Constructing the Written Evidence-Based Proposal: Final

Constructing the Written Evidence-Based Proposal: Final
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Table of Contents
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Abstract  PAGEREF _Toc404182678 \h
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1.0 Problem Description  PAGEREF _Toc404182679 \h
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2.0 Solution Description  PAGEREF _Toc404182680 \h
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2.1 Rationale for Selecting the Proposed Solution  PAGEREF _Toc404182681 \h
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3.0 Implementation Plan  PAGEREF _Toc404182682 \h
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3.1 Method of Obtaining Necessary Approval and Securing Support for Proposal  PAGEREF _Toc404182683 \h
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3.2 Evidence From Review of Literature  PAGEREF _Toc404182684 \h
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3.3 Implementation Logistics  PAGEREF _Toc404182685 \h
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3.4 Resources Needed for Implementation  PAGEREF _Toc404182686 \h
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3.5 Incorporating Theory  PAGEREF _Toc404182687 \h
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4.0 Evaluation Plan  PAGEREF _Toc404182688 \h
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4.1 Methods to Evaluate Effectiveness of the Proposed Change  PAGEREF _Toc404182689 \h
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4.2 Variables to be Assessed when Evaluating Project Outcomes  PAGEREF _Toc404182690 \h
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4.3 Tools to Educate Project Participants  PAGEREF _Toc404182691 \h
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4.4 Tools to Evaluate Project Outcomes  PAGEREF _Toc404182692 \h
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5.0 Dissemination Plan  PAGEREF _Toc404182693 \h
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6.0 Review of Literature  PAGEREF _Toc404182694 \h
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7.0 References  PAGEREF _Toc404182695 \h
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8.0 Appendices  PAGEREF _Toc404182696 \h
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Appendix A: Content of the educational materials: leaflets, brochures, and handouts  PAGEREF _Toc404182697 \h
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Appendix B: Questionnaire to evaluate the project outcomes  PAGEREF _Toc404182698 \h
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Abstract
The frequency of people with MRSA infections has increased considerably in recent years. In 2006, over 50% of all cases of skin infections because of MRSA happened in healthy persons living in the community. The 3 types of MRSA include healthcare-associated MRSA, hospital-associated MRSA, and community-associated MRSA. In the year 2008, MRSA resulted in about 89,786 cases of invasive disease leading to nearly 15,300 deaths in America. In the year 2008, roughly 27 percent of hospital-acquired MRSA infections were because of USA300 strains. MRSA is a major threat to communities and to patients in healthcare facilities. An MRSA infection can actually be more severe compared to other bacterial infections and can be life threatening. In America, studies indicate that MRSA is actually responsible for about 60 percent of community acquired infections with S. Aureus presenting to healthcare facilities. The rates of MRSA is escalating very fast all over the world. At present, healthcare associated/acquired MRSA (HA-MRSA) is endemic in hospitals.
The proposed solution for the prevention of MRSA is to provide education to individuals and communities on the ways to prevent the spread as well as transmission of the difficult-to-treat MRSA. The main reason for providing education to communities and individuals is essentially to promote health and prevent disease. The proposed solution is selected for the purpose of addressing the increasing rates of MRSA. Support would be obtained from the key contributors by explaining to them the justification and validation for the proposed solution, and the reasons as to why the proposed solution is indispensable in the heath care facility. An educational program is effective in both preventing and controlling MRSA infections not only in healthcare settings, but also in the community (Harris, 2014). The prevention of this bug/germ is of considerable significance as it will save the patients substantial medical costs and help in improving the patients’ quality of life. Resources needed for the implementation of this project include human resources such as registered nurses, doctors, nurse assistants, nurse managers, and charge nurses; educational materials such as handouts, booklets, leaflets, and brochures. Money, since this project is budgeted to cost $73,549; and tools for assessment such as questionnaires, surveys, pretests, and post-tests. To ensure effective dissemination of the findings, several strategies would be used such as making the content understandable, and using a variety of avenues for dissemination including publication in well-known journals such as Science Journal, New England Journal of Medicine, Nature Journal and JAMA. Other strategies include using flyers and brochures; using websites; and holding conferences and seminars.
Key Words: methicillin-resistant staphylococcus aureus (MRSA), strains, prevention, education
1.0 Problem Description
Mascitti et al. (2010) mentioned that Staphylococcus is a significant public health issue, and is known to be associated with infections that are difficult to treat. It is also linked to high incidences of mortality and morbidity, in addition to higher costs of health care. Staphylococcus is essentially a bacterium which is carried on the nasal lining or skin of about 30% of healthy people (Stefani et al., 2012). In such settings, the bacteria usually does not cause any symptoms, and in such instances the individual is colonized with MRSA. Nonetheless, when the skin of that person is damaged, for instance is cut or scratched, this bacterium can bring about various problems ranging from severe illness to a mild pimple, particularly in older adults young children, and persons whose immune system is weakened (Koydemir et al., 2011). Methicillin-resistant Staphylococcus aureus (MRSA) are the strains of Staphylococcus that are not sensitive to methicillin – a medicine that was made specifically to treat Staphylococcus – and other similar antibiotics (Golding et al., 2012).
Romano, Lu and Holtom (2011) stated that MRSA infections occur in 3 particular groupings of people: (i) people with recent hospitalization or continuing contact with dialysis units, medical clinics, or those who are going through intricate outpatient treatments, for instance chemotherapy. These people are exposed to healthcare-associated MRSA. (ii) People who are presently within the hospital setting, and these are exposed to hospital-associated MRSA. (iii) People in the community, and these are exposed to community-associated MRSA (Green et al., 2012). A person can become colonized – that is, infected with MRSA – by touching a surface which is contaminated, for instance a phone, a door handle, or a counter top; and by touching the skin of an individual colonized with MRSA (Raygada & Levine, 2009). In the year 2006 in America, there were roughly 94,350 invasive MRSA infections, resulting in over 17,900 deaths annually (Green et al., 2012).
2.0 Solution Description
For the identified problem, the proposed solution for the prevention of MRSA is to provide education to individuals and communities on the ways to prevent the spread as well as transmission of the difficult-to-treat MRSA. The main reason for providing education to communities and individuals is essentially to promote health and prevent disease. The education activities would be aimed at healthcare workers and the community members in order to prevent community-associated MRSA, healthcare-associated MRSA, and hospital-associated MRSA. In essence, appropriate training and education would be provided to the direct healthcare providers and other health care professional, patients, and visitors. In the community, posters that describe MRSA would be provided. Posters will have the images that illustrate proper hand washing and environmental cleaning. In addition, there would also be slide presentations with regard to the MRSA bug/germ.
Radio interviews would also be conducted in which MRSA germ would be discussed at length. During the radio interviews, questions on what MRSA is, its clinical presentation including the signs and symptoms that a person will have, treatment of MRSA, and how it can actually be avoided would be answered satisfactorily and in an in-depth manner. The radio broadcasts would be developed and then broadcasted to the local radio stations using English and local languages. Equally important, educational materials including leaflets, pamphlets, handouts and brochures would be prepared and distributed to the general public within the targeted communities. See content of leaflets, handouts, brochures in Appendix A. Videos would also be prepared about the nature of MRSA and how community members can prevent themselves from getting it. Healthcare workers should also be educated about their role in the prevention of MRSA and other topics related to MRSA as appropriate. To educate the nursing staff, meetings, conferences, seminars, and forums will be held where they will be educated regarding their role in preventing MRSA.
2.1 Rationale for Selecting the Proposed Solution
The proposed solution is selected for the purpose of addressing the increasing rates of MRSA. The general public, through educational activities would be educated on soft tissue and skin infections, and proper washing of hands. Education will be effective in the prevention of MRSA. The education will be aimed at altering the behavior of people in the community and personnel in healthcare settings so that they can practice proper environmental cleaning, hand hygiene, as well as disinfection (Calfee et al., 2014). In essence, educating patients and their families regarding MRSA as well as the recommended precautions can be helpful in reducing patient and family anxiety related to precautions. It may also help in reducing the possibility of developing symptomatic infection, and the risk of transmitting the germ to visitors and families. Education of health workers may also improve compliance with the recommended practices and visitor policies at the health care facility (Golding et al., 2012). Equally important, it improves patient satisfaction. In essence, patient and family education has to be provided without delay in cases in which the patient has previously been infected with MRSA or the moment the MRSA-positive status of the patient has actually been detected (Calfee et al., 2014).
3.0 Implementation Plan
3.1 Method of Obtaining Necessary Approval and Securing Support for Proposal
In essence, to ensure that this project succeeds, support from the key stakeholders including the management of the healthcare facility and fellow staffs at the place of work including the doctors, nurses, nurse managers, charge nurses, and nurse assistants is of major importance. These stakeholders are important since they have to endorse and support the project for it to be successfully implemented. In conjunction with patients who have presented with MRSA infections, the healthcare team members and the hospital’s management are the audiences of this project. Support would be obtained from these key contributors by elucidating to them the justification and validation for the proposed solution, and the reasons as to why the proposed solution is indispensable in the heath care facility.
Basically, the hospital’s management, as well as physicians, nurses, charge nurses, nurse managers, and nurse assistants would be informed about the value of change and how the hospital is going to benefit in consequence of the change. It is worth mentioning that an educational program is effective in both preventing and controlling MRSA infections not only in healthcare settings, but also in the community (Harris, 2014). The prevention of this bug/germ is of considerable significance as it will save the patients substantial medical costs and help in improving the patients’ quality of life (Gray, 2014).
Besides informing the administration of the hospital and doctors, nursing staffs, nurse managers, nurse assistants, and other healthcare professionals about the possible benefit of the proposed change, I will also encourage them to state their worries and concerns, if there are any, in relation to the proposed change. Their concerns and worries would be addressed clearly and satisfactorily. In essence, there would be less possibility of opposition to the proposed change when all their concerns and worries as regards the proposed change are addressed in an adequate and clear manner, when all healthcare personnel are adequately engaged and consulted, and when they are appropriately informed regarding the justification for this change (Marchione, 2010). Therefore, these healthcare personnel at the hospital would undoubtedly approve the proposed change and support it. It is of note that consulting and involving the hospital’s leadership and every healthcare worker during the project will ensure that they all have the feeling of involvement and ownership of the project, something that may increase the likelihood of them accepting the proposed the change (Prosperi et al., 2013).
3.2 Evidence From Review of Literature
Previously, MRSA was largely a hospital-acquired organism. However, community-acquired MRSA is today causing outbreaks amongst healthy sports people. Measures for controlling infection include providing awareness and education to athletes and employees (Romano, Lu & Holtom, 2010). An important way of protecting community members, healthcare workers, and patients against MRSA is by providing education both to patients and community members (Green et al., 2012; Durai, Ng & Hoque, 2010). In their study, Golding et al. (2012) developed educational materials to reduce the spread of community-associated MRSA to tackle the problem of increased community-associated MRSA infection in the northern half of Saskatchewan, Canada. In this part of Canada, the yearly rate of persons reported having community-associated MRSA infection rose considerably from 8.2 for every 10,000 people in the year 2001 to 168.1 in every 10,000 persons in the year 2006 (Golding et al., 2012). To tackle this problem, educational materials were developed to reduce the spread of community-associated MRSA. The educational intervention was targeted at healthcare professionals and it included the development as well as implementation of an active surveillance system for enhancing the data collection, including prescribing practices, microbiologic information – organism identification and vulnerability data – and general patient demographic information for clients within three communities in the northern part of Saskatchewan. Moreover, Golding et al. (2012) addressed the issues of microbial resistance through education activities that were targeted at the community. Slide presentations and radio interviews regarding antibiotic resistance and community-acquired MRSA were provided to the targeted communities. Radio broadcasts were also provided to further educate the people in the community about soft tissue and skin infections, hand washing and hygiene, and finishing the whole course of antibiotics.
After the implementation of educational program, Golding et al. (2012) reported that the MRSA infections rates within the targeted communities reduced by almost two-fold from the year 2006 to the year 2008 compared to other northern communities in Saskatchewan that were not targeted where the rates continued to rise over the same period of time. Calfee et al. (2014) pointed out that an effective strategy that can be used to prevent and control MRSA entails providing education to health care workers and community members about MRSA. Yan et al. (2013) mentioned that healthcare professionals have to be provided with education regarding their role in MRSA prevention in addition to other topics related to MRSA as appropriate.
3.3 Implementation Logistics
The hospital’s leadership – that is, the management – would integrate the proposed change into the existing structure, work flow, and culture of the organization by putting into practice principles and standards that would incorporate the change into the current organizational culture, work flow and structure. Moreover, the proposed change can be integrated into the organization’s existing structure, work flow, and culture using punitive measures whereby staff members would be manipulated and compelled to agree to the change or else they would be fired or demoted. Equally important, the organization can integrate the proposed change by using inducements that will encourage the hospital’s health care workers to be amenable and open to the change and actually accept it. Inducements can be in the form of rewards such as salary increments or cash rewards (Otter & French, 2011).
A nurse manager and a charge nurse are vital to this project, and these two would be in charge of initiating the change process, educating all nurses, as well as supervising the process of implementation. The charge nurse will initiate the change process and develop a shared vision for the institution. The nurse manager, on the other hand, will supervise the process of implementation to make certain that it is actually carried out effectively. The nurse manager and the charge nurse are critical to influencing change within an organization (Raygada & Levine, 2009).
3.4 Resources Needed for Implementation
Quite a lot of resources are necessary to ensure successful implementation of this project. These include the following: staff: the workers at the health care facility who comprise registered nurses, doctors, nurse assistants, nurse managers, charge nurses, and other health personnel at the hospital will be included in the implementation of the change process. Educational materials: several educational materials such as handouts, booklets, leaflets, and brochures would be needed. The content of the educational materials is at Appendix A. Money: this project is budgeted to cost $73,549 taking into consideration the size as well as scope of this project. Tool for assessment: this would also be needed and survey questionnaires will be used.
3.5 Incorporating Theory
MRSA prevention is a series of events that takes a considerably long time before it is wiped out or all prevention measures put in place. It of note that the proposed solution for the prevention of MRSA is education of individuals and communities on the ways to prevent spread and prevention of the difficult to treat MRSA. Health promotion and primary prevention of diseases is the main aim of these teaching proposals for the community. The first plan was to estimate how long the teaching time would last, materials and equipment needed for the whole teaching process, credentials of the teaching nurse and estimated costs of the whole teaching process.
Callista Roy, the theorist who came up with the adaptation model of the grand theory stated that health is, in essence, a state of being. He added that health is in a continuous state with illnesses. Roy came up with the model after much experience and study on the way that patients can be taught to adapt in each mode. The four modes that she proposes are interdependence, role function, self-concept and physiological. Roy in this case employs six steps to ensuring high quality of health which includes assessment of behavior, stimuli assessment, diagnosis of the problem, setting of goals, nurse intervention and evaluation of the patient’s reaction to what they have been given. The model is not only important for individual illness cases but also for families and communities. This is important for nurses who have to assist a patient cope with stimuli from both external and internal environment. The rationale for choosing the above theory is that it takes into consideration important features that is, conditions faced by the patient, circumstances and influence that distorts a person’s way of life. The model helps nurses to identify the problem and find solutions that can improve the patient’s condition.
The theory involves observation, analysis and solutions to such. Once a nurse is able to know where the infections might have been gotten from, it becomes easier to treat the patient. If the patient for instance has infections in the urinary tract, a revelation to the nurse will assist in knowing the type of medication to be given. Once treated, the nurse can be explaining to the patient the problem and how to avoid such in future. This is education, as proposed in the solution. This model can be used to provide scientific information pertaining to nursing education part of which can be incorporated fully in to the learning system in many medical training centers, institutions and colleges. It can also be fully useful in analysis and assessment of critical human conditions like emerging diseases, threats and issues such as MRSA.
4.0 Evaluation Plan
4.1 Methods to Evaluate Effectiveness of the Proposed Change
It is worth mentioning that an educational program would be carried out to prevent and control MRSA infections not only in healthcare settings, but also in the community. As such, to evaluate the effectiveness of the proposed change, the MRSA infection rates will be measured in both the community and the healthcare setting before and after the intervention. In essence, to measure the effectiveness of educational programs for the prevention and control of methicillin-resistant Staphylococcus aureus (MRSA), the rate of MRSA infection before the educational program would be compared to the rate after the implementation.
This program entails providing education to individuals and communities on the ways to prevent the spread and transmission of the difficult-to-treat MRSA. This is because providing education to communities and individuals has been shown to promote health and prevent illness (Green et al., 2012). The educational activities would be targeted at healthcare workers and the general public in the community in order to prevent community-associated MRSA, healthcare-associated MRSA, and hospital-associated MRSA infections. The educational program would be implemented in both the community in which the general public would be educated on soft tissue and skin infections, and proper washing of hands. The educational program would also be implemented in the health care setting where healthcare providers would be educated about their role in the prevention of MRSA.
Prior to the implementation of the education program, the rates of MRSA infections would be noted. These would then be compared with the rates of these infections after the implementation of the educational program. Essentially, the proposed solution would be considered as a success if the rate of MRSA infections after the implementation of the educational program has reduced because of this intervention. Conversely, the proposed solution would be considered to have been ineffective if there is no change at all in the rate of MRSA infections and/or if the rate of MRSA infections has increased.
The other method that would be used to evaluate the effectiveness of the proposed solution is by comparing it with a population wherein educational program is not provided. In the community, this will entail having two groups and educational program would be provided to one of the groups, whereas the other group would not be provided with the educational program. After a period of 12 months, the rates of MRSA infections would be compared between the two groups. The educational program would be considered as a success and effective if the rates of MRSA infection are lower in the intervention group than in the group where the educational program was not implemented. Otherwise, it will be seen as ineffective (Otter & French, 2011; Harris, 2014).
4.2 Variables to be Assessed when Evaluating Project Outcomes
Staff perceptions and attitudes: this is an integral variable given that the success and efficacy of the proposed change is largely dependent on how the hospital’s health care professionals would perceive it. In essence, the proposed change would be successful and effective if employees in the healthcare facility are receptive to it and actually have a positive attitude toward it. When the hospital staffs have an assenting perception and a confirmatory attitude toward the proposed change, then they would certainly accept it without exhibiting resistance (Koydemir et al., 2011). They will also not attempt to frustrate the implementation of the project. Conversely, if the hospital staffs have negative perceptions and unconstructive attitudes toward the proposed change, they are more likely to resist the change and frustrate its implementation. In turn, this will make the proposed change be unsuccessful and ineffective (Romano, Lu & Holtom, 2010).
Perceptions and attitudes of patients and the community: Another variable that would be assessed when evaluating the project outcomes is the attitudes and perceptions of patients and people in the community toward the proposed change. The education program would be provided to the MRSA patients and members of the public only if they are responsive to it and are actually willing to accept it. In essence, this connotes that if they have a confirmatory perception and positive attitudes toward the proposed change, then they would without doubt accept it. In this way, it will be effective and successful (Green et al., 2012). Conversely, it will not be considered as effective if the patients and the community members who have been intended for the educational program have low opinion and unconstructive attitudes toward the change. In this way, the proposed change will not be successful.
4.3 Tools to Educate Project Participants
Tools to educate participants: several vital tools would be utilized in educating the different participants who will take part in this project. The educational tools will include brochures, booklets, handouts, fliers, and pamphlets. The educational materials will have the pertinent text for educational purposes. They will be distributed to every participant in the project. In addition, MS PowerPoint presentations will be used.
4.4 Tool...