NURS 6052 EBP week 3 assignment – Clinical Inquiry & Research Methodologies

Assignment: Evidence-Based Project
Is there a difference between “common practice” and “best practice”?
When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.
Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.
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Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?
In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.
To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest.
Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: An Introduction to Clinical Inquiry
Create a 4- to 5-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.
Describe how you used keywords to search on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four peer-reviewed articles you selected.

Part 2: Identifying Research Methodologies
After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

The full citation of each peer-reviewed article in APA format.
A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

References
Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. American Journal of Critical Care, 27(4), 334–337. https://doi-org.ezp.waldenulibrary.org/10.4037/ajcc2018727
Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitising in infection control. British Journal of Nursing, 27(7), 382–388. https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2018.27.7.382
Lim, K., Kilpatrick, C., Storr, J., & Seale, H. (2018). Exploring the use of entertainment-education YouTube videos focused on infection prevention and control. American Journal of Infection Control, 46(11), 1218–1223. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ajic.2018.05.002
Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., … Cruickshank, M. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. Lancet Infectious Diseases, 18(11), 1269–1277. https://doi-org.ezp.waldenulibrary.org/10.1016/S1473-3099(18)30491-2
Loftus, R. W., Dexter, F., & Robinson, A. D. M. (2018). High-risk Staphylococcus aureus transmission in the operating room: A call for widespread improvements in perioperative hand hygiene and patient decolonization practices. American Journal of Infection Control, 46(10), 1134–1141. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ajic.2018.04.211
 
Part 1: An Introduction to Clinical Inquiry
Evidence-Based Practice
Theory
Student’s Name
Institution Of Affiliation
Course Name
Date
Introduction
üThe integration of EBP in nursing practice has helped to promote patient safety and health outcomes
üEBP supports clinical decision making with evidence
üIt is the most preferred  approach to  managing patient and clinical outcomes
üWhen correctly applied in every stage, both patients and healthcare providers understand a condition
üEBP integrates a patient’s preferences, values and beliefs with the best available scientific evidence and clinician’s expertise in decision making.
Evidence-based practice is an intense process which integrates a patient’s preferences, clinical expertise and scientific evidence in clinical decision making when providing care. It has greatly contributed to improvements in patient’s safety and health outcomes based on scientific and clinical evidence. Its use in nursing practice has also improved the understanding of both patients and healthcare providers on specific conditions. This EBP project aims at comparing the effectiveness of various disinfection procedures used in infection control in heathcare settings.
 
Clinical Issue
üHospital Acquired Infections are a major issue of public health concern in the US and across the globe
üApproximately 2million HAIs and up to 100,000 associated deaths happen annually in the US
üPoor hand hygiene during patient care is the major cause of HAIs
üPreventing against HAIs requires improvement in hand hygiene practices
Hospital Acquired Infections are a major public health concern in the United States and across the globe. Their occurrence has been associated with poor hand hygiene practices in routine patient care. According to the statistics provided by the World Health Organization, up to 100, 000 deaths and 2 million cases every year are associated with HAIs. However, majority of these cases can be prevented through hand hygiene practices. This calls for the implementation of better infection control strategies and education to the public, healthcare providers and everyone at high risk of infection.
 
Search Methodology
üThe articles were searched for in online scientific databases
ü The search keywords were: infection control, hand hygiene, hand washing, alcohol-based hand rub and hospital acquired infection
üThe search included articles published within the last 5 years,
üGeneral search yielded  twelve  articles but only five met the inclusion criteria
Extensive searches in online scientific databases of CINAHL, PubMed, Medline and EBSCOHost. The searched used keywords such as infection control, hand hygiene, hand washing, alcohol-based hand rub and hospital acquired infection (HAI).  Although thousands of results were found, an inclusion criterion was used to narrow down the search. Therefore, only articles published within the last five years were included and articles that were specific to the use of alcohol-based hand rub and hand washing.
 
Research Databases
üAn online search was conducted in the databases of CINAHL, PubMed, EBSCOHost and Medline
üMedline was freely accessible over the internet and the use of Medical Subject Headings promoted retrieval of data
üThe EBSCOHost database promoted the ability to access internal and external information from a single search box
üPubMed was easy to use since it automatically translated an initial search using Boolean operators to search results
üCINAHL was fast and provided broad content to full-text top nursing journals
An online electronic search was done in the following scientific databases: CINAHL, PubMed, EBSCOHost and Medline.  Medline could easily be accessed over the internet and its procedure to use Medical Subject Headings promoted fast retrieval of data. EBSCOHost database enhanced easier access to internal and external information from a single search box.  PubMed was easy to use as it automatically translated an initial search using Boolean operators to search results. The CINAHL database was also was fast but somewhat challenging to work with although it provided top broad content and full-text nursing journals. NURS 6052 wk 3 assignment Matrix Worksheet Template
 
References
üGrayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., … & National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. The Lancet Infectious Diseases, 18(11), 1269-1277.
üHalm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs vs Handwashing. American Journal of Critical Care, 27(4), 334-337.
üLoftus, R. W., Dexter, F., & Robinson, A. D. (2018). High-risk Staphylococcus aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. American journal of infection control, 46(10), 1134-1141 NURS 6052 wk 3 assignment Matrix Worksheet Template.
ü
References
üLim, K., Kilpatrick, C., Storr, J., & Seale, H. (2018). Exploring the use of entertainment-education YouTube videos focused on infection prevention and control. American journal of infection control, 46(11), 1218-1223.
üMunoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitising in infection control. British Journal of Nursing, 27(7), 382-388.
 
Part 2: Identifying Research Methodologies – Analysis
Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M.,  & National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. The Lancet Infectious Diseases, 18(11), 1269-1277.
Relation To The Clinical Issue
This article similarly highlights how Healthcare-Associated infections hinder patient safety, increases mortality and morbidity rates prolong hospital stays and increases medical costs. The researchers further acknowledge compliance of hand hygiene among healthcare providers as a significant strategy to maintain patient safety especially with regards to methicillin-resistant staphylococcus Aureus. However, very few national programs have been sustained and integrated successfully into the national-health structure. Based on the results of the NHHI (National Hand Hygiene Initiative), hand hygiene reduces the risks of healthcare-associated infections which continue to be a major public health concern. NURS 6052 wk 3 assignment Matrix Worksheet Template
Aim of the Study

The study aimed at evaluating the outcomes of the NHHI including its effect on the incidences of healthcare-associated Staphylococcus Aureus and hand hygiene compliance. This study aim was influenced by the background knowledge that a healthcare provider’s compliance with hand hygiene is a significant national strategy for patient safety.
Research Methodology
This was a quantitative longitudinal study where the outcomes of the NHHI eight years after implementation were assessed. The assessment included the extent of hand hygiene guidelines compliance and the hospital’s participation, costs, and association with healthcare-associated Staphylococcus Aureus and educational engagement.
Strengths of Research Methodologies
Wide population data were used to evaluate the clinical impact of NHHI, specific, statistical analysis was done comparisons of proportions (χ² or t-test), with a p-value of 0·05 or less (two-tailed) which was considered to be statistically significant and increased the accuracy of results. Besides, hand hygiene and compliance data were assessed for errors and consistency using a standard process for review and validation. To maximize the validity and accuracy of data, two systems were established including representative hospital samples and the poorly performing sites. NURS 6052 wk 3 assignment Matrix Worksheet Template
Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitizing in infection control. British Journal of Nursing, 27(7), 382-388.
Relation To The Clinical Issue
The article addresses a similar clinical issue by acknowledging Healthcare-Associated Infections as a public health concern for the health sector across the globe according to NICE. Some of the commonly identified infections include surgical, respiratory and urinary tract infections. This calls for the implementation of better strategies to control infections including education, reinforcing knowledge to the public, healthcare providers and individuals at high risk of infections in all areas of nursing practice.
Aim of the Study

The study aimed at evaluating the effectiveness of alcohol-based gel for hand rubs in controlling infections in the clinical setting. The article was specific to renal nursing following a growth in the focus of evidence-based practice.
Research Methodology
The EBP process for clinical decision making was reviewed for effective literature on the effectiveness of alcohol-based gel and the results published recently concerning the findings of the best model.
Strengths of Research Methodologies
The review utilizes the steps of EBP and numerous articles relevant to the review purpose are used to justify the information shared.
General Comment
When compared to approaches that use detergents and disinfectants that can result in pathogen dissemination, alcohol when adequately used is even more effective. Therefore, hand rubs should be at every patient’s bedside, ward entrance and hospital for use after, before and when performing all activities related to care
Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs vs Handwashing. American Journal of Critical Care, 27(4), 334-337.
Relation To The Clinical Issue
The researchers refer to the guidelines by the CDC and WHO which have been driven hand hygiene practices for more than ten years. According to these guidelines, when hands are deeply soiled with body fluids or blood or after visiting the toilet with suspected Clostridium difficile pathogens, the most preferred way to manage and control infections is through Handwashing with soap and water. However, for all other clinical scenarios, the researchers recommend that routine hand hygiene should be maintained with alcohol-based hand rubs. This discussion on infection prevention perfectly resonates with my clinical issue to be addressed.
Aim of the Study

According to the researchers, frequent Handwashing is a major cause of contact dermatitis thus rarely preferred by healthcare providers in clinical settings as a way of managing and controlling infections.  On the other hand, alcohol-based hand rubs are notably effective in bacterial reduction and causes less skin irritation. These perceptions greatly influence the degree of staff compliance to hand hygiene guidelines which ultimately impacts the rates of HAIs. Therefore, the study aimed to determine the impact of ABHRs supplemented by the use of creams and lotions on health outcomes.
Research Methodology
The study was a systematic review of literature that used qualitative methods approach.  The researchers searched the databases of MEDLINE and CINAHL using the keywords ABHR, contact dermatitis, dermatitis, and Handwashing. This search was limited to articles that had been published within the last 10 years. Only original articles were considered NURS 6052 wk 3 assignment Matrix Worksheet Template. The findings were presented in the form of tables to show outcomes and comparisons.
Strengths of Research Methodologies
The comprehensive literature search that was conducted was within the limit of 10 years. This aimed at ensuring that the findings could still be applied to current clinical practice and were in line with the recommended practice guidelines. Besides, the researchers used the following keywords to conduct the literature search: hand hygiene, ABHR, hand washing, dermatitis, and contact dermatitis. This ensured that only studies that were relevant to the clinical issue were addressed.
General Comments
To promote the use of ABHRs and lessen the occurrence of contact dermatitis, nurses should be taught that Handwashing after and before using ABHRs removes emollients and sebum layers thus increasing the risk of contact dermatitis
Loftus, R. W., Dexter, F., & Robinson, A. D. (2018). High-risk Staphylococcus aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. American journal of infection control, 46(10), 1134-1141.
Relation To The Clinical Issue
The article discusses how an increase in the awareness and epidemiology of pathogen transmission can help to expand compliance with intraoperative infection control measures. This was specific to the risk of transmitting Staphylococcus Aureus during operations which are associated with high transmission rates, antibiotic resistance, and virulence. It was also attributed to a significant growth pathogen spread within acute care settings to healthy community dwellers in community settings. The researchers further discuss evidence-based solutions that can be used to address this issue to improve patient safety.
Aim of the Study

The researchers acknowledged Healthcare-Associated Infections to be an overwhelming issue related to antibiotics resistance. It is for this reason that healthcare providers have been urged to ensure compliance with some of the most basic prevention measures to prevent the unnecessary use of antibiotics and prevent infections. The study was specific to reducing the incidence of surgical site infections through the preoperative decolonization of staph Aureus through improvement measures in novel hand hygiene. Therefore, the study aimed to characterize the epidemiology of sequence types  of  Staphylococcus Aureus in the operating environment.
Research Methodology
The study used quantitative research methods where Staphylococcus Aureus species that were isolated and collected from three medical centers underwent biofilm absorbance, genome analysis, and API (analytical profile indexing). 274 case pairs were randomly selected using a computer-generated list from a total of three medical centers in the US.  178 species of Staphylococcus Aureus were isolated. Of these, 173 were associated with the possibility of transmissions. The researchers also conducted an assessment on the virulent, antibiotic-resistant and hyper transmissible and strains of staphylococcus Aureus.  Statistical analyses using X2 tests and Poisson regression with variances were used for statistical analyses.
Strengths of Research Methodologies
The researchers used randomization of study participants and a large study sample which increased chances of applicability of the results to wide-population settings. Besides, randomization helped to establish a cause and effect relationship between the variables that were being studied. The researchers also used conceptual frameworks to list the possible courses of action regarding the concept that was an understudy. When conducting the statistical analyses, χ2 tests were used in examining the possible associations of covariates previously mentioned variates about transmission.
General Comments
Intraoperative strains of Staphylococcus Aureus are pathogenic and hyper-transmissible. To control their spread, compliance with hand hygiene and patient decolonization are essential.
References
Grayson, M. L., Stewardson, A. J., Russo, P. L., Ryan, K. E., Olsen, K. L., Havers, S. M., … & National Hand Hygiene Initiative. (2018). Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. The Lancet Infectious Diseases, 18(11), 1269-1277. NURS 6052 wk 3 assignment Matrix Worksheet Template
Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs vs Handwashing. American Journal of Critical Care, 27(4), 334-337.
Loftus, R. W., Dexter, F., & Robinson, A. D. (2018). High-risk Staphylococcus aureus transmission in the operating room: a call for widespread improvements in perioperative hand hygiene and patient decolonization practices. American journal of infection control, 46(10), 1134-1141.
Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitizing in infection control. British Journal of Nursing, 27(7), 382-388. NURS 6052 wk 3 assignment Matrix Worksheet Template
 

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