Consider the population in which the solution is intended, the staff that will participate, and the key contributors that must provide approval and/or support for your project to be implemented. These stakeholders are considered your audience.
Develop an implementation plan (1,500-2,000 words). The elements that should be included in your plan are listed below:
1. Method of obtaining necessary approval(s) and securing support from your organization's leadership and fellow staff.
2. Description of current problem, issue, or deficit requiring a change. Hint: If you are proposing a change in current policy, process, or procedure(s) when delivering patient care, describe first the current policy, process, or procedure as a baseline for comparison.
3. Detailed explanation of proposed solution (new policy, process, procedure, or education to address the problem/deficit).
4. Rationale for selecting proposed solution.
5. Evidence from your review of literature in Module 2 to support your proposed solution and reason for change.
6. Description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)
7. Resources required for implementation: Staff; Educational Materials (pamphlets, handouts, posters, and PowerPoint presentations); Assessment Tools (questionnaires, surveys, pre- and post-tests to assess knowledge of participants at baseline and after intervention); Technology (technology or software needs); Funds (cost of educating staff, printing or producing educational materials, gathering and analyzing data before, during, and following implementation), and staff to initiate, oversee, and evaluate change.
Developing an Implementation Plan
? Explains method(s) of obtaining necessary approval(s) and securing support for proposal.
? Provides thorough description of current problem, issue, or deficit requiring change.
? Provides detailed explanation of proposed solution.
? Discusses rationale for selecting proposed solution.
? Incorporates evidence from review of literature in Module 2 to support proposed solution.
? Provides a detailed description of implementation logistics.
? Identifies resources required for implementation (Staff, education materials, assessment tools, technology, funds, etc.).
POPULATION is Healthcare workers and patients, SOLUTION is Hand-hygiene
. LITERATURE review module 2
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Hand Washing Articles Review
1. Caglar S; Yildiz S; Savaser S. (2010). Observation results of hand-washing by health-care workers in a neonatal intensive care unit. International Journal of Nursing Practice, 16(2), 132-137.
In this article the authors wanted to determine whether healthcare professionals were washing their hands and if they were doing so effectively. The researchers observed 344 incidents in which hand washing was warranted and found that nurses were 63% compliant and physicians were 53% compliant. However, when it came to making sure that the job was done thoroughly, physicians were able to do a better job than nurses at a 24% to 13% rate of success. Since hand washing has been proven to be the most effective and simplest method for preventing infection, it is imperative that healthcare professionals perform it as often as needed and thoroughly.
2. Ramos. M. M., Schrader, R., Trujillo, R., Blea, M., & Greenberg, C. (2011). School nurse inspections improve hand-washing supplies. Journal of School Health, 81(6), 355-358.
The research was conducted to determine whether reporting inadequate hand washing supplies to the New Mexico Department of Health (NMDOH) alone or both to the NMDOH and the school was the most effective method for ensuring the supplies were more readily available. The researchers used a random number of schools which were of roughly the same student population and split the schools into equal sized control and test groups. The researchers at both types of locations checked whether the schools had adequate hand washing supplies and reported it either to just the NMDOH (control) or the NMDOH and the school. It was discovered that when the lack of supplies was conveyed to the school they were more likely to be filled quickly. Nurses recognize the importance of hand washing supply availability because of the prevalence of infectious disease spread, especially at schools.
3. Akyol, A. D. (2007). Hand hygiene
among nurses in Turkey: opinions and practices. Journal of Clinical Nursing, 16(3), 431-437
This study looked at nurses in Turkey specifically and whether they had the education, supplies and ability to adequately wash their hands after patient care. A questionnaire was used to determine the education of 129 participants at 2 different facilities. It was found that the nurses showed an inadequate level of comprehension regarding the need to wash their hands and how to conduct a proper hand washing procedure. The researchers determined that more education is needed as to skin conditions and the ability to wash hands had to be available at all times. It is important for nurses to speak up when the workload is too demanding for them to provide basic patient care such as hand washing.
4. Hussein, R., Khakoo, R., & Hobbs, G. (2007). Hand hygiene
practices in adult versus pediatric intensive care units at a university hospital before and after intervention. Scandinavian Journal of Infectious Diseases, 39(6-7), 566-570
This article looked at the difference between the hand washing technique and frequency in adult versus pediatric ICUs and tested healthcare workers knowledge of using alcohol hand sanitizer versus traditional hand washing. It was found that adult ICU nurses were far less likely to wash their hands than those in pediatric ICUs (35% versus 90%). A training was conducted after which the adult ICUs were tested again and it was found that proper hand washing technique had increased to a large degree. Nurses, especially those that work in areas where infection is a greater danger, need to understand the efficacy of simple hand washing and how to do it properly.
5. Gould, D. & Drey, N. (2009). Preventing the spread of acute respiratory viral infections. Nursing Standard, 24(5), 44-49
This article is a meta-study which examines the research done with regard to hand washing technique and how it lessens the likelihood of the spread of respiratory illnesses. The study looked at the techniques that have been practiced since the 1970?s to determine how methods have changed and whether the incidence of the spread of infectious disease has lessened with better education for nurses. They found that although the incidence had gone down, it was not sufficient as of yet. Nurses need to understand not only the importance of hand washing, but they also need to know the proper techniques and how different methods of disinfection can be used.
6. Wilson, S., Jacob, C. J., & Powell, D. (2011). Behavior-change interventions to improve hand-hygiene
practice: a review of alternatives to education. Critical Public Health, 21(1), 119-127
This paper is a literature review rather than a study in which the authors hope to determine other methods of increasing hand washing compliance numbers among nurses. Because methods such as education and training had been tried numerous times with little result, the researchers looked at behavioral methods that could be used to increase compliance. They found that although peer pressure and other techniques have shown some success it is more likely that the in-born behavior of the individual will have to be changed. Nurses need to have a desire to personally have clean hands or they will not comply completely.
7. Hart, S. (2007). Using an aseptic technique to reduce the risk of infection... art & science clinical skills. Nursing Standard, 21(47), 43-48
This article deals with the question of healthcare-associated infection and how it can be prevented. The researchers found that there was a belief among healthcare workers that aseptic techniques were commonly used in the operating room, but were not called for during a patients stay in the wards. However, the researchers found that the high degree of sepsis (45% to 70% depending on the study) was generally from hospital care. Hand washing technique alone was not enough, so nurses also need to know how to use aseptic procedure when dealing with fluids and procedures that are more invasive and infection-prone for patients.
8. Warren, E. (2008). ENT in primary care: part 3: Upper respiratory tract infection. Practice Nurse, 35(8), 38-39
This article was a look at the literature with regard to the effectiveness of hand washing techniques as they applied to the decreased incidence of upper respiratory infections. The researchers found that many studies had indicated that the use of proper hand washing technique was able to deter such infections. The issue was that many of the nurses surveyed did not have a good grasp of what constituted proper hand washing technique. Because of this deficiency, it was shown that upper respiratory infections were increasing in some areas. The researchers argued for better education and for different protocols which could be used to ensure better compliance.
9. Groothuis J., Bauman, J., Malinoski, F., & Eggleston, M. (2008). Strategies for prevention of RSV nosocomial infection. Journal of Perinatology, 28(5), 319-323
This study looked at the literature regarding techniques to prevent respiratory syncytial virus (RSV) as a cause of nosocomial infection specifically in NICUs. The researchers discovered that many techniques, from improved usage of medications to improved diagnosis, had been used and that few showed a significant drop in the incidence of the disease. The best course was found in early detection and then proper hand washing techniques with ?cohorting? of patients and staff was the best suggestion. Nurses need to understand the full efficacy of proper hand washing procedures. It may seem to be an unnecessary bother at times, but as this study shows, it can be the most important weapon nurses and other healthcare workers have at their disposal.
10. Newnham, D. (2009). Outside in. Nursing Standard, 23(21), 26-27.
This article discusses how nurses can better comply with hand washing standards if they use non-water hand washing aids to supplement the times when water is not available. The author?s short discussion revealed that the majority of nurses did not realize the effectiveness of alcohol-based non-water hand washing liquids and that they could adequately protect from infection if the proper technique was used. He also discussed the fact that alcohol-based hand washing stations needed to be more commonplace in all hospitals. It is important for nurses to understand that they can adequately disinfect their hands if they use these methods.
11. Newnham, D. (2008). Outside in. Nursing Standard, 23(8): 24-25.
Sepsis is a major problem for hospitals and it has been for a number of years. The author looks at how sepsis has been treated through the years and how management has changed recently. He looks at new research which reaffirms that the use of proper hand washing techniques is the best way to prevent these types of infections, and that nurses are receiving better training all of the time regarding prevention. The author admits some reluctance to follow trends, but allows that when treating sepsis he has to use the best information available. Right now the best aseptic method is to wash hands properly and use other aseptic methods of care.
12. Staff. (2009). Hand-washing campaign to include all hospital staff. Nursing Standard, 23(30), 11.
The article was more of an announcement than an actual research article, but it did reiterate the importance of hand washing as a major deterrent in preventing secondary infections. The article looked at one agency that had a high than average level of infections happening to its patients, and the administrators were trying to determine how they could end the problem. One of the interventions that they started was to re-educate the entire nursing staff as to proper hand washing technique. The article stated that the ?campaign? was organized to reiterate the importance of the activity, and to make sure that all personnel were aware of this.
13. Oliveira, A. C., & Lucas, T. C. (2008). Adoption of measures of the precaution in the teaching care practice by health care workers team: Perceptions and limitations. Online Brazilian Journal of Nursing, 7(3): 1.
This study was designed to determine how well healthcare workers in a Brazilian public hospital were trained in the use of infectious disease controls. The study looked at all techniques of training (traditional, behavioral, etc.), to see if any was more successful than the other. One hundred fifty nine healthcare workers were involved in the study which involved survey knowledge of training methods for infection control. Only 38% of workers knew about the training and just over half of them had participated in it. Also, more than 90% of the participants knew of the effectiveness of hand washing in preventing infection spread, but only 46% knew proper technique and fewer still used that technique. The implication for nurses is that training has to be used in order to be effective.
14. Snow, T. (2008). Weighing of soap dispenser bags sees staff hand-washing rates soar. Nursing Standard, 22(40), 11.
Researchers are trying different techniques to increase the incidence of compliance with hand washing guidelines and in this study they used social pressure. Initially, compliance with hand washing regulations was deemed to be significantly below expected standard within the nursing staff. To hopefully combat this, researchers told the staff that they were going to weigh the soap dispenser bags to see if people were actually using them or not. The object of the study was to determine if this type of pressure would induce the staff into better compliance with hand washing regulations. The researchers found that this type of behavioral technique is very effective.
15. Parish, C. (2008). Patient campaigner calls for TV cameras to check hand-washing. Nursing Standard, 22(38), 6.
The author of the article looked at the compliance records of staff and whether patients and visitors used infection controls. The campaigner, Roger Goss, said that because MRSA and other similar healthcare-acquired infections were becoming more dangerous that staff and visitors needed to be monitored more closely to prevent spread. The man advocated that close-circuit televisions be used to determine compliance with regulations, and he encouraged staff to be fired and visitors not welcomed if they did not comply. The warning here to nurses is that people are watching whether they wash their hands properly, and they are ready to have them terminated if they do not.
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