Answer

Reducing Nosocomial Infections

Hospital-acquired infection also referred to as nosocomial infection, is a grave issue that poses a big challenge to nursing care given the ability of the bacteria that cause such infections to resist some antibiotics (Saavedra, Ordóñez, Díaz, 2015). The gravity of the issue is posited by the high mortality rate resulting from nosocomial infections. According to the Centers for Disease Control and Prevention (CDC), nosocomial infections contribute to ninety thousand deaths annually (Saavedra, Ordóñez, Díaz, 2015). Besides, the economic impact is a grave concern as it increases the health care treatment cost and burdens the healthcare system with a cost to the tune of over five billion dollars annually. Notably, the prevalence of hospital-acquired infection is attributed to poor hygiene compliance augmented by the lack of proper education on the importance of hand hygiene (Saavedra, Ordóñez, Díaz, 2015).

Research question

Can hand hygiene compliance help reduce nosocomial infection?

The qualitative research method

To address the above research question, this document considers ethnography as the best qualitative research method that can be used to study the trend of nosocomial infection prevalence and its impact on the public (Allbutt, Masters, 2010). Ethnography refers to the study of people and culture (Allbutt, Masters, 2010). It would best address the research question by exploring the cultural phenomenon associated with the prevalence of nosocomial infections through observations of the conduct of the society as regards hand hygiene compliance (Allbutt, Masters, 2010).

Anticipated issues during the research  

The research project is anticipated to demand huge resources for its running and implementation. Thus, issues of funding is an anticipated constraint if the research project is to be conducted. Besides, it would be challenging to determine the safe distance to keep between the researcher and the community under observation (Allbutt, Masters, 2010). The project would also demand massive human resource and technological backing to enhance digital transmission, storage and analysis of data through computer gadgets and laptops. These anticipated issues revolve around funding of the project and human resource. I intend to handle these issues by seeking financial support from relevant research financing bodies and the institution’s financial department and, in cooperating colleagues to provide the much needed human resource. The issue about safe distance shall be handled by getting into the system of the community and behaving like them to promote acceptance and cooperation from members (Allbutt, Masters, 2010).

Strength and weakness of ethnographic methodology 

The biggest strength of this methodology is its ability to explore a complex cultural phenomenon (Allbutt, Masters, 2010). However, this method posit a limitation of lack of interest in individuals’ hand hygiene compliance and subjective observations and responses (Allbutt, Masters, 2010), but only focused on the community as a whole.

An alternative method of study

The grounded theory posits an alternative methodology that can be used to address the research question. The grounded theory involves theory construction through data analysis (Whiting, Vickers, 2010). Notably, the research project will involve analysis of data generated from the impact and prevalence of nosocomial infections. This analysis will be critical in the coding of data and grouping them into concepts and categories that may form the basis for a new theory (Whiting, Vickers, 2010). Thus, grounded theory is an alternative methodology towards the research question.

1 B:

Personal Health Records

Personal health record refers to a record maintained by the patient, detailing the data and information about the medical care of the patient (Reti, Feldman, Ross, Safran, 2010). It is a critical tool in patient management as it provides a complete and accurate summary of the medical history of the patient that can be accessed online.

Benefits

The personal health records are beneficial to patients in a number of ways; they enable patients to access a wealth of health knowledge, best medical practices and health information sources (Schneider, 2010). For instance, these records enable patients to who encounter medical conditions to access their health information with a click of the button. Besides, these records are critical in identifying health threats to an individual through the analysis of the individual’s health profile hence promoting improvement opportunities based on analyzed drug interaction, identified gaps in medical care plans and identified medical errors (Schneider, 2010). For instance, patient illness can be tracked, and early intervention promoted in cases of health status deviation.

Challenges  

Despite the advantages of the personal health records, there are some challenges with this approach. The most prominent challenge is the low pace of adoption of this approach hence the sites selected for evaluation have a very little functionality to the general public (Schneider, 2010). Notably, the low adoption is attributed to limitations of these applications’ data entry, data validation and the methods used to display the information (Schneider, 2010).

Selected personal health patient portal

FollowMyHealth: Retrieved from http://followmyhealth.jardogs.com/  on 22/1/16

This patient portal posit systems and methods of the dispensation of medication through electronic precipitations, subject to prior authorization and adherence to a formulary that is pre-established.

Influence of PHR on health care delivery

The personal health record can positively influence my professional practice and promote patient health outcomes by enabling me to provide more continuous data and make better and informed treatment decisions (Wagner, Howard, Bentley, Seol, Sodomka, 2010). Besides, it enables me to care more for the patient through continuous communication as opposed to episodic. Consequently, these records are crucial for positive patient health outcome to be realized (Wagner, Howard, Bentley, Seol, Sodomka, 2010).

My position

I wish to support mandating personal health records because electronically engaging patients about their health is at the core of Meaningful Use Stage 2. It involve the patients in their own care and grant them the opportunity to become proactive in their health management. Hence, the health care providers get geared towards achieving Meaningful Use and enhance patient outcomes. FollowMyHealth as a patient portal posit reliable features that might motivate individuals towards maintaining personal health records. These features include; secure messaging, Quality Management System for the eligible provider and Automated Numerator Recording. However, the limitations of its applications’ data entry, data validation and the methods used to display the information are some of the factors that can deter individuals from signing up for these services.

2 A: Qualitative Research in Nursing Practice

Qualitative research is a study that focused on a comprehensive understanding of and seeks to explore the meaning of life experiences while Quantitative research is a study that involves scientific approach in investigating rapports among a given set of variables that relate to the phenomenon. It involves data collection and thorough statistical data analysis (Smith, Firth, 2011).

Quantitative research is more rigorous than qualitative research given its scientific angle of inclination and the thoroughness of statistical data analysis involved. However, it’s of no value to make such comparisons and generalization since every research method is relevant in a given context based on the objective of the research.

An article of qualitative research study

• Brunetti, L., Santoro, E., De Caro, F., Cavallo, P., Boccia, A., Capunzo, M., & Motta, O. (2015). Surveillance of nosocomial infections: a preliminary study on hand hygiene compliance of healthcare workers. Journal of preventive medicine and hygiene, 47(2).

Research question

Does hand hygiene compliant individuals report lower cases of nosocomial infections than the non-compliant individuals?

The researcher of this study performed a less thorough study by focusing only on the hand hygiene on health care workers and ignoring the statistical data of patients who acquired the nosocomial infections. To improve the vigor, the researcher should have considered both the patients statistical data and the contributing culture of the health care workers.

My view on qualitative and quantitative research methods

In my view, the qualitative research is more rigorous than the qualitative research due to its scientific approach to investigating rapports among a given set of variables that relate to the phenomenon and its involvement in thorough data collection and thorough statistical data analysis. This is unlike the qualitative research that is merely focused on a comprehensive understanding and exploration of the meaning of life experiences. 

Summary of the research article

This article describes a qualitative research study that confirms that nosocomial infection is a challenge in hospitals. It further asserts that hand washing can significantly reduce these infections. The statistical data indicates that the baseline rate of hand wash before contact with patients was 17%. After education, hand wash before contact with the patients increased to 44%. Using education and performance feedback, hand wash further increased to 58%.  Notably, increase in hand wash translated to decline in nosocomial infection cases. The article supports my proposal on the change in mitigating the risk of nosocomial infection.

2 B: Coding of Qualitative Data

Coding refers to an analytical process in which data is categorized to facilitate analysis (Bazeley, Jackson, 2013). Coding of qualitative data can be done using the Framework Method of data management and analysis. The strategy involves analysis in series of stages (Bradley, Curry, Devers, 2007). To demonstrate this strategy, I shall use five of my classmates’ Introduction posts to code and analyze using Framework method. In doing this, a series of stages are involved;

Stage 1: Transcription

The five posting are made to transcripts with large margins and adequate line spacing for note taking and later coding (Bazeley, Jackson, 2013).

Stage 2: Familiarization with the interview

Using the transcripts of the postings, I familiarize with the content of all the postings by going through each one of them keenly (Bazeley, Jackson, 2013).

Stage 3: Coding

The transcript is carefully read line by line, and a code is assigned to mark the key points in the passage (Bazeley, Jackson, 2013).

Stage 4: Developing a working analytical framework

The codes applied are grouped into categories based on similarity of the themes they present using a tree diagram to form analytical framework as coding continues (Bazeley, Jackson, 2013).

Stage 5: Applying the analytical framework

The analytic framework is applied by indexing the subsequent transcripts using the generated categories and codes. Each code is represented by a number and written onto the transcript (Bazeley, Jackson, 2013). The data is then fed to Qualitative Data Analysis Software to be organized and stored for easy access and processing.

Stage 6: Charting data into the framework matrix

The data is summarized by category from each transcript (Bazeley, Jackson, 2013).

Stage 7: Interpreting the data

This involves mapping connections between categories to explore the interconnectedness of the categories to generate theoretical concepts (Bazeley, Jackson, 2013).

Qualitative research methods and evidence-based practice

 Qualitative research methods can promote evidence-based practice through generation of hypotheses that can be tested in future, enhance the development and validation of medical instruments and provide the context for evaluating evidence-based practice (Bradley, Curry, Devers, 2007).

Themes selected from coding the posts

The selected theme from the coded posts includes poor hand hygiene characterized by the lack of hand disinfection among those interviewed (Bradley, Curry, Devers, 2007). This theme is selected owing to its relevance to the prevalence of nosocomial infections that posit a big challenge to the health care organizations.

Brief analysis and conclusion

Analysis

The majority of individuals do not practice proper hand hygiene. This is due to lack of proper education on the importance of hand hygiene compliance in reducing nosocomial infections. The majority of interviewees that were hand hygiene non-compliant reported more incidences of nosocomial infections compared to those that were hand hygiene compliant. Thus, there exist high prevalence of nosocomial infections within healthcare facilities among hand hygiene non-compliant individuals.

Conclusion

The qualitative research study is critical for the collection and analysis of data about hygiene compliance and nosocomial infections. Notably, qualitative research study posit hand hygiene compliance as the most effective way to combat nosocomial infections. With proper public education on hand hygiene, the prevalence is anticipated to reduce significantly.

2 C: Information Systems and Changing Organizational Culture

 Practice setting

My practice setting is a hospital-based practice as a head nurse in which am constantly asked to see more patients and supervise other nurses. In this practice setting, a lot of benefits would be drawn from introducing a new information system that enables patients to directly communicate their concerns to the head nurse office to help in early detection of patient dissatisfaction. The new information system proposed here is installing computer systems for every patient bed to with a personal health record software and a link through which every bed occupant can link directly to the head nurse’s office and the organization management. The new information system initiative would greatly help the head nurse to monitor and supervise other nurses through direct patient feedback on the service delivery as well as promote the keeping of personal health records among patients (Liaw, Gray, 2010). Moreover, this new information system will significantly promote strategies designed to address staff concerns and implement changes directed towards achieving positive organizational culture. Within my practice setting, the service delivery is characterized by manual handling of medical records of patients, hence, introducing the new information system described above will significantly promote medical data handling, storage, dissemination, access and security (Liaw, Gray, 2010).

Barriers

However, there is a potential barrier to this initiative stemming from the lack of computer knowledge by most patients. Some patients who would provide vital information to the head nurse’s office about their view on the quality of service delivery are computer illiterate and, hence, may be locked out by the initiative (Liaw, Gray, 2010). Consequently, the initiative will not present a holistic evaluation strategy for service delivery. Also, resistance to change and reluctance to part with old ways by the nursing staff may significantly affect the implementation process.

Change Management strategy

To facilitate a successful implementation, I would employ the normative-reeducative management strategy. This strategy involves redefining and reinterpreting the norms and values of the organization and developing a commitment to new ones such as the principles of the new information systems (Technology Informatics Guiding Education Reform, 2011). This change management strategy is more focused on the culture of the organization and the way of doing things within the organization. Consequently, this strategy will significantly influence the desired change in the manner of patient handling and further help establish the culture of information technology within the health facility.

Overcoming the barriers

The successful implementation of this plan is dependent on overcoming the potential barriers. To promptly overcome these barriers, education materials will be a key resource. Education materials will be critical resources for patients and their carers as a guide on how to use the new information system (Technology Informatics Guiding Education Reform, 2011). These materials can be the computer user guides prepared for each patient on how to utilize the services. Besides, education materials will also entail training of staff on the new information system and their role in the implementation process (Technology Informatics Guiding Education Reform, 2011). To establish a culture that supports the new information system, I will employ the following leadership strategies; prioritize the organizational culture, share a positive vision and develop a Fleet of Bus Drivers (Technology Informatics Guiding Education Reform, 2011).

Prioritize culture

This leadership strategy will focus on creating a winning culture and a team environment by uniting all the stakeholders along the course of change.

Share a positive vision

This strategy will focus on putting everyone on board through sharing the vision of change in simple and clear terms that are understandable to everyone so as to encourage all stakeholders to support the implementation.

Developing a Fleet of Bus Drivers

Once the vision is understood and adopted by everyone, this strategy will significantly help in empowering individuals to generate a fleet of bus drivers by driving their own bus along with the organization in the same direction with the shared vision, focus, and purpose.

3 A:

Using both Quantitative and Qualitative Methods

Evidence-Based Nursing Practice

Evidence-Based Nursing Practice involves the translation of the available evidence and its application to clinical decision-making. The qualitative and quantitative research projects are critical for evidence-based nursing practice as they generate findings that relate directly to the health care outcomes. For instance, the qualitative and quantitative research projects generate hypotheses that are critical for future research (Chow, Quine, Li, 2010). When research findings present hypotheses about a particular phenomenon, these hypotheses become critically important in evidence finding during future research on the phenomenon.

            Besides, the qualitative and quantitative research projects have fundamentally contributed to the validation and development of quantifiable health instruments. This is achieved through the collection of qualitative information and data that are translated into quantifiable instruments (Esposito, Taylor Gold, 2009). Moreover, the qualitative and quantitative research projects are critical tools in the evaluation of evidence-based practice in nursing that include process and outcome evaluation that are described both qualitatively and quantitatively (Esposito, Taylor Gold, 2009). Finally, the qualitative and quantitative research projects are significant in designing the nursing interventions, based on both qualitative and quantitative data, for evidence-based practice. Notably, the complimentary relationship between quantitative and qualitative data is that one seeks to clarify the other throughout the study process.

Challenges when using mixed method research

Mixed method approach to research posit some challenges that may be encountered during the study of evidence-based practice in nursing (Esposito, Taylor Gold, 2009). These could include difficulty in combining the two types of data. The qualitative and quantitative data may be difficult to combine and manipulate. Besides, it will pose a challenge to time and the resources required to conduct the study. A study conducted using the mixed method research would demand more time to conclude and would require a lot of resources and much money to make. Thus, such research approach is expensive to carry out.

3 B:

Information System Evaluation

Health information technology refers to information technology applied to health and healthcare. The process of evaluating health information technology defers from other evaluation types in health care through its regulatory framework (Rahimi, Vimarlund, 2007). The evaluation of health information technology is done on a risk-based framework that assesses the risks of a given technology as well as process outcomes, whereas the other types of evaluation in health care are based on frameworks that asses the process outcomes on patients. For an information system evaluation, I would employ criteria-based evaluation strategy. This strategy involves formative and summative approaches to different criteria. The formative evaluation would provide systematic feedback to implementers and designers of the technology system while the summative evaluation will help to identify and assess the worth of the process outcome based on specified success criteria at the end of the implementation process (Nahm, Vaydia, Ho, Scharf, Seagull, 2007). To judge the system’s effectiveness, I would examine the user perception and understanding on the system’s quality, observations of interaction between the system and the user, the system itself and the documentation about the system.

Challenges in designing a successful information system evaluation

When designing a successful information system evaluation, the some challenges may be encountered (Nahm, Vaydia, Ho, Scharf, Seagull, 2007). The challenges may include conflicting or changing evaluation goals, large efforts required for the study’s preparation and execution, the results obtained may be complex and contradictory and the uncertainty surrounding the results as to whether they can be generalized to the environment (Nahm, Vaydia, Ho, Scharf, Seagull, 2007).