Benchmark- Capstone Project Change Proposal Essay

Benchmark- Capstone Project Change Proposal Essay


Background of the Change Proposal

Respiratory viruses in hospitals are among healthcare-associated infections (HCAIs) that result in adverse consequences, including increased morbidity and mortality, increased care costs, prolonged hospitalization, and poor quality of life (QoL) (Kong et al., 2021). Examples of respiratory viruses that overwhelm healthcare systems include influenza and coronaviruses. Often, these viruses spread due to cross-contamination, contact with contaminated surfaces, and the absence of practical interventions for preventing transmission patterns. Despite the actual and potential ramifications of respiratory virus infections in hospitals, healthcare professionals grapple with the urge to embrace evidence-based practices for preventing viral transmission. For instance, the COVID-19 pandemic exacerbated the situation by increasing healthcare professionals’ susceptibility to respiratory viruses.

The Covid-19 pandemic necessitates implementing a contingency plan for preventing respiratory viruses and other healthcare-associated infections (HCAIs), including ventilator-associated pneumonia. In this sense, hospitals implement various strategies, including hand hygiene, personal protective equipment, staff education, and environmental hygiene. However, these strategies achieve varying effectiveness since they depend on organizational factors such as norms, leadership commitment, and change implementation. Therefore, this paper elaborates on the role of hand hygiene in preventing respiratory viruses in emergency departments and general wards.

Clinical Problem Statement

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Undoubtedly, the high prevalence of respiratory viruses in emergency departments and general wards results in detrimental ramifications, including deaths, compromised quality of life for patients and healthcare professionals, lengthy hospitalization, and increased economic burden. According to Chow & Mermel (2017), respiratory viruses in hospital settings spread through direct contact with infected visitors, workers, and patients and indirectly through contact with contaminated fomites. Also, patient-to-patient contact facilitates viral transmission when practical hand hygiene protocols are lacking. Yu et al. (2018) argue that acute respiratory infections (ARIs) pose a significant global public health because of their high morbidity and mortality. With the entry of Covid-19 as a new coronavirus strand, hospitals have grappled with the subsequent problems of overwhelmed emergency departments and general wards, increased workload, and compromised hygiene. As a result, hand hygiene protocols remain a profound, practical, and cost-effective strategy for preventing acute respiratory infections (ARIs) in different healthcare settings due to inconsistencies from other preventive measures.

Purpose of the Change Proposal

The purpose of this change proposal is to present evidence-based approaches to implementing hand hygiene guidelines in hospital settings. As stated earlier, health organizations implement various preventive measures, including personal protective equipment (PPE), environmental hygiene, staff education, and hand-rub practices. However, the effectiveness of these interventions relies massively upon the institutional ability to promote behavioral change and sustain new safety interventions. Regardless of the inconsistent result of different preventive measures, hand hygiene guidelines are now universal for preventing nosocomial infections such as acute respiratory infections (ARIs). Therefore, the change proposal aims to identify motivators and barriers to hand hygiene guidelines and support their plausibility in preventing respiratory viruses in emergency departments and general wards.

PICOT Question

While establishing the effectiveness of hand hygiene in preventing respiratory viruses in emergency departments and general wards, it is crucial to develop a culture of clinical inquiry by defining a clinical problem, comparing alternatives, and conceptualizing questions to aid in nursing research. The PICOT format enables researchers to organize ideas by identifying the problem/population (P), defining interventions (I), comparing alternatives (C), stipulating potential outcomes (O), and setting a timeframe for intervention implementation (T). The PICOT question for this change proposal includes the following essentials:

P: Emergency departments and general wards

I: Hand hygiene implementation

C: Other interventions

O: Preventing respiratory viruses

T: One month

These essentials narrow down to a statement PICOT question: In the emergency department and general wards (P), does hand hygiene implementation (I), compared to other approaches (C), prevent respiratory viruses (O) within one month of implementation (T)?

Literature Search Strategy

The purpose of developing a PICOT question is to guide nursing research to investigate the effectiveness and applicability of hand hygiene protocols in preventing respiratory viruses. After developing the clinical question, I searched, located, and selected credible sources to answer the question. I accessed reputable internet-based databases such as PLOS ONE, Springer, PMC, Canadian Journal of infection Control, JMIR Nursing, and Scholarly Commons (the University of Pennsylvania’s open access institutional repository). I selected five scholarly sources articles for review. The search criteria included keywords and subtitles such as hand hygiene and respiratory viruses, hand washing and nosocomial infections, and handwashing effectiveness.

After selecting the potential evidence sources for answering the PICOT question, I applied the CRAAP (Currency, Relevance, Authority, Accuracy, and Purpose) test to appraise the articles. I included sources published within the last five years (2017-2022). Other measures such as sources’ relevance, authority, accuracy, and purpose revolved around authors’ credibility, the sources’ resonance with the clinical question, and the generalizability of the sources.

Evaluation of Literature

The sources supported the clinical question by establishing the rationale for implementing hand hygiene protocols to prevent respiratory viruses in hospitals. According to Kong et al. (2021), increased healthcare workers’ awareness of nosocomial infections and knowledge of hand hygiene protocols translate to decreased trends in Hospital-associated Infections (HAIs) during the COVID-19 pandemic (p. 383). A study by Akram et al. (2020) supports this observation by arguing that hand hygiene and low-level disinfection of equipment behaviors among hospital staff are leading cost-effective methods of reducing hospital-acquired infections (HAIs) among patients. Hori et al. (2021) argue that hand hygiene complements other preventive measures, including personal protective equipment (PPE) and regular antibody surveillance.

Equally, a scholarly article by Bello et al. (2020) states that hand wash and alcohol hand-rub preparations effectively prevent HCAIs in intensive care units (ICUs). Finally, Sands & Aunger’s (2020) study states that hand hygiene is the simplest and most effective measure for preventing healthcare-associated infections. However, health organizations should address barriers to effective implementation of hand hygiene, including nurse workload, workplace stressors, ineffective communication, and organizational norms that compromise change implementation.

Applicable Change or Nursing Theory

Since implementing hand hygiene guidelines requires health institutions to challenge status quos, behavioral issues, and stressors, it is essential to embrace a reputable change model or theory. According to Sands & Aunger (2020), a behavior-centered design (BCD) can support organizational learning needs and new approaches for preventing HCAIs. In the same breath, it is vital to implement Kotter’s 8-step model when implementing change. According to Carman et al. (2019), Kotter’s 8-step change model narrows down to three tenets; creating a climate for change, engaging and enabling the whole organization to implement change, and sustaining change. It is possible to utilize this theory in promoting hand hygiene protocols by educating employees, encouraging preventive behaviors, and transforming organizational culture to accommodate safer procedures.

Proposed Implementation and Outcome Measures

The proposed change proposal targets establishing the effectiveness of hand hygiene guidelines after a month of implementation. The prerequisite activities for implementing the proposal include staff education, behavior monitoring, promotion of preventive behaviors through creating awareness, and availing necessary resources, including sanitizers. The outcome measures for the project include reducing mortality and morbidity of respiratory viruses among patients and healthcare professionals, bolstering employees’ knowledge of handwashing essential including the six steps of handwashing as proposed by the World Health Organization (WHO), reduced readmissions for patients with respiratory viruses, and shorted hospitalization.

Evidence-based Practice in Intervention Plan

The rationale of developing this change proposal obtains backing from evidence-based practice and insights from scholarly literature. It is essential to note that many scholarly studies support the plausibility of implementing hand hygiene protocols in preventing respiratory viruses and other nosocomial infections. According to Andriani & Nadjib (2018), hand hygiene is still the most profound way of reducing HCAIs since it entails washing hands with anti-bacterial and non-anti-bacterial soaps and alcohol-based sanitizers. Despite the simplicity and effectiveness of hand hygiene, employees’ compliance with these guidelines is relatively low. As a result, it is essential to address barriers by implementing and sustaining change. Eventually, the prevailing disparities in compliance with hand hygiene protocols validate the rationale of this change proposal.

Plan for Evaluation

Within one month of implementing hand hygiene protocols in emergency departments and general wards, it will be essential for the project implementation team to emphasize progress-focused and summative evaluations to assess the level of compliance and behavioral transformation. Progress-focused evaluations are frequent assessments (often weekly) that identify areas of improvement, employees’ opinions and views, and alignment of the project with set objectives. On the other hand, a summative evaluation will reveal the project’s impact on set outcome measures, including reducing HCAIs mortality and morbidity rates, employees’ familiarity with hand hygiene protocols, and behavioral modification to sustain change.

Barriers and Solutions to Implementation Challenges

As stated earlier, health organizations face challenges in implementing hand hygiene despite its simplicity and effectiveness in preventing respiratory viruses in healthcare settings. Sands & Aunger (2020) identify organizational norms, nurses’ cognitive workload, ineffective communication, stress, and busyness as barriers to the effective implementation of hand hygiene guidelines. While hospitals grapple with increased workload and overwhelmed units because of the Covid-19 pandemic, it is possible to address barriers to the practical implementation of hand hygiene by educating healthcare professionals, enhancing communication openness, modifying behaviors, enhancing communication, setting objectives, and increasing interactions between healthcare professionals.


Respiratory viruses are a class of healthcare-associated infections (HCAIs) that result in mortalities, lengthy hospitalization, increased care costs, and compromised quality of life (QoL). Although hand hygiene protocols present a simple and effective way of preventing HCAIs, organizational factors such as inconsistent behaviors, norms, increased workload, busyness, and workplace stressors affect its implementation. Therefore, this change proposal elaborates on evidence-based practices for promoting hand hygiene protocols and expounds on insights from the current literature. Also, the proposal presents an ideal change implementation and management theory that focuses on transforming behaviors and sustaining safer approaches.



Akram, H., Andrews-Paul, A., & Washburn, R. (2020). Assessing hand hygiene and low-level disinfection of equipment compliance in an acute care setting: Mixed Methods Approach. JMIR Nursing, 3(1).

Andriani, Y., & Nadjib, M. (2018). The importance of implementation of hand hygiene practice in reducing healthcare-associated infections: A systematic review. KnE Life Sciences, 4(9), 135.

Bello, S., Bamgboye, E. A., Ajayi, D. T., Ossai, E. N., Aniwada, E. C., Salawu, M. M., & Fawole, O. I. (2020). Handwash versus hand-rub practices for preventing nosocomial infection in hospital intensive care units: A systematic review and meta-analysis. Canadian Journal of Infection Control, 82–90.

Carman, A. L., Vanderpool, R. C., Stradtman, L. R., & Edmiston, E. A. (2019). A change-management approach to closing care gaps in a federally qualified Health Center: A rural Kentucky case study. Preventing Chronic Disease, 16.

Chow, E. J., & Mermel, L. A. (2017). Hospital-acquired respiratory viral infections: Incidence, morbidity, and mortality in pediatric and adult patients. Open Forum Infectious Diseases, 4(1).

Hori, H., Fukuchi, T., Sanui, M., Moriya, T., & Sugawara, H. (2021). Comprehensive infection control measures prevent hospital-acquired severe acute respiratory syndrome coronavirus 2 infections: A single-center prospective Cohort Study and seroprevalence survey. PLOS ONE, 16(10).

Kong, A., Botero Suarez, C. S., Rahamatalli, B., Shankweiler, J., & Karasik, O. (2021). Hand hygiene and hospital-acquired infections during COVID-19 increased vigilance: One hospital’s experience. HCA Healthcare Journal of Medicine, 2(5).

Yu, J., Xie, Z., Zhang, T., Lu, Y., Fan, H., Yang, D., Bénet, T., Vanhems, P., Shen, K., Huang, F., Han, J., Li, T., Gao, Z., Ren, L., & Wang, J. (2018). Comparison of the prevalence of respiratory viruses in patients with acute respiratory infections at different hospital settings in North China, 2012–2015. BMC Infectious Diseases, 18(1).


In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

Clinical problem statement.
Purpose of the change proposal in relation to providing patient care in the changing health care system.
PICOT question.
Literature search strategy employed.
Evaluation of the literature.
Applicable change or nursing theory utilized.
Proposed implementation plan with outcome measures.
Discussion of how evidence-based practice was used in creating the intervention plan.
Plan for evaluating the proposed nursing intervention.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
Appendix section, if tables, graphs, surveys, educational materials, etc. are created.
Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

My PICOT Question: In the emergency department and general wards does implementing hand hygiene compared to other preventative measures prevent respiratory viruses within a month of implementation?

I request writer Jordan Elise (writer ID:1199) to please write this paper.

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