Today, more than ever before, the nursing profession is faced by many challenges that require to be effectively addressed to ensure patient safety and facilitate optimal care delivery in healthcare settings. While it is true that some of these challenges require concerted efforts across a multiplicity of stakeholders to solve, others can be solved using evidence-based practices and research documented in the expansive nursing literature (Hayes, 2006). In this light, the main purpose of this section of the paper is to identify a problem that can be changed by nursing professionals and demonstrate how to search for the literature on the issue in existing databases.
Step 1 Identify the Problem
The issue of hand washing has continued to attract widespread attention among researchers, health care practitioners and nursing students, with available literature demonstrating that compliance with hand washing is positively linked to a reduction of healthcare-associated infections (HCAI) and other positive outcomes within healthcare settings (Beggs, Shepherd, & Kerr, 2008; Upshaw-Owens & Bailey, 2012).
But despite this critical importance, several studies and systematic reviews conducted on hand washing have concluded that non-compliance is a widespread problem in most healthcare institutions (Randle, Firth, & Vaughan, 2012). This chilling discovery raises the question of what needs to be done to increase the number of health professionals, patients and visitors complying with hand washing regulations, as such an initiative would substantially reduce HCAIs and associated treatment costs (Cherry, Brown, Bethell, Neal, & Shaw, 2012). In this light, the purpose of this paper is to use relevant literature to demonstrate how the issue of non-compliance with hand washing can be solved within the realms of nursing practice.
Step 2 Identify a Potential Solution
A number of studies (e.g., Garus-Pakowska, Sobala, & Szatko, 2013) have shown that health practitioners and patients fail to comply with hand washing and hand hygiene as they are yet to internalize the behaviors. A literature review conducted by Ott and French (2009) shows that improving compliance to hand washing can be achieved through the employment of various interventions, such as “education-based techniques to teach hand hygiene practices (posters, in-services, and videos), as well as reminders and performance feedback interventions” ( p. 702).
Owing to the fact that educational interventions are a regularly employed and core technique of disseminating knowledge within healthcare (Cherry et al, 2012), a potential solution for the identified problem would be to design informational posters and place them at strategic locations within the hospital setting to reinforce hand washing behavior.
Step 3 Creating your Research Question
How can informational posters be used within professional settings to ensure more healthcare practitioners comply with hand washing practices?
Step 4 Select Key PICOT Terms for Searching the Evidence
|Focus of the Question||The focuses is on identifying components that could be included in the informational posters to ensure more compliance with hand washing practices among nurses|
|P = Patient(s) or Problem||“Low compliance with hand washing among nursing professionals”|
|I = Interventions under consideration|| |
|C = Comparison||None/missing|
|O = Outcome|| |
|T = Time||Six months|
Question 1 Three Databases Used
The three databases used to search for relevant articles to address the key research question include CINAHL, Health Source (Nursing/Academic edition), and Cochrane. These databases have been selected due to their reputation of having relevant, evidence-based clinical and educational articles on hand washing. The subject heading used to perform the search is “compliance with hand washing among nurses.”
Question 2 Focusing or Expanding the Search
This has been done by
- using “OR” and “AND” Boolean operators,
- adding one or more concepts to the search,
- combining some of the previous searches into a new one in databases with a “Search History” feature, and
- using controlled vocabulary terms.
Question 3 Ways to Refine Search
One can use Boolean operators (AND, OR, and NOT) to refine the general results and ensure the electronic database is able to give results that are more relevant to the topic of interest, in this case “hand washing.” It is also possible to create a targeted search using the EBSCO subject headings, special modifiers, and the Boolean operators. The limiters that have been used to search for the six scholarly articles include English language limiter, publication year limiters (from 2008 to 2014), and peer-reviewed/journal article limiter.
Literature Review Worksheet
This section aims to find relevant literature that can support the intervention of introducing informational posters to enhance compliance with hand washing among nurses.
The search question is “what components can be included in informational posters to enhance compliance with hand washing among nurses?”
|APA Reference for Article||Peer Reviewed||Brief Description of Research||Type of Research||Study Outcomes/ Recommendations|
|1||Randle, J., Firth, J., & Vaughan, N. (2012). An observational study of hand hygiene compliance in pediatric wards. Journal of Clinical Nursing, 22(17/18), 2586-2592.||Yes||“Study evaluates compliance with hand hygiene”||Quantitative||There is low hand hygiene compliance among visitors in spite of hand washing being perceived as an influential and cost-effective way to reduce HCAIs|
|2||Cherry, M.G., Brown, J.M., Bethell, G.S., Neal, T., & Shaw, N.J. (2012). Features of educational interventions that lead to compliance with hand hygiene in health care professionals within a hospital case setting: A BEME Systematic review: BEME Guide No. 22. Medical Teacher, 34(6), e406-e420.||Yes||Study details major components that can be included in an educational program intended to positively influence hand washing practices.||Systematic Review of Literature||Reminders, incentives, checklists, surveillance and feedback can be used in designing informational posters with the view to raising compliance with hand washing practices|
|3||Beggs, C.B., Shepherd, S.J., & Kerr, K.G. (2008). Increasing the frequency of hand washing by health care workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward. BMC Infectious Diseases, 8(1), 1-11.||Yes||Study shows why health care professionals need to comply with hand washing practices to deal with HCAIs||Quantitative||Although hand hygiene is an effective control measure of HCAIs, ward management, colonized admissions, and environmental contamination are equally important.|
|4||Upshaw-Owens, M., & Bailey, C.A. (2012). Preventing hospital-associated infection: MRSA. MEDSURG Nursing, 21(2), 77-81.||Yes||Study demonstrates importance of hand washing and contact isolation in reducing the transmission and prevalence of MRSA in practice settings.||General Review||Study’s evaluation of MRSA can be used in informational posters to reinforce importance of hand washing.|
|5||Garus-Pakowska, A., Sobala, W., & Szatko, F. (2013). Observance of hand washing procedures performed by the medical personnel after the patient contact: Part II. International Journal of Occupational Medicine & Environmental Health, 26(2), 257-264.||Yes||Study evaluates the compliance demonstrated by healthcare professionals in terms of cleaning or disinfecting hands upon coming into contact with patients.||Quantitative||Study details the activities that oblige hand washing in practice settings|
|6||Ott, M., & French, R. (2009). Hand hygiene compliance among health care staff and student nurses in a mental health setting. Issues in Mental Health Nursing, 30(11), 702-704.||Yes||Study reviews literature on various components that could be used to motivate and change hand washing practices and behaviors among healthcare professionals.||Systematic review of literature||Components included in the recommendations (e.g. reminders, posters, in-services) can be incorporated into proposed intervention.|
Beggs, C.B., Shepherd, S.J., & Kerr, K.G. (2008). Increasing the frequency of hand washing by health care workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward. BMC Infectious Diseases, 8(1), 1-11.
Cherry, M.G., Brown, J.M., Bethell, G.S., Neal, T., & Shaw, N.J. (2012). Features of educational interventions that lead to compliance with hand hygiene in health care professionals within a hospital case setting: A BEME Systematic review: BEME guide no. 22. Medical Teacher, 34(6), e406-e420.
Garus-Pakowska, A., Sobala, W., & Szatko, F. (2013). Observance of hand washing procedures performed by the medical personnel after the patient contact: Part II. International Journal of Occupational Medicine & Environmental Health, 26(2), 257-264.
Hayes, E. (2006). Promoting nurse practitioner practice through research: Opportunities, challenges, and lessons. Journal of the American Academy of Nurse Practitioners, 18(4), 180-186.
Ott, M., & French, R. (2009). Hand hygiene compliance among health care staff and student nurses in a mental health setting. Issues in Mental Health Nursing, 30(11), 702-704.
Randle, J., Firth, J., & Vaughan, N. (2012). An observational study of hand hygiene compliance in pediatric wards. Journal of Clinical Nursing, 22(17/18), 2586-2592.
Upshaw-Owens, M., & Bailey, C.A. (2012). Preventing hospital-associated infection: MRSA. MEDSURG Nursing, 21(2), 77-81.