1) Minimum 7 full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

  Part 1: Minimum 1 page

             Part 2: minimum 5 pages

             Part 3: Minimum 1 page

Submit 1 document per part

2)¨******APA norms

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

    Part 2: minimum 6 references 

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:
Part 1  

Part 2.do

__________________________________________________________________________________

Part 1: Nursing Research

 Suppose you are going to conduct a study utilizing Qualitative Research Design

1. Which type of research would you use

2. Which method would you utilize to collect data and select your sample.

Part 2: Nursing Research

For you to know and become familiar with the project topic and the bases of this part, see File 2. There you will find the approved project on which you should develop this work.

PURPOSE

The purpose of this assignment is to be able to actively search for relevant research related to your PICOT topic and present it in a formal annotated bibliography.

GENERAL DIRECTIONS

1. Limit your search to identify empirical articles. 

On finding an empirical study:

Assess the validity of the conclusion by determining if the conclusion answers your proposed research question

Assess if the methodology is appropriate.

2. Locate six articles directly related to your proposed PICOT question. 

PICOT question:

It is unknown the application of an educational program to ICU nurses about central line management. Will improve central line infection rate compared with the infection rate before the teaching within12 week?

Write an annotation for each of the six articles that includes a concise summary in your own words and the correct APA citation for each article.

3. Refer to the Annotated Bibliographies sample (File 1)  for additional guidance on completing this assignment in the appropriate style.

ANNOTATED BIBLIOGRAPHY (Mandatory)

1. Title Page

2. Introduction with the PICOT question

3. Annotated Bibliography 6 articles that support you’re your PICOT

a. Article reference in APA format

b. Summary of each article

i. Purpose of each article

ii. Research question of each article

iii. Methodology of each article

iv. Results of each article

v. Conclusion of each article

4. Conclusion

For you to know and become familiar with the project topic and the bases of this part, see File 2. There you will find the approved project on which you should develop this work.

Part 3: Pathopysiology

A  group of nursing students have to develop a health promotion topic on nutrition for a seniors’ resource center.

1. What nutritional concepts should they include in their project?
2. How would they develop a healthy eating program for this group?

Running head: CENTRAL LINE INFECTIONS 1

CENTRAL LINE INFECTIONS 2

Infection associated with Centrals lines

Infection Associated with Centrals Lines

Central line-associated bloodstream infection is one of serious infection that takes place germs commonly bacteria and viruses penetrate bloodstream via the central line. The infection causes millions of deaths every year despite the infections being preventable. The central line gets infected when contaminated catheter devices especially before the insertion, contaminated infusate, and contaminated catheter hub are used (Kirk, 2018). Skin organisms are also named as the cause of the infection. The central line of the patient gets infected when the virus or bacteria or other related germs enter into the bloodstream causing serious infections. Central line infection may become serious but can be successfully treated by health workers. The common central lines that are commonly infected are “Femoral central venous catheters”.

Most infections occur when doctors put the central line also called a central venous catheter in a large vein found in the neck, groin, chest, or arm so that to provide blood, other fluids, or medication in the areas. The insertion of the central venous catheters may not effective and therefore causing catheter malfunction, thrombosis or central vein stenosis, and other catheter-associated infections (Kuriakose, 2020). The common risks that have been found to increase central line infection include ICU placement of the central nervous catheter, the existence of the nonoperative cardiovascular illness, and the existence of the gastrostomy tube in the veins.

Problem Statement

The central line-associated bloodstream infections are regarded as the most lethal-hospital acquired disorder impacting high costs to health care institutions approximately $ 46 000 in every infection and causing a mortality rate of 18%. The health care institutions have noticed that when patients are infected with CLABSI, the number of days to 12 weeks is extended as well as the antibiotics to improve the situation of the patients. The infections of central lines in hospitals do not only affect the reimbursement but also create a negative perception of the hospitals and therefore training is required for the ICU nurses within one week (Tan et al. 2017). The hospital-acquired rates of infections are alarming hence there is need for training of ICU nurses or medics through establishing a compelling program that will help nurses remedy the situation. Preventing hospital-acquired CLABSI will improve the quality of care and enhance patient wellness. There is a need for quality interventions to be conducted to attain the goal of high infection of the central line and reduce the number of days taken in the ICU unit.

PICOT Question

It is unknown the application of an educational program to ICU nurses about central line management. Will improve central line infection rate compared with the infection rate before the teaching within12 week?

The ICU nurses play a vital role in proper maintaining of the central lines hence preventing the development of the CLABSI. The ICU nurses have more access to central lines daily when offering services as blood draws, medication administration as well as delivery of parenteral nutrition to the affected individuals. It is very critical for ICU nurses as the population of interest to be much aware of evidence-based interventions both the current and past to optimize the process of maintaining central lines and prevent infections (Ayala, 2019). ICU nurses should be trained for twelve weeks to improve service delivery that will help reduce the number of infections. Nurses should be equipped well enough to make them determined to offer quality and effective nursing services that will reduce the high cost and the lengths of care taken by the patients in the hospital. ICU nurses are one of the key components in the treatments of central line infections and should be equipped with adequate skills and knowledge through training. Implementing effective-based interventions in the field of nursing care especially in the occurrence of CLABSI will help to decrease the instances of infections among people. ICU nurse is the population of interest that can be improved and reduce the mortality and infections of CLABSI in hospital-based settings through competent nursing interventions.

Intervention of Interests

Training of ICU nurses is the key intervention used in this project to reduce infection of central lines. Training of ICU nurses within 12 weeks on how to manage and reduce the incidences of the infection was conducted based on nursing evidence-based approaches seeking to equip ICU nurses with sufficient knowledge of reducing the incidence associated with causing central line infections. Preventing the introduction of bacteria and viruses (microorganisms) to the central lines which take place in hospitals is the most key area the training focused on to control CLABSI. The efforts of preventing central line infections lie in the hand of nurses because they are the ones mandated for the routine care and maintenance of the central lines (Kuriakose, 2020). The actions and compliance of the nurses depicting the best evidence-based practices depicted a direct impact on patient outcomes. The intervention required the ICU nurses to strictly adhere to intervention measures of not introducing microorganisms in central lines. Putting more effort into the insertion and post-insertion maintenance should be well monitored and evaluated by nursing professionals through training because they are the major processes that cause risks of infections.

The interventions through training purposed to analyze the intrinsic and extrinsic factors to have a better understanding of the disease considering the age, patient’s gender, or other underlying conditions of the patients because they are the main clients served by ICU nurses on matters relating to central lines. The training also intervened and articulated conditions that lead to –prolonged hospitalization before the process of insertion is enacted. The education on the use of Chlorhexidine gluconate (CHG) was emphasized (antiseptic solution) due to its ability to possess wide spectrum activity that reacts against bacteria, viruses, and other microorganisms that are to the central line-associated bloodstream infections (Lacerna, 2020).

The use of CHG helps to prevent CLABSI, especially on the skin. Other evidence-based steps that the training as the intervention addressed for CLABSI prevention include the use of the appropriate hand hygiene during and after central line insertion, use of “chlorhexidine” for skin preparation, stopping using the “femoral vein” by the ICU nurses for catheters especially in adult patients, removing catheters that are considered unnecessary and lastly utilizing full barrier precautions or warnings during the insertion process of the central venous catheter (Moore, 2016).

Comparison

The central line-associated bloodstream infections rate will have analyzed and concluded after the interventions that involve training of ICU nurses and making a comparison with the outcomes or results obtained before starting the training and at the end of the 12 weeks where will evaluated the knowledge of nurses. The outcome of this alternative intervention will better outcomes in preventing central line-associated bloodstream infection.

Outcome

The training process aims to reduce the baseline incidences of CLABSI, according to Taylor et al. (2017) are 40/1000 days of central line, after the training of ICU nurses, it is expected that there will be a significant reduction. Likewise, it is intended to reduce the incidence of central line-based bloodstream infections, showing the positive impact of training in the effort to prevent or reduce central line infections that occur in the hospital environment.

Approximately 98 ICU nurses (sample convenience) will be used in the project. At the end of the 12 weeks of training for ICU nurses, a maximum reduction of 50% in CLABSI is expected after the adoption of prevention measures, compared to starting the training. CLABSI rates tend to vary from healthcare to healthcare based on facilities (Kirk, 2018). Therefore, reduction in the costs of post-training care is also expected. Likewise, it is expected to take into account associated factors such as limited space between beds, shortage of ICU nursing staff, little knowledge and training of hospital institutions for health personnel, incomplete documentation, among other possible reasons that are also intended. identify before the 12 week training is completed.

Time

The period taken for the interventions listed above to achieve an outcome is 12 weeks. The training of ICU nurses to achieve the intended purpose of reducing the infection incidences of central lines was completed at the end of the twelve weeks. This stipulated time allowed ICU nurses to be equipped with sufficient knowledge that aimed to influence patients positively.

Conclusion

The intensive education through training sessions with the response originating from ICU nurses over 12 weeks led to the significant improvement of matters about central line-associated bloodstream infections. The recollection of data in phase three of the training reaffirmed the significance and role of education in reducing infection incidences. During the project, it was found that high adherence to the “CL bundle intervention’’ adopted through training of ICU seemed to correlate positively to the reduction of central line infections in the ICU (Taylor et al. 2017). The study reveals that data from NHSN was more comprehensive as well as an effective benchmarking tool that established comparison to INICC as it tries to represent or depict those countries developing surveillance systems. More studies on projects should be conducted to formulate or design the national policy that can be used to benchmark the surveillance outcome of proposed devices or tools that are associated with infections of central lines in ICU.

References

Ayala, J. L. (2019). Development and Evaluation of a Nurse Leader-Directed Compliance Coach Program to Improve Central Line Maintenance. Wilmington University (Delaware).

Kuriakose, L. (2020). Decreasing Central Line-Associated Bloodstream Infection Through Limiting the Use of Central Venous Catheters for Routine Blood Draws. Journal of Doctoral Nursing Practice.

Moore, M. A. (2016). Evaluation of Central Line Insertion Bundle Practices in a Trauma/Surgical Intensive Care Unit.

Kirk, M. P. H. (2018). Healthy Work Environment Improves Nurse-Sensitive Patient Outcomes (Doctoral dissertation, Grand Canyon University).

Lacerna, C. (2020). Application of Sustainability Framework for Quality Improvement in an Integrated Health System.

Taylor, J. E., McDonald, S. J., Earnest, A., Buttery, J., Fusinato, B., Hovenden, S., … & Tan, K. (2017). A quality improvement initiative to reduce central line infection in neonates using checklists. European journal of pediatrics, 176(5), 639-646.

Running head:

ANNOTATED BIBLIOGRAPHY

1

6

ANNOTATED BIBLIOGRAPHY

Annotated bibliography

Introduction

PICOT question: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Annotated Bibliography

1. Ann, M. H., Davis, A., & Glowatz, T. (2015). Development of a diabetes learning needs assessment tool to promote an individualized predischarge patient education plan. The Journal of Continuing Education in Nursing, 46(11), 484-486. doi:http://dx.doi.org/10.3928/00220124-20151020-12

The purpose of this artic le is to motivate nurses’ staff to empower patient to improve their understanding of their diabetes management. The article emphasizes the importance of the knowledge and successful glycemic control in diabetic patients. Therefore, Authors promote the necessity of implement a pre-discharge patient education plan to identify and address the knowledge and skill needed for diabetic patients after discharge. The pre-discharge need assessment consist in several questions that the nurse can ask to patient such us: What medication do you take? Do you know how to administer correctly those medications? Are you in insulin? Do you how to how to drawing it up and injecting it? Do you know what A1C is? Etc. The experiment was done to 44 diabetes patients. The need assessment was used in the admission and in discharge day. Nurses used the data collected to select appropriate learning materials and used them to reinforce the patients’ knowledge. As a result, the diabetic education increased in from 36% to 63% in five months. The documentation of diabetes education also increased because nurses understood the importance of the education in diabetic patients.

2. Blackman, N. (2008). The development of an assessment tool for the bereavement needs of people with learning disabilities. British Journal Of Learning Disabilities, 36(3), 165-170. Retrieved from: http://search.ebscohost.com/login.aspx?direct=true&db=tfh&AN=33863849&site=ehost-live

The aim of this article is the development of a bereavement needs assessment tool to assess the need for crisis intervention for people with learning disabilities after a family death. With the assessment tools, health professionals can make a comprehensive assessment at the bereavement time to discover the problem and a plan can be put it in action. The tool was developed with the recompilation of several collected experience over the years of supporting grieving people with learning disabilities. The assessment tool has ten questions with sub- questions. The main points of the assessment are the practical issues, social issues, and emotional issues. The assessment tool has been tried out in three community teams and their results are being used to redefine the tool. The author will incorporate findings from research results to the assessment tool to refine the bereavement assessment. The used of the bereavement assessment toll will promote discussion and reflection among health care providers about losses in people with learning disability.

3. Ewing, G., & Grande, G. (2013). Development of a carer support needs assessment tool (CSNAT) for end-of-life care practice at home: A qualitative study. Palliative Medicine, 27(3), 244-56. doi:http://dx.doi.org/10.1177/0269216312440607

The authors of this article recognized the need to assess and support the care givers that are providing end- of – life care to help them in their caring role. The purpose of this article is to collect care givers’ perception of key aspects of end of life care at home and to create a need assessment tool that can be used every day. A qualitative research method was done. Seventy five adult care givers for hospice patients we interviewed in the United Kingdom. They were divided in nine focus groups. Twenty two participants had private interviews no more than ten minutes in duration. All participants sing their informed consent before the experiment started. The assessment tool used evaluated 14 domains of support needs within physical, practical, social, financial, physiological, and spiritual needs that the care givers may have. The experimental study identified two brad groups of support that the care givers need. The first one was to enable them to care for their relatives and the second one to have more support for them. The Carer Support Needs Assessment Tool that was used in this research is an evidence based toll to measure the care givers support needs.

4. Jenkins, J. O. (2010). A multi-faceted formative assessment approach: better recognizing the learning needs of students. Assessment & Evaluation In Higher Education, 35(5), 565-576.Retrieved from: http://search.ebscohost.com/login.aspx?direct=true&db=tfh&AN=53155623&site=ehost-live

The purpose of this article is to create a multi-faceted formative assessment that enabled student to be more engage in the assessment process. The assessment will better meet the students’ learning and assessment needs. The approaches in this article put the students in the center of the learning experience to improve students understanding the assessment. The multifaceted formative assessment had six initiatives: (1) The creation of subject specific reader that present more clearly the purpose of the assessment, (2) The assessment was refocused depend on the hours involved and not in the number of words that it has, (3) The amount of assignment was reduced, (4) The assessment had detailed guidance notes to help creating an effective self-study environment, (4) an assignment tutorial was created to facilitate discussion of the assignment to improve learning, and (6) an E-learning environment was introduced to enhance the assignment submissions and comments that will help in the assessment’s formative process. The results of the assessment were done by reading and analyzing the students’ feedback and perceptions of the assessment process. The results of this study indicate that the development of a module reader was useful for the students to be engaged with the subject being studied. It also shown that the assignment tutorial and guidance note helped them to be more engage with the assessment. Therefore, the author of this article recommends that other subjects use the readers, assignment –based tutorials and the guidance note to help the student with their learning process

5. Kamaraj, D. C., Dicianno, B. E., & Cooper, R. A. (2014). A participatory approach to develop the power mobility screening tool and the power mobility clinical driving assessment tool. BioMed Research International, doi:http://dx.doi.org/10.1155/2014/541614

The development of evidence based training protocol for electric powered wheelchair users such us disability persons has been a challenge because of a lack of standardized assessment toll. The purpose of this article is to develop the Power Mobility Screening Tool (PMST) and the Power Mobility Clinical Driving Assessment (PMCDA). The research method was a qualitative participatory research. The research was done an approved by the University of Pittsburgh’s Institutional. Twenty one participants were agreed to participate in the surveys and in the focus groups phases of the research. In the process, there were two surveys to create a list of items that will be including in the PMST and in the PMCDA. The participants rank, in the surveys, each of the screening tests in order of importance. After the survey was done, he participant were invited to participate in a focus group in which they discuss two sections the screen tool and the assessment tool. The results of this research realized tree standards that need to be fallow in the creation of the assessments. First, the goal of the PMCDA should toward improving mobility and independence of individual with disability rather than improve the access to the wheel chair. Second, the goal should be measurable so can identify progress with training. Third, the measurement should be able to recognized areas in which trainings should improve. Because this research was done with a small sample group, authors subject that further testing is needed to evaluate the effectivity of administrating these tools in clinical environment

6. Macan, T., Konczak, L., & Breaugh, J. (2013). At your service: Blending science and practice to develop a customer service assessment tool. Applied H.R.M.Research, 13(1), 24-36. Retrieved from http://search.proquest.com/docview/1448424808?accountid=458

This article describes specific strategies and factors that can be utilized to achieve the high quality customer services oriented in an organization. This article explains a detail a project that involves the development of a customer service oriented paper and pencil assessment. The purpose of this article was to share different approaches to be considered in order to achieve high quality services. The article included five practical challenges that the organizations can face in this project. Those challenges explain were (1) Cost effectiveness and administrative efficiency,(2) Get the attention to the stakeholders, (3)Diversity of the applicants, (4) Balance statistic and practical significance, and (5) Gather multiple forms of validity evidence. The authors created an assessment tools taking into consideration those five challenge. They created an assessment tool to measure employee performance for part time positions. The assessment tool has 27 items that can be done in ten minutes and it is ease to score by hand. The assessment tool was made by taking into consideration age and race diversity of the applicants. The assessment is ease to read with the fifth grade reading level. The authors highlight the necessity of doing more researchers to provide more evidence for using the different approaches used in the study to have better strategies in implementing an innovative and scientific assessment measures.