NURS 6052 Assignment EBP Part 3 Critical Appraisal of Research

NURS 6052 Assignment EBP Part 3 Critical Appraisal of Research

A assists in reducing the research burden by enabling a researcher to identify and focus more on relevant articles to their research question. The research can either provide support or disapprove the claims made by the researcher through the utilization of quality, and evidence-based practice interventions. The selected topic for the research study is use of resilience training to redice the problem of nurse burnout among nurses in different care settings. Nurse burnout remains a critical problem that impacts the quality of care and patient outcomes in different care setting. Resilience training allows nurses to develop and use evidence-based interventions to reduce burnout and enhance their overall performance and improve the quality of care.

Evidence-based practice (EBP) incorporates best practices from studies and patient care information with clinician experience and patient preferences leading to the delivery of highest quality of care, and improving patient outcomes. The use of EBP requires care providers to formulate a clinical question of interest. In this case, the PICOT question is: Among nurses with burnout (P), does resilience training (I) compared to no intervention (C) reduce burnout(O) in six months (T)? The purpose of this assignment is to appraises

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment,

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
	Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: an observational study. BMJ quality & safety, 28(9), 706-713. https://qualitysafety.bmj.com/content/28/9/706	Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O. A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International nursing review, 64(1), 91-98.doi:	Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health services research, 53(6), 4943–4969. https://doi.org/10.1111/1475-6773.12997	Jarrar, M. T., Minai, M. S., Al‐Bsheish, M., Meri, A., & Jaber, M. (2019). Hospital nurse shift length, patient‐centered care, and the perceived quality and patient safety. The International journal of health planning and management, 34(1), e387-e396.
Evidence Level * (I, II, or III)	Level III because it was an observational study (non-experimental)	Level II	Level II	Level II
Conceptual Framework   Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	Not stated	The Quality Health Outcomes Model (QHOM) guided the study. The model demonstrates the existence of a linear correlation between process, structure and outcomes. The nurse practice environment was considered the structural factor that influences nurse outcomes that included burnout, turnover and job dissatisfaction among nurses.	The turnover theory and Self-Determination Theory were used to guide this study. The turnover theory was used to conceptualize the dissatisfaction-motivated desired as well as the intention of the employees to leave their jobs. The Self-Determination Theory was used to provide underpinnings for the role of work environment on behaviors such as motivation and energizing employees to perform optimally.	The conceptual framework was note stated.
Design/Method   Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The study was secondary of observational data. The study was conducted in two NHS hospital Trusts in England. Six wards that provided care to paged aged above 65 years were selected. The wards had an average of 44-full-time registered nurses staffs and healthcare assistants. The relationship between length and quality of interaction was determined using Quality of Interaction Schedule. The observations were undertaken between 2015 and 2016. Index patients were chosen randomly to participate in the study. The exclusion criteria included patients who were not able to communicate their choices, those who did not wish to participate in the study, unconscious and critically ill or isolated due to being at a risk of infection.	The study utilized a cross-sectional study design. Questionnaires were used for data collection. Stratified sampling was used for random selection of hospitals to participate in the study. Work units in each hospital were selected using purposive sampling. Inclusion criteria included inpatient nurses with at least two years’ experience as bedside nurses. The exclusion criteria included nurse managers.	The study was a multisource study. Participants were provided with online surveys to provide information related to their experiences. The inclusion and exclusion criteria was not provided in the research.	The study design was a cross-sectional survey study. The study was conducted on nurses who were identified using stratified random sampling. All the nurses working in the medical, surgical and multidisciplinary wards that agreed to participate in the study were included. The exclusion criteria included nurses who decline to participate in the study.
Sample/Setting   The number and characteristics of patients, attrition rate, etc.	The sample consisted of 270 elderly patients aged 65 years and above. The setting was two NHS hospital Trusts in England. The participants were obtained from six wards that included urology, orthopedics, and medicine wards for the older people.	The setting of the study was 43 inpatient units in five university hospitals in Thailand. The participants comprised of 1351 nurses who were working in the above setting.	The setting of the study was Army Military Treatment facilities in the United States. The participants included 2596 registered nurses that were working in 110 Army treatment hospitals and facilities across 35 healthcare systems in the US.	The setting of the study was 12 private hospitals in Malaysia. The participants included 1055 nurses working in the medical and surgical wards alongside multidisciplinary wards. Of this number, 652 nurses provided complete responses to the survey questionnaires.
Major Variables Studied   List and define dependent and independent variables	The dependent outcomes included quality of staffing and staff-patient interactions. The independent variables included a reduction or increase in nurse staffing and skill mix, professional background of the healthcare staffs and duration of the staff-patient interaction.	The dependent or outcome variables in the study included burnout, job dissatisfaction and intention to leave among the participants. The independent variables included nature of work environment, resource adequacy, staffing level, nurse engagement in organizational affairs, management and leadership ability, and collegial nurse-physician relationships.	The dependent or outcome variables in the study included turnover cognitions and outcomes, nursing satisfaction and attitude. The independent variables included leadership style, nature of work environment and collegial relationships with other providers.	The dependent variables in the study included quality and safety of care as perceived by nurses. The independent variables included shift length and patient-centered care.
Measurement   Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The statistics included three-level mixed logistic regression using command xtmelogit in Stata V.11.0, odds ratio for QuIS rating, Wald tests for post-estimation of interaction effect, negative binomial model for patient experiences with interaction and normal-based models for time that patient and staffs spent interacting.	Lake’s Practice Environment Scale of the Nursing Work Index was used to measure nurse work environment. The composite scores in the rating scale was tabulated by aggregating individual nurse-level responses with the responses of the unit followed by calculating the mean of the subscale means. The level of job satisfaction was measured by asking the current satisfaction of the nurses with their jobs. Intention to leave was measured by asking nurses to provide information on whether they intend to leave their current jobs in a year. The Emotional Exhaustion subscale of the Maslach Burnout Inventory was used to measure burnout.	Measurement and analysis were done at three different levels to test the hypotheses. Level 1 measurement and analysis was done on individual-level perception of nurses on outcomes and predictors. Level 2 measurement and analysis were done on six aggregated variables of patient satisfaction. Level 3 measurement and analysis were done using adverse event indicators and predictors of nurses’ responses. CFA was used to confirm the fit for Level-1 independent variables. Exploratory factor analysis using Promax rotation was used to analyze non-hypothesized factors. Variance inflation factor was used to test threat of common method variance. Multilevel modeling was performed at levels 1 and 2 to test all the hypotheses of the study. Multilevel mixed effects modelling was used to analyze level 1 data on dissatisfaction due to intention to quit and desire. Multilevel logistic regression and ordinary least squares regression were used for level 3 analyses.	The study used Hayes macro for regression analyzes to determine the mediation effect of patient-centeredness on the relationship between care quality, safety and shift length.
Data Analysis Statistical or Qualitative findings   (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The results of the study showed that 3076 interactions were observed. Of this number, 10% of them were rated negatively. The odd of a negative interaction rose significantly as more patients were added to each registered nurse (p=0.035, OR of 2.82 for > 8 patients/RN compared with >6 to<8 patients/RN). The results also showed a similar but insignificant pattern for healthcare assistance (p=0.056). The results also showed that odds of negative interaction increased with high level of healthcare assistants staffing and low registered nurse staffing.	The study results showed that 97% of the participants were females. The composite score of the mean of 5 PES-NWI was 2.91 with the highest mean being 3.23 and lowest being 2.56. Of the 43 units, the participants ranked 16 units as good and seven units being poor. The odd of nurses reporting to be dissatisfied with their jobs was (OR=0.67, 95% CI 0.57-0.77), intention to leave their current job (OR=0.75, 95% CI 0.54-0.99), and emotional exhaustion (OR=0.78, 95% CI 0.70-0.99) were significantly reduced in nurses working in better work environment when compared to those working in mixed environment. The rate of job dissatisfaction, emotional exhaustion and intention to leave in nurses with better work environment was at a 39 to 55% lower than those working in poor work environments.	The results showed that level 1 results were adequately supported. Staffing, teamwork, and reliance on nursing practices were negatively associated with intentions to leave. Self-reported level of nurse satisfaction was a significant predictor of patient willingness to recommend alongside see providers when needed. Self-reported satisfaction was found a significant predictor for medication errors and falls with injury. Dissatisfaction-based desire to leave a job was a significant predictor for patient falls and medication errors.	The majority of participants (99%) were of Malaysian origin. Regression analysis indicated insignificant impact of the length of shift on quality of service (F=1.27, P=0.28) and safety (F=1.81, P=0.13). Patient-centeredness has potential mediating effect in relation to shift length and service quality (F=42.90, P=0.000). Nurses working 12-hour shift (95% CI, -0.18 to -0.15) and 10 hour shift (95% CI, -0.17 to -0.03) indirectly affected the quality of care unlike those working for 7-hour shift. Patient-centeredness was also found to have a linking effect on patient safety and shift length (F=25.12, P=0.000). The results also showed that a significant mediation effect of patient-centered care exist between the effect of length of shift on perceived patient safety (F=25.12, P<0.001) and perceived quality (F=42.90, P<0.001).
Findings and Recommendations   General findings and recommendations of the research	The general finding of this study was that the ratio of registered nurses to patients is a critical determinant of nature of nurse-patient interaction. A reduction in registered nurses staffing level causes a change in the quantity and quality of staff-patient interaction. The results also showed that staff-patient interactions does not improve in cases where registered nurses staffing is low with increased staffing of healthcare assistants. Therefore, adequate register nurse staffing ratio is important for quality staff-patient interaction.	The general results of the study were that nurse working in university hospitals that have better work environments have less intention to leave, burnout and job dissatisfaction. The researchers recommended that health organizations should strive to improve the work environment for the nurses. Improving the work environment will lower the levels of job dissatisfaction, burnout and intention to leave.	The general findings of this study were that predictors of nurse satisfaction as well as turnover cognitions included staffing levels, supportive leadership, nurse-physician teamwork, advancement opportunities and adoption of nursing care practice. The results also showed aggregated nurse satisfaction to be the most consistent predictor of adverse events and patient satisfaction. Therefore, the authors recommended the need for healthcare organizations, managers and leaders to adopt interventions that enhance job satisfaction and retention among nurses.	The general findings of this study is that there exist a significant mediation effect of patient-centered care between the effect of length of shift on the perceived quality of care and patient safety. The authors recommended that health policymakers should consider restructuring shift length for nurses and strengthening patient-centeredness in nursing care.
Appraisal and Study Quality     Describe the general worth of this research to practice.   What are the strengths and limitations of study?   What are the risks associated with implementation of the suggested practices or processes detailed in the research?   What is the feasibility of use in your practice?	The study informs the importance of adequate staffing ratios in nursing. The study shows that staffing ratio determines the quality of care that registered nurses give. The study is worthy for implementation in practice. The strengths of the study include the use of large sample size and randomizing patients to the intervention group. The study has weaknesses of not assigning participants to a control group. It also has the weakness of lacking inference of exposure versus effect relationship because it was an observational study. The risk of implementing the suggested practices in the research is therefore the lack of highly valid and reliable data on the effectiveness of the interventions in nursing. The intervention is however highly feasible for use in practice due to the replicable nature of the study methods.	The study is worthy and relevant to nursing practice. It informs the need for the adoption of interventions that aim at improving the environmental conditions for nurses. The study also shows the negative effects of unhealthy work environments. The strength of this study is the use of a large number of participants. The study is also a multicenter investigation. The study has the limitation of relying on self-reported findings from the nurses. The validation of self-reported experiences might be a challenge. The study is feasible for use in my practice. The feasibility is seen in the applicability of interventions to improve workplace conditions in nursing.	The study is important to nursing practice because it informs the need for the creation of enabling cultures for provider and organizational success. The study also informs the adoption of effective leadership styles that promote performance and excellence. The strength of this study is that it has high validity and reliability due to it being a multisource study. The study has the weaknesses of lack of generalizability of findings due to it being conducted in military setting. The risk of implementing this study in a general setting is that the workplace conditions in a military setting might be different from the general setting, hence, inapplicability of findings. The study is therefore less feasible in use in my practice.	The study is worthy for use in nursing because it informs the adoption of interventions that promote safety and quality in patient care. The study also advocates the adoption of organizational interventions that promote effective workplace culture. The strength of this study is the large sample size and being multi-center in nature. The weakness of this study was that it mainly used private hospitals, which might affect the generalizability of findings. The risk of implementing the interventions in this study is that they might not produce similar outcomes as those seen in the study. The contexts might differ because the current study was conducted in private hospitals. The study however has high feasibility as seen from the use of interventions that are applicable to any healthcare setting.
Key findings	Low levels of registered nurses staffing affects the quality and quantity of staff-patient interactions. A high level of staffing for healthcare assistants and low level of staffing for registered nurses does not improve the quality of staff-patient interactions. Sufficient registered nurses staffing levels is therefore critical determinant of the quality of staff-patient interactions.	The findings of this study showed that better work environments have less job dissatisfaction, intent to leave and burnout.	Nurse attitude have an effect on the actual and perceived performance across health care systems and facilities. Perceived nurse satisfaction is a critical predictor of adverse events and patient satisfaction.	Patient-centeredness in care mitigates the effects of shift length on outcomes of care that include safety and quality.
Outcomes	The outcomes included the quality and quantity of staff-patient interactions.	The outcomes of the study included burnout, job dissatisfaction and intervention to leave among nurses.	The outcomes in the study included patient and nurse satisfaction, patient outcomes and turnover cognitions among nurses.	The outcomes in this study included patient safety and quality of care as perceived by the nurses.
General Notes/Comments	The study has results that are generalizable.	The study findings are highly generalizable to practice due to the use of a high sample size.	The results have high validity and reliability. However, they are not generalizable because it was conducted in a military setting that might have different environmental characteristics from general settings.	The shift length should be restructured to underpin safety and quality in nursing care and practice.

 

Reflection

According to the evidence analyzed above, the best practice that can be implemented to promote safety and quality in nursing care is the transformation of work environmental conditions. According to the evidence, the nature of the work environment has a direct influence on the level of satisfaction, burnout, and intent to leave among nurses. Organizations with better working conditions or healthy work environments have lower rates of burnout, intention to leave, and job dissatisfaction among their nurses (Nantsupawat et al., 2017). The reduction or elimination of these issues promotes nursing care and practice safety and quality. The analysis also revealed that work environment transformation includes the adoption of effective leadership behaviors that increase job satisfaction and reduce nurses’ intent to leave. As a result, the evaluation revealed that supportive leadership, effective nurse-physician teamwork, and the provision of opportunities for professional and personal advancement increase provider satisfaction and reduce nurse burnout (Bridges et al., 2019).

Environmental transformation also includes identifying work-related factors that contribute to burnout, job dissatisfaction, and high turnover rates among nurses. The evidence reviewed revealed that workplace factors such as staffing levels, nursing care practice adoption, and patient-centeredness play an important role in influencing the behaviors of nurses and other healthcare providers (Perry et al., 2018). Adequate registered nurse staffing levels reduce burnout and errors in practice, which improves safety and quality of care. The negative effects of length shift and perceived safety and quality of care are mitigated by patient-centeredness (Jarrar et al., 2019). As a result, nurse managers and leaders must be proactive in assessing the need for and implementing strategies to improve working conditions in their organizations. It will achieve care goals such as safety, quality, efficiency, and patient-centeredness.

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References

Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff–patient interactions: An observational study. BMJ Quality & Safety, 28(9), 706–713. https://doi.org/10.1136/bmjqs-2018-008948

Jarrar, M., Minai, M. S., Al‐Bsheish, M., Meri, A., & Jaber, M. (2019). Hospital nurse shift length, patient-centered care, and the perceived quality and patient safety. The International Journal of Health Planning and Management, 34(1), e387–e396. https://doi.org/10.1002/hpm.2656

Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O.-A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review, 64(1), 91–98. https://doi.org/10.1111/inr.12342

Perry, S. J., Richter, J. P., & Beauvais, B. (2018). The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health Services Research, 53(6), 4943–4969. https://doi.org/10.1111/1475-6773.12997

Fill out the Evaluation Table in the Critical Appraisal Tool Worksheet Template to conduct a critical analysis of the four peer-reviewed papers you chose. Select a total of four peer-reviewed papers that are connected to the clinical topic you were interested in exploring in Modules 2 and 3.

you may select any combination of articles from Modules 2 and 3. For instance, you may select one item from Module 2 and three articles from Module 3 or two unfiltered research papers from Module 2 and two filtered research articles (systematic reviews) from Module 3. As long as both modules and categories of research are represented, you may select any combination of articles from the previous module assignments.

Part 3B: Research Critical Appraisal

In a 1-2 page critical appraisal, recommend a best practice that comes from the research you examined based on your evaluation. Give a succinct explanation of the best practice and support your claim with APA research citations.

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

• Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
• Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
• Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.

The Assignment (Evidence-Based Project)

 

NURS 6052 Assignment EBP Part 3 SAMPLE 2

The use of evidence-based practice (EBP) interventions in healthcare is essential in addressing healthcare associated infections (HAIs). A critical appraisal of resources to implement these interventions ensures that researchers have the best evidence and practice to incorporate in their settings to counter HAIs (Kakkar et al., 2021). The use of peer-reviewed articles ensures that providers recommend the best practices to mitigate the occurrence of HAIs in care settings. The purpose of this critical appraisal paper is to identify best EBP practice to reduce HAIs in care settings among provider by focusing on four peer-reviewed journal articles used in other program and earlier modules.

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
	Jin, Y. H., Huang, Q., Wang, Y. Y., Zeng, X. T., Luo, L. S., Pan, Z. Y., … & Wang, X. H. (2020). Perceived infection transmission routes, infection control practices, psychosocial changes, and management of COVID-19 infected healthcare workers in a tertiary acute care hospital in Wuhan: a cross-sectional survey. Military Medical Research, 7(1), 1-13. DOI:https://doi.org/10.1186/s40779-020-00254-8	Ford. C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. British Journal of Nursing, 27(20), 1164-1166. https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2018.27.20.1164	Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. American Journal of Critical Care, 27(4), 334–337. https://doi-org.ezp.waldenulibrary.org/10.4037/ajcc2018727	Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112–118. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nedt.2018.01.022
Evidence Level * (I, II, or III)	III-Non-experimental study on COVID-infected participants	Level V as it entails quality improvement initiatives’ recommendations.	I-Experimental study	II-Quasi-experimental study on hand hygiene practices among nursing and medical students
Conceptual Framework   Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	The conceptual framework entails the contexts of infection route, factors causing infections and management of the infected individuals like during the COVID-19 pandemic and their relationships.	The article has no conceptual framework.	The conceptual framework is the comparison of the efficacy of alcohol-based hand rubs (ABHRs) and handwashing with soap and water based on WHO guidelines in reducing hospital acquired infections (HAIs).	The conceptual framework highlights the concept of hand hygiene among nursing and medical students in Ireland to reduce HAIs.
Design/Method   Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	Study uses a cross-sectional design in a single facility	The study uses a systematic review of literature where by giving evidence on hand hygiene practices and information by basing on the previous findings and evidence.	The study uses a systematic review of literature from existing evidence and previous findings. The inclusion criteria involved three articles that met the requirements for review on the topic.	The observational study uses a cross-sectional self-report model through the administration of questionnaires
Sample/Setting   The number and characteristics of patients, attrition rate, etc.	The setting was a single hospital where 105 healthcare workers were recruited to participate in the program. Only 103 participants completed a valid questionnaire offered by the researchers.	No sample is provided as the article gives guidelines and raises awareness on the need for better techniques to wash hands among healthcare providers.	The article does not use sampling or show the setting as it is a systematic review meaning that evidence came from different studies based on the used search criteria and databases like Medline and CINAHL.	The setting for the study was a university comprising of nursing and medical students. The nursing students (BSN) were 342 and medical students were 530. The response rate was 37% implying that they are the ones who submitted their filled questionnaires. All the four cohorts of the programs were included as sample.
Major Variables Studied   List and define dependent and independent variables	The major variables included the route of infections, factors leading to infections, psychosocial change and management procedures to reduce susceptibility to infections among infected healthcare providers.	No dependent and independent variables exist in the study as it only offers guidelines and information on enhancing hand hygiene practices.	No dependent and independent variables were used as it was a systematic review of literature on the benefits of handwashing against rubs.	The main variables studied included compliance rates to hand hygiene practices among the two types of healthcare students in the university. The dependent variable was the level of compliance while the independent variable was the type of intervention to stop or prevent infections.
Measurement   Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	The primary statistics came from data collected during the study at a single hospital where participants volunteered based on the inclusion criteria as healthcare workers.	The main statistics used by the article in answering clinical questions is data from healthcare organizations like the World Health Organization (WHO). It does apply actual tests.	The test done in this article entailed assessing the impact of hand rubs against the effects of handwashing using soap and water as recommended by the WHO.	The researchers employed the Pearson Chi Square test of independence in testing the variables’ association
Data Analysis Statistical or Qualitative findings   (You need to enter the actual numbers determined by the statistical tests or qualitative data).	The qualitative findings suggest that most of the infections were transmitted through close contacts, the use of protective equipment and use of common equipment like gloves and masks.	The qualitative findings from the guidelines based on NICE framework shows that effective handwashing using liquid soap is the most effective way of decontaminating one’s hands.	The qualitative findings show that use of water and soap for handwashing was more effective that hand rubs that contain different types of alcohol.	The researchers used a statistical package for social science (SPSS) version 24 to analyze a host of aspects from the study. They also employed descriptive statistics based on the frequencies and percentages.
Findings and Recommendations   General findings and recommendations of the research	The findings suggest that the primary mode of transmission was lack of protection while working closely with the infected patients. It also included intimate contacts with the infected individuals. The researchers recommend the implementation of positive psychological intervention to address the issue.	The study recommends healthcare workers and other people to adhere to the protocols that it offers to enhance handwashing and reduce infections, especially in healthcare settings.  The findings show that use of liquid soap is the most effective way to reduce infections in healthcare facilities among providers.	The findings show that despite the wide belief that ABHRs caused skin damages than handwashing with soap and water, these rubs can reduce infections in a significant manner and lead to lower incidences of poor outcomes. The findings suggest the need for providers to use both approaches as the best way to reduce possibility of infections in their settings.	The findings from the study shows that students complied to hand hygiene more when exposed to body fluids as oppose to when in contact with a patient’s surroundings. The study also demonstrates that most of the participants in both disciplines had a positive attitude towards the use of hand hygiene measures like handwashing and hand rubs. The findings also show that more medical students (46%) complied with the use of alcohol-base hand rub to decontaminate their hands than nursing students (22%). The study recommends a review of curricula based on the knowledge gaps, deficiencies in practice settings and barriers to utilization of ABHR.
Appraisal and Study Quality     Describe the general worth of this research to practice.   What are the strengths and limitations of study?   What are the risks associated with implementation of the suggested practices or processes detailed in the research?   What is the feasibility of use in your practice?	The article is valuable as it can be applied in practice to increase protection against infectious diseases like COVID-19 and other types of flu. The study’s strengths include wide scope, use of a significant sample based on the care setting and effective analysis. However, its limitations include focusing on one condition and having a limited sample of only infected healthcare workers. The risks associated with the implementation of suggested processes include limited resources and training as well as sufficient time. The feasibility of using the study is high based on the benefits that it offers to the facility and providers.	The article is valuable to practice as it shows and models the most effective way of attaining hand hygiene for healthcare workers and patients to reduce hospital acquired infections. The strengths of the study include being simple and easy to apply because of illustrations used and language. However, it does not include comprehensive overview of the issue and relies mainly on evidence from past studies. No risks exist in implementing the suggested practices and processes as detailed in the research. It is feasible to use the recommended practices as they are not costly to implement. The NICE guidelines are fundamental in enhancing overall patient safety.	The article is valuable to practice because it shows that providers can use hand rubs alongside handwashing to reduce infections among patients. The strengths of the study include its level of evidence as level I since it is a systematic review that pieces evidence from various sources. The only limitation is that it does not occur in real setting to show the outcomes and compare them to previous studies. No risks exist in the implementation of the suggested practices or processes as they lead to a reduction in infections. There is a high possibility of using these recommendations in practice since they lead to better outcomes.	The article is very valuable to practice as it implores organizations to entrench hand hygiene measures among healthcare professionals like nurses and physicians. The strengths of the article include a wide sample, better analysis and inclusion criteria. The researchers also comply with ethics and demonstrate credibility. However, it only occurs in teaching setting as opposed to real healthcare environment or setting. No risks exist in implementing these recommendations and that it is feasible to enroll them in our facility.
Key findings	Key findings from the study show that hospitals can use different approaches to reduce and prevent the occurrence of infections, even deadly one like the COVID-19 pandemic.	Key findings from the study is that most people, including healthcare providers do not know effective way to wash hands and decontaminate them to reduce infections	The core findings show that infection control is fundamental and requires different interventions by providers and organizations to improve quality of care.	The key findings demonstrate that increased education is essential to enhance compliance among nursing students and nurses to embrace hand hygiene measures.
Outcomes	The outcomes from the research offer hope for healthcare workers who are susceptible to infections because of the nature of their work.	The outcomes of the study show that healthcare providers can be more effective when implementing hand hygiene measures to reduce infections in their settings.	The outcomes from the study demonstrate the need to invest in different approaches to lower infection rates among providers and patients in health facilities.	The outcomes show that having sufficient educational awareness among students improves the likelihood of using hand hygiene measures in health care settings.
General Notes/Comments	The research illustrates the need to invest in protective equipment, better training for patients and developing infection control and prevention protocols, especially to counter emerging infectious conditions like the COVID-19.	The study is categorical that hand hygiene is an effective way of reducing and preventing hospital acquired infections, especially among healthcare providers by using liquid soaps or hand rubs.	The study underscores the need to raise awareness about the efficacy of different health strategies to reduce and prevent infections in healthcare settings.	The research is elaborative that health care students in different settings should embrace hand hygiene measures as way of reducing infections among nurses and patients.

 

Part B: Critical Appraisal of Research

The critical analysis approach is essential in appraising evidence from different research studies on the use of EBP interventions in healthcare settings. The reviewed articles demonstrate that infection control and prevention is an important aspect of attain patient and providers’ safety in any healthcare practice and profession. the studies show that the best practice in preventing and reducing the prevalence of hospital associated infections (HAIs) is having effective hygiene and patient safety measures like hand hygiene and use of protective equipment (Haque et al., 2020). Hand hygiene measures among healthcare providers like nurses and physicians improves their safety standards and reduces susceptibility to infections.

The study by Kingston et al. (2018) shows that both nursing and medical students and providers require effective infection prevention knowledge and use of hand hygiene measures to reduce the rates of infections. The study also observes that medical students and practitioners are more likely to use hand rubs than nursing students and nurses in healthcare practice. Above all, the study is categorical that none of the professions uses hand hygiene measures by over fifty percent with physician probability or likelihood being at 46% and nurses at 22%. These findings as corroborated with the other studies like Ford and Park (201) and Halm and Sandau (2018) show that hand hygiene measures are critical in addressing hospital associated infections. The peer articles are also categorical that using hand hygiene measures through handwashing and deployment of alcohol-based hand rubs (ABHRs) allows healthcare professionals to reduce and prevent the occurrence of HAIs (Kakkar et al., 2021). The implication is that these measures are important and should be picked as the best practice to lower, and prevent hospital associated infections.

Conclusion

The use of critical appraisal is important to help nurses and other providers understand the application of evidence-based practice (EBP) interventions to address healthcare challenges like infections. The critical appraisal process ensures that nurses get the best evidence and ascertain best approach to clinical issues to improve care delivery. The paper shows that the most effective EBP intervention to reduce and prevent hospital acquired infections (HAIs) is hand hygiene that include handwashing and use of hand rubs.

 

 

 

 

 

References

Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F. M., Islam, S., … & Charan, J. (2020). Strategies to prevent

healthcare-associated infections: a narrative overview. Risk management and healthcare policy, 13, 1765.

DOI https://doi.org/10.2147/RMHP.S269315

Kakkar, S. K., Bala, M., & Arora, V. (2021). Educating nursing staff regarding infection control practices and assessing its

impact on the incidence of hospital-acquired infections. Journal of Education and Health Promotion, 10(40). https://www.jehp.net//text.asp?2021/10/1/40/308146

Macho, A. Y., Mayens, A. L. W., Valverde, E. M. P., Ordaz, R. G., Méndez, J. A. J., Iglesias, J. L. P., … & Parreira, P.

(2021). Nursing Students’ Perceptions on Healthcare-Associated Infection Control and Prevention Teaching and Learning Experience: Development and Validation of a Scale in Four European Countries. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.701208