Research Topics: Nursing Research Proposals

An integral function of health promotion involves working with groups of people, both community members, hospital staff and patients and colleagues

NURS325 COMMUNITY HEALTH NURSING: THEORY AND PRACTICE   Week 8, 9 and 10: Units Nine and Ten:  Working with Groups   An integral function of health promotion involves working with groups of people, both community members, hospital staff and patients and colleagues. An understanding of group dynamics are very important. It is vital to develop an understanding of groups work so that the group works effectively together for what it is trying to achieve, rather than allowing the dynamics to work against what it is trying to achieve. Groups are also useful in health promotion because of cost-effectiveness and the ability to reach a wider audience. Groups can range in size from 2-3 people to several hundreds and can be homogenous (similar) or heterogeneous (different) in nature. Group methods have been used by health educators to empower individuals, organisations and communities in key ways. These include: • assisting individuals to modify or maintain health-related behaviour; • providing a supportive setting for individuals sharing a common goal or problem; • organising community or organisational members to improve their health literacy to identify and solve their own problems (community organisation); and • organising individuals and groups to undertake macro-level social change, for example training community leaders or building strong coalitions or partnerships. Please read the supplied reading.   Reading Tabot, L and Verrinder, G (eds.) 2005 Promoting health: The Primary care Approach 3rd edn., Elsevier, Sydney. pp. 198-214   Activities/Tasks <li class="MsoNormal" style="text-autospace: none"> Describe the major group elements of group purpose, member interaction, and cohesion. </li> <li class="MsoNormal" style="text-autospace: none"> Examine how group members are affected by group norms. </li> <li class="MsoNormal" style="text-autospace: none"> Explain the usefulness of groups in promoting individual health. </li> <li class="MsoNormal" style="text-autospace: none"> Evaluate nursing behaviours that assist groups in promoting health for individuals. </li> <li class="MsoNormal" style="text-autospace: none"> Identify the groups constituting a community and illustrate links between them. </li> <li class="MsoNormal" style="text-autospace: none"> Describe the role of the nurse in working with established groups to meet community health goals. </li>   Credit:ivythesis.typepad.com

An integral function of health promotion involves working with groups of people, both community members, hospital staff and patients and colleagues

NURS325 COMMUNITY HEALTH NURSING: THEORY AND PRACTICE Week 8, 9 and 10: Units Nine and Ten: Working with Groups An integral f...

Sample Research Proposal on the Performance Management of a receptionist in a medical clinic

PERFORMANCE MANAGEMENT SKILL BUILDER 3.1 1.      The job selected in this exercise is that of a receptionist in a medical clinic. Identified are a number of situational items for the possible system causes that are specific to the work setting of a medical clinic:         4Failure to become knowledgeable about the internal organization of medical records in the clinic                4Lack of knowledge of medical terminology and medical records procedure                4Poor ability to communicate orally with the nurses, doctors, telephone callers and clinic patients                4Poor work coordination with the nurses, nursing assistants and doctors employed in the clinic                4Lack of an efficient system for keeping medical records                4Poor ventilation and lighting and uncomfortable seats in the reception area                4Lack of leadership and supervisory training to develop initiative, decisiveness and such other skills                4Inadequate information about clinic standing operating procedures concerning procedures for scheduling, rescheduling, canceling patient appointments, providing information, recording and filing information in patient charts, various medical test procedures.                4Failure to receive inadequate training regarding transcription of a variety of doctor’s orders on various charts and in-patient records, charting of medical data (for example temperature, blood pressure and respiration) completing and routing requests for patient activities and treatment procedures, obtaining, entering, and filing results of laboratory, X-ray, EKGs, and other procedures in patient’s records, among other basic miscellaneous support duties associated with patient care and treatment. 2.      The list of possible system causes generated above should be used as indicators of performance on which performance appraisal should be partially based. As there are factors that are beyond the immediate reach of the receptionist (for example, the poor physical conditions of the reception area), the list should not be the primary basis for performance evaluation. Specifically for diagnostic purposes, the list might be used as the guide with which to base subsequent actions from. For instance, knowledge that there are poor physical conditions in the reception area could pave way for the clinic administration to do something about the situation. Another, poor work coordination among the medical receptionist, nurses, nursing assistants and doctors employed in the clinic indicates that there might be a communication problem in the organizational midst. Therefore measures could be taken to remedy the situation for the betterment of the clinic as a whole. 3.      The use of the above list could affect the actor significantly because it could either improve or worsen the present circumstances, depending on how the participants to the system would react to the changes that will be more likely implemented in the light of such identification of system causes. The observer might be impacted by way of the end-results, whether positive or negative, which will be brought about by the use of the list. 4.      It would be important to view the possible impact of system factors as a continuum from inhibiting to facilitating in order to be more receptive of possible organizational changes or work systems associated with the achievement of a high performance system. There is a need of the understanding that such effects of the system factors could be viewed in a different light, given the right orientation and a large amount of willingness on the part of the participants to the system. SKILL BUILDER 3.2 1.      Attribution is a three- stage process that involves: (1) the observation of the behavior of the subject; (2) determination if the observed behavior is deliberate or otherwise; and (3) attribution of the observed behavior to internal (controlled) or external (uncontrolled) causes[1]. Focus is on the two internal attributions, namely the ability and the effort, which affect the outcome of performance. The ability cause of performance is a relatively internal and stable factor over which the individual does not exercise much direct control while the effort cause is an internal and unstable factor over which the person can exercise a great deal of control[2]. The success of the individual’s own performance and the failure of the performance of others generally would lead to ability and effort attribution. This is due to peoples’ tendency to adapt a self-serving attribution, meaning it is a general perception that it is one’s merit and the others’ fault. Internal attributions can also be a result of the degree of consistency to which the actor performs the same behavior toward an object on different occasions, the degree of distinctiveness to which the actor performs different behaviors with different objects and the degree of consensus to which other actors perform the same behavior with the same object[3]. 2.      Questions which can be asked are: 4Do I like the person or not? There are only two possible answers: yes or no. If so, attributing the performance outcome to the ability of the observed is more likely in the case of success, or if not, attribution would be to some other causes apart from ability. Causal inference which would support the positive answer would be that the person worked hard enough to have achieved a successful performance. On the other hand, the causal inference which would support the negative response would be that the success is a mere product of pure luck or coincidence. 4Is the person highly motivated or not? As with the first question, this question also has two probable answers: yes or no. If the observed is highly motivated, he will approach rather than avoid the task related to succeeding. The inference would be that if the highly motivated subject succeeds, it is mainly due to his ability to carry out the task, which he is confident of. Otherwise, or if the person is not highly motivated, the observed will avoid the task as much as possible, in the belief that his ability would not suffice to help in the attainment of a successful performance outcome. 4Is the performance within the spectrum of his strengths? If so, then it can be inferred that the performance problem is largely due to some other cause, because if it was within his capacity, there would have been a successful outcome in the first place. If not, then the causal inference which could support it would be that there was a problem in relating the performance to what he can and cannot do. 3.      a. The abilities that might be important for the effective and efficient performance of the medical receptionist job are: (1) multitasking ability; (2) critical thinking ability; (3) ability to remain calm; (4) ability to follow instruction with a minimum amount of supervision; (5) proficient record keeping ability; (6) ability to communicate effectively; and (7) selective attention ability or the ability to concentrate. b. The above list of abilities could serve as the standard to which performance will be measured. If there is a finding that all of the abilities are possessed by the receptionist, then there is a good indicator that a high performance management is being carried out. However, if this is not the case, performance problems could then be traced back to the inadequacy or lack of such abilities needed to perform the medical receptionist’s duties and responsibilities. 4.      a. The efforts to: (1) do as much task in as little time; (2) help in activities within the medical clinic outside the work description; (3) maintain a harmonious relationship with coworkers and patients; (4) know the other concerns of coworkers and patients to which the receptionist might be of help; and (5) make the patients as comfortable as possible. There are basically five types of motivation (achievement, affiliation, competence, power and attitude). Performance management naturally focuses on the achievement motivation where the pursuance and attainment of goals is main driver in order to succeed. The identification of these types of motivation will be helpful in the diagnosis process in that through knowing them, the system will be able to apply the motivation which will push the system participants into becoming a high performing group.       b. It is important to distinguish between intrinsic and extrinsic efforts because a number of findings have shown that there a paradox between intrinsic and extrinsic motivators in that intrinsic motivation is far stronger a motivator than extrinsic motivation, yet external motivation can easily act to displace intrinsic motivation. With the differentiation, the system will be able to handle the participants effectively through the knowledge of what type of motivation drives them more. 5.      Effort is a combination of internal person factor and external system factor. There is the need for the individual to source his inspiration in doing better from within himself, but the outside environment, the individual being a part of it,  also affects how much or how little effort he exerts in the performance of the particular duty he has at hand. In that light, if the performance diagnosis show that there is low effort, there may be the initial need to assess the internal and external factors which affect the effort exerted by the subject, then from there identify the measures imperative for bringing up the level of effort brought into the work performed. SKILL BUILDER 3.3 1.      The structure for keeping a record of performance observations for a medical receptionist on the absolute performance appraisal technique where the observer will have to use written, absolute standards. Reviews are not based upon relative standing of the employee in a specific work group. The most common absolute style, which utilizes very general personal characteristics as a basis for evaluating the employee, will be used. The system would observe past performance as a standard for observation with the intention of tying in concrete examples from the past to motivate in the future. Observations will be made annually and the major headings to be found there will include, among other things, problem-solving, teamwork/cooperation, customer relations, leadership/supervision, communication and resource management. The performance observations will be organized by observation period, as it has, as mentioned, the intention of tying in concrete examples from the past to motivate in the future. 3.   The form worked well in all the aspects of observation. There is no need to change the structure of the form, as it adequately provided for all the information essential to monitoring and evaluating the performance of the medical receptionist. There is a need to increase the frequency of the observation though, from annually to twice a year, as it might be relatively easier to compare data from closer periods of time. Also, it will be more accurate and more up-to-date in that way. SKILL BUILDER 3.4 1.      The same medical receptionist work is chosen for this activity. The major tasks that an analysis of the receptionist’s job uncovered are the following: 4Receives and screens telephone calls.                   4Receives patients to the clinic, interviewing patients for treatment and confirms patient eligibility. 4Maintains patient logs (results of laboratory, X-ray, EKGs, and other procedures in patient’s records) and organizes all clinic files for easier filing and retrieval. 4Charting of medical data (for example temperature, blood pressure and respiration. 4Transcription of a variety of doctor’s orders on various charts and in-patient records. 4Completing and routing requests for patient activities and treatment procedures. 2.      I. PROBLEM SOLVING a.      Flexibility, adaptability and decisiveness are exercised appropriately 4 - b.      Assists coworkers in medical treatment when called for 4+ c.      Applies standard rules, procedures or operations to resolve routine problems 4+ d.      Independently carries out routine tasks 4 + e.      Takes initiative in selecting and implementing appropriate procedures 4 -                   II. TEAMWORK/COOPERATION a.      Personal and organizational interactions exhibit and foster cooperation and teamwork 4 + b.      Works with others to accomplish routine tasks 4 + c.      Contributes ideas on routine procedures 4 - d.      Regularly completes tasks in support of team goals 4 +                   III. CUSTOMER RELATIONS a.      Personal and organizational interactions enhance customer relations and actively promote rapport with customers  4+ b.      Assists customer support activities4 + c.      Meets routine customer needs 4+ d.      Interacts with customers on routine issues within specific guidelines 4+                IV. LEADERSHIP/SUPERVISION a.      Takes initiative in accomplishing assigned tasks4 - b.      Asks for assistance as appropriate4- c.      Seeks and takes advantage of developmental opportunities4 -                V. COMMUNICATION a.       Communications are clear, concise, and at appropriate level4+ b.       Communicates routine task/status results as required4+ c.       Writes timely and accurate draft documentation4+ d.       Explains status/results of assigned tasks4+                VI. RESOURCE MANAGEMENT a.      Resources are utilized effectively to accomplish tasks 4+ b.      Uses assigned resources to accomplish tasks4+ c.      Plans individual and assigned resources to accomplish tasks4+ 3.      There is a significant lack of leadership ability and supervision in the pattern of observed performance levels of the medical receptionist. It is evident that the employee lacks the leadership abilities which would otherwise let the individual perform the job responsibilities with as much confidence as possible. The social aspect of the job appeared easier to accomplish than those involving decision-making and such other activities requiring leadership skills. SKILL BUILDER 3.5 1.      The following are the situation-specific system factors operating in the medical receptionist work situation : 4Knowledge about the internal organization of medical records in the clinic 4Ability to communicate orally with the nurses, doctors, telephone callers and clinic patients 4Coordination of work with the nurses, nursing assistants and doctors employed in the clinic 4An efficient system for keeping medical records 4Leadership and supervisory training to develop initiative, decisiveness and such other skills 4Adequate information about clinic standing operating procedures concerning procedures for scheduling, rescheduling, canceling patient appointments, providing information, recording and filing information in patient charts, various medical test procedures. 4Adequate training regarding transcription of a variety of doctor’s orders on various charts and in-patient records, charting of medical data (for example temperature, blood pressure and respiration) completing and routing requests for patient activities and treatment procedures, obtaining, entering, and filing results of laboratory, X-ray, EKGs, and other procedures in patient’s records, among other basic miscellaneous support duties associated with patient care and treatment. 2.      The performance observations show that all the list of situation-specific factors applies. There were instances in where performance difficulties were caused by a system factor. For instance, the lack of leadership and supervisory training has contributed to the receptionist’s difficulty in handling situations where initiative, decisiveness and like leadership and supervisory skills are called for. On the other hand, excellent social performance is facilitated by the receptionist’s ability to communicate with everyone in the clinic. 3.      The abilities important for performance in the medical clinic environment are as follows: (1) multitasking ability; (2) critical thinking ability; (3) ability to remain calm; (4) ability to follow instruction with a minimum amount of supervision; (5) proficient record keeping ability; (6) ability to communicate effectively; and (7) selective attention ability or the ability to concentrate. Motivations needed on the other hand involve a combination of extrinsic and extrinsic factors to bring out an attitude conducive to high performance on the job. 4.       There are no places where a different interpretation could be drawn as all the observation ties up with one another and is consistent of the performance level of the observed medical receptionist. 	 		 		 		[1] 		From Human Motivation by Bernard Weiner (1980), Publisher: 		Lawrence Erlbaum Associates, Hillsdale, New Jersey. 		 		[2] 		From The Psychology of Interpersonal Relations by Fritz Heider 		(1958), Publisher: Wiley, New York. 		 		 		[3] 		From 		Attribution Theory in Social Psychology by Harold Kelley, Publisher: 		University of Nebraska Press, Lincoln, Nebraska. 		  Credit:ivythesis.typepad.com

Sample Research Proposal on the Performance Management of a receptionist in a medical clinic

PERFORMANCE MANAGEMENT SKILL BUILDER 3.1 1. The job selected in this exercise is that of a receptionist in a medical clinic. Ident...

Proposal for the implementation of surgical clippers/shavers versus razors to comply with best practices and the reduction of surgical site infections

Proposal for the implementation of surgical clippers/shavers versus razors to comply with best practices and the reduction of surgical site infections   1.0  Background of Evaluation Preventing surgical site infection is a health care intervention which is based on scientific evidence. The prevention is perceived to improve patient care and prevent avoidable deaths during the preoperative period that is why the intervention is strongly advocated. The preoperative period refers to the time period encompassing a patient’s surgical procedure including ward admission, anesthesia, surgery and recovery. Generally, the term preoperative refers to the three phases of surgery namely preoperative, intraoperative and postoperative. Surgical site infection, on the other hand, refers to the infection at the site of an operation caused by the operation. Surgical site infection is one of the most common types of adverse events occurring in hospitalized patients. As such, infections are identified to increase preoperative mortality, re-admission rate, length of stay and incurred cost for patients.   The care components of surgical site infection include the day of surgery admission, the appropriate use of prophylactic antibiotics, appropriate hair removal and compliant with local surgical wound dressing protocol. Such ‘bundle’ is a group of evidence-based intervention for patients who will and is currently undergoing surgery. It was believed that when these care components are implemented together, substantial improvement will be achieved. Historically, preoperative hair removal had been a customary preoperative practice thought to offset the increased risks for post-surgical infections. Multiple studies revealed, however, that hair removal may be a contributing risk factor for developing infections. It has been demonstrated that the act of shaving causes skin abrasions or microscopic nicks that can provide a favorable avenue for bacterial colonization. According to the CDC 1999 Guideline for Prevention of Surgical Site Infection, preoperative shaving of the surgical site the night before an operation is associated with a significantly higher risk for surgical site infections than either the use of depilatory agents or no hair removal.[26] In a randomized study of 1,980 consecutive adult patients undergoing cardiopulmonary bypass surgeries over a two-year period,   reported that the infection rate was significantly higher in the manually shaven (13/990, 1.3%) than in the electrically clipped patients (4/990, 0.4%). In another randomized study of 200 patients having elective inguinal herniorrhaphies, ., concluded that “preoperative clipping of hair with electric barber’s clippers immediately before operation is a safe, well tolerated procedure that does not increase the risk of postoperative wound infection.” There was also a systematic literature review by, which states that depilatory or electric clipping, preferably immediately before surgery, should be used and that shaving should be avoided. A number of studies have also been conducted on neurosurgical patients that assessed the effects of hair removal or skin shaving on postoperative infection rates. In all of these studies, no hair was removed. Instead, the incision was made after the hair was thoroughly scrubbed with an antiseptic solution and parted with a sterile metal comb or clamp. Results showed no differences in the reported surgical site infections. If hair removal must be practiced, shaving the night before surgery or at any time other than immediately prior to the operation is considered inappropriate. It is preferable to use electric clippers. Hospitals must increase the level of physician and clinical staff awareness, including purchasing personnel, on the increased infection rates associated with preoperative shaving. Patients should also be informed about the risks of shaving the surgical site before surgery as part of their preoperative preparation. All razors should be removed from stock carts and surgical prep kits. Heavy-duty clippers are an appropriate alternative and can be purchased should hair removal be necessary. Traditionally, surgical sites have been shaved with disposable razors due to the belief that hair would interfere with proper wound closure and healing. For decades, however, studies have been published demonstrating that shaving damages the skin and increases the risk of infection. Razor shaving increases the risk of infection by creating micro abrasions in the skin that allow skin-dwelling microorganisms to collect and multiply. These organisms may then migrate into the incision site and may also collect on catheters or sheaths that must remain in place for a period of time following the procedure. In contrast to shaving, clipping hair using a rechargeable electric trimmer with a disposable head does not damage the skin and is associated with lower infection rates In a prospective study that compared infection rates among 1,980 surgical patients whose hair was either shaved or clipped pre-operatively, patients who were clipped had a statistically significantly lower infection rate than patients who were shaved.   These results support an earlier study of the effects of shaving versus clipping on infection rates among 1,013 patients undergoing elective surgery. Clipping decreased infection rates both at discharge and at 30-day follow-up. Cost savings of 0,000 per 1,000 patients were estimated (in 1983 dollars) if clipping replaced shaving. A study comparing the clinical and cost outcomes of shaving and clipping found a moderate initial increase in hospital cost when converting from razors to clippers, but concluded that substantial long-term cost savings could be expected due to the decreased incidence of postoperative wound infections. This study further recommended discontinuation of razor shaving because of its associated risk of infection. Depilatories also have been evaluated, although recent data demonstrating a beneficial effect on infection rates are not available. The primary advantage to using depilatories is for hair removal in areas that are difficult to shave. However, depilatories are associated with hypersensitivity reactions.   2.0  Justification for Evaluation 3.0  Review of Literatures   4.0  Relevant Stakeholders Basically, the evaluation will include the surgery ward and operating suite as well as the surgeons, anesthetists, nursing staff from ward and operating suite, infection control professional and nursing clinical coordinator.     5.0  Criteria for Evaluation 6.0  Resource Implications/Requirements 7.0  Data Sources and Collection 8.0  Data Analysis and Interpretation 9.0  Communication of Results 10.0         References     Credit:ivythesis.typepad.com

Proposal for the implementation of surgical clippers/shavers versus razors to comply with best practices and the reduction of surgical site infections

Proposal for the implementation of surgical clippers/shavers versus razors to comply with best practices and the reduction of surgical si...

Preventing surgical site infection is a health intervention

Proposal for the implementation of surgical clippers/shavers versus razors to comply with best practices and the reduction of surgical site infections   1.0  Executive Summary   2.0  Background of Evaluation The preparation for surgery has traditionally included the routine removal of body hair from the intended surgical wound site. Customary hair removal in the preoperative phase is a practice thought to offset the increased risk for post-surgical infections especially that hair removal was discovered to be a significant risk contributor toward developing infections. The act of shaving causes skin abrasions or microscopic nicks which can provide a favorable avenue for bacterial colonization, allowing skin-dwelling microorganisms to collect and multiply. Aside from this it was noted that the hair would interfere with proper wound closure and healing. There are three choices for removing hair: razors, clippers or shavers and chemical depilation. It was believed that razor shaving increases the risk of infection through the creation of microabrasions in the skin while clipping hair using electric shavers or trimmers does not damage the skin thereby lower infection rates. Preoperative shaving of the surgical site which is done the night before the operation is associated with significantly higher risks of surgical site infections (2007; 2005).   Preventing surgical site infection is a health care intervention which is based on scientific evidence. Surgical site infection is one of the most common types of adverse events occurring in hospitalized patients. As such, infections are identified to increase preoperative mortality, re-admission rate, length of stay and incurred cost for patients. The care components of surgical site infection include the day of surgery admission, the appropriate use of prophylactic antibiotics, appropriate hair removal and compliant with local surgical wound dressing protocol. Such ‘bundle’ is a group of evidence-based intervention for patients who will and is currently undergoing surgery. It was believed that when these care components are implemented together, substantial improvement will be achieved. The prevention is perceived to improve patient care and prevent avoidable deaths during the preoperative period that is why the intervention is strongly advocated. The preoperative period refers to the time period encompassing a patient’s surgical procedure including ward admission, anesthesia, surgery and recovery. Generally, the term preoperative refers to the three phases of surgery namely preoperative, intraoperative and postoperative. Surgical site infection, on the other hand, refers to the infection at the site of an operation caused by the operation.   As debatable as it is, the question remains to be about the best method to be used given that appropriate removal of hair does help prevent surgical site infections. Surgical site infections remain a major source of postoperative morbidity in patients undergoing surgery with complications that compromises patient outcomes while also increasing the cost of healthcare delivery (2008). Thereby, the requirement is to prevent nosocomial infection after surgery through appropriate patient skin preparation. Anderson and Millard (2006) believed that the results of research have been so overwhelming in favor of clipping that several healthcare organizations recommend a procedural change from shaving to clipping. As stated by the Association of preoperative Registered Nurses (AORN), when hair removal is necessary, an electric or battery powered clipper with a disposable or reusable head that can be disinfected between patients should be used, if possible. In accordance, the Centers for Disease Control and Prevention (CDC) Guideline for Prevention of Surgical Site Infection affirmed that: if hair is removed, remove immediately before the operation, preferably with electric clippers (as cited in  2006).   3.0  Evaluation Design   4.0  Justification for Evaluation It is of my best belief that evaluation could lead to significant improvements in the health care sector. However, evaluation has been a practice which lacks recognition in literature and research. Evaluating the implementation of surgical clippers/shavers as opposed to utilization of razors during the preoperative phase could lead to the development of a systematic understanding of reducing and preventing surgical site infection. Given that, there are no concrete and updated guidelines about the best practices in implementing surgical devices, the findings of this evaluation will be important. As such, the results of the evaluation will be a significant development of evidence-based benchmark practices. This evaluation will be significant for practitioners and service managers as well as policy makers and purchasers of the health service. Such evaluation will be also an important area of study for the academia towards the establishment of benchmark practices when it comes to proper hair removal using the most appropriate medium.     5.0  Review of Literatures   The evidences of the implementation of surgical clippers/shavers instead of razors have its root since the 1980s. Several studies were conducted during that time. One is that of (1982) which reported that preoperative clipping immediately before operation is a safe and well-tolerated procedure. The researchers conducted the study through 200 patients while adhering to strict hospital protocols. They have discovered that unsatisfactory skin preparation was noted in 7% while that of clipped with 4%. Subcutaneous wound infections also occurred in 2% of the shaved patients and 1% in the clipped group. The problem, however, in this research is evidently on the generalisability of the findings. The researchers used a relatively small sample and that their findings are almost close to perfect. The research is also conducted during skin hair removal and does not provide a significant amount of time for subsequent occurrences.    (1983) clearly said that preoperative shaving is deleterious and that the practice should be abandoned. The influence of preoperative shaving versus clipping was conducted with the contributions of 1, 013 patients whom will undergo elective operation the following day at a single hospital. The AM clipper method was used and was associated with significantly fewer infections than were the other methods as evidenced by scrutiny at discharge and after 30 days. The authors also noted that in every 1, 000 patients treated a saving of 0, 000 could be realized. Admittedly, however, the greatest benefit was in the group with clean wounds. This study has a clear implication for the responsibilities and competence of nurses with respect to preoperative preparation. A separated study after at least 13 years established this point.  (1996) conducted a case report with emphasis on the role of nurses, relating that preoperative hair removal is extremely dangerous when practitioners at all levels are not educated and that although they are informed, nursing negligence is punishable. The report figured that the findings reinforce the importance of strict adherence to hospital protocols to protect patient’s safety.    A randomized prospective study conducted by  (1985) assessed the necessity of shaving before operation. They have included 716 cases which were divided into two groups. The first group is treated with traditional method of preoperative skin preparation, employing routine shaving and using centralize and chlorhexidine in alcohol for cleansing, while the second group was treated with an alternative method – without preoperative shaving. They have discovered that routine shaving has no advantage in reducing wound infection rate as evident by the 5.08% rate for the traditional method group and 5.56% for the alternate method group. Even so, the study is clearly one-sided as it only examined the before aspect of the operation. The question lies in the fact that the necessity of hair removal also applies in the condition after the operation. In lieu with this, another study offers a different perspective.  (1984), although their research is conducted a year before that of  , discovered that aside from having no distinct advantages, shaving is costly for both the patient and the care providers.       A randomized controlled trial conducted by  (2005) found out that if hair removal is required, clippers cause fewer abrasions than razor blades based on interviews with 157 patients. These patients were interviewed twice, after shaving using a razor or a clipper and then two weeks after the surgery in aspects of pain, itchiness, redness and sustained cuts as well as opinions on shaving methods. However, the methods used by the researchers have inherent subjectivity since it focuses on self-assessment of the patients hence may not be reliable. The second interview was done through telephone. Nonetheless, the patients reported that 10% of both groups reported that they had experienced redness of the skin. In line with this study,  and  (2007) conducted a systematic review stating that there is insufficient evidence that using razor can increase the risks of nosocomial infections. However, if the need for removing hair arises, clippers must be prioritized over razor shaving because of the proven lesser infection rates of using clippers and trimmers.  (2003) supported such view, disclosing that clipping is a better hair removal method to prevent surgical site infection.      A clinical review by  (2007) recommended that if hair removal must be practiced, then it would be conceivable to note that shaving the night before the surgery or at any time other than immediately prior to operation is considered inappropriate. Preferably, the use of electronic clippers shall be applied and razors should be removed from surgical preparation kits. While also, the hospitals must increase the level of physician and clinical staff awareness regarding the infection rates associated with preoperative shaving and that the patients must be also made aware of the consequences of shaving as part of the preoperative preparation. Aside from these recommendations,  (2005) also suggested that hair must not be removed unless necessary and unless the physician orders that it be removed. The decisions of whether to remove hair or not must depend on the basis of the amount of hair, the location of the incision and the type of surgical procedure to be performed.         6.0  Relevant Stakeholders Basically, the evaluation will include the surgery ward and operating suite as well as the surgeons, anesthetists, nursing staff from ward and operating suite, infection control professional and nursing clinical coordinator and the patients as well as the academia and the health and social care community. Specific considerations in choosing and determining the levels of engagement highlight three important aspects as health service improvement, accountability and confidence. Important is to held stakeholder consultation process after the stakeholders are identified and analyzed. Next is to disclose the information to them then negotiate.  Stakeholder engagement could take many forms and shape many consequences and influences but proactive engagement must be practiced at all times. As such, stakeholders will be engage as early as possible to cultivate ownership of the process. Stakeholders are a significant source of expertise which contributes to the design, implementation and outcomes of the evaluation.       7.0  Criteria for Evaluation There are five general criteria for this evaluation: safety, process effectiveness, economic impact/cost, clinician acceptability and patient satisfaction. Primarily, safety is a judgment of the acceptability of the health risk associated with using surgical clippers/shavers and razors. Though this aspect is more of a function of the clinician, infection control officer or the surgeon itself, safety is much important for the surgery patients. Efficacy of the process of hair removal using the most appropriate device is central on the risk reduction for patients, leading to improvement of signs, symptoms, diagnosis, treatment and prognosis. Consequently, there are direct, indirect and operational costs, and which could be determine using cost-related analyses. In the evaluation, acceptance of healthcare professionals is a must due to the negative influences imposed by levels of control over patient care. As such, clinician might avoid implementing a practice therefore precluding the benefits of complying with best practices. Specific aspects of patient satisfaction must be also considered such as convenience, comfort and willingness.         8.0  Resource Implications/Requirements It is hope that the evaluation will push through simply because I believe that the evaluation and implementation will benefit the healthcare community. There are direct costs of the evaluation including capital costs, building-related expenditure and other service-related expenditure. As well, there are also inherent administrative costs to the evaluation.  Nevertheless, the costs have differing relationships with the level of activity with respect to evaluation. For instance, the capital cost is fixed while other may vary depending on the changes of the level of activities. Overall, the evaluation is feasible considering the unit of activity. For every unit of activity, accomplishing an estimate of cost allocation would be plausible. In the meantime, the actual cost of evaluation cannot b determined because it is yet to decide whether to use top-down or bottom up approach to cost valuation of evaluation and implementation.   9.0  Data Sources and Collection This evaluation will make use of the randomized controlled experimental model through random allocation. The rationale behind random allocation is to make the reduction of potential biases between two groups of people with different interventions easy. For this evaluation, the summative approach was chosen. The aim is to provide a summing up assessment of the things being evaluated, in this case, the implementation of surgical clippers/shavers against the use of razors. This evaluation also intends to inform decision makers of the necessary next step through a final report which will shape how the intervention develops ( 2002).     Primary and secondary data sources will be both incorporated in this evaluation. Survey and interview will be conducted spontaneously because in-person interviews are the most effective method in obtaining answers to complex questions and that people are more likely to complete a survey when they are interviewed in person and when sufficient background information is provided. A semi-structured questionnaire will be used for this evaluation. Accordingly, semi-structured interviews provide the opportunity to ‘probe’ answers, which can be done in instances where there is a need or want for the interviewees to explain further or build on their responses. As initially planned, 500 patients, 250 of which are incised through razors and 250 through clippers/shavers, and relevant stakeholders will be surveyed and interviewed including surgeons, anesthetists, infection control professionals and nursing coordinators.   Archival data, hospital administrative data, patient records, medical reports, issue and working papers will be used as secondary sources of information. Journal and research papers to be retrieved both online and from local libraries also represents good source of secondary data and are probably the most reliable sources of information. This is because these resources tend to detail the results of other researchers’ findings compared to books. The biggest problem however will be finding specific papers on my subject area. Based on initial search, online libraries dedicated to medical category include eMedicine, PubMed and BMJ. Official statistics will be also incorporated in the evaluation in addition to books, the Internet, magazine and newspaper articles.      Further, exact and sophisticated observation will be also employed during the evaluation process. Non-participant observation will be conducted and the observer will make use of audio and visual devices for recording observations. Observation guide will be prepared to aid observers during the process. A resource person with clinical expertise will be contacted to assist in observation. Observation encounters will start from preoperative to post-operative periods. What will be observed is the process of hair removal including the timing of removal and after effects of the process. Prior to observation, written consent and interview forms will be accomplished.        10.0         Data Analysis and Interpretation Multi-data analysis methods will be utilized for this evaluation. First is the qualitative analysis. Thematic analysis will be used for both secondary research and interview. Analyzing by theme, this type of analysis is highly inductive as the themes emerge from data and are not imposed by the researcher or evaluator. Background reading can form part of the analysis process. Thematic analysis is always accompanied by comparative analysis. For the qualitative analysis of the responses, content analysis will be used, a process which is more mechanical where analysis takes places after data has been collected. In this evaluation, there are two approaches to content analysis as the questionnaire will include open-ended questions. The first is through preparing a list of categories and the second is letting the categories emerge from the data, enabling the researcher and/or evaluator to quantify the responses (1998,). Further, the evaluation will make use of contrasts of photographs for further assessment of effectiveness.   The second analysis will be carried out through quantitative analysis to know the prevalence rate and incidence rate of the occurrence of surgical site infections.  Prevalence refers to the number of existing cases identified or arising in a population at a particular time while prevalence rate is the proportion of cases in a population at a particular time. Incidence rate, on the other hand, is defined as the proportion of new cases which arise over a period of time.      Decision analysis method will be the third method. Decision analytic methods are primarily used in health care research towards the development of sound clinical interventions, policies or programs. Decision analysis is used to identify, clearly represent and formally asses the important aspects of a decision situation for the purpose of prescribing the recommended course of action. This can be done through applying the maximum expected utility to a well-formed representation of the decision. Influence diagrams and decision trees are the two most commonly used graphical representation of decision analysis. Influence diagrams (or decision network) and decision trees presents possible consequences, which include chance event outcomes, resource costs and utility.  (1996) asserts that both tools are useful in representing alternatives available to the decision makers as well as the uncertainty they are facing.      11.0         Communication of Results The evaluator’s responsibilities also include the communication of evaluation findings. There are two ways by which results will be communicated. First is through written reports. The final report will be divided into three subreports including the program antecedents, program implementation and program results. In addition, summary tables and technical appendix documents will be provided. Prior to final reporting, prerelease reviews of drafts and feedback workshops will be conducted. The final written report will be published in medical journals accessible to users and electronically via putting the findings on a database or dissemination network accessible to both users and other stakeholders. There will be also informal discussions of the findings with relevant stakeholders.   12.0         Recommendation   Credit:ivythesis.typepad.com

Preventing surgical site infection is a health intervention

Proposal for the implementation of surgical clippers/shavers versus razors to comply with best practices and the reduction of surgical si...

RESEARCH FOR REGISTERED NURSES

Criticizing individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization in their area belies a simplistic approach to the problem.   Introduction   Health care is continually changing in the way health care professionals like individual practitioners and clinical managers organize and deliver care to the patients. For this reason, health care knowledge must continuously grow and expand to keep health care approaches relevant, current and appropriate. Without new knowledge, health care professionals cannot improve techniques for therapies and even management.   One important source of knowledge is research. Research is viewed in most professional circles as necessary for the continuous development of the scientific body of knowledge, which is the hallmark of a profession. The essence of evidence-based practice is the provision of quality and cost-effective health care to the health consumer ( 2003).   Research provides a solid foundation on which health care professionals base their practice. The scientific knowledge base for professional health care practice is developed through scholarly inquiry of the research literature, use of existing research findings, and the actual conduct of research ( 2004).   The gap between research and its translation to practice in the healthcare arena became a focus for policy discussion in some healthcare organizations in the last decade. Studies have continued to reveal that the gap between research and practice seems to be most obvious in the nursing profession. It is disheartening, however, to note that regardless of the millions of dollars spent on funding clinical research, the integration of the findings into practice has been relatively slow among nurses (2003).   There have been previous attempts at improving research utilization among nurses worldwide. The disparity in the conduct of research and its integration into practice became an international nursing concern. Various groups are made in the attempts at reducing the research conduct and utilization gap.   Integrating the findings of research to improve clinical practice should be a vision for most health care professionals – the nurses, who form the largest proportion of care providers at the bedside. There is a need to search for the missing link between the dissemination and implementation of research findings for evidence-based practice among nurses ( 2003).   There are several studies focusing on the barriers to research utilization among nurses but few on attitudes toward research. Researchers noted that where ability was higher, attitudes toward research activities were more positive, and vice versa. Attitude and availability of research reports were related to research utilization.   Although interest in research-based practice seemed to be present among a majority of the health care professional population, the reality of the situation suggests that it is not occurring as frequently as desired. The statistical section of a research study could be intimidating to the beginning researcher.   In a nationwide study focusing on the state of research utilization in the United States, it revealed that the culture of healthcare institutions does not value research utilization. The study noted that nurses without a baccalaureate degree did not fully understand or value research, while some of the baccalaureate-prepared nurses who had classes on research in their program complained that the way in which nursing research was taught in the schools turned them off ( 2003).   These are just some examples that depict the increasing lack oaf awareness and utilization of may health care professionals. The purpose if this paper is to identify the main reasons why nurses do not utilize research in their practice; discuss three of these reasons and why they exist; and make evidenced based recommendations for future nursing practice to overcome each of these three barriers.   Body   Nursing has long been urged to base care on research findings rather than tradition and ritual. The rapid growth of doctorally prepared nurse researchers has enabled the scientific base for nursing practice to grow ( 2004)   There are, however, barriers to utilization of research in clinical settings. This includes individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization. Barriers limit the potential of identifying clinical outcomes in nursing care ( 2004). However, recognizing and acknowledging the existence of these barriers enable to implement change in practice in a timelier manner.   The reasons why nurses do not utilize research evidence in their clinical practice are complex and multi-factorial. Studies focusing mainly on barriers to research utilization noted that the following reasons answer why most nurses so not utilize research: (a) characteristics of the nurse, which revolves around poor knowledge of research; (b) characteristics of the research presentation, with statistical terms beyond the level of the average nurse; and (c) characteristics of the organization settings in clinical areas constitute barriers.   In particular, barriers to research utilization revealed by studies include nurses’ lack of time and independence in the organization, together with lack of support from nurse managers. Organizational characteristics were noted to present one of the greatest barriers to nursing research utilization in the practice setting (1998). The conclusions of many previous studies revealed that, in addition to the limitations in the workplace settings, the resistance among more senior nursing staff and the research values and skills of the nurses were important in research utilization (, 2003).   Most of these studies, however, have been conducted with samples consisting of nurses working mostly in urban settings, but the more one ventures out of the large urban medical centers, the less one hears about research and its utilization. Studies on nurses working in rural areas is paramount, if we are to “leave no nurse behind” in our professional struggle for evidence-based practice (, 2003).   For this paper, three reasons why nurses lack utilization and awareness of research will be discussed. These are: (1) lack of support from administration to implement new practices and fund research, (2) lack of time to investigate research findings, and (3) lack of interest and knowledge on the part of the nurses themselves.   Nurses encounter these three major barriers: lack of time for investigating and implementing research, lack of knowledge on the nurses’ part, and lack of support by the administrators and other health care professionals. All these barriers have been documented in other studies.   The finding that the desire for research utilization among nurse administrators was affected by their lack of support and budget for research from administration, needs closer consideration. Making no budget allowance for research in the nursing division could be seen as reflective of the importance attached to research by the nurse leaders. It is pertinent, however, to note that qualitative comments by the nurses in this study who were utilizing research showed that support by the administrators was an encouraging facilitator in their use of scientific findings in their practice settings. This supports previous studies that revealed one of the most effective facilitators for research utilization was the increased support and encouragement from administrators (, 2003).   Under this barrier of lack of support is uncooperative physicians, which seems to be an international problem. This is unfortunate because nurses and physicians work together closely and, in some cases, nurses are dependent on physicians to implement research findings in the any health care setting (, 2004).   Lack of time to read research articles and to investigate and implement research findings in practice is the second barrier. This is congruent with findings of other studies. One researcher found that time was an important factor to improve research use in clinical practice.   Perioperative nurses in one study reported that heavy activity and workload gave them neither time nor energy to do research-related activities. The administrative requirement to improve efficiency and long waiting lists press the surgical team to treat more patients. This pressure, acute procedures, and lack of personal resources increase nurses’ workload. Perioperative nurses have no authority to administer their time at work, and the possibility of finding time for research activities in practice depends on nurse leaders. Only nurse leaders can organize the OR team so that perioperative nurses have on-duty time to perform research activities ( 2004).   Recommendations   Developing a favorable attitude among nurses that encourages the integration of research evidence into nursing practice at the health care setting needs the cooperation of nurse leaders and other health care professionals in the clinical areas.   It is time for nurses to stop projecting nursing research as an academic exercise and start perceiving it as a scientific base for evidence-based practice. There is a need to stress support for nursing research as one of the important means of providing scientific evidence for practice in every forum for nurse executives (, 2003).   It is interesting to note the enthusiasm with which research results are presented in nursing conferences locally, nationally, and internationally. However, it becomes very frustrating when the wide gap between the enthusiastically presented research findings and what actually occurs in clinical practice remains for many years after the dissemination of such evidence reports and clinical guidelines. The existence of the gap between research and practice should continuously be a concern for researchers/educators and nurse administrators (, 2003).   Educators and administrators in healthcare organizations need to create collaborative strategies that emphasize the importance of research in enhancing evidence-based practice in the clinical setting, especially in the rural areas. Whatever approach is taken, if we are to improve nursing practice through scientific evidence, it will take the commitment and collaboration of educators/researchers, clinicians, and administrators to see that no nurse is left behind in the march toward evidence-based practice ( 2003).   There are several reasons why nurses should implement research findings. Using research increases the quality of nursing care’ and provides increased efficiency in patient care, as well as personal and professional growth for nurses. Most nurses are required by individual governments to work in accordance with scientific knowledge. Patients and their relatives increasingly expect nurses to incorporate research findings into their everyday practice, and most nursing councils all over the world require that nursing practice be evidence based. The health care setting continues to become more technologically challenging, and nurses must combine use of new technology with knowledgeable and safe patient care so patients do not experience complications ( 2004).   It is recommended that nurses have to be given study days for the lack of time they have in research investigation and implementation. Competence in the research process, statistics, and research methodology can help nurses argue for use and evaluation of research findings. This may improve support and collaboration from the physicians and other health care administrators.               To determine whether research findings can be used as a basis for nursing practice, the nurse should consider the scientific worth of the study, the substantiating evidence provided in other studies, the similarity of the research setting to the nurse’s own clinical practice setting, the status of current nursing theory, and factors affecting feasibility of application.   Conclusion               The utilization and awareness of research in nursing profession is a basis for scholarly and professional decision making in clinical practice and is essential in providing competent, efficient, and state-of-the-art nursing care.               Advances in care through research are meaningless unless they reach nurses at the point of care. Nurses should utilize these research findings if they are to improve the quality of care that they offer to their clients. Nurses must therefore read publications like journals and textbooks and other source which contain research reports in nursing and other related fields in the provision of health care.               Unfortunately, there are many barriers that prevent the nurses from utilizing these research finding. Among these are the lack of time and interest on the part of the nurses to investigate and implement research findings, the lack of support from the health care administration and other health care professionals, and the lack of knowledge of the nurses on the significance of research findings and its implementation. These barriers have to be overcome by the nurses with the help of the administration and other health care professionals.               Nurses in all health care settings must continue to seek knowledge by taking time to review research and practice findings, critique research studies, and discuss with fellow nurses the implications of using and not using new knowledge in nursing practice.             Nursing research is important and it addresses issues that are important to the discipline of nursing. Nurses must therefore be aware and use research findings in there practice. Acquisition and application of new knowledge is very important in contributing to nursing practice and patient care.                       REFERENCES   Credit:ivythesis.typepad.com

RESEARCH FOR REGISTERED NURSES

Criticizing individual practitioners for their lack of research awareness or clinical managers for the low level of research utilization ...