Module 6 DQ 1 and DQ 2Tutor MUST have a good command of the English languageThese are two discussion questionsDQ1 and DQ2 posts must be at least 150 words and have at least one reference cited for eac

The 10 Strategic Points

Broad Topic Area

1. Broad Topic Area:

The topic taken into consideration is the Central Line-Associated Bloodstream Infections (CLABSIs) and prevention

Introduction

1. Introduction

• The paper is an analysis of the CLABSIs infection and how best the infection can be prevented or even eliminated among patients.

• The infection is characterized by a catheter gaining entry into the bloodstream, greatly affecting either the inferior or the superior vena cava or the vessels of the neck.

• The location of the catheter makes entry of pathogens into the bloodstream very occasional. Patients thus become sick easily.

• The risk factors associated with the infection can result from the healthcare provider and also the patients and include; contamination on insertion, the skin flora of the patient, non-intact dressing, poor nutrition, position of the central line, poor patient and healthcare provider hygiene.

• Symptoms include redness, swelling, discharge at the central line exit, fever, chills, respiratory distress, and altered cognitive state.

• The infection can be prevented, through monitoring of the patients for any signs and symptoms, ensuring proper hygiene practices, and keeping patients educated about management of their central line.

• The paper gives all these information in detail, why there is a need to address Central line-associated bloodstream infections (CLABSIs) and how best the infection can be handled both by the health care givers and the patients.

Literature Review

1. Literature Review:

1. Primary points basis four sections in the Literature Review:

1. 1. Background of the problem/gap:

• Researchers have dedicated numerous efforts towards the cause and the probable symptoms related to Central line-associated bloodstream infections (CLABSIs) that one needs to be on the look-out for.

• Attention has thus been shifted from the different measures to prevent the occurrence of the infection among patients.

• There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs.

• The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections

• The nurses need to have the significant knowledge associated with evidence-based practices for the Central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter (CVC) patients.

Theoretical foundations (models and theories to be the foundation for the project)

• The efficacy of training of nurses over the prevention of Central line-associated bloodstream infections (CLABSIs) in neonates and children, through the exploitation of a questionnaire defining their socio-demographic data and their practical skills (Elbilgahy, A. A. et al., 2015).

• Knowledge about evidence practice reveals the discrepancies in the praxis, by the different nursing Pedagogics (Esposito, M. R. et al., 2017).

• Prophylactic measures to eradicate the incidence of CRIs or Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich, M. et al., 2014)

1. 1. Review of literature topics with a key theme for each one.

   2. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

• The efficacy of hygiene maintenance in the preponderance of CLABSIs rates in patients with CVCs, maintenance of patients with CVCs (Elbilgahy, A. A. et al., 2015); The key concepts in the study entail CLABSIs, ICU patients with CVCs, dressings, hygiene hub (Esposito, M. R. et al., 2017); The relevance of various interventions in reducing device-related infections. The key concepts are related to interventions (Hentrich, M. et al., 2014)

1. Educating on the science of safety. Care givers should be made knowledgeable on all hazards related to the infection. There is every need to address professionalism and morality among the nurses handling such patients.

2. A hazard free environment. Such enhances patient recovery. Patients need an environment that safe and is characterized by love and kindness.

Conceptual Framework

1. Jean Watson’s Theory of Human Caring

• Jean Watson’s theory encompasses various values and ethics that are expected from every health care giver and especially the nurses.

• Such values are loving, kindly, being authentically present and enable belief, growing one’s spiritual practice associated with wholeness, providing a caring and a healing environment, and also believing that miracles do occur.

• The argument and the content of the theory are closely related to the variables of the study; prevention of a bloodstream infection will call for the presence of a nurse who is willing to an extra mile to ensure that the infection is prevented.

• The theory also places a moral obligation on health care providers to enhance human dignity. Caring for ICU patients will call for the same.

• An environment characterized by care and which enhances the healing process will also come in handy.

Summary

• Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention including the nursing education

• Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting.

• Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia

2.

Problem Statement

1. Problem Statement:

Though studies have substantiated the CLABSIs to be a significant health concern as it impedes the recovery of the patients, the degree of efficacy of hygiene of hub, before each access in the prevention of CLABSIs, is unknown

Clinical/
PICOT Questions

1. Clinical/PICOT Questions:

• In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections)compared to standard care over a one-month period?

P: Patients > 65 years of age with a central line in ICU Regional Medical Centre, Texas.

I: Staff training and reinforcement of central catheter, hub hygiene

C: Compared to standard care

O: Reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections)

T: A period of one-month

Sample

1. Sample (and Location):

   1. Location: ICURegional Medical Center, , Texas

2. The selection of a sample population should not be haphazard for it will lead to biased results, furthermore, a large sample size helps in having precise results.

3. It necessary to calculate sample size for validity and reliability of results. The study will, therefore, allow an error of plus-minus 5 (Patino & Ferreira, 2016).

4. To avoid oversampling so as to have a minimal sample size that we are targeting are the 120 adult nurses out of the 335. The 120 nurses sampled will be the study participants who will aid in data collection.

5. Inclusion/exclusion criteria of the subjects

• People who are 65 or above and are from ICU Lake Regional Medical Centre, the central line catheter hub clinic section.

• The nurses who are not from the Central line of ICU Lake Regional Medical Centre will be excluded (Patino & Ferreira, 2018).

• Those who will have signed consent will be included in the study because of having fulfilled the research ethics standards.

• When the interviews and questionnaires have been conducted, the incomplete questionnaire forms will be excluded while the interview subjects who have not attended the interview will not be considered.

• Questionnaires that are fully filled and interview subjects who will turn for the interview and response will be included in the findings.

Define Variables

1. Define Variables:

1. Independent Variable: CLABSIs (Central Line Associated Blood-stream Infections) is a laboratory-confirmed infection of the bloodstream where a central line is confimerd to have been in place two days before the bloodstream infection developed.

2. Dependent Variable: the preventive measures refers to the techniques that need to be adopted in the nursing care institutions for patients with the bloodstream infection and are meant to improve the condition when administered to the patient.

Methodology and Design

1. Methodology and Design:

• The appropriate study methodology is the mixed methods approach through which questionnaires.

• Questionnaires refers to a set of questions that are aligned to the topic of study and are aimed at soliciting information from the study participants.

• Closed-ended questionnaires will be administered to the sampled nurses. Closed-ended questionnaires will ensure that data analysis is not mind-blowing because the respondents are tied to specific answers.

• The questionnaires will be based on a Yes or No responses.

• The interview questionnaires will be acquired from the previous literature that handles the same issues in the study.

• For evidence-based practice in a healthcare setting, it is proper to have the nurses asked questions about the particular practices in relation with the staff training, reinforcement of the Central line catheter hub hygiene once it has been inserted, the cleansing of the site and cases of Central Line-Associated Blood-stream Infections.

• The process will assist in acquiring the observational, additional, and the basic data that is targeted.

• The questionnaires will focus on the Adult ICU practices (Rodrigues, Correia, & Kozak, 2016).

• The data tools were exploiting the practices of nurses in Adult ICU, questionnaire responses, and a review of the other related articles.

• The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues.

• The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews.

• The research design that will be adopted will be exploratory especially because there is still a lot that has not been done on the topic under study.

Purpose Statement

1. Purpose Statement:

The purpose of this quantitative project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff at hospitals in, Texas for the prevention of CLABSIs.

Data Collection Approach

• The data collection approach techniques for the study will be questionnaires and also observation. The questionnaires will be short and precise, requiring the respondents to spend the least amount of time to answer to the questionnaires. The respondents may be busy and may not have enough time and the researcher will have to get a way of motivating them to be part of the study through minimizing the participation time.

• The observation technique will come as a backup to the study questionnaires. The researcher will take time to watch the nurses as they go about their duties.

• Observation is one effective way of getting first hand information about the question under study. The level of hygiene and also adherence to the recommendations put in place for the professionals will be easier determined through observation.

Data Analysis Approach

1. Data Analysis Instruments

• Data analysis will enable the researcher to organize the data collected so that conclusions can be drawn.

• The data analysis will capture the demographic information of the respondents including their age and the number of years they have dealing with patients suffering from CLABSIs (Central Line Associated Blood-stream Infections). Such will be presented using charts.

• The responses from the questionnaires will be studied to show the frequency of the relationships between variables as indicated by the respondents. The relationships will then tell the researcher whether there is a need to address the preventive measures and whether the proposed solutions will actually work.

• The relationships will be based on the study variables of the bloodstream infection and whether there are any preventive measures that need be adopted to reduce the rates of infection.

• A descriptive data analysis technique will come in handy, clearly giving relevant information about the study findings to enable logical conclusions.

• The instruments utilized in the research are the interview questions and a questionnaire. The creation was founded on the PICOT question and the statement of the problem, so as to acquire the desired information.

• While the questionnaire had most questions as closed, the interview questions will be open to allow attainment of supplementary data from the participants.

• Direct questions are expected to occur at the end of the interview (Nayak & Singh, 2015), Nevertheless, in this interview process, there will be utilization of indirect question with more direct questions for the target information from the nurses who have been retrained on hygiene of the hub at Clear Lake Regional Medical Centre and they are handling adult patients with CVC versus others who might not have had a similar training from two other hospitals and not every other nurse anywhere.

• The questions will be simplified as much as possible and they will allow one response at a time. The questions will avoid the analysis, hearsay, and opinions so as to obtain objective data.

• The questionnaires will contain demographic questions on the gender, the CLABSI prominence among the adult patients with CVC, how regular the cleansing process is conducted by the trained nurses, and any other hygiene process that are carried out by the re-educated nurses.

The dietary practice, interview guidelines and demographic questionnaire were as clear as possible to allow the response of the clients.

Ethical Consideration

• Ethical considerations are critical in any research work because research studies are tied into moral values which are meant to ensure that researchers do what is right in areas of human rights, respect for other researchers’ work and compliance with the laws and regulations.

• Throughout the research work, there will be no cases of plagiarism and all information used from other sources will be adequately cited.

• The researcher will ensure that the study does not cause any harm whatsoever to the respondents.

• In this research project not a study, any details that the respondent will not want it disclosed will be removed and deleted from any written or oral records, while others are candidly presented.

• Before the recruitment process, the participants will be contacted and be informed of the research and its significance (Castillo-Montoya, 2016).

• They will then beasked to declare their readiness to partake in the study and the free times they have for the interview process or questionnaire filling process.

• The form will have the clinical question, the usability of results, assurance of anonymity and confidentiality in which the researcher will indicate how the results will be exposed, to whom they will be exposed and how the subjects will be prevented from harm.

• The only harm could be labelling the nurses as unhygienic, hygienic, effective or ineffective, and mentioning their particular names.

• Since the study is checking on evidence-based care and its impact, the subjects will not be mentioned and the results will be written in a manner that they do not openly show which health care has a particular condition (Kamat, 2018).

• It is necessary that the health care centers be informed of the study.

• Before the study, the researcher will acquire their permission through formal e-mails which will be sent to the administration of the centers for approval.

The 10 Strategic Points

Broad Topic Area

1. Broad Topic Area:

The topic taken into consideration is the Central Line-Associated Bloodstream Infections (CLABSIs) and prevention

Literature Review

1. Literature Review:

1. Primary points basis four sections in the Literature Review:

1. 1. Background of the problem/gap:

      • There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs.

      • The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections

      • The nurses need to have the significant knowledge associated with evidence-based practices for the Central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter (CVC) patients.

   2. Theoretical foundations (models and theories to be the foundation for the project)

• The efficacy of training of nurses over the prevention of Central line-associated bloodstream infections (CLABSIs) in neonates and children, through the exploitation of a questionnaire defining their socio-demographic data and their practical skills (Elbilgahy, A. A. et al., 2015).

• Knowledge about evidence practice reveals the discrepancies in the praxis, by the different nursing Pedagogics (Esposito, M. R. et al., 2017).

• Prophylactic measures to eradicate the incidence of CRIs or Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich, M. et al., 2014)

1. 1. Review of literature topics with a key theme for each one.

   2. Prevention of Central Line Associated Blood Stream Infection (CLABSI)

• The efficacy of hygiene maintenance in the preponderance of CLABSIs rates in patients with CVCs, maintenance of patients with CVCs (Elbilgahy, A. A. et al., 2015); The key concepts in the study entail CLABSIs, ICU patients with CVCs, dressings, hygiene hub (Esposito, M. R. et al., 2017); The relevance of various interventions in reducing device-related infections. The key concepts are related to interventions (Hentrich, M. et al., 2014)

Setting

• • Adult ICU (Elbilgahy, A. A. et al., 2015).

  • The incidence of CRIs in cancer patients at the hospital (Hentrich, M. et al., 2014).

Summary

• Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention including the nursing education

• Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting.

• Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia

Problem Statement

1. Problem Statement:

Thoughthe studies have substantiated the CLABSIs to be a significant health concern as it impedes the recovery of the patients, the degree of efficacy of hygiene of hub, before each access in the prevention of CLABSIs, is not well documented

Clinical/
PICOT Questions

1. Clinical/PICOT Questions:

“In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of Central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections)?”

P: Patients > 65 years of age with a Central line

I: Staff training and reinforcement of Central Catheter, Hub Hygiene

C: Other area hospitals

O: Reduce probability of CLABSIs

Sample

1. Sample (and Location):

   1. Location: ICU Clear Lake Regional Medical Center, Webster, Texas

   2. Population: The population being sampled in the study is 120 adult ICU nurses (Elbilgahy, A. A. et al., 2015); 335 nurses were intrigued (Esposito, M. R. et al., 2017)

Define Variables

1. Define Variables:

   1. Independent Variables: crystalloid fluids, hub hygiene and line changes

   2. Dependent Variables: pedagogy

Methodology and Design

1. Methodology and Design:

The data tools were exploiting the practices of nurses in Adult ICU, questionnaire responses, and a review of the other related articles.

**The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues. The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews.

Purpose Statement

1. Purpose Statement:

The purpose of this quantitative project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff at hospitals in Webster, Texas for the prevention of CLABSIs.

Data Collection Approach

1. Data Collection Approach:

The primary instruments were nursing observations being done. The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues. The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews.

Data Analysis Approach

1. Data Analysis Approach:

The specific data analysis approach was chi-square and t-test are exploited for data analysis, and analysis was performed by using descriptive statistics through SPSS Statistics, Version 16.0. Also, The approach used for analysis of data will be thematic analysis as the data collected from interviews will be coded and these codes will further assist in the development of themes based on similarity in the content of interview data. Thematic analysis will facilitate in answering the clinical question developed.