Category: DNP

NURS FPX 8045 Assessment 4 Interpretation and Synthesis of Scholarly Sources Name Capella university NURS-FPX 8045 Doctoral Writing and Professional Practice Prof. Name Date Interprofessional Communication and Practice Gap Inconsistent infection control practices, exacerbated by the ongoing nursing shortage, have contributed to an increase in Central Line-Associated Bloodstream Infections (CLABSIs), challenging patient care and healthcare quality in acute care settings. The rising incidence of these infections highlights the critical need for implementing effective and standardized infection control strategies (Badparva et al., 2022). Project focuses on implementing evidence-based interventions, such as standardized infection control protocols, including daily Chlorhexidine Gluconate (CHG) bathing at Lima Memorial Hospital (LMH). By engaging stakeholders in the development and execution of these strategies, the project aims to foster a collaborative environment that prioritizes patient safety and enhances care quality. The initiative not only seeks to reduce CLABSI rates but also aims to strengthen team dynamics and improve infection control practices within the organization. Identification of Practice Gap The identified practice gap for the DNP project is the inconsistent adherence to central line care protocols, exacerbated by the ongoing nursing shortage, which increases the risk of CLABSIs. The shortage of nursing staff often leads to increased workloads and time constraints, making it difficult for nurses to consistently follow central line care protocols (Kim & Choi, 2023). Evidence shows that inadequate staffing can contribute to lapses in infection control practices, resulting in higher CLABSI rates (Karapanou et al., 2020). For instance, nurses working longer shifts can experience fatigue, reducing their ability to maintain sterile techniques (Xia et al., 2020). Aiming to address the gap of inconsistent infection control measures, the project implements a standardized central line care protocol, incorporating strategies to optimize workflow despite staffing challenges. Regular monitoring and staff education will help ensure compliance, ultimately reducing infection rates. The scope of this DNP project is appropriate as it focuses on improving central line care processes in a specific clinical setting over 8 to 12 weeks, addressing both procedural adherence and workload factors related to the nursing shortage. However, broader issues like long-term staffing solutions and central line care practices in other facilities are beyond the scope of this project, which will concentrate on immediate, site-specific improvements at LMH. Evidence of Problem in Project Site Inconsistent adherence to central line care protocols, exacerbated by the ongoing nursing shortage, continues to contribute to the significant challenge of CLABSIs in acute care settings, including at LMH. In the USA, only 66% of nurses adhere to recommended central line care protocols (CDC, 2021). Nationally, CLABSIs affect approximately 41,000 patients annually, with mortality rates ranging from 10-30% and treatment costs between $25,000 to $56,000 per case (AHRQ, 2021; Johns Hopkins, 2022). The national benchmark for CLABSI rates in acute care hospitals is 0.8 infections per 1,000 central line days (CDC, 2022). However, the nursing shortage has resulted in inconsistent adherence to these protocols, hindering infection control efforts. While states like North Dakota and Vermont have lower CLABSI rates, demonstrating the effectiveness of rigorous infection control (Joint Commission, 2024). LMH has seen a 43% reduction in CLABSI rates over five years through targeted infection control initiatives (Leapfrog, 2022). LMH Hospital has a CLABSI rate of 0.458, which is lower than the national benchmark, highlighting the need for consistent adherence to central line care protocols to maintain and further improve these outcomes (Medicare, 2024).  This highlights the critical need for standardized protocols that can withstand the pressures of staffing shortages to maintain safety and quality care. However, challenges persist due to the ongoing nursing shortage, leading to increased workloads and inconsistent adherence to central-line care protocols. Hyte et al. (2023), indicate that the shortage of staff and the lack of consistent training and education have resulted in elevated infection rates. These statistics highlight the urgent need for further improvements and the implementation of a standardized central line care protocol, which will be the focus of the proposed DNP project aimed at reducing infection rates at LMH. Formulating PICOT Question In adults with central lines (P), how does the implementation of daily CHG bathing (I), compared to current central line care (C), reduce CLABSI rates (O) within twelve weeks (T)? Inconsistent adherence to infection control protocols due to nursing shortages contributes significantly to the high rate of CLABSIs at LMH. CLABSIs not only increase patient morbidity and mortality but also lead to considerable healthcare costs, ranging from $25,000 to $56,000 per case (AHRQ, 2021). The nursing shortage exacerbates this issue, making it challenging to consistently implement necessary infection control measures. Evidence suggests that daily CHG bathing can reduce CLABSI rates and improve patient outcomes (Reynolds et al., 2021). Implementing CHG bathing is a key action of this project to lower infection rates, which could, in turn, reduce costs and enhance patient safety. This approach aligns with the goal of reducing CLABSIs by addressing the practice gap while improving adherence to protocols despite staffing shortages. Addressing the practice gap of inconsistent protocol adherence, the project aims to improve outcomes despite the challenges posed by the ongoing nursing shortage. Facilitating Discussions with Stakeholders Facilitating discussions among stakeholders at LMH regarding the reduction of CLABSIs required effective communication strategies tailored to the hospital’s unique challenges. Engaging the nursing staff, who were dealing with staffing shortages, was crucial, and face-to-face meetings proved to be the most effective communication method. This approach allowed for real-time interaction, immediate feedback, and collaborative problem-solving on evidence-based interventions like daily CHG bathing (Reynolds et al., 2021). Studies indicate that direct engagement in decision-making fosters accountability and better adherence to infection control measures (Krauss et al., 2022). In contrast, email-based communication was less effective, often resulting in delays and miscommunication, which hindered progress (Lord et al., 2020). By organizing more in-person discussions and workshops, we ensured that stakeholders, especially nursing staff, felt heard and involved in the solution process. This tailored communication strategy helped mitigate the challenges of the nursing shortage and strengthened the team’s dedication to reducing CLABSI rates. Linking back and emphasizing real-time,

NURS FPX 8045 Assessment 3 Craft a PICOT question and a Search Research Name Capella university NURS-FPX 8045 Doctoral Writing and Professional Practice Prof. Name Date Differentiating QI/PI Projects from Research Studies Quality Improvement (QI) and Performance Improvement (PI) projects, along with research studies, play critical roles in addressing challenges within healthcare environments. The primary objective of the QI/PI project at Lima Memorial Hospital (LMH) is to minimize re-hospitalization rates in patients with Chronic Obstructive Pulmonary Disease (COPD) by enhancing discharge protocols. While both QI/PI projects and research studies aim to solve healthcare issues, they differ significantly in their goals and methodologies. QI/PI projects focus on enhancing existing processes within a specific setting by implementing practical changes and assessing their outcomes, leading to immediate improvements. These projects employ structured strategies and data evaluation to identify areas needing enhancement (Faiman, 2021). At LMH, a QI/PI initiative might emphasize improving discharge protocols, given the evidence that effective discharge strategies reduce hospital readmissions and associated risks (Miravitlles et al., 2023). These projects emphasize practical, locally relevant solutions designed for immediate application to existing operations. They require an understanding of the underlying factors influencing current practices (Mohan, 2023). Conversely, research involves a systematic and structured investigation focused on gathering, analyzing, and interpreting data to answer a specific question. Research studies aim to generate broadly applicable knowledge that contributes to the larger body of evidence through comprehensive analysis and systematic observation (Hays & McKibben, 2021; Renjith et al., 2021). Table: Comparing QI/PI Projects and Research Studies Aspect QI/PI Projects Research Studies Purpose Enhance existing processes for immediate improvements. Generate generalizable knowledge for broader application. Methodology Systematic evaluation of current practices and data. Structured data collection, evaluation, and interpretation. Focus Local, practical solutions for specific organizational needs. Extensive evidence to inform policy and practice at larger scales. Application in Healthcare Improvement Both QI/PI projects and research contribute significantly to healthcare improvement but differ in scope and application. For example, research on COPD patient readmissions would examine factors contributing to the problem using methods such as longitudinal studies or randomized controlled trials. Such studies analyze data to uncover trends and publish findings that influence policies and practices broadly. Meanwhile, a QI/PI initiative at LMH would address immediate patient safety concerns by optimizing discharge protocols. By doing so, it could reduce re-hospitalizations and improve patient outcomes. While research offers critical insights into systemic causes and broader medical issues, QI/PI projects provide actionable solutions tailored to current operational needs. References Faiman, B. (2021). Quality improvement projects and clinical research studies. Journal of the Advanced Practitioner in Oncology, 12(4), 360–361. https://doi.org/10.6004/jadpro.2021.12.4.1 Hays, D. G., & McKibben, W. B. (2021). Promoting rigorous research: Generalizability and qualitative research. Journal of Counseling & Development, 99(2), 178-188. https://doi.org/10.1002/jcad.12365 Miravitlles, M., Bhutani, M., Hurst, J. R., Franssen, F. M., van Boven, J. F., Khoo, E. M., & Scullion, J. E. (2023). Implementing an evidence-based COPD hospital discharge protocol: A narrative review and expert recommendations. Advances in Therapy, 40(10), 4236-4263. https://doi.org/10.1007%2Fs12325-023-02609-8 NURS FPX 8045 Assessment 3 Craft a PICOT question and a Search Research Mohan, S. (2023). Widely adopted surgical quality improvement initiatives. Journal of Vascular Surgery-Vascular Insights, 1, 100009–100009. https://doi.org/10.1016/j.jvsvi.2023.100009 Renjith, V., Yesodharan, R., Noronha, J. A., Ladd, E., & George, A. (2021). Qualitative methods in health care research. International Journal of Preventive Medicine, 12(1), 20. https://doi.org/10.4103%2Fijpvm.IJPVM_321_19

NURS FPX 8045 Assessment 2 Summarize a Passage Name Capella university NURS-FPX 8045 Doctoral Writing and Professional Practice Prof. Name Date Summarize a Passage Overview of Pulmonary Hypertension Pulmonary hypertension is a medical condition marked by elevated blood pressure in the veins that connect the heart to the lungs. This abnormal pressure causes narrowing of the arteries and reduced blood flow, which may lead to complications such as heart failure and dysfunction in vital organs like the lungs and kidneys. The diminished oxygen supply to the lungs further exacerbates the condition, contributing to its severity (Brown et al., 2011). Causes and Risk Factors The causes of pulmonary hypertension are multifaceted, ranging from congenital issues to associations with underlying conditions like connective tissue disorders, coronary artery diseases, and liver cirrhosis. Certain groups, such as females, individuals over the age of 75, and Black populations, are at a higher risk of developing this condition. Symptoms like chest pain, shortness of breath, and dizziness not only affect the individual’s physical health but also significantly impact their quality of life (Brown et al., 2011). Prevention and Management Strategies While pulmonary hypertension cannot always be prevented, risk mitigation strategies focus on controlling blood pressure and avoiding harmful habits, such as tobacco use. Despite the lack of a definitive cure, available treatments can help manage the condition and alleviate symptoms. Additionally, proactive measures, including lifestyle modifications, play a vital role in reducing the prevalence and severity of pulmonary hypertension among at-risk populations (Brown et al., 2011). NURS FPX 8045 Assessment 2 Summarize a Passage Heading Details Overview of Pulmonary Hypertension Pulmonary hypertension involves elevated blood pressure in the veins connecting the heart and lungs, causing arterial constriction and reduced oxygen delivery (Brown et al., 2011). Causes and Risk Factors Causes include congenital conditions and diseases such as connective tissue disorders and liver cirrhosis. Females, older adults, and Black populations are more at risk (Brown et al., 2011). Prevention and Management Strategies Risk reduction involves controlling blood pressure and avoiding harmful substances like tobacco. While there is no cure, treatments and lifestyle changes help manage symptoms (Brown et al., 2011). References Brown, L. M., Chen, H., Halpern, S., Taichman, D., McGoon, M. D., Farber, H. W., … Elliott, C. G. (2011). Delay in recognition of pulmonary arterial hypertension: Factors identified from the REVEAL registry. Chest, 140(1), 19–26. https://doi.org/10.1378/chest.10-1166 NURS FPX 8045 Assessment 2 Summarize a Passage

NURS FPX 8045 Assessment 1 Name Capella university NURS-FPX 8045 Doctoral Writing and Professional Practice Prof. Name Date

NURS FPX 8030 Assessment 5 Creation of Policy or Procedure Name Capella university NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner Prof. Name Date Hospital Acquired Infection Avoidance among ICU Patients through Hand Hygiene Protocol at Regional Memorial Hospital Purpose:  A comprehensive Hand Hygiene (HH) protocol-based policy aims to control and lower the patient security and care quality concerns of Hospital-Acquired Infections (HAIs) in Regional Memorial Hospital, particularly in its Intensive Care Units (ICUs). Patients in ICU are at an increased likelihood of HAI because of the frequent use of invasive operations and gadgets, immunodeficiency comorbidities, and fragility. The issue of HAIs is severe due to their increased healthcare costs, lengthening hospital stays, and worsening patients’ medical conditions. Every year, HAIs harm around 140,000 people around the world. Based on incidence surveys in the United States, ICUs account for 30.1% of HAIs (Blot et al., 2022). Such infections are directly linked to the nation’s monetary damage; HAIs affect around 2 million individuals in the US each year, resulting in 90,000 fatalities and a cost of $28.1 to $45.2 billion (Marty et al., 2024). Regional Memorial Hospital has experienced a surge in HAIs, owing mainly to disparities in HAI prevention efforts and HH compliance. The Regional Memorial Hospital’s internal evidence revealed that 30% of patients suffer from HAIs in the ICU. The events of Central Line-Associated Bloodstream Infections (CLABSI) and Catheter-Associated Urinary Tract Infections (CAUTI) were 0.553 and 0.924 per 1,000 device days, surpassing national criteria (Leapfrog, 2024). CLASBI and CAUTI cause approximately 25.1% of patients to experience death in one year. This discrepancy causes an enormous gap in HAI prevention strategies, which should be addressed.  NURS FPX 8030 Assessment 5 Creation of Policy or Procedure Reviewing earlier compliance audits and HAI control reports found that staff needed to follow current HAI preventive strategies such as HH. Given this practice gap, a clear policy is essential to guarantee that all divisions, notably ICU settings, comply with standardized HAI avoidance strategies. Research confirms the usefulness of the HH procedure and its adherence to minimizing HAI rates. For example, Boora et al. (2021) argued that increasing HH compliance lowers HAI rates. The lowest HAI was 4.26%, with a 63.66% compliance to HH. While HH compliance declined by 53.96%, the rate of HAI increased to 6.8%. The evidence was gathered utilizing databases such as PubMed, Cochrane Library, and CINAHL from observational studies, research on HAI prevention, and a comprehensive literature review while following the criteria for exclusion and inclusion. The PICO(T) question that informs the policy is: In ICU patients at Memorial Regional Hospital (P), how does the implementation of hand hygiene protocol (I), as compared to current practices (C), affect the rate of HAIs (O) over 12 weeks (T)? Immediate intervention is required as HAIs among ICU patients result in extended hospitalizations, increased hospital expenses, and poor patient results. The HAI avoidance policy has an impact on patients and medical facilities. Such infections can cause diseases that extend the time required for full healing and necessitate extra treatments, which strains patients and hospitals. The HH protocol intervention strategy can improve patient safety and make it easier for health facilities to execute infection prevention policies. Further, this strategy will assist in minimizing the financial load of the hospital. Population Affected by the Policy: The intervention policy applies to all patients admitted to Regional Memorial Hospital’s ICU, focusing on critically ill patients who are most susceptible to HAIs, excluding the patient population of other settings. Such patients are frequently vulnerable because of intrusive therapies, including central lines and weakened immune systems (Blot et al., 2022). The policy also applies to medical personnel primarily accountable for carrying out and monitoring the daily HH regimen, including ICU physicians, nurses, and other infection prevention staff. Hospital administration, quality assurance teams, and infection prevention staff are also affected because they will monitor adherence and determine how effectively the intervention functions to reduce HAI rates and improve care quality and patient results. The scope and depth of this issue are extensive as HAI affects those who are seriously ill in ICUs globally, adversely impacting their medical condition and leading to complications like sepsis. The problem of HAI is also prevalent in neonatal settings like neonatal ICUs, affecting the health of babies and jeopardizing their safety (Marty et al., 2024). The severity of infection contributes to morbidity, prolonged hospitalization, higher costs for healthcare, and increased fatality rates. Definitions:  Hospital Acquired Infections (HAIs): Infections that are usually absent or can be incubated upon hospital admission. Such infections generally occur during hospitalization and emerge 48 hours after admittance (Monegro et al., 2023). Bacteria and other pathogens are abundant in hospitals, and insufficient HAI control procedures frequently cause these infections. Hand Hygiene Self-Assessment Framework (HHSAF): The World Health Organization (WHO) developed ICAT to conduct an incident examination of HH development and practices inside a particular healthcare organization. The tool helps identify major areas that require attention and change. The results can help establish a road map for the hospital HH advancement strategy (WHO, n.d.). Central Line-Associated Bloodstream Infections (CLABSI): Illnesses happen when pathogens, typically fungi or bacteria, penetrate the circulatory system through a central line due to an unsanitized method. The central line is a tube that healthcare workers commonly insert into a major neck vein or abdomen to administer drugs or fluids or obtain blood for clinical evaluations (Centers for Disease Prevention and Control, 2024). Such infections are common adverse effects among ICU patients receiving invasive treatment. NURS FPX 8030 Assessment 5 Creation of Policy or Procedure Catheter-Associated Urinary Tract Infections (CAUTI): Illness occurs when fungi or bacteria penetrate the urinary tract through a tube or catheter due to poor sterilization methods (Rubi et al., 2022). Hand Hygiene Protocol: The protocol refers to guidelines for HH to avoid HAIs. Guidelines comprise the HH method of hand preparation and sanitization before surgical procedures, the use of HH chemicals for washing hands, such as soap and sanitizer, the utilization of Alcohol-Based Hand Rub (ABHR) and gloves, appropriate skin care, and staff training on HH methods (Buković et al., 2021). Hand Hygiene Compliance: Hand hygiene compliance is the adherence of medical staff to approved HH procedures at the appropriate times during patient care

NURS FPX 8030 Assessment 4 Methods and Measurement Name Capella university NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner Prof. Name Date Methods and Measurement Hospital-Acquired Infections (HAIs) are a serious security concern in Intensive Care Units (ICUs), where natural sensitivity to severe sickness procedure intrusions is increased. In Memorial Regional Hospital, HAIs are a severe problem in ICU patients. According to 2023 figures, the frequency of Central Line-Associated Bloodstream Infections (CLABSI) and Catheter-Associated Urinary Tract Infections (CAUTI) were 0.554 and 0.925 per 1,000 device days, correspondingly exceeding national standards (Leapfrog, 2024). Addressing HAIs among patients in ICU settings is a pressing issue in medical settings, which is frequently exacerbated by poor HAI prevention techniques such as Hand Hygiene (HH) policies and HH compliance among hospital staff. The paper aims to assess the effectiveness of HH protocol interventions using evaluation tools. Instruments were chosen based on their validity and supporting techniques, which provide a solid platform for assessing and enhancing HH practice compliance. Employing these tools aids in preventing HAI among patients admitted to the ICU by showing compliance levels and improving patient safety outcomes. Instruments Used for the Effectiveness of Interventions HAI is a safety and quality problem, especially in ICU patients, which requires an effective strategy based on HH protocol to answer the PICO(T) inquiry: In ICU patients at Memorial Regional Hospital (P), how does the implementation of Hand Hygiene (HH) protocol (I), as compared to current practices (C), affect the rate of HAIs (O) over 12 weeks (T)? HH protocols typically involve washing hands with soap, utilizing alcohol-based disinfectants, wearing gloves, and caring for skin to prevent infections (Buković et al., 2021). Adherence to proper HH measures is an effective intervention for preventing infection spread in hospitals. It is critical to evaluate the effectiveness of solutions in addressing safety concerns and bringing about practice change in the hospital context. The success of an intervention can be assessed by utilizing tools that provide quantitative and qualitative information on HAI risks, HAI rates, and intervention compliance rates via surveillance and feedback. The chosen tools are:  Hand Hygiene Self-Assessment Framework  The Hand Hygiene Self-Assessment Framework (HHSAF) tool, created by the World Health Organization (WHO) in 2009, is valuable in assessing the intervention efficacy and sustainability of HH practices in medical facilities. The evaluation framework utilizes a mixed-methods approach involving qualitative adherence assessments with quantitative infection rates. The HHSAF is a self-reported survey created to gather an organized context evaluation of HH organizational structures, assets, promotions, or procedures in hospitals. The tool is validated to measure HH adoption levels linked to HAI rates (Kraker et al., 2022). The present approach to applying the HH protocol intends to reduce HAIs among ICU patients; the HHSAF tool would help evaluate whether and how everyday HH practices are being accomplished and retained. Research by Kraker et al. (2022), has demonstrated its validity and accuracy and is credible. The reliability ensures that the data acquired is accurate and can be used to make informed choices about the efficacy of HH procedures. The framework entails 27 indicators in five categories, with the highest grade of 500 points: organizational change, staff training, assessment and feedback, HH practice alerts in the workplace, and organizational safety (Kraker et al., 2022). Personnel can track changes in HH practices by using the HHSAF regularly before and after implementing the HAI prevention strategy. The tool divides hospitals into four levels based on compliance practices: insufficient (0-125), basic (126-250), moderate (251-375), or outstanding (376-500). The tool identifies current HH status and hospital development opportunities for HAI avoidance (Kasujja et al., 2024). Infection Control Assessment Tool The Infection Control Assessment Tool (ICAT) is an evaluation tool developed by the Centers for Disease Prevention and Control (CDC) that assesses HAI interventions, such as hand washing with soaps and sanitizer, utilizing Alcohol-Based Hand Rubs (ABHR), and protective supplies like gloves. The framework is crucial to assessing the efficacy of HH protocol interventions in HAI prevention in an ICU setting. The tool helps hospitals identify, manage, and prevent HAIs. HAI is simple to administer and assess, highlighting points of concern and recommending cost-effective solutions (USAID, n.d.). The credibility and applicability are confirmed by its formulation and comprehensive analysis tool by CDC. Utilizing the ICAT will help evaluate whether daily HH practices have been performed and maintained. The incompliance with HH practices will be identified. The tool consists of modules adapted to various medical settings, including the ICU. The evaluation tool comprises 21 categories measuring infection avoidance and hospital management actions. The modules address many infection prevention themes and can be customized to align with standard guidelines and available resources in medical settings (USAID, n.d.). The ICAT incorporates quantitative analysis approaches to measure compliance rate and incidence of HAIs, using checklists to measure HAI avoidance domains such as HH; the scale ranges from full adherence to nonadherence to HAI prevention practices. The validity of the tool is exhibited by evidence such as Abed and Eldesouky (2020),  have adopted ICAT to analyze the efficacy of HAI prevention solutions. ICAT provides a practical framework for baseline evaluation, intervention, and tracking of infection avoidance initiatives. Using ICAT ensures an extensive assessment of measures for infection prevention, improving patient security and minimizing the incidence of HAIs. Relevant Studies Relevant literature has supported the reliability and efficacy of tools to assess HAI avoidance programs’ success and adherence. For instance, Sakihama et al. (2020), conducted research utilizing the HHSAF tool, aiming to assess the long-term effectiveness of a comprehensive HH intervention on HH compliance rates among medical staff at five Japanese hospitals. Using HHSAF, the researchers closely monitored and observed HH compliance before and after the HH intervention. The results demonstrated that healthcare workers’ HH compliance rate increased from 18.1% to 32.8%, reducing HAIs. The hospitals’ HHSAF scores, graded by HH compliance, reveal that hospitals A and B scored 336 and 291, moderate, respectively, while hospital C showed a basic score of 232.8. Further, Kraker et al. (2022), validated the effectiveness of the HHSAF in determining the level of HH adoption and its drivers in hospitals. The findings revealed that the HHSAF score implied an HH adoption level (350 points). Institutional change possessed the greatest score (86 points), indicating that alcohol-based hand rubs during care are a consistent practice in medical facilities to

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature Name Capella university NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner Prof. Name Date Critical Appraisal of Evidence-Based Literature Hospital-Acquired Infections (HAIs) are an important safety issue due to their high mortality rate, extended hospital stay, and financial impact. HAIs endanger patient safety at Memorial Regional Hospital, notably in the Intensive Care Units (ICUs), leading to elevated death, disability, and medical expenses. HAI exposes patients to hazards like antimicrobial resistance and microflora imbalance, jeopardizing patient safety. In the United States, HAI-related expenses are $ 28.3 to $ 45.2 billion, causing financial strain (Gidey et al., 2023). This paper is based on a critical literature analysis concentrating on HAI problems. PICO(T) Question In ICU patients at Memorial Regional Hospital (P), how does the implementation of Hand Hygiene (HH) protocol (I), as compared to current practices (C), affect the rate of HAIs (O) over 12 weeks (T)? This PICO(T) aims to assess whether introducing HH protocols can reduce HAIs among ICU patients. It is concerned with patients who are hospitalized in an ICU setting. It compares a standardized HH protocol with present preventative measures to determine its efficacy in reducing HAI rates during 12 weeks. The HH protocol entails washing hands with soap or using an alcohol-based sanitizer before touching patients. The results will be determined by decreased HAI frequency and increased patient security, including reduced HAI-related complications, length of stay, and care expenses. Thesis Statement Employing a standardized HH protocol in ICU settings is crucial to HAI avoidance within 12 weeks, enhancing patient safety and improving medical outcomes. The intervention boosts the quality of care and positively impacts organizational performance and reputation. An extensive analysis of recent evidence will exhibit the efficacy of HAI control interventions. The HAI issue underscores the need for rigorous research evaluation to inform healthcare practices to improve patient safety. Critical Appraisal and Selection of Tool The CASP (Critical Appraisal Skills Programme) checklist is employed to evaluate the quality and relevance of the selected studies. The CASP tool is intended to systematically identify the legitimacy, relevance, and findings of published studies. The tool entails a set of inquiries that help the assessment of multiple facets of a study, such as its methods, validity, and relevance to practice (Long et al., 2020). Critical assessment aims to evaluate the quality of the methodology used in research and determine how effectively it handled bias during design, execution, and assessment. The CASP checklists comprise criteria for determining study validity, findings, and usefulness in practice, ensuring an accurate assessment of the flaws and strengths of research. The CASP tool is utilized because it presents a structure to assess peer-reviewed publications common in HAI control research, ensuring that the literature synthesis on HAI preventive strategy is effective and applicable to healthcare settings, improving patient results. Annotated Bibliography Buković, E., Kurtović, B., Rotim, C., Svirčević, V., Friganović, A., & Važanić, D. (2021). Compliance with hand hygiene among healthcare workers in preventing healthcare associated infections–A systematic review. Journal of Applied Health Sciences, 7(1), 57-69. https://doi.org/10.24141/1/7/1/6 The study delivered a systematic review of the importance of medical staff’s HH compliance with World Health Organization (WHO) guidelines. The study is remarkable for its comprehensive and methodical approach. Its rigorous research methods used databases such as PubMed to complete procedures for gathering information based on inclusion criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study offered valuable suggestions for HAI avoidance by boosting HH compliance. For example, adhering to multimodal WHO guidelines like providing staff training, using reminders for HH, and improving infrastructure boost compliance. Based on the CASP tool analysis, the article demonstrates exceptional quality in several areas, including a well-defined research subject, study design, and solid evidence to support its results, showing reliability. This study is pertinent to the issue of HAI because comprehending the approaches to enhance compliance among staff is essential to executing HAI prevention efforts through HH guideline compliance effectively. For instance, HH guidelines are based on the HH method of surgical hand preparation, HH agents and gloves, proper skin care, and staff education on HH practices. Offering literature on HAI prevention studies helps staff understand methods that can aid them in minimizing HAI.  NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature Chen, N., Arbogast, J. W., Henry, D., Allen, T. T., O’Hara, S., & Xia, C. H. (2024). A simulation study of touch-free automatic alcohol-based handrub dispensers on hand hygiene disruption in healthcare settings. Computers & Industrial Engineering, 193(1), 110312. https://doi.org/10.1016/j.cie.2024.110312 The authors conducted a simulation-based study to determine the effect of automated Alcohol-Based Handrub (ABHR) dispensers on HH functioning.  The study found that the percentage of missed HH chances due to refill deficiency ranged from 403.2 to 1232.5, with total unavailability ranging from 0 to 96.4 hours in hospitals. Maintenance initiatives like service refill reminders can minimize the likelihood of ABHR depletion, leading to an 81.7% reduction in HH delays for one dispenser with substantial usage. Scholar evidence for the study’s trustworthiness derives from its rigorous research design, discrete event simulation model use, and statistical analysis. Using the CASP checklist, this study displays credibility and quality in various ways, including a clear explanation of the research question, purpose of the study, and findings. The article adds to the literature and promotes patient safety by assisting in interventions using automated sanitizer dispensers to reduce HAIs by identifying shortcomings with automated sanitizers. For example, the study suggests that novel solutions, like refill maintenance reminders, successfully decrease HH misses. The study is useful because it recommends that hospitals evaluate dispenser usage trends and develop optimum procedures and regulations for dispenser refilling service to boost HH compliance and avoid HAI events.  NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature Clancy, C., Delungahawatta, T., & Dunne, C. P. (2021). Hand-hygiene-related clinical trials reported between 2014 and 2020: A comprehensive systematic review. Journal of Hospital Infection, 111, 6-26. https://doi.org/10.1016/j.jhin.2021.03.007 The authors conducted an in-depth systematic review of clinical trials to evaluate HH solutions for preventing HAIs in care settings. The study displays exceptional quality through its comprehensive literature selection technique, which incorporates databases such as CINAHL, Embase, Cochrane, and PubMed, and specific inclusion standards. Scholastic evidence for the research’s

NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization Name Capella university NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner Prof. Name Date Patient Safety Issue, PICO(T) Question and Evidence Hospital Acquired Infections (HAIs) pose a threat to patients’ safety at the Memorial Regional Hospital especially in Intensive Care Units (ICUs). The incidence rates Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infections (CAUTI) and other HAIs have been on the rise, resulting in higher mortality, morbidities and increased health care costs. Internal data from Memorial Regional Hospital reveals CLABSI and CAUTI rates of 0.553 and 0.926 per 1,000 device days, respectively, in 2023, which exceed national benchmarks (Leapfrog, 2024). The HAIs compromise patient safety, prolong recovery, and strain hospital resources, necessitating immediate intervention to reduce their incidence. Gaps in infection control practices, identified through staff interviews and internal data, contribute to the prevalence of HAIs in ICUs. External evidence supports the urgency for change. Peters et al. (2022) highlight the importance of hand hygiene, environmental cleanliness, antimicrobial stewardship, and staff education in preventing HAIs. CDC (2024) reports that one in 31 hospitalized patients acquire an HAI annually, resulting in over 72,000 deaths. The findings stress the need for multifaceted, evidence-based strategies to reduce HAIs and improve patient safety at Memorial Regional Hospital. The PICOT Question In ICU patients at Memorial Regional Hospital (P), how does the implementation of hand hygiene protocol (I), as compared to current practices (C), affect the rate of HAIs (O) over 12 weeks (T)? Best Evidence Search Strategy Establishing an efficient approach to developing the search terms is crucial to finding the most relevant evidence for the PICOT question about Memorial Regional Hospital and ICU patients and the impact of a comprehensive hand hygiene protocol on the rates of HAIs. In identifying the main components of the PICOT question, ICU patients are the population of interest, and a hand hygiene protocol and antimicrobial stewardship are the interventions of choice compared to the current practice in reducing HAIs and enhancing patient safety (Akkoc et al., 2021). PubMed, CINAHL, and the Cochrane Library databases were used, since these are rich sources of medical, nursing, and clinical research articles (Kuti et al., 2021). Such an approach guarantees access to the most relevant evidence for implementing such interventions in the ICU. The PRISMA flowchart is presented in the Appendix to outline the process of study identification and inclusion and exclusion criteria. Databases and Keywords Selecting appropriate databases and keywords is critical for conducting an effective search to gather the best evidence on the impact of a hand hygiene protocol and antimicrobial stewardship on HAIs in ICU patients. Databases such as PubMed, CINAHL, and the Cochrane Library were utilized for their extensive collections of high-quality clinical and nursing research (Kuti et al., 2021). Key search terms included “hand hygiene,” “Healthcare-Associated Infections (HAIs),” and “infection prevention.” Boolean operators like AND, OR, and NOT optimized the search by refining and expanding it to identify relevant studies that could guide quality improvement initiatives. Inclusion and Exclusion Criteria The selection criteria involved articles in English published after 2019 that compared the effects of hand hygiene and antimicrobial stewardship on HAIs in ICU patient populations. The inclusion criteria included studies with samples of ICU patients, reported at least one of the PICOT question’s outcomes, such as CLABSI and CAUTI rates, and contained evidence-based interventions. Studies performed outside the ICU were excluded, and studies with pediatric patients and those addressing other types of interventions other than hand hygiene were excluded (Raoofi et al., 2023). According to these criteria and to ensure the quality of the articles selected, the authors screened and included 12 articles in the review. Only articles directly relevant to the issue were included in the review, thus proving the effectiveness of targeted interventions in decreasing HAIs and increasing patient safety (Raoofi et al., 2023). A total of 12 studies were retained as they provided information on the applicability of interventions in ICUs, which closely matched addressing HAIs at Memorial Regional Hospital. References Akkoc, G., Soysal, A., Gul, F., Kepenekli Kadayifci, E., Arslantas, M. K., Yakut, N., Bilgili, B., Ocal Demir, S., Haliloglu, M., Kasapoglu, U., & Cinel, I. (2021). Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system. The Journal of Infection in Developing Countries, 15(12), 1923–1928. https://doi.org/10.3855/jidc.14156  CDC. (2024). HAIs: Reports and data. Centers for Disease Prevention and Control.gov. https://www.cdc.gov/healthcare-associated-infections/php/data/?CDC_AAref_Val=https://www.cdc.gov/hai/data/portal/index.html Kuti, B. P., Ogunlesi, T. A., Oduwole, O., Oringanje, C., Udoh, E. E., & Meremikwu, M. M. (2021). Hand hygiene for the prevention of infections in neonates. Cochrane Database of Systematic Reviews, 21(7). https://doi.org/10.1002/14651858.cd013326.pub3  NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization Leapfrog. (2024). Hospital details table. Hospitalsafetygrade.org. https://www.hospitalsafetygrade.org/table-details/memorial-regional-hospital Peters, A., Schmid, M. N., Parneix, P., Lebowitz, D., de Kraker, M., Sauser, J., Zingg, W., & Pittet, D. (2022). Impact of environmental hygiene interventions on healthcare-associated infections and patient colonization: A systematic review. Antimicrobial Resistance & Infection Control, 11(1), 1–9. https://doi.org/10.1186/s13756-022-01075-1  Raoofi, S., Pashazadeh Kan, F., Rafiei, S., Hosseinipalangi, Z., Noorani Mejareh, Z., Khani, S., Abdollahi, B., Seyghalani Talab, F., Sanaei, M., Zarabi, F., Dolati, Y., Ahmadi, N., Raoofi, N., Sarhadi, Y., Masoumi, M., sadat Hosseini, B., Vali, N., Gholamali, N., Asadi, S., & Ahmadi, S. (2023). Global prevalence of nosocomial infection: A systematic review and meta-analysis. Public Library of Science, 18(1), e0274248. https://doi.org/10.1371/journal.pone.0274248 Appendix Identification of Studies Via Databases and Registers Search Strategy Selecting Databases: The search was done by using PubMed, CINAHL, and the Cochrane Library databases. These databases were selected based on their ability to provide coverage of biomedical and nursing literature, providing the best information on hand hygiene standards and HAI prevention in the ICU. Initial Search Results: A total of 25 records were identified across the selected databases. No additional records were found in registers or other sources. Screening Process: The first 25 records were excluded by reviewing the title and abstract of each record in order to evaluate relevance to the PICOT question. A total of 9 records were excluded after the screening due to irrelevance or poor quality. Eligibility Criteria:

NURS FPX 8030 Assessment 1 Building the Case for Healthcare Improvement Name Capella university NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner Prof. Name Date Building the Case for Health Care Improvement [Slide 1] Hi to everyone! I am Felicia. Today, I will underline the serious problem of Hospital Acquired Infections (HAIs) at Memorial Regional Hospital. I emphasize the increased occurrence of HAIs, validated by external studies and internal evidence, and provide Evidence-Based Practice (EBP) solutions to improve results and patient security.  Presentation Outline [Slide 2] During this presentation, I will discuss the following points: Hospital Acquired Infections as a patient safety issue External resources supporting the necessity of change Priorities of organization for HAI prevention intervention  Quality Improvement (QI) project proposal Patient Safety Issue [Slide 3] In advanced care settings, HAIs are a critical security issue in worldwide medical systems, particularly at Memorial Regional Hospital. The growing frequency of HAI in Intensive Care Units (ICU) of US hospitals has raised mortality and morbidity among patients while also imposing an immense cost on the hospitals (Gidey et al., 2023). Higher HAI rate, notably Central-Line Associated Bloodstream Infections (CLABSI) at 25% and Catheter-Associated Urinary Tract Infections (CAUTI) at 29%, compromises patients’ health (Teja et al., 2021). For example, inserting a nonsensitized catheter can result in infection and related issues like fever, pain, and even sepsis. It necessitates extra therapies, resulting in postponed recovery, so resolving HAI issues has become a top priority. Gidey et al. (2023), emphasize the enormity of patient security risk; in America, the direct yearly expense of caring for HAIs is $ 28.5 to $ 45.1 billion, which strains the medical system. Patients in ICUs are 5 to 10 times more likely to develop an HAI because of internal variables such as immunodeficiency and external aspects like medical instrument use, impacting patient safety (Teja et al., 2021). So, it is necessary to manage HAI to boost outcomes. NURS FPX 8030 Assessment 1 Building the Case for Healthcare Improvement [Slide 4] Patients in ICUs are in danger of HAI owing to the widespread use of invasive treatments and equipment, immunodeficiency, comorbidities, vulnerability, and advanced age. In the United States, 30% of all HAIs happen in the ICU (Blot et al., 2022). Internal data on HAIs, obtained through surveys and dashboard analysis, revealed that 30% of ICU patients experience HAIs. CLASBI and CAUTI cause around 25% of patients to die within a year. Through staff interviews, it is revealed that inadequate HAI prevention practices are followed. One-third of the patients admitted to the ICU face severe complications due to HAIs. Further, the survey reported that in 2023, HAIs are prevalent in Memorial Regional Hospital; the rate of CLASBI is 0.553 per 1,000 central-line days, showing worse performance, and the CAUTI rate is 0.926 per 1,000 catheter days. These severe infections can cause other complications, requiring more recovery time, and can often lead to mortality, compromising patient safety (Leapfrog, 2024). External Sources Support for Need of Change [Slide 5] External resources support the necessity of change in the hospital to avoid HAIs. A peer-reviewed study by Haque et al. (2020), highlights the effect of HAIs on critical care and emphasizes the need for effective approaches to prevent HAIs. These practices include hand hygiene, sustaining a clean atmosphere, staff education, adhering to patient security protocol, and Antimicrobial Stewardship, as well as reducing the chances of HAIs. Another source is the Center for Disease Prevention and Control’s (CDC) HAI report, which underscores the necessity for improved HAI control. The CDC discovered an alarming nationwide pattern: On a single day, almost one in every 31 hospitalized individuals had one HAI. Annually, over 680,000 HAIs occur, and 72,000 hospitalized patients die due to HAIs during hospital stays (CDC, 2024). The rise in damage to patients is directly linked to the issues observed at Memorial Regional Hospital, particularly in the ICU. The CDC report underlines the crucial need for EBP solutions to address HAI. Evidence from these two resources is closely pertinent to the issue of HAI in Memorial Regional Hospital, where 0.553 scores for CLASBI and 0.926 for CAUTI were identified in 2023. Executing EBP solutions can boost patient security and outcomes in hospitals. Organizational Priority for Intervention [Slide 6] HAI prevention is a top focus at Memorial Regional Hospital due to its major impact on patient security, health results, and clinical costs. Vital stakeholders like hospital executives, clinical staff, and nurses are concerned about resolving the HAI issue. It leads to more operating expenses, potential legal consequences, lower reimbursements and funding, and hospital penalties for higher HAI incidents. For example, the suffering due to HAI causes prolonged hospital stays, additional care procedures due to complications, and more usage of antibiotics, raising clinical costs. Poor health outcomes due to HAI, like CAUTI, can result in serious repercussions, such as organ failure or disability, morbidity, and even death (Blot et al., 2022). Communities and patients are concerned about resolving HAI as they want secure and quality care. The higher HAI events erode their trust in staff and the hospital. It is crucial to address the HAI issue to sustain patient safety, trust, and hospital credibility. Proposal of Quality Improvement Project [Slide 7] The intended result of HAI intervention at Memorial Regional Hospital is a significant reduction in the rate of HAIs and associated complications like death. This can be accomplished by employing comprehensive, EBP multifaceted HAI avoidance approaches such as patient safety procedure adherence, environmental and hand hygiene, risk assessment, and staff training (Haque et al., 2020). The goal is to minimize HAIs and linked complications by 55% while meeting present criteria and national standards. Reducing HAI will boost patient results, security, and HAI-linked clinical costs. [Slide 8] The impact of the QI effort is multifaceted, including enhanced health results, greater patient and staff satisfaction, and reduced clinical expenses. Blot et al. (2022) illustrated that effective EBP solutions like staff education and hygiene procedures can reduce HAIs and related complications. For example, environmental hygiene practices like surface sanitation and cleaning, waste handling, sterilization, and equipment reconditioning can lower the rate of HAIs (Peters et al., 2022). Memorial Regional Hospital can strengthen its status as a renowned clinical group by implementing these methods to improve its care quality and patient security. Conclusion [Slide 9] Incorporating EBP HAI reduction solutions in Memorial Regional Hospital is

NURS FPX 8014 Assessment 3 Leading Global Health Strategic Planning and Policy Development notes Name Capella university NURS FPX 8014 Global Population Health Prof. Name Date Leading Global Health Strategic Planning and Policy Development Hello, greeting everyone. I am____, and today I am here to present a life-threatening global health concern: Malaria. I have decided to attend the meeting with a professional organization in the US community to share the profoundly affected Sub-Saharan Africa (SSA) with over 290 million cases and 608k deaths globally in 2022 (WHO, 2023). It has significantly impacted individual health, community well-being and economic development. My presentation will focus on strategies and policies to address the crisis, leveraging historical successes and innovative approaches. Several initiatives have been pivotal in addressing the situation, especially by The World Health Organization (WHO) and the Global Fund. By choosing exercise A, I attended a meeting of a professional organization within the community, specifically the local chapter of the American Nurses Association (ANA). Presenting at this meeting allows for direct interaction with nursing professionals who are at the forefront of healthcare delivery and advocacy. My objective is to develop and present comprehensive strategies, policies, and sustainable resource advocacy after extensive research on the topic and affected populations. This presentation will highlight the urgency of the malaria crisis, outline actionable solutions, and emphasize the importance of culturally sensitive approaches. By engaging stakeholders, the  aim is to drive impactful changes and foster collaborative efforts to reduce malaria prevalence and improve health outcomes in the most affected regions. Culturally Sensitive Strategies and Potential Policies Being a nurse encourages helps understand the cultural aspect of effective healthcare delivery. Malaria has impacted the SSA region excessively, and one of the reasons it is still an epidemic is their cultural beliefs and values. For that, culturally sensitive interventions are vital in addressing this issue, as malaria is beyond the biomedical concern. It involves the social and cultural factors. This part of the paper proposes and evaluates culturally sensitive interventions to address malaria through awareness campaigns, community-based interventions, increased access to medications, and maternal and child health initiatives.  Culturally Sensitive Awareness Campaigns These programs are essential to address malaria in SSA because many communities rely on traditional interventions (such as herbal remedies) due to deep-rooted cultural norms and limited access to healthcare. There are also misconceptions about malaria, for instance, relating it to witchcraft or supernatural forces. This deters people from seeking medical care (Orok et al., 2021). The indigenous population and low-income communities require support which must be provided through provision of educational and medical resources.For that reason, educational/awareness campaigns need to be designed to respect and integrate traditional beliefs while providing information regarding malaria prevention and treatment. Programs should include culturally appropriate messaging and involve women, who are often primary caregivers and crucial in the education process (Aremu et al., 2022). Community-Based Interventions The interventions can effectively address malaria by aligning with cultural beliefs and practices. Involving community leaders would be effective in efforts to increase acceptance and integration of modern practices. The community-based interventions should mainly focus on vulnerable groups like children and pregnant women. Community health workers can pay home visits and work with local leaders to promote insecticide-treated bed nets (ITNs), modern treatments, and Indoor Residual Spraying (IRS) (Awasthi et al., 2024). Integrated Vector Management (IVM) policy advocates for a comprehensive approach to vector control combining various strategies mentioned. This approach helps build trust and ensures that preventive measures and treatments are culturally acceptable. A prominent awareness campaign is “Zero Malaria Starts with Me”, which allows the SSA community to address the disease with knowledge and adequate resources available. It mobilizes resources and keeps malaria elimination a political agenda (Sarpong et al., 2022). Increase Affordability of Medication and Treatment The SSA’s 25% of income is used to treat malaria, which discourages the population from seeking care for its prevention. Unaffordability is a huge concern and a barrier to malaria prevention (Haileselassie et al., 2023). Policies that encourage affordable supplies, including artemisinin-based combination therapies (ACTs), can improve early detection and effective treatment. Malaria Vaccine Implementation Programme (MVIP) is an approach to pilot test to see the effectivness of vaccines like RTS,S. Further, international funding initiatives can help subsidize costs and ensure a steady supply, especially for women and children.  Maternal and Child Health Specific interventions for maternal and child health are essential to reducing mortality and morbidity rates among the vulnerable population of SSA. For instance, Antenatal care should offer insecticide-treated bed nets and intermittent preventive treatment for pregnant women. Child health services should focus on early diagnosis and prompt treatment of malaria in children under five (Park et al., 2020). Case Management Guidelines by WHO provides detailed guidelines on the use of rapid diagnostic tests (RDTs), appropriate antimalarial medications, and the management of severe malaria. Areas for Better Preparation of Strategies To improve the preparation for presenting culturally sensitive malaria strategies, deeper insights into local cultural beliefs and practices are needed. For example, understanding regional variations in traditional treatments and misconceptions about malaria could help tailor education programs more precisely. Incorporating systematic feedback from community members and leaders involved in the interventions could provide real-time insights into the effectiveness and acceptability of the strategies (Finda et al., 2020). Moreover, assessing local resources such as personnel and logistics, infrastructure including healthcare facilities, and the economic impact of interventions will help address feasibility and sustainability. It will help ensure that strategies are practical and well-integrated into existing healthcare systems (Finda et al., 2020). Sustainable Resources and Policy Development Addressing malaria in SSA requires a multifaceted approach that emphasizes the importance of sustainable resources and robust policy development. Advocating for policies that promote sustainable resource allocation and systematic improvements is crucial for achieving long-term success in malaria control. The purpose aligns well with the Sustainable Development Goals (SDGs), particularly SDGs 3, which advocates for healthy lives and the well-being of people of all ages (RBM partnership, 2020). First, investing in sustainable resource allocation is critical