John Hopkins Nursing EBP Process Design for Change Proposal

This proposal identifies a nursing problem that the researcher finds significant enough to warrant a counter solution. The particular problem identified is the lack of hand hygiene education among health workers, which consequently translates to increased healthcare-acquired infections (HAIs). The proposal identifies one potential counter solution, which is the introduction of hand hygiene education among health professionals.

Previous researchers have found substantial proof regarding the effectiveness of hand hygiene education among health practitioners (Sharma, Koushal, & Sharma, 2012). The scholars’ research findings are a clear indicator that there is a need for increased hand hygiene education in the health sector; otherwise, patients contract HAIs.

Change Model Overview

The current study employed the John Hopkins Nursing Evidence-Based Practice Process. The model comprises three primary elements, namely practice question, evidence, and translation (PET). Every element is further structured into a set of steps that should be followed in the event of implementation of this model in the health sector. There is a total of 18 steps – five-under practice question, five under the evidence, and eight under translation (John Hopkins Medicine, n.d.). The steps will be elaborated on in the subsequent sections.

This model is a fundamental tool in the medical fraternity as it provides a foundation for the implementation of desired changes. Nurses should use it in facilitating change because the PET process systematically addresses a looming crisis based on the existing evidence and later replicated in recent research. Moreover, the model fosters improved health care practices and improved patient care (John Hopkins Medicine, n.d.).

The John Hopkins EBP process can be illustrated as follows:

Figure 1: The John Hopkins EBP process

Practice Question

Step 1: Recruit Inter-professional Team

The researcher purposes to incorporate a team of seven relevant stakeholders. The team is expected to participate actively in the research process. These seven members include two medical officers, a clinical officer, a nurse, a pharmacist, a pediatrician, and a dentist.

Step 2: Develop and Refine the EBP Question

The study uses a question to guide the research. The question is: Does hand hygiene education among healthcare personnel produce better results in the reduction of healthcare-acquired infections as compared to no education? The study further seeks to refine the research model by employing particular elements known as PICO. P stands for a population, problem, or patient. In this case, P is healthcare workers. I implies intervention. In this study, the intervention is hand hygiene education. C denotes the comparison with other treatment practices. Thus, the comparison is no education. Lastly, O represents the desired outcome. The researcher intends to evaluate the study’s desired result over a six-month period.

Step 3: Define the Scope of the EBP

Lack of hand hygiene education among healthcare workers is a critical issue as it has the potential to trigger HAIs. Underlying research provides credible statistics to corroborate the above assertion. In a study involving 2,400 participants, the ratio of medical practitioners washing their hands before handling patients to those who forfeited the practice was 2.6 (72.5%) to 1 (27.5%) (Sharma, Koushal, & Sharma, 2012). Despite the minimal number of health care workers who do not practice hand hygiene, there is still a high risk of patients acquiring infections. Tanwir (2012) confirms the fact that poor hygiene causes HAIs, as the author notes that proper hand hygiene techniques reduce chances of patients acquiring nosocomial infections.

Lack of hand hygiene education impacts healthcare on a broader scale. For instance, there is bound to be an increase in medical costs as patients have to make extra payments for treatment of the freshly-acquired infections. Moreover, these infections are likely to spread to other persons within and outside the health facility if they get in contact with the infected patients. In other cases, health centers could be shut down by healthcare regulatory bodies if they are found operating without proper hand hygiene (Joyce, 2012).

Steps 4 and 5: Determine the Responsibility of Team Members

The members chosen in step 1 are essential to this project as each one of them has a significant role to play. Thus, medical officers will provide expert advice on HAIs prevention as well as highlight the public health policies. Moreover, they will oversee the installation of hand-washing sinks and supply of anti-bacterial soaps. Furthermore, clinical officers will be charged with the responsibility of diagnosing cases of HAIs among a chosen sample of patients. At the same time, nurses will aid in tracking health records of patients handled without hand hygiene practice in comparison with those treated with proper hygiene measures. Thus, pharmacists will be required to supply hand hygiene safety tools such as gloves, sterilized scalpel blades, needles, and cotton wool. Pediatricians will monitor the handling of babies in regards to hand hygiene practices. Finally, dentists will file reports on the dental care standards observed during all dental procedures, including tooth removal and dental implants.

Evidence

Steps 6 and 7: Conduct Internal/ External Search for Evidence and Appraisal of Evidence

The researcher found evidence to support the research proposition in the form of EBP quality improvement data, qualitative research, position statements, guidelines, and quantitative research.

EBP guidelines advocate the practice of proper hand hygiene among health workers before and after touching the patient as well as after exposure to body fluids (Cullen & Adams, 2012). Underlying research suggests the need for increased campaigns towards hand hygiene education, which would eventually minimize HAIs. EBP guidelines were sourced from peer-reviewed scholarly journal articles and the World Health Organization (WHO) publications. At the same time, quality improvement data was obtained from underlying research of hygiene practices in the medical field as well as education initiatives in the health sector. Position statements were drawn from key research participants who were mainly professionals in the area of health. Lastly, the researcher collected qualitative and quantitative data from both primary and secondary sources.

The evidence gathered is to be used to support the research proposition. Mostly, the internal and external search for evidence focused on the relationship between the introduction of education on hand hygiene among health workers and the reduction of health acquired infections (HAIs). A control experiment was also conducted where no training was employed in the health sector. Evidence appraisal was presented in a worksheet, summarizing research instruments used by previous researchers.

The strength of the research is founded on the fact that the data was gathered from scholarly journal articles published within the past 10 years. Moreover, the data was sourced from a wide range of empirical research articles, thus increasing the credibility of research findings.

Steps 8 and 9: Summarize the Evidence

The researcher identified several relevant sources, from which the following information is obtained. In summary, the articles argue that the creation of hand hygiene awareness among health practitioners fosters the implementation of this practice as well as the reduction of HAIs and communicable diseases such as diarrhea among patients (Sharma, Koushal, & Sharma, 2012; Tanwir, 2012). Other researchers observe that education alone is not enough to ensure hand hygiene practice among health care workers. Rather, intensified knowledge and skills, as well as improved teaching strategies, are required to enhance maximum desired result (?kodov? et al., 2015; Asadollahi et al., 2015).

Step 10: Develop Recommendations for Change Based on Evidence

The researcher has gathered several points of recommendation based on research evidence. First, health care regulatory bodies ought to initiate a program for educating practitioners on hand hygiene practices. Additionally, medical professionals deserve to be enlightened on the benefits of proper hygiene practices in respect to patient care and prevention of HAIs. Second, qualified personnel should be appointed to develop the curriculum and implement the teaching plan for hand hygiene education. Thus, the personnel ought to instill both theoretical and practical skills to the healthcare workers.

Translation

Steps 11, 12, and 13, 14: Action Plan

The research is yet to become a complete project. Therefore, the current phase highlights the concrete steps to be taken towards the implementation of pilot study. First, the researcher intends to state the project goals on the purpose of this initiative. Second, the seven members chosen in step 1 will be brought together to discuss project goals. The third step will involve sketching a full-fledged design of how the project will be done, including how primary data will be gathered as well as a synthesis of secondary data. The fourth step will include drafting a budget that will cover the entire research process. The project will take a period of six months to be completed. Lastly, the researcher will evaluate the outcomes and method to report the results.

Steps 15 and 16: Evaluating Outcomes and Reporting Outcomes

The researcher anticipates the introduction of hand hygiene courses in the medical curriculum as well as an increased number of health workers pursuing these courses. Another desired outcome is that there will be minimal or no cases of healthcare-acquired infections in the patients, following proper hand hygiene practices among medical practitioners.

The expected outcomes will be measured, using comparative data at the beginning of the campaign and the end of the six-month period. The researcher will report the results to the key stakeholders by emailing each of them a copy of the final project.

Steps 17: Identify Next Steps

The plan will be initiated on a larger scale by publishing the report and sharing it with relevant stakeholders in the health sector. Furthermore, the plan is generalizable to all units with health facilities, which will increase its reliability. The researcher also purposes to appeal to the medical regulatory body to make it a mandatory requirement for healthcare workers to undertake hand hygiene education. The request is aimed at ensuring that the implementation is sustainable in the long-term.

Step 18: Disseminate Findings

The researcher will disseminate the results internally by calling for conference meetings and highlighting key points in powerpoint presentation format with the aid of a projector. Several copies will also be prepared and issued to individuals. Outside the organization, the research findings will be published and made available online. Hard copies will also be availed to local libraries.

Conclusion

The proposal has discussed the research problem that concerns health professionals’ hand hygiene and healthcare-acquired infections. The study proposes that increased education initiatives on hygiene practices within the health sector will reduce HAIs. The proposal adopts the John Hopkins EBP process as the change model. The model comprises three levels, namely practice question, evidence, and translation (PET). The first level, P, is mainly concerned with the particular research problem and the concept of teamwork. The second level, E, focuses on existing evidence in support of the study’s hypothesis. Lastly, T represents the project implementation phase, where the project proposition is either confirmed or refuted based on results. The proposal itself implies 18 steps to be taken to achieve the desired outcome.