PICOT Statement Paper

Grand Canyon University


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The First Line Is Your Title, Centered, Non-Bolded, Not Underlined

Hand hygiene (HH) is an essential tool in reducing the spread of infections among patients and the healthcare professionals in the clinical setting. Multiple studies have however showed that healthcare professionals do not comply with the HH guidelines provided by the World Health Organization. This has led to increased healthcare related infections resulting in increased mortality rates. There are various factors that lead to non-compliance of the World Health Organization guidelines such as work environment and behavioral motivational factors. This shows that more needs to do in creating awareness among healthcare professionals about the importance of hand hygiene and patient safety (Anna, & Sobala, 2013).

PICOT Statement

For patients and healthcare workers in the hospital (p) does hand washing using soap and water (I) compared to an alcohol hand-based rub (C) reduce hospital acquired infection (O) within a period of stay in the hospital (T)? You got it!

Evidence Based Solution

Multiple studies show that hand washing protocol in the healthcare setting is very effectual in reducing healthcare related infections. The practice of cleaning hand before and after attending patients can help to reduce the spread of germs in hospitals. Healthcare professionals wash their hands more than half times they should on average (Deochand & Deochand, 2016). This increases the chances of spreading healthcare acquired infection (Deochand & Deochand, 2016). While hand washing protocol is useful, alcohol-based solution is more effective as it kills most of the germs that can be transmitted in the healthcare setting (Deochand & Deochand, 2016). Since alcohol-based solution is a bit expensive, patients and healthcare workers should reduce the spread of germs by complying with the hand washing protocol (Deochand & Deochand, 2016).

Nursing Intervention

Nurses interact with patients more often than other healthcare professionals and this exposes them to hospital acquired infections. For this reason, nurses should ensure all their practices are based on patient education, nursing research and are evidence based. Nurses should apply universal precautions to ensure they work in a safe environment (Sung-Ching et al., 2013). Under the universal precaution guidelines, nurse practitioners must wear protective gear before coming into contact with any patient (Sung-Ching et al., 2013). Nurses must also wash their hands before and after interacting with patients. Alcohol based solution can be used as a substitute (Sung-Ching et al., 2013).

Patient Care

Patients are very vulnerable to hospital acquired infections. Healthcare providers should create awareness among patients about the importance of hand hygiene. Patients must clean their hands regularly in the healthcare setting. They should also ask those people visiting them to ensure that they clean their hand before visiting and after living patient wards. This ensures that visitors to not spread diseases to the patients and also the patients do not infect those visiting them. Healthcare workers must put the necessary measures to facilitate the hand washing protocol (Chatfield et al., 2016).

Healthcare Agency

The healthcare agency must ensure their facilities have enough hand washing points to facilitate hand washing protocol. Patients and healthcare professionals will not be able to clean their hands as required if there are not enough areas designated for hand washing. Healthcare providers should also provide alcohol-based solutions in case there is any issue to do with the designated hand washing points. The agency should also ensure that all patients understand the importance of HH while in the healthcare setting. This plays a significant role in reducing the spreading of healthcare related infections (Dyson et al., 2013). Healthcare agencies should also train their healthcare professionals to increase compliance to the hand washing protocol (Dyson et al., 2013).

Nursing Practice

Combining hand washing protocol and alcohol-based solutions can help prevent most of the hospital acquired infections increasing patient safety and better overall patient outcomes (Sendall, McCosker & Halton, 2019). When patient maintain hand hygiene it will be difficult for them to spread hospital acquired infection. The same applies to healthcare professionals. A safe healthcare environment depends on the ability of both the patients and healthcare professionals to comply with the hand washing protocol. Increasing awareness of the importance of HH in the hospitals may increase compliance to the WHO guidelines reducing the spread of infections (Sendall, McCosker & Halton, 2019).

A conclusion statement is a comprehensive assessment of the paper. It does not include references or any new ideas. It is the author’s conclusion.

References you must cite a doi if you have one

Anna, G. P & Sobala, W. (2013). Observance of hand washing procedures performed by the medical personnel before patient contact part 1 Retrieved from international journal of occupational medicine and environmental health 2013

Chatfield, S. L., Nolan, R., Crawford, H., & Hallam, J. S. (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE open medicine4, 2050312116675098.

Deochand, N., & Deochand, M. E. (2016). Brief Report on Hand-Hygiene Monitoring Systems: A Pilot Study of a Computer-Assisted Image Analysis Technique. Journal of environmental health78(10). Doi?

Dyson, J., Lawton, R., Jackson, C., & Cheater, F. (2013). Development of a theory-based instrument to identify barriers and levers to best hand hygiene practice among healthcare practitioners. Implementation Science, 8(1), 111. Doi?

Sendall, M. C., McCosker, L. K., & Halton, K. (2019). Cleaning Staff’s Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study. International journal of environmental research and public health16(6), 1067. Doi?

Sung-Ching, P., Tien, K. L., Hung, I., Yu-Jiun, L., Wang-Huei, S., Wang, M. J., & Yee-Chun, C. (2013). Compliance of Health Care Workers with Hand Hygiene Practices: Independent Advantages of Overt and Covert Observers. PLoS One, 8(1), e53746. Doi?


Literature Review

Professor’s Name

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Course Title



Hand hygiene (HH) is a good way of preventing hospital acquired infections (HAI) among healthcare professionals, patients and those visiting them. However, studies show that patient and healthcare professionals are non-compliant to the HH standards set by the World Health Organization. This has increased the spread of HAI among patients in the healthcare system increasing their hospital stay. This paper analyzes the existing research on the topic to determine how it supports the PICOT statement for this study. The paper will also compare the sample population, research question and limitations of the existing research.

Picot Statement

For patients and healthcare workers in the hospital (p) does hand washing using soap and water (I) compared to an alcohol hand-based rub (C) reduce hospital acquired infection (O) within a period of stay in the hospital (T)?

Comparison of Research Questions

One of the studies on the topic aimed to determine the effectiveness on providing educational programs among nurses to increase compliance with HH guidelines (Daisy & Sreedevi, 2015). Another study on the topic focused on determining how the observation of HH can reduce the rate of infections in hospitals (Fox et al., 2015). A study conducted in 2017 aimed to determine the hand washing procedures used by healthcare professionals before making any contact with their patients in hospitals (Knighton, 2017). Another study conducted in 2018, aimed to determine how providing training programs for nurse could improve adherence to HH (Graveto et al., 2018). These research questions all focus on how compliance to HH guidelines in healthcare systems can improve patient outcomes.

A study conducted in 2015 aimed to aim to determine the effectiveness of HH in large healthcare organizations in Vietnam (Thoa et al., 2015). Another study aimed to explore the procedures and practices of HH among healthcare professionals in hospitals (Lawal et al., 2018). A research done in 2018 aimed determine the availability of necessary hand washing tools , compliance among nurses and access to essential hand washing tools on surgical general wards, intensive care unit and medical education (Niyonzima, Brennaman & Beinempaka, 2018). Another similar study conducted in 2018 aimed to review the experiences of HH among nurses working in the acute care department (Phan et al., 2018). These research questions in one way or the other provide significant insights that support the current PICOT statement.

Comparisons of sample population

The existing studies have been conducted in different environment with different sample sizes. The first study conducted in 2015 has a sample size of 60 nurses working in various private healthcare facilities (Daisy & Sreedevi, 2015). The second research was conducted within two hospitals. The third study has a sample size of 120 medical personnel among them being physicians and nurses. This represented more than twice the population of the previous studies combined. Another study done in 2018 was conducted among various healthcare personnel working at an intensive care unit. This study had a significant lower population as compared to the previous three studies (Graveto et al., 2018).

The fifth study was conducted in fifteen critical care unit and two intensive care units (Thoa et al., 2015). This allowed the researchers to explore different aspects associated with HH comprehensively. Another study conducted in 2018 involved 113 nurse practitioners and was done in 12 weeks (Lawal et al., 2018). Another research was done in five units that handle critically ill patients in surgical wards, ICU and medical emergency units (Niyonzima, Brennaman & Beinempaka, 2018). The final study was conducted among eight nurses in various departments in United States healthcare facilities (Phan et al., 2018). The sample populations included in each of these studies were enough to present the desired findings. However, the studies that had bigger population provided more reliable findings.

Comparison of limitations

Each of the studies that were reviewed had their own limitations. The first time used a labor intensive approach that led to a lot of time wastage (Daisy & Sreedevi, 2015). The sample population of the second study was very small and the results found may not represent the general population (Fox et al., 2015). The third study had an improper representation of the target population and this led to inability of researchers to control the environment (Knighton, 2017). The fourth study was a review and therefore had a lot of biasness issue to deal with. This approach also made it difficult for researchers to identify all data connected to their research question (Graveto et al., 2018). This has significant impacts on the findings of the study.

The fifth study had limited ability to compare as groups used where not alike (Thoa et al., 2015). This presented significant threats to the internal validity of the study. The sixth study had an improper representation of the target population and there was difficulty in the process of analyzing data (Lawal et al., 2018). The seventh research was limited by the fact that behaviors could not be analyzed over a given period of time (Niyonzima, Brennaman & Beinempaka, 2018). It also did not help in determining cause or effect and allowed for conflict of interest that could have affected the findings. The eighth study used a labor intensive approach which made it difficult to investigate various aspects among the groups selected (Phan et al., 2018). It also was time consuming and interpretations were widely limited.


In conclusion, the studies that have been reviewed in this paper support the PICOT statement. Most of the studies had a good sample size which allowed their findings to be reliable. It is recommended that healthcare organizations implement HH programs to create awareness among burses on the importance of hand hygiene. Healthcare organizations should also develop educational programs to increase adherence to HH guidelines among nurses. This study will help to advance knowledge on the importance of using hand washing protocol in HH and lay grounds for future studies.


Daisy, V. T., & Sreedevi, T. R. (2015). Effectiveness of a Multi-Component Educational Intervention on Knowledge and Compliance with Hand Hygiene among Nurses in Neonatal Intensive Care Units. International Journal of Nursing Education7(4), 98-103.

Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., … & Bader, M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal of Critical Care24(3), 216-224.

Knighton, S. (2017). The Use of Instructional Technology to Increase Independent Patient Hand Hygiene Practice of Hospitalized Adults in an Acute Care Setting. In Open forum infectious diseases (Vol. 4, No. suppl_1, pp. S411-S412). US: Oxford University Press.

Graveto, J. M. G. D. N., Rebola, R. I. F., Fernandes, E. A., & Costa, P. J. D. S. (2018). Hand hygiene: nurses’ adherence after training. Revista brasileira de enfermagem71(3), 1189-1193.

Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo, H. T., Theorell-Haglow, J., & Gordon, C. J. (2018). An educational intervention to improve hand hygiene compliance in Vietnam. BMC infectious diseases18(1), 116.

Thoa, V. T. H., Van Trang, D. T., Tien, N. P., Van, D. T., Wertheim, H. F., & Son, N. T. (2015). Cost-effectiveness of a hand hygiene program on health care–associated infections in intensive care patients at a tertiary care hospital in Vietnam. American journal of infection control43(12), e93-e99.

Lawal, T. O., Monsudi, K. F., Zubayr, B. M., Michael, G. C., Duru, C., Ibrahim, Z. F., & Aliyu, I. (2018). Hand hygiene practices among nurses in health facility in a semi-urban setting. International Journal of Health & Allied Sciences7(3), 191.

Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018). Practice and compliance of essential handwashing among healthcare workers at a regional referral hospital in Uganda: A quality improvement and evidence-based practice. Canadian Journal of Infection Control33(1), 33-38.

Topic 9 DQ 2

Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers.

Re: Topic 9 DQ 2

The great challenge of today’s world is providing efficient and high-quality healthcare treatments to patients. EBP is the problem-solving perspective for taking decisions on the basis of current best evidence. It is not the part of a research; however, it belongs to quality and standard improvement. (Wong, 2015). There are many barriers that may prevent EBP change proposal from continuing. One of them is ability to approach and evaluate evidences. (Harding, 2014) The well-designed projects will always base on evidences to check what works and what doesn’t? To overcome this issue, it is better to get feedback through surveys or if it is already implemented then record your own results to evaluate. Good evidence is the one which includes all details like what we want to know, what the objective is and in what context does these evidences needed? The other is cultural or personal values. Patients might refuse to get recommended treatments due to socials, cultural or religious factors. A nurse practitioner described the culture barrier as actuality that is the cause of worst nursing practice. (Yates, 2015).

There must be the culture that allow practice with evidences that keep us up to date. This issue doesn’t only regard patient but also the values of organization matters a lot. Somehow professional advancement among nurses is undermined because of cultural attitudes of hospital system and that needs to work on.


Harding, K. E.‐T. (2014). Not enough time or a low priority? Barriers to evidence‐based practice for allied health clinicians. Journal of Continuing Education in the Health Professions , 224-231.

Wong, C. S. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders.

Yates, M. J. (2015). From a Provider’s Perspective: Integrating Evidence-Based Practice into the Culture of a Social Service Organization. Child Welfare, 87.


Title of Your Paper

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Submitted to Your Professor Here

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Grand Canyon University

June 20, 2015

Title of Your Paper

The issue of nursing incivility and its effect on a healthy workplace are disturbing. The nursing profession and the safety of the patients nurses care for, are at risk when nursing incivility is allowed. The purpose of this paper is to define nursing incivility, explore the effects on the workplace and patient care, and identify resolutions.

Defining Nursing Incivility

Nursing incivility is not easily defined and it can be vague and passive. One definition of workplace incivility is “low intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect” (Laschinger, Wong, Cummings, & Grau, 2014, p. 6). Some examples of this deviant behavior include “dismissing an employee’s ideas or opinions, making derogatory or demeaning remarks about individuals at work, and excluding people from unit-based social activities” (Laschinger et al, 2014, p. 6).


The nursing profession has a history of incivility. “Nurses eat their young has been a well known but dark secret within the nursing profession” (Hippeli, 2009).

Pros and Cons of Nursing Incivility

It is difficult to identify any positives from nursing incivility. Disrespectful and uncivil behavior should never be allowed. The question then becomes “why is this still a problem?” The answer lies in what would be considered “pros”.


Addressing the behavior of incivility has risks.


The costs of nurse training, turnover, and lost productivity as a result of nursing incivility has been well documented.


The two main stake holders identified for the issue of nursing incivility is the nursing profession and governing bodies.

Nursing Profession

The nursing profession as a whole, has a duty to maintain its credibility and continue the integrity.

Governing Bodies

In 2008, the Joint Commission released a sentinel event alert regarding behaviors that undermine a culture of safety (Joint Commission, 2008).

Plan of Action

Hippelli wrote this about nursing incivility: “professional nurses recognize the problem but are convinced that they are not part of the problem or the problem needs to be solved by somebody else” (Hippelli, 2009, p. 187).


Obtaining outcomes can be done through education.

Proposed Funding

Considering that staff turnover due to a hostile workplace is costly, the benefits of establishing a healthy workplace environment is easy to calculate.


In conclusion, a toxic workplace costs the patient and the profession of nursing.


American Nurses Association. (2010). Nursing: Scope and standards of practice. (2nd ed.). Silver Spring, MD:

Centers for Disease Control. (2014). Workplace safety & health topics: Workplace violence. Retrieved from

Hippeli, F. (2009). Nursing: does it still eat its young, or have we progressed beyond this?. Nursing Forum44(3), 186-188. doi:10.1111/j.1744-6198.2009.00141.

Joint Commission. (2008). Behaviors that undermine a culture of safety. [Data file]. Retrieved from

Khadjehturian, R. E. (2012). Stopping the Culture of Workplace Incivility in Nursing. Clinical Journal Of Oncology Nursing, 16(6), 638-639. doi:10.1188/12.CJON.638-639.

Lachman, V.D. (2014). Ethical Issues in the Disruptive Behaviors Of Incivility, Bullying, and Horizontal/Lateral Violence. MEDSURG Nursing, 23(1), 56-60.

Laschinger, H.S., Wong, C. A., Cummings, G. G., & Grau, A. L. (2014). Resonant Leadership and Workplace Empowerment: The Value of Positive Organizational Cultures in Reducing Workplace Incivility. Nursing Economic$, 32(1), 5-44.

Occupational Safety and Health Administration. (2015). Guidelines for preventing workplace violence for healthcare and social service workers [Data file]. Retrieved from

Riffkin, R. (2014). Americans rate nurses highest on honesty, ethical standards. Gallup. Retrieved from

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