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Assignment: Evidence-Based Project

Assignment: Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change

reference page at least 4 not more 5 years ago)


Plagiarism free work…. Thank you

***Remember to follow the Grading Rubric and Instructions for this and all written assignments require APA formatting

Attached previous temples, that are related to this work, be guided by them to answer.

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

· Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.

· Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

· Consider the best method of disseminating the results of your presentation to an audience. 

The Assignment: (Evidence-Based Project)

Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

· Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

· Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

· Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

· Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.

· Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.

· Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

· Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

· Add a lessons learned section that includes the following:

· A summary of the critical appraisal of the peer-reviewed articles you previously submitted (MODULE 4 )

· An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

Rubric


Excellent

Good

Fair

Poor

Part 4: Disseminating Results

Create a, 8-9-slide narrated PowerPoint presentation of your Evidence-Based Project:

Briefly describe the following: your healthcare organization and culture, current opportunity for change, scope of issue, and EBP best practice recommendation.

Explain how you would plan knowledge transfer and dissemination.

Describe measurable outcomes with the implementation of EBP best practice.

Summarize lessons learned.

68 (68%) – 75 (75%)

The narrated presentation accurately and completely summarizes the evidence-based project. The narrated presentation is professional in nature and thoroughly addresses all components of the evidence-based project.

The narrated presentation accurately and clearly describes in detail the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation.

The narrated presentation accurately and clearly describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing specific and relevant examples.

The narrated presentation clearly and accurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned.

60 (60%) – 67 (67%)

The narrated presentation adequately summarizes the evidence-based project. The narrated presentation is professional in nature and adequately addresses the components of the evidence-based project.

The narrated presentation accurately describes in detail the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation.

The narrated presentation accurately describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing specific and relevant examples.

The narrated presentation accurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned.

53 (53%) – 59 (59%)

The narrated presentation vaguely, inaccurately, or incompletely summarizes the evidence-based project. The narrated presentation may be professional in nature and somewhat addresses the components of the evidence-based project.

The narrated presentation inaccurately or vaguely describes the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation.

The narrated presentation inaccurately or vaguely describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing specific and relevant examples.

The narrated presentation vaguely or inaccurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned.

0 (0%) – 52 (52%)

The narrated presentation vaguely and inaccurately summarizes the evidence-based project or is missing. The narrated presentation is not professional in nature and inaccurately and incompletely addresses the components of the evidence-based project or is missing.

The narrated presentation vaguely and inaccurately describes the healthcare organization and culture, current opportunity for change, scope of the issue, and EBP best practice recommendation, no examples are provided, or it is missing.

The narrated presentation vaguely and inaccurately describes how to plan for knowledge transfer, disseminate the results of the project to an audience, citing no specific and relevant examples.

The narrated presentation vaguely or inaccurately describes measurable outcomes with the implementation of the EBP best practice and summarizes lessons learned.

Resource Synthesis

5 (5%) – 5 (5%)

The narrated presentation fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation.

4 (4%) – 4 (4%)

The narrated presentation integrates at least one outside resource and two or three course-specific resources that may support the presentation.

3.5 (3.5%) – 3.5 (3.5%)

The narrated presentation minimally integrates resources that may support the presentation.

0 (0%) – 3 (3%)

The narrated presentation fails to integrate any or presents minimal resources to support the presentation.

Presentation Narration

10 (10%) – 10 (10%)

Narration is present.

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)

Narration is missing.

PowerPoint Presentation:

The presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.

5 (5%) – 5 (5%)

The presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.

4 (4%) – 4 (4%)

Eighty percent of the presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.

3 (3%) – 3 (3%)

Sixty to seventy nine percent of the presentation follows these guidelines: presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.

0 (0%) – 2 (2%)

Less than sixty percent of the presentation follows these guidelines: presentation is professional; images are appropriately attributed; images are clear. The presentation text is readable. Presentation flows well and is presented in a logical order.

Written Expression and Formatting—English Writing Standards:

Correct grammar, mechanics, and proper punctuation.

5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

Contains a few (one or two) grammar, spelling, and punctuation errors.

3 (3%) – 3 (3%)

Contains several (three or four) grammar, spelling, and punctuation errors.

0 (0%) – 2 (2%)

Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Assignment: Evidence-Based Project

image1.emf

Evaluation Table

Use this document to complete the
evaluation table
requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

Full APA formatted citation of selected article.

Article #1

Article #2

Article #3

Article #4

Akkoc, G., Soysal, A., Gul, F., Kepenekli Kadayifci, E., Arslantas, M., & Yakut, N. et al. (2021). Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system. The Journal Of Infection In Developing Countries15(12), 1923-1928. https://doi.org/10.3855/jidc.14156

Filbay, S. R., Judge, A., Delmestri, A., Arden, N. K., Altman, D., Beard, D., & Prieto-Alhambra, D. (2018). Evaluating patients’ expectations from a novel patient-centered perspective predicts knee arthroplasty outcome. The Journal of arthroplasty, 33(7), 2146-2152. https://doi.org/10.2106/JBJS.18.00695

Augustine, L., Brown, R., & McCollum, W. (2019). A Qualitative Case Study Exploring Hand-Hygiene Standards in an Intensive Care Unit. International Journal of Applied Management and Technology18(1), 126-141. https://doi.org/10.5590/IJAMT.2019.18.1.09

Kohring, J. M., Pelt, C. E., Anderson, M. B., Peters, C. L., & Gililland, J. M. (2018). Press Ganey outpatient medical practice survey scores do not correlate with patient-reported outcomes after primary joint arthroplasty. The Journal of Arthroplasty, 33(8), 2417-2422. https://doi.org/10.1016/j.arth.2018.03.044


Evidence Level *

(I, II, or III)



Level II

Level II

Level III

Level III

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

· There is no conceptual or theoretical framework mentioned in the study.

The conceptual framework that provided basis for this study is:

· Cohort Design

The conceptual framework that provided basis for this study is:

· Case Study Design

There is no conceptual or theoretical framework mentioned in the study

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

· Quasi-experimental

· Description of unit caregivers’ perception about hand hygiene compliance in an anesthesia and reanimation intensive care unit (ICU).

· Inclusion-All unit caregivers having direct contact with the patients (including physicians, nurses, transporters, and nurse of the specified unit).

· Exclusion-Any staff outside the unit and not in direct contact with the patient.

· Quasi-experimental

· Pre and post implementation

comparison of patient

satisfaction scores

· Inclusion – Patients within

specified unit undergoing uni-compartmental knee arthroplasty (UKA) or primary total knee arthroplasty (TKA)

· Exclusion – Patients undergoing hip procedures, revision TKA and patellofemoral procedures

· Non-experimental

· Description of the healthcare workers’ perception about hand hygiene compliance in ICU.

· Inclusion- Study limited to nurses, doctors, and patient care technicians in the specified unit (ICU).

· Exclusion-Anyone outside the unit and other healthcare workers (HCWs).

· Systematic Review

· Analyzing evidence from a combination of randomized trials (RCTs)

· Inclusion-Relevant RCTs on the topic within the specified years of publication

· Exclusion- Any RCT outside the topic and not within the specified publication period.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

Sampling- Purposeful Sampling

Setting: An anesthesia and reanimation ICU with 12 beds in the tertiary Marmara University Pendik Research and Training Hospital

Participants – 248 caregivers in direct contact with the patients in the specified unit.

Attrition rate -100% as all participants participated in direct observation and completed surveys.

Sampling-Systematic

Setting- Nuffield Orthopaedic Centre in Oxford/ 

orthopaedic department at Southampton University Hospital 

· Oxford, n=1441

· Southampton, n=330

Participants-1771 patients subjected to baseline evaluation. Includes both male and female, aged 18 years and above, and on the waiting list for knee or hip arthroplasty.

1044 patients subjected to UKA or primary TKA competed the one-year follow-up.

Attrition rate-74% as only 1044 out of the 1771 who underwent baseline appraisal completed the one-year follow-up.

N=1771, The baseline and one-year follow-up questionnaires collected

Sampling- Purposeful sampling

Setting- An ICU in a private university hospital in Washington, DC.

Participants-35 HCWs (15 nurses, 15 physicians, and 5 five patient care technicians within the ICU).

Attrition rates- 100% as all participants participated in direct observation and completed questionnaires.

Sampling-Random sampling

Setting-Orthopaedic hospital

Participants-540 patients who underwent primary total joint arthroplasty within the stipulated period.

Attrition rates-100% as all patients completed the survey.

N=540, complete surveys received from the unit.

Major Variables Studied

List and define dependent and independent variables

DV= Dependent

IV= Independent

DV: Healthcare-associated infections rates (HCAIs).

IV: Nursing to use an automated and electronic hand hygiene reminding and recording systems (EHHRRSs).

DV: Patient Satisfaction Scores

IV: Nursing to use baseline and Oxford Knee Score (OKS)

DV: HCWs perception scores

IV: Nursing to use standardized questionnaires report.

DV: Patient Satisfaction with experience Scores

IV: Nursing to use Standardized bedside report

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

· Statistical analysis included regression models to compare HCAIs rates.

· Descriptive Stats using EXCEL

· Patient demographics included age, sex, length of hospital stay, and causes of hospitalization including total percentages, numbers, ranges and medians.

· Statistical analysis included binary logistic regression to establish the relationships between preoperative expectations and one-year outcome.

· Descriptive stats using using Stata/IC 14.1

· Patient demographics include age and sex, including percentages and frequencies or standard deviations and means.

· Numerical rating scales measures HCWs perception using questionnaire questions with satisfaction queries.

· Statistical analyses included inductive content analysis to establish relationships between the main categories of HCWs perception scores.

· Descriptive Stats using NVivo 12 Plus.

· Patient demographics include age and sex, including either percentages and frequencies or standard deviations and means.

· Press Ganey measures patient satisfaction using a survey statements with satisfaction questions

· Statistical analysis included Spearman correlation coefficient (rs) to compare patient reported outcomes at provider and hospital levels patient care satisfaction survey questions.

· Patient Demographic included age and sex, including means and standard deviations.

Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

· Quantitative findings from EHHRRS interventions, and other factors made; as subgroup analyses were conducted. Patterns emerged and grouped into themes. Two themes developed from the research which was HCAIs rates and Caregiver behavior.

· Quantitative findings from interventions and significant factors made; as subgroup analyses were conducted. Patterns emerged and grouped into themes. Two themes developed from the research which was Patient Expectations and Patient Satisfaction.

· Qualitative findings from questionnaires and significant statements made; as transcripts were read and reread, data coded to sort/group/categorize data using NVivo 12 qualitative softwares. Patterns emerged and grouped into themes, two themes developed from the research which was Patient perception and Patient experience on the selected aspects of hand hygiene.

Qualitative findings from surveys and significant statements made; as transcripts were read and reread, data coded to sort/group/categorize data. Patterns emerged and grouped into themes, two themes developed from the research which was Patient Satisfaction and Patient Experience.

Findings and Recommendations

General findings and recommendations of the research

· Increased hand hygiene compliance rates from 49.1% to 89.2% following EHHRRS intervention.

· During the EHHRRS period, the rate of HCAIs was substantially lower when compared with the CHHO period (31.89% vs. 18.43%)

Recommendations

· Repeat similar study in other facilities with diverse patient populations.

· Further research into finding out other effective methods that may result in better HCAIs rates.

· Non-return to activity was predicted by patients’ expectation of moderate-to-extreme pain.

· Worse outcomes for patients with better preoperative pain-related to quality of life was predicted by patients’ expectation of mild pain.

· Worse outcomes for patients with worse preoperative pain-related quality of life were predicted by the patient’s expectations of moderate-to-extreme pain.

· There were higher odds of a poor outcome in people with worse expectations in UKA patients.

Recommendations

· Repeat similar study in other facilities with diverse patient populations.

· Further research into finding out other factors that may affect knee-arthroplasty expectations and surgical outcomes.

· HCWs believe that leadership must hold HCWs accountable to motivate peers to practice hand hygiene.

· Direct observation is the best practice to monitor hand hygiene.

· HCWs ability to practice hand hygiene by broken or empty foam dispensers.

· Technology can positively impact infection rates by reducing them, and may increase compliance.

Recommendations

· Repeat similar study in other facilities with diverse patient populations.

· Further research into finding how proficient and engaged nursing staff, and the kind of leadership vital in achieving quality and safety outcomes towards realizing proper hand hygiene.

· At all time points evaluated, there was little correlation between the Press Ganey Scores and PROs (all, rs: −0.13 to 0.14).

· Separate evaluation of knee and hip arthroplasty cases indicated same results (all, rs: −0.33 to 0.18).

Recommendations

· Repeat similar study in other facilities with diverse patient populations.

· Further research into finding out other factors that may affect patient satisfaction should be completed.


Appraisal and Study Quality

I. Describe the general worth of this research to practice.

II. What are the strengths and limitations of study?

III. What are the risks associated with implementation of the suggested practices or processes detailed in the research?

IV. What is the feasibility of use in your practice?

Adds to the support for a change in practice in HCAIs reduction in hospital units, and the importance of hand hygiene training and reminder systems.

Strengths

· The study uses an observational approach, including nurses and physicians using electronic reminders for hand hygiene. It is a key strength of the qualitative methodology to ensure that the approach is recorded to examine how reminders can improve hygiene practices.

· A large sample size (n=249), which is generalizable.

Limitations

· The study was conducted in a short duration, hence, may not have sufficiently recorded compliance to hand hygiene practices.

Risks

· Healthcare workers not compliant with wearing the tracking device badge.

Feasibility

· My practice area is also surveyed by a tracking system similar to the EHHRRSs.

· The study would be introduced and maintained in my practice due to the significant number of nurses in the unit.

Adds to the support for a change of practice in knee-arthroplasty care and management.

Strengths

· Large sample size, which is generalizable.

· The data was self-reported from the patient participants, hence reliable source of data to healthcare professionals.

Limitations

· Potential of biased responses from patients, which could limit the credibility of the research results.

Risks

Less clinical improvement resulting in unmanaged expected worse outcomes among patients.

Feasibility

· The study would be introduced and maintained in my practice due to the significant number of nurses in the unit.

· The Oxford Knee Score minimal important change (OKS <MIC) is related to the assessment instruments used to survey my area of practice.

Adds to the support for a change in practice in hand hygiene.

Strengths

· Use of well-structured questionnaires specific to HCWs’ perception and experience.

· The transcripts were transcribed in verbatim from the recordings, hence reliable sources of data of healthcare professionals.

Limitations

· Small sample size, n=35, which is not generalizable

Risks

· Nurses not compliant with adhering to hand hygiene protocols.

Feasibility

· My current practice area is also surveyed by HCAHPS scores, which is similar to the measures used .

· This study would be easily introduced and maintained in my practice due to the significant number of nurses in the unit.

Adds to the support for a change in practice in primary joint arthroplasty care and management.

Strengths

· Use of a large sample size, which is generalizable to the general population.

· The Press Ganey Outpatient Medical Practice Survey included questions specific to patient satisfaction and experience.

Limitations

· Study completed on one unit, not generalizable.

Risks

· Nurses not compliant with using The Press Ganey Outpatient Medical Practice Survey.

Feasibility

· My current practice area is also surveyed by Press Ganey and HCAHPS scores

· The study would be introduced and maintained in my practice due to the significant number of nurses in the unit.

Key findings



· Increase in rates of hand hygiene compliance from 49.1% to 89.2% following EHHRRS intervention.

· During the EHHRRS period, the rate of HCAIs was substantially lower than the CHHO period (31.89% vs. 18.43%).

· Less clinical improvement, surgical dissatisfaction, and non-return to most wanted action predicted the patient’s expectation of a worse outcome.

· Better surgical outcomes were achieved in patients expecting a more optimistic outcome relative to preoperative status.

.

· HCWs ability to practice hand hygiene by broken or empty foam dispensers

· The kind of leadership determines HCWs adherence to hand hygiene.

· Assessment at all time points shows that the PROs and the Press Ganey Scores are less correlated.

· Patients’ satisfaction, care experience, and individual perception of physical function had little correlation.

Outcomes



The findings are significant; hence implementation of future research was suggested in the entire organization

The findings are significant; hence implementation of future research was suggested in the entire organization.

The findings are significant; hence implementation of future research was suggested in the entire organization.

The findings are insignificant; hence the data presented raises the question regarding these scores’ value as proxy measures of quality in healthcare.

General Notes/Comments

This paper focuses on hand hygiene in intensive care units (ICUs). Hand washing is a key practice in preventing the spread of hospital-acquired infections in healthcare facilities. Based on this article, quality healthcare begins with simple actions such as hand hygiene. The study established that healthcare providers’ willingness and compliance impacted the EHHRRSs hand-hygiene intervention. Promoting reminders would be significant in increasing hand hygiene compliance. It is crucial to involve nurses and physicians in using reminders for compliance in order to limit the number of hospital-acquired illnesses. Healthcare workers should wash their hands frequently, especially in patients’ rooms based on the Centers for Disease and Prevention Control (CDC) recommendation.

According to the author’s conclusion, less clinical improvement, surgical dissatisfaction, and non-return to most wanted activity results in patients’ anticipating worse outcomes following knee-re arthroplasty. Moreover, better surgical outcomes are achieved when patients expect a more optimistic outcome. Evidence shows that applying a patient-centered perspective to evaluate patients’ expectations for knee arthroplasty results in positive patient-reported outcomes. Healthcare facilities should ensure more clinical improvement for patients undergoing knee arthroplasty to promote patient satisfaction and return to desired activity.

Putting these factors in place will promote patients’ expectations of more optimistic outcomes when undergoing knee arthroplasty.

Hand hygiene in the ICUs is a major theme of this paper. It is a critical component when it comes to preventing the spread of illnesses in healthcare facilities. The CDC recommends that healthcare workers wash their hands frequently, especially in patients’ rooms. Healthcare organizations should adopt best practices and technologies that enhance HCWs’ compliance to hand hygiene. Having the right leadership that holds the HCWs accountable motivates them to practice hand hygiene.

According to this article, patients’ satisfaction, their care experience, and perception of physical function is less correlated among patients undergoing primary joint arthroplasty. Patients report low satisfaction levels and poor experience primarily linked to poor outpatient clinical encounters.

Healthcare organizations should identify ways to promote better outpatient clinical encounters to ensure patients are highly satisfied with the care they receive. They should identify more reliable patient delivery of care satisfaction surveys as effective instruments to evaluate the quality of care at both provider and organizational levels. Promoting better outpatient encounters and utilizing reliable assessment tools is crucial in measuring the quality of care given to patients undergoing primary joint arthroplasty.

Part 3B: Critical Appraisal of Research

One of the best practices that emerge from the research I reviewed is hand hygiene compliance to reduce healthcare-associated infections (HCAIs). The articles by Akkoc et al. (2021) and Augustine et al. (2019) demonstrate the importance of complying with the facility’s hand hygiene practices among healthcare providers as best practice to reduce hospital acquired infections such as CAUTI infections and CLABSI infections. The article by Akkoc et al. (2021) is significant as it highlights why hand hygiene is still an issue in clinical setting. It has effectively incorporated modern technology into clinical practice to significantly improve health care facilities’ hand hygiene compliance practices. Particularly it underpins how the utilization of electronic hand hygiene and recording for reminder purposes to improve hand hygiene practices. The article presents significant findings that further elaborate on the importance of regularly engaging healthcare providers in hygiene practices as a foremost strategy to reduce most of the hospital acquired infections significantly. I also find these findings significant as they demonstrate the importance of regular hygiene training and educational programs to increase organizational awareness of hand hygiene. Thus, it is necessary for health facilities to adopt hand hygiene training and reminder systems to reduce HCAIs and the costs associated with acquiring additional infections and longer hospital stays. The article by Augustine et al. (2019) is significant as it presents significant findings that emphasize the significant role of increased instruction in hygiene practices. It suggests to healthcare facilities to make hand-washing a regular habit among healthcare providers and other staff in the facility to attain proper hand hygiene. It proposes the installation of hand washing points and hand sanitizers in healthcare institutions towards improving patient compliance (Augustine et al., 2019). Overall, these articles express the need for hospitals to have well-regulated infection control and hand hygiene systems. It should be a responsibility of every healthcare provider to maintain proper hygiene within the healthcare facility. Therefore, hospitals should adopt best practices for hand hygiene such as electronic reminders, increased instruction in hygiene practices, regular hand-washing and other practices that will enhance hand hygiene compliance within healthcare facilities. This move will help in reducing the spread of infections within healthcare organizations and guarantee patient safety.

References

Akkoc, G., Soysal, A., Gul, F., Kepenekli Kadayifci, E., Arslantas, M., & Yakut, N. et al. (2021). Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system. The Journal Of Infection In Developing Countries15(12), 1923-1928. https://doi.org/10.3855/jidc.14156

Augustine, L., Brown, R., & McCollum, W. (2019). A Qualitative Case Study Exploring Hand-Hygiene Standards in an Intensive Care Unit. International Journal of Applied Management and Technology18(1), 126-141. https://doi.org/10.5590/IJAMT.2019.18.1.09

Filbay, S. R., Judge, A., Delmestri, A., Arden, N. K., Altman, D., Beard, D., … & Prieto-Alhambra, D. (2018). Evaluating patients’ expectations from a novel patient-centered perspective predicts knee arthroplasty outcome. The Journal of Arthroplasty, 33(7), 2146-2152. https://doi.org/10.2106/JBJS.18.00695

Kohring, J. M., Pelt, C. E., Anderson, M. B., Peters, C. L., & Gililland, J. M. (2018). Press Ganey outpatient medical practice survey scores do not correlate with patient-reported outcomes after primary joint arthroplasty. The Journal of Arthroplasty, 33(8), 2417-2422. https://doi.org/10.1016/j.arth.2018.03.044

Critical Appraisal Tool Worksheet Template

© 2021 Walden University, LLC

4

Assignment: Evidence-Based Project

image1.emf

Evaluation Table

Use this document to complete the
evaluation table
requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

Full APA formatted citation of selected article.

Article #1

Article #2

Article #3

Article #4

Akkoc, G., Soysal, A., Gul, F., Kepenekli Kadayifci, E., Arslantas, M., & Yakut, N. et al. (2021). Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system. The Journal Of Infection In Developing Countries15(12), 1923-1928. https://doi.org/10.3855/jidc.14156

Filbay, S. R., Judge, A., Delmestri, A., Arden, N. K., Altman, D., Beard, D., & Prieto-Alhambra, D. (2018). Evaluating patients’ expectations from a novel patient-centered perspective predicts knee arthroplasty outcome. The Journal of arthroplasty, 33(7), 2146-2152. https://doi.org/10.2106/JBJS.18.00695

Augustine, L., Brown, R., & McCollum, W. (2019). A Qualitative Case Study Exploring Hand-Hygiene Standards in an Intensive Care Unit. International Journal of Applied Management and Technology18(1), 126-141. https://doi.org/10.5590/IJAMT.2019.18.1.09

Kohring, J. M., Pelt, C. E., Anderson, M. B., Peters, C. L., & Gililland, J. M. (2018). Press Ganey outpatient medical practice survey scores do not correlate with patient-reported outcomes after primary joint arthroplasty. The Journal of Arthroplasty, 33(8), 2417-2422. https://doi.org/10.1016/j.arth.2018.03.044


Evidence Level *

(I, II, or III)



Level II

Level II

Level III

Level III

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

· There is no conceptual or theoretical framework mentioned in the study.

The conceptual framework that provided basis for this study is:

· Cohort Design

The conceptual framework that provided basis for this study is:

· Case Study Design

There is no conceptual or theoretical framework mentioned in the study

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

· Quasi-experimental

· Description of unit caregivers’ perception about hand hygiene compliance in an anesthesia and reanimation intensive care unit (ICU).

· Inclusion-All unit caregivers having direct contact with the patients (including physicians, nurses, transporters, and nurse of the specified unit).

· Exclusion-Any staff outside the unit and not in direct contact with the patient.

· Quasi-experimental

· Pre and post implementation

comparison of patient

satisfaction scores

· Inclusion – Patients within

specified unit undergoing uni-compartmental knee arthroplasty (UKA) or primary total knee arthroplasty (TKA)

· Exclusion – Patients undergoing hip procedures, revision TKA and patellofemoral procedures

· Non-experimental

· Description of the healthcare workers’ perception about hand hygiene compliance in ICU.

· Inclusion- Study limited to nurses, doctors, and patient care technicians in the specified unit (ICU).

· Exclusion-Anyone outside the unit and other healthcare workers (HCWs).

· Systematic Review

· Analyzing evidence from a combination of randomized trials (RCTs)

· Inclusion-Relevant RCTs on the topic within the specified years of publication

· Exclusion- Any RCT outside the topic and not within the specified publication period.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

Sampling- Purposeful Sampling

Setting: An anesthesia and reanimation ICU with 12 beds in the tertiary Marmara University Pendik Research and Training Hospital

Participants – 248 caregivers in direct contact with the patients in the specified unit.

Attrition rate -100% as all participants participated in direct observation and completed surveys.

Sampling-Systematic

Setting- Nuffield Orthopaedic Centre in Oxford/ 

orthopaedic department at Southampton University Hospital 

· Oxford, n=1441

· Southampton, n=330

Participants-1771 patients subjected to baseline evaluation. Includes both male and female, aged 18 years and above, and on the waiting list for knee or hip arthroplasty.

1044 patients subjected to UKA or primary TKA competed the one-year follow-up.

Attrition rate-74% as only 1044 out of the 1771 who underwent baseline appraisal completed the one-year follow-up.

N=1771, The baseline and one-year follow-up questionnaires collected

Sampling- Purposeful sampling

Setting- An ICU in a private university hospital in Washington, DC.

Participants-35 HCWs (15 nurses, 15 physicians, and 5 five patient care technicians within the ICU).

Attrition rates- 100% as all participants participated in direct observation and completed questionnaires.

Sampling-Random sampling

Setting-Orthopaedic hospital

Participants-540 patients who underwent primary total joint arthroplasty within the stipulated period.

Attrition rates-100% as all patients completed the survey.

N=540, complete surveys received from the unit.

Major Variables Studied

List and define dependent and independent variables

DV= Dependent

IV= Independent

DV: Healthcare-associated infections rates (HCAIs).

IV: Nursing to use an automated and electronic hand hygiene reminding and recording systems (EHHRRSs).

DV: Patient Satisfaction Scores

IV: Nursing to use baseline and Oxford Knee Score (OKS)

DV: HCWs perception scores

IV: Nursing to use standardized questionnaires report.

DV: Patient Satisfaction with experience Scores

IV: Nursing to use Standardized bedside report

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

· Statistical analysis included regression models to compare HCAIs rates.

· Descriptive Stats using EXCEL

· Patient demographics included age, sex, length of hospital stay, and causes of hospitalization including total percentages, numbers, ranges and medians.

· Statistical analysis included binary logistic regression to establish the relationships between preoperative expectations and one-year outcome.

· Descriptive stats using using Stata/IC 14.1

· Patient demographics include age and sex, including percentages and frequencies or standard deviations and means.

· Numerical rating scales measures HCWs perception using questionnaire questions with satisfaction queries.

· Statistical analyses included inductive content analysis to establish relationships between the main categories of HCWs perception scores.

· Descriptive Stats using NVivo 12 Plus.

· Patient demographics include age and sex, including either percentages and frequencies or standard deviations and means.

· Press Ganey measures patient satisfaction using a survey statements with satisfaction questions

· Statistical analysis included Spearman correlation coefficient (rs) to compare patient reported outcomes at provider and hospital levels patient care satisfaction survey questions.

· Patient Demographic included age and sex, including means and standard deviations.

Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

· Quantitative findings from EHHRRS interventions, and other factors made; as subgroup analyses were conducted. Patterns emerged and grouped into themes. Two themes developed from the research which was HCAIs rates and Caregiver behavior.

· Quantitative findings from interventions and significant factors made; as subgroup analyses were conducted. Patterns emerged and grouped into themes. Two themes developed from the research which was Patient Expectations and Patient Satisfaction.

· Qualitative findings from questionnaires and significant statements made; as transcripts were read and reread, data coded to sort/group/categorize data using NVivo 12 qualitative softwares. Patterns emerged and grouped into themes, two themes developed from the research which was Patient perception and Patient experience on the selected aspects of hand hygiene.

Qualitative findings from surveys and significant statements made; as transcripts were read and reread, data coded to sort/group/categorize data. Patterns emerged and grouped into themes, two themes developed from the research which was Patient Satisfaction and Patient Experience.

Findings and Recommendations

General findings and recommendations of the research

· Increased hand hygiene compliance rates from 49.1% to 89.2% following EHHRRS intervention.

· During the EHHRRS period, the rate of HCAIs was substantially lower when compared with the CHHO period (31.89% vs. 18.43%)

Recommendations

· Repeat similar study in other facilities with diverse patient populations.

· Further research into finding out other effective methods that may result in better HCAIs rates.

· Non-return to activity was predicted by patients’ expectation of moderate-to-extreme pain.

· Worse outcomes for patients with better preoperative pain-related to quality of life was predicted by patients’ expectation of mild pain.

· Worse outcomes for patients with worse preoperative pain-related quality of life were predicted by the patient’s expectations of moderate-to-extreme pain.

· There were higher odds of a poor outcome in people with worse expectations in UKA patients.

Recommendations

· Repeat similar study in other facilities with diverse patient populations.

· Further research into finding out other factors that may affect knee-arthroplasty expectations and surgical outcomes.

· HCWs believe that leadership must hold HCWs accountable to motivate peers to practice hand hygiene.

· Direct observation is the best practice to monitor hand hygiene.

· HCWs ability to practice hand hygiene by broken or empty foam dispensers.

· Technology can positively impact infection rates by reducing them, and may increase compliance.

Recommendations

· Repeat similar study in other facilities with diverse patient populations.

· Further research into finding how proficient and engaged nursing staff, and the kind of leadership vital in achieving quality and safety outcomes towards realizing proper hand hygiene.

· At all time points evaluated, there was little correlation between the Press Ganey Scores and PROs (all, rs: −0.13 to 0.14).

· Separate evaluation of knee and hip arthroplasty cases indicated same results (all, rs: −0.33 to 0.18).

Recommendations

· Repeat similar study in other facilities with diverse patient populations.

· Further research into finding out other factors that may affect patient satisfaction should be completed.


Appraisal and Study Quality

I. Describe the general worth of this research to practice.

II. What are the strengths and limitations of study?

III. What are the risks associated with implementation of the suggested practices or processes detailed in the research?

IV. What is the feasibility of use in your practice?

Adds to the support for a change in practice in HCAIs reduction in hospital units, and the importance of hand hygiene training and reminder systems.

Strengths

· The study uses an observational approach, including nurses and physicians using electronic reminders for hand hygiene. It is a key strength of the qualitative methodology to ensure that the approach is recorded to examine how reminders can improve hygiene practices.

· A large sample size (n=249), which is generalizable.

Limitations

· The study was conducted in a short duration, hence, may not have sufficiently recorded compliance to hand hygiene practices.

Risks

· Healthcare workers not compliant with wearing the tracking device badge.

Feasibility

· My practice area is also surveyed by a tracking system similar to the EHHRRSs.

· The study would be introduced and maintained in my practice due to the significant number of nurses in the unit.

Adds to the support for a change of practice in knee-arthroplasty care and management.

Strengths

· Large sample size, which is generalizable.

· The data was self-reported from the patient participants, hence reliable source of data to healthcare professionals.

Limitations

· Potential of biased responses from patients, which could limit the credibility of the research results.

Risks

Less clinical improvement resulting in unmanaged expected worse outcomes among patients.

Feasibility

· The study would be introduced and maintained in my practice due to the significant number of nurses in the unit.

· The Oxford Knee Score minimal important change (OKS <MIC) is related to the assessment instruments used to survey my area of practice.

Adds to the support for a change in practice in hand hygiene.

Strengths

· Use of well-structured questionnaires specific to HCWs’ perception and experience.

· The transcripts were transcribed in verbatim from the recordings, hence reliable sources of data of healthcare professionals.

Limitations

· Small sample size, n=35, which is not generalizable

Risks

· Nurses not compliant with adhering to hand hygiene protocols.

Feasibility

· My current practice area is also surveyed by HCAHPS scores, which is similar to the measures used .

· This study would be easily introduced and maintained in my practice due to the significant number of nurses in the unit.

Adds to the support for a change in practice in primary joint arthroplasty care and management.

Strengths

· Use of a large sample size, which is generalizable to the general population.

· The Press Ganey Outpatient Medical Practice Survey included questions specific to patient satisfaction and experience.

Limitations

· Study completed on one unit, not generalizable.

Risks

· Nurses not compliant with using The Press Ganey Outpatient Medical Practice Survey.

Feasibility

· My current practice area is also surveyed by Press Ganey and HCAHPS scores

· The study would be introduced and maintained in my practice due to the significant number of nurses in the unit.

Key findings



· Increase in rates of hand hygiene compliance from 49.1% to 89.2% following EHHRRS intervention.

· During the EHHRRS period, the rate of HCAIs was substantially lower than the CHHO period (31.89% vs. 18.43%).

· Less clinical improvement, surgical dissatisfaction, and non-return to most wanted action predicted the patient’s expectation of a worse outcome.

· Better surgical outcomes were achieved in patients expecting a more optimistic outcome relative to preoperative status.

.

· HCWs ability to practice hand hygiene by broken or empty foam dispensers

· The kind of leadership determines HCWs adherence to hand hygiene.

· Assessment at all time points shows that the PROs and the Press Ganey Scores are less correlated.

· Patients’ satisfaction, care experience, and individual perception of physical function had little correlation.

Outcomes



The findings are significant; hence implementation of future research was suggested in the entire organization

The findings are significant; hence implementation of future research was suggested in the entire organization.

The findings are significant; hence implementation of future research was suggested in the entire organization.

The findings are insignificant; hence the data presented raises the question regarding these scores’ value as proxy measures of quality in healthcare.

General Notes/Comments

This paper focuses on hand hygiene in intensive care units (ICUs). Hand washing is a key practice in preventing the spread of hospital-acquired infections in healthcare facilities. Based on this article, quality healthcare begins with simple actions such as hand hygiene. The study established that healthcare providers’ willingness and compliance impacted the EHHRRSs hand-hygiene intervention. Promoting reminders would be significant in increasing hand hygiene compliance. It is crucial to involve nurses and physicians in using reminders for compliance in order to limit the number of hospital-acquired illnesses. Healthcare workers should wash their hands frequently, especially in patients’ rooms based on the Centers for Disease and Prevention Control (CDC) recommendation.

According to the author’s conclusion, less clinical improvement, surgical dissatisfaction, and non-return to most wanted activity results in patients’ anticipating worse outcomes following knee-re arthroplasty. Moreover, better surgical outcomes are achieved when patients expect a more optimistic outcome. Evidence shows that applying a patient-centered perspective to evaluate patients’ expectations for knee arthroplasty results in positive patient-reported outcomes. Healthcare facilities should ensure more clinical improvement for patients undergoing knee arthroplasty to promote patient satisfaction and return to desired activity.

Putting these factors in place will promote patients’ expectations of more optimistic outcomes when undergoing knee arthroplasty.

Hand hygiene in the ICUs is a major theme of this paper. It is a critical component when it comes to preventing the spread of illnesses in healthcare facilities. The CDC recommends that healthcare workers wash their hands frequently, especially in patients’ rooms. Healthcare organizations should adopt best practices and technologies that enhance HCWs’ compliance to hand hygiene. Having the right leadership that holds the HCWs accountable motivates them to practice hand hygiene.

According to this article, patients’ satisfaction, their care experience, and perception of physical function is less correlated among patients undergoing primary joint arthroplasty. Patients report low satisfaction levels and poor experience primarily linked to poor outpatient clinical encounters.

Healthcare organizations should identify ways to promote better outpatient clinical encounters to ensure patients are highly satisfied with the care they receive. They should identify more reliable patient delivery of care satisfaction surveys as effective instruments to evaluate the quality of care at both provider and organizational levels. Promoting better outpatient encounters and utilizing reliable assessment tools is crucial in measuring the quality of care given to patients undergoing primary joint arthroplasty.

Part 3B: Critical Appraisal of Research

One of the best practices that emerge from the research I reviewed is hand hygiene compliance to reduce healthcare-associated infections (HCAIs). The articles by Akkoc et al. (2021) and Augustine et al. (2019) demonstrate the importance of complying with the facility’s hand hygiene practices among healthcare providers as best practice to reduce hospital acquired infections such as CAUTI infections and CLABSI infections. The article by Akkoc et al. (2021) is significant as it highlights why hand hygiene is still an issue in clinical setting. It has effectively incorporated modern technology into clinical practice to significantly improve health care facilities’ hand hygiene compliance practices. Particularly it underpins how the utilization of electronic hand hygiene and recording for reminder purposes to improve hand hygiene practices. The article presents significant findings that further elaborate on the importance of regularly engaging healthcare providers in hygiene practices as a foremost strategy to reduce most of the hospital acquired infections significantly. I also find these findings significant as they demonstrate the importance of regular hygiene training and educational programs to increase organizational awareness of hand hygiene. Thus, it is necessary for health facilities to adopt hand hygiene training and reminder systems to reduce HCAIs and the costs associated with acquiring additional infections and longer hospital stays. The article by Augustine et al. (2019) is significant as it presents significant findings that emphasize the significant role of increased instruction in hygiene practices. It suggests to healthcare facilities to make hand-washing a regular habit among healthcare providers and other staff in the facility to attain proper hand hygiene. It proposes the installation of hand washing points and hand sanitizers in healthcare institutions towards improving patient compliance (Augustine et al., 2019). Overall, these articles express the need for hospitals to have well-regulated infection control and hand hygiene systems. It should be a responsibility of every healthcare provider to maintain proper hygiene within the healthcare facility. Therefore, hospitals should adopt best practices for hand hygiene such as electronic reminders, increased instruction in hygiene practices, regular hand-washing and other practices that will enhance hand hygiene compliance within healthcare facilities. This move will help in reducing the spread of infections within healthcare organizations and guarantee patient safety.

References

Akkoc, G., Soysal, A., Gul, F., Kepenekli Kadayifci, E., Arslantas, M., & Yakut, N. et al. (2021). Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system. The Journal Of Infection In Developing Countries15(12), 1923-1928. https://doi.org/10.3855/jidc.14156

Augustine, L., Brown, R., & McCollum, W. (2019). A Qualitative Case Study Exploring Hand-Hygiene Standards in an Intensive Care Unit. International Journal of Applied Management and Technology18(1), 126-141. https://doi.org/10.5590/IJAMT.2019.18.1.09

Filbay, S. R., Judge, A., Delmestri, A., Arden, N. K., Altman, D., Beard, D., … & Prieto-Alhambra, D. (2018). Evaluating patients’ expectations from a novel patient-centered perspective predicts knee arthroplasty outcome. The Journal of Arthroplasty, 33(7), 2146-2152. https://doi.org/10.2106/JBJS.18.00695

Kohring, J. M., Pelt, C. E., Anderson, M. B., Peters, C. L., & Gililland, J. M. (2018). Press Ganey outpatient medical practice survey scores do not correlate with patient-reported outcomes after primary joint arthroplasty. The Journal of Arthroplasty, 33(8), 2417-2422. https://doi.org/10.1016/j.arth.2018.03.044

Critical Appraisal Tool Worksheet Template

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