of this theory, stakeholders are mobilized through awareness to inspire change by acknowledging the need to adopt new interventions to solve existing problems (Wojciechowski et al., 2016). After planning, the moving phase follows where is implementation is actualized. In this case, planning to improve hand hygiene compliance and the implementation of measures to actualize the plan is an outcome of following this theoretical framework. Finally, refreezing is evident when the healthcare organization and providers formulate and execute policies to sustain the evidence-based solution.
Implementation Plan with Outcome Measures
The plan will commence with the collection of credible evidence from peer-reviewed sources about the problem of HAIs and the need for complying with hand hygiene protocols and guidelines as the most appropriate solution. This step will be followed by the organized engagement of nurses and other stakeholders through meetings, discussions, and dissemination of written evidence to inspire change. Consequently, collective planning through a team-based approach will help in designing protocols and measures to improve hand hygiene compliance. This plan will then be actualized during the implementation phase before evaluations of the effectiveness to achieve high adherence levels, reduce the occurrence of HAIs in the ICU, the duration of ICU stay, and improve the associated health outcomes, among others.
The lack of knowledge, nurses’ resistance to change, and the insufficiency of hand hygiene resources are the potential barriers to the successful implementation of this proposed plan. Zhao et al. (2018) explain that hand hygiene attractiveness can be achieved and sustained through increased training of providers and inclusion of the same clinicians into planning change interventions. Through the inclusion and training of nurses, the challenges of provider resistance and knowledge deficit will be mitigated. Further, these providers require sufficient hand hygiene resources to comply with hand hygiene protocols and guidelines effectively. As such, the administration should seek and obtain funds to purchase the resources, such as soap, water, and alcohol-based solutions, as well as facilitate the training of healthcare workers.
Overall, HAIs are a menace to the health and lives of hospitalized patients in ICUs; however, the solution to this problem is hand hygiene, which is a simple practice but difficult for healthcare workers to comply with when delivering services. The best solution is to promote soap-and-water or alcohol-based hand washing, which are two effective methods to clean and remove microbial pathogens from contaminated hands. However, adequate resources should be available in addition to reducing potential resistance through teamwork and inclusivity and improving provider knowledge levels of the need and technical knowledge about hand hygiene practices.