Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment

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Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment

Falls are a major public health concern in the contemporary clinical setting. They often occur in the Intensive Care Unit and acute care units and have continuously increased the economic burden of the healthcare system. The increased mortality and morbidity rates as well as the rising needs and the cost of care of patients has been over the years associated with these falls and associated injuries (Linehan& Linehan, 2018). They result in long stays at the hospitals thus causing overcrowding, overburdening of the staff leading to burnout and nurse shortages often due to turnovers (Tricco et al., 2016). As such, there is a need for developing effective strategies to reduce and prevent the occurrence of these events within the healthcare settings. Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment.

Several interventions to reduce and prevent the occurrence of falls in the hospitals are available. These include policy changes, structural modifications, fall training and education programs, installation of bedside alarms and hourly rounding of staff (Fleig et al., 2016). This practice focused on hourly rounding of hospital staff which has been believed to present significant potential to resolving falls in the hospital since it facilitates early identification of risks and enhances prevention before the falls occur (Linehan& Linehan, 2018). The practice was carried out in inpatient adults urban acute care agency in Midwestern United States seeking to answer the question, ‘In elderly inpatient adults within an urban acute care agency in Midwestern United States, does hourly rounding of nursing staff protocol adoption as recommended by geriatric specific standard of care compared to the use of bedside alarms reduce the rate of falls in three months of implementation?’

The implementation of the hourly staff rounding protocol in the acute care setting expected to significantly reduce the rates of falls and also prevent them from occurring. However, according to a study I conducted in the facility, the use of this intervention presented insignificant impacts on the prevalence of falls within the acute care setting. This was contrary to the existing evidence-based literature available in the scholarly databases which emphasize on the use of this intervention.

Within the three months of study, at least three patients fell with two acquiring fatal injuries that increased their medical needs and prolonged their stay within the facility (Guirguis-Blake et al., 2018). The reason for their falling was attributed to the presence of slippery floors within the washrooms and bathrooms. This increased their risk of falling due to the spillage of water in the area while bathing and using the toilets. The hourly rounding of staff majored mainly on the inpatients within the wards and overlooked the other facilities frequented by the clients which posed high risks of falls. This therefore resulted to the difference observed in the outcomes of the application of the hourly rounding of staff intervention.

Another reason would be lack of patient engagement of patients in the implementation of the program. This discouraged them from notifying the rounding staff of their problems which could have helped mitigate the falls. Moreover, lack of adequate training of staff on risk identification could have resulted in the unexpected outcomes (Bassett, Siu & Honaker, 2018). Probably the staff did not understand the exact essence of rounding and hence were not able to focus on the high-risk areas. Lastly, disoriented staff could have neglected the possibility of falls occurring in the areas and expected the patients to take care of themselves.

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References

Bassett, A. M., Siu, K. C., & Honaker, J. A. (2018). Functional measures for fall risk in the acute care setting: a review. Western journal of nursing research, 40(10), 1469-1488.

Fleig, L., McAllister, M. M., Chen, P., Iverson, J., Milne, K., McKay, H. A., … & Ashe, M. C. (2016). Health behaviour change theory meets falls prevention: feasibility of a habit-based balance and strength exercise intervention for older adults. Psychology of Sport and Exercise, 22, 114-122.

Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., &Beil, T. L. (2018). Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. Jama, 319(16), 1705-1716. Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment.

Linehan, J., & Linehan, J. (2018). Fall Prevention in Long Term Care Using Purposeful Hourly Rounding. Journal of the American Medical Directors Association, 19(3), B17.

Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., … & Riva, J. J. (2017). Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. Jama, 318(17), 1687-1699.

Hospital Acquired infections are a major public health concern in the contemporary clinical setting. They often occur in the Intensive Care Unit and acute care units and have continuously increased the economic burden of the healthcare system. The increased mortality and morbidity rates as well as the rising needs and the cost of care of patients has been over the years associated with these infections (Boev & Kiss, 2017). Hospital acquired infections result in long stays at the hospitals thus causing overcrowding, overburdening of the staff leading to burnout and nurse shortages often due to turnovers (Phu et al., 2016). As such, there is a need for developing effective strategies to reduce and prevent the occurrence of these illnesses within the healthcare settings.

Several interventions to reduce the acquisition of infections in the hospitals are available. These include the use of chlorhexidine wipes antibacterial agents and hand washing with running water and soap. This practice focused on the use of chlorhexidine wipes antibacterial agents which are considered easy to use due to their convenient access and short application process compared to running water. Chlorhexidine are classified in the group of medicines known as antiseptic antibacterial agents particularly used before and after surgery, cleaning wounds or even before injections (Frost et al., 2016). Moreover, it cleans hands before procedures are undertaken in the healthcare facility. Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment. Antiseptic antibacterial agents prevent the growth of bacteria as well as kill the bacterial agents present on the skin (Musuuza et al., 2019). Some research suggests that they are also able to kill viruses.

The use of chlorhexidine antiseptic antibacterial agents in the intensive care unit is expected to significantly reduce the rates of hospital acquired infections. However, according to a study I conducted in the Township Healthcare Center, the use of these antibacterial agents presented insignificant impacts on the prevalence of infections acquired in the hospital. This was contrary to the existing evidence-based literature available in the scholarly databases which emphasize on the use of these agents.

The probable reasons behind this contradiction could be the lack of compliance of both the patients and the healthcare providers. This can be through ignorance or forgetfulness. The mode of preservation and storage of these antiseptics also contributes to their effectiveness. Therefore, poor storage of the chlorhexidine wipes could have contributed to their ineffectiveness. On the other hand, the quality issues of the antiseptic could have deteriorated or else the manufacturer could not have met the recommended standards. Another reason can be the resistant nature of microbial agents to these antibacterial agents (Boonyasiri et al., 2016). Most of the hospital surfaces are colonized by multidrug resistant microorganisms which cause the hospital acquired infections. Considering these and other possibilities, we can deduce that chlorhexidine antibacterial wipes are not as effective in the prevention of hospital acquired infections as depicted in the research literature.

References

Boev, C., & Kiss, E. (2017). Hospital-acquired infections: current trends and prevention. Critical Care Nursing Clinics, 29(1), 51-65.

Boonyasiri, A., Thaisiam, P., Permpikul, C., Judaeng, T., Suiwongsa, B., Apiradeewajeset, N., & Thamlikitkul, V. (2016). Effectiveness of chlorhexidine wipes for the prevention of multidrug resistant bacterial colonization and hospital-acquired infections in intensive care unit patients: a randomized trial in Thailand. infection control & hospital epidemiology, 37(3), 245-253.

Frost, S. A., Alogso, M. C., Metcalfe, L., Lynch, J. M., Hunt, L., Sanghavi, R., & Hillman, K. M. (2016). Chlorhexidine bathing and healthcare-associated infections among adult intensive care patients: a systematic review and meta-analysis. Critical Care, 20(1), 379. https://dx.doi.org/10.1186%2Fs13054-016-1553-5

Musuuza, J. S., Guru, P. K., O’Horo, J. C., Bongiorno, C. M., Korobkin, M. A., Gangnon, R. E., & Safdar, N. (2019). The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC infectious diseases, 19(1), 1-10.

Phu, V. D., Wertheim, H. F., Larsson, M., Nadjm, B., Dinh, Q. D., Nilsson, L. E., … & Tran, C. T. (2016). Burden of hospital acquired infections and antimicrobial use in Vietnamese adult intensive care units. PloS one, 11(1), e0147544. Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment.

Falls are considered to be a public healthcare concern across the world. In essence, fall risks increase with age and hospitalization and they result in injuries, illnesses, long hospital stays and increased treatment cos as well as morbidity and mortality. As such, falls are devastating to both clinicians and patients and the general healthcare system. This necessitates the development of an evidence-based intervention to help reduce and prevent falling particularly in the acute care settings where severe injuries, urgent medical conditions and surgical recoveries are actively treated. A gap in practice is evident from the increased number of fall rates in acute care setting. Hourly rounding of hospital staff presents significant potential to resolving falls in the hospital since it facilitates early identification of risks and enhances prevention before the falls occur(Linehan& Linehan, 2018).

Project question

In elderly inpatient adults within an urbanacute care agency in Midwestern United States, does hourly rounding of nursing staff protocol adoption as recommended by geriatric specific standard of care compared to the use of bedside alarms reducethe rate of falls in three months of implementation?

Salient elements

Behavior change theories are essential in the success of most evidence-based practices in nursing practice. They help in understanding why people practice or fail to practice health promoting behaviors, identify the needed information in designation of effective interventions as well as offer insights into designing a successful program(Tricco et al., 2016). In this case, the social learning / social cognitive behavior change theory is identified to inform the project question.

Social cognitive theory is associated with individual experiences, environmental factors and the actions of others and the impact on individual health behaviors. This theory was developed by Albert Bandura in 1960s as the social learning theory characterized by self-evaluation, self-observation, self-reaction and self-efficacy(Guirguis-Blake et al., 2018).This theory is informative to the practice in that it explains the importance of resources and support in raising self-efficacy in individual behaviors. It also notes that environmental changes encourage behavior change by providing opportunities, assisting changes, and offering social support(Tricco et al., 2017). It also helps to recognize the environmental constraints that might discourage changes in behavior. As such, this theory will support the organizational change and help the nurses to increase their self-efficacy levels in making the intervention a success(Bassett, Siu & Honaker, 2018). They will be able to develop positive attitudes towards hourly rounding and develop an intentional behavior focused on patient welfare.

Questions and concerns

The questions or concerns I may have related to project development include:

Will the hourly rounding of healthcare providers improve patient satisfaction?
What health or safety risks are associated with the intervention?
Does the intervention require an increased nursing staff level?
Does the nursing staff require education on how to conduct the hourly rounds? How effective will be the education and how will it be carried out if necessary? Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment.
What strategies should be put forward to enhance the active engagement and collaboration of patients and the nurses in the intervention to make it more purposeful?
What strategies will be developed to identify and recognize the concerns of both the nurses and the patients during the course of implementation of the hourly rounding intervention?

Conclusion

Falls are a major healthcare concern particularly due to the increasing aging population requiring acute care treatment. Hourly rounding of hospital staff is an effective intervention in reducing falls and the project seeks to employ behavior change theory to explore and adopt the change in acute care setting.

References

Bassett, A. M., Siu, K. C., & Honaker, J. A. (2018). Functional measures for fall risk in the acute care setting: a review. Western journal of nursing research, 40(10), 1469-1488.

Linehan, J., & Linehan, J. (2018). Fall Prevention in Long Term Care Using Purposeful Hourly Rounding. Journal of the American Medical Directors Association, 19(3), B17.

· Writing Tip of the Month: Run-On Sentences and Sentence Fragments

Run-on sentences and sentence fragments are often misunderstood, with some writers thinking of them simply as sentences that are too long or too short, respectively. Instead, these syntax errors result when necessary sentence components are missing or connected incorrectly, regardless of sentence length. Please take the time to review the rules for constructing a complete sentence to identify and avoid these types of errors.

· Add a cover page (no running head). include your name and the assignment title and include a Reference Page in APA format

· it is BEST to always have a brief introduction and conclusion/summary paragraph to round out the paper.

· Note: Up to 1 point may be deducted for grammar, spelling, and/or APA 7 errors.

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Assignment: Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment

In many of the courses in the DNP program, you have been asked to analyze research literature when exploring issues in health care. Reflect now on an issue in your practice area that has different outcomes from what is supported by the literature. For example, the literature evidence notes that nosocomial infections are reduced when procedures such as hand washing, glove use, and isolation strategies are implemented. In your clinical area, you have implemented these strategies and you are not seeing a reduction in nosocomial infections.

For Application 1, you select an issue that will serve as the launching point for your Evidence-Based Practice (EBP) Assignment.

Before you proceed with this assignment, you may wish to review the overview of the full EBP Assignment.

To prepare for Application 1:

Consider the specifics of your practicum setting, as well as practice-related challenges in your specialty area that interest you. Brainstorm practice issues in which an outcome is different from what would be expected according to the research literature.
Select one issue to focus on for this assignment. This will be your issue for the entire EBP Assignment, so be sure it is one that will enable you to fulfill the project requirements (e.g., you can develop new approaches to practice). You may wish to speak with your Practicum Mentor about your selection.
Explore the research literature on this issue. Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment.

To complete:

In a 1- to 2-page paper, address the following:

Provide a summary of the selected practice issue in which the outcome is different from what would be expected according to the research literature. (Note:The issue you select must be suitable for completing the entire EBP Assignment.)

Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project (6 points)

To students: In addition to the Learning Resources and facilitated discussions provided each week, you are expected to integrate articles from peer-reviewed journals to inform and support your positions and conclusions in the Application Assignments. Graduate-level scholarship provides the foundation for your work and requires a higher level of evidence than lay references, such as the dictionary, Wikipedia, general Internet sites, nursing newspapers, expert opinion, and the like.

In a 1- to 2-page paper, address the following:

Provide a summary of the selected practice issue in which the outcome is different from what would be expected according to the research literature. (Note: The issue you select must be suitable for completing the entire EBP Project.) (6 pts)

Note: Up to 2 points may be deducted for grammar, spelling, and/or APA errors. Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Assignment.