Hospital-Acquired Diseases & Hand Hygiene Studies Writing Sample

In medicine, research, experiments, and surveys are regularly conducted and serve as excellent tools for the development of new treatment methods, understanding patients’ needs, concerns, and so on. It also helps healthcare professionals to evaluate the effectiveness of new medications and medical procedures. One of the ways to conduct successful research is the so-called PICOT question technique. In this essay, a comparison of research questions, sample populations, and the limitations of the study based on PICOT questions will be presented.

PICOT is a tool that comprises the four components of clinical questions, such as patient (problem), intervention, comparison, outcome, and time. The PICOT system helps professionals clarify research questions, which makes the process of finding answers easier. For example, the PICOT tool was used for identifying the effect of a thorough handwashing and antiseptic rule implementation for staff on improving the rate of hospital-acquired infections.

Various articles related to the subject support the PICOT tool providing appropriate evidence. Thus, Indian scholars aimed to improve hand hygiene compliance among the staff (Chavali, Menon, & Shukla, 2014). American researchers try to achieve similar goals, but their research questions are different. Thus, Mitchell, Boisvert, Wilson, and Hogan (2017) set a goal to increase the awareness of hand hygiene, while Chassin, Mayer, and Nether (2015) target causes of noncompliance with hand hygiene. These articles are supplemented by the work that analyzes the health worker’s explanation for the reluctance to comply with the rules (Fulller et al., 2014).

Some scholars define the rate of hand contamination of health workers (Tajeddin et al., 2016). Ethiopian researchers identify factors that ensure hand hygiene compliance (Abdella et al., 2014). Further research evaluates the methods that are introduced by the World Health Organization to control diseases caused by hospital-acquired infections (Reilly et al., 2016). These ideas are supported in the article of Australian scholars who analyze explanations of health workers for noncompliance with head hygiene rules (White et al., 2014). Each piece contains information on the same subject but has different purposes.

Comparing the research articles mentioned above, it can be concluded that they all have mutual goals. These goals are to raise awareness of health workers about the necessity to comply with hand hygiene rules to reduce the number of patients who have hospital-acquired infections. Another similarity is that these articles were written with the help of the PICOT tool. First of all, the problems related to patients are clearly identified. Second, the effect of compliance with hand hygiene by staff is proven, which can be considered as the intervention. Third, the comparison of possible outcomes depending on either keeping or noncompliance with hygiene rules is conducted.

What distinguishes these articles is the fact that they represent different stages of research. Thus, if someone wants to know more about hospital-acquired diseases, he or she should start from the readings about the importance of hand hygiene. These works should be followed by articles that determine key hand hygiene factors and the rate of hands’ contamination of health workers. Then, it is logical to pay attention to the possible ways of dealing with this problem. It includes compliance with hand hygiene rules and implementation of steps introduced by the World Health Organization and the Center for Disease Control. One more difference is that each group of scholars sees various ways to resolve the existing problem and, therefore, focuses on different aspects of the same problem.

It is also worth mentioning that sample populations are different for each survey or research. The number of people who took part in interviews varies from 38 to more than a thousand healthcare workers and patients. In some research, however, the total number of participants was not provided. What brings exceptional value to the offered articles is that they contain information about the situation with hand hygiene in different parts of the world, including the USA, Australia, Ethiopia, and Iran. Therefore, comparing the articles in terms of the sample of populations, it is clear that they are all different in terms of the number of participants and their locations. However, the contingent is similar, as it implies the participation of healthcare professionals and their patients.

There are no doubts that the research papers bring some positive results as it promotes people’s awareness about the problem and helps to reduce the number of those who have hospital-acquired infections. However, it is necessary to notice that these studies have some limitations.

Thus, each paper concentrates on a particular aspect of a subject, which limits its opportunities to explore the problem from different angles. For example, a study that aims to consider the effect of dealing with infections suggested by the World Health Organization does not deem critical factors of noncompliance to hygiene rules. Therefore, comparing the limitations of these studies, it can be concluded that each article has its regulations regarding the described subjects and research questions.

It can be concluded that all the mentioned articles contain essential information about hand hygiene. The literature review revealed that research papers support the PICOT tool as the themes follow its main components. As a result of the study, all these components became known in the evidence. In addition, a comparison of research papers, sample populations, and the limitations of the study was conducted.

Even though these articles made a significant contribution to people’s awareness of hospital-acquired infections, there is still room for improvement. Thus, it is necessary to mention that each hospital has its own challenges. Therefore, it is recommended to investigate the cases in each hospital separately to understand the causes of noncompliance to hand hygiene rules. Also, it would be beneficial to suggest more effective ways to carry out antibacterial procedures in addition to handwashing and alcohol-based hand rub.


Abdella, N., Tefera M., Eredie, A., Landers, T., Malefia, Y., & Alene, K. (2014). Hand hygiene compliance and associated factors among health care providers in Gondar University Hospital, Gondar, North West Ethiopia. BMC Public Health, 14(96), 1–7.

Chassin, M., Mayer, C., & Nether, K. (2015). Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance. The Joint Commission Journal on Quality and Patient Safety, 41(1), 4–12.

Chavali, S., Menon, V., & Shukla, U. (2014). Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian Journal of Critical Care Medicine: Official Publication of Indian Society of Critical Care Medicine, 18(10), 689–693.

Fuller, C., Besser, S., Savage, J., McAteer, J., Stone, S., & Michie, S. (2014). Application of a theoretical framework for behavior change to hospital workers’ real-time explanations for noncompliance with hand hygiene guidelines. American Journal of Infection Control American Journal of Infection Control, 42(2), 106–110.

Mitchell, A., Boisvert, E., Wilson, T., & Hogan, S. (2017). Hand hygiene- a quality improvement project. Biomedical Journal of Scientific & Technical Research, 1(7), 1–4.

Reilly, J., Price, L., Lang, S., Robertson, C., Cheater, F., Skinner, K., & Chow, A. (2016). A pragmatic randomized controlled trial of 6-step vs. 3-step hand hygiene technique in acute hospital care in the United Kingdom. Infection Control & Hospital Epidemiology., 37(6), 661–666.

Tajeddin, E., Rashidan, M., Razaghi, M., Javadi, S., Sherafat, S., Alebouyeh, M., … Zali, M. (2016). The role of the intensive care unit environment and healthcare workers in the transmission of bacteria associated with hospital-acquired infections. Journal of Infection and Public Health, 9(1), 13–23.

White, K., Jamieson, N., Obst, P., Graves, N., Barnett, A., Cockshaw, W., … Martin, E. (2015). Using a theory of planned behavior framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses. BMC Health Services Research, 41(1), 1–9.

Forensic Vs. Advanced Practice Nursing Evolution


Effective collaboration among specialists from different healthcare units enables better patient outcomes. To achieve such beneficial cooperation, the understanding of varieties between nursing roles is required. Advanced practice nursing (APN) is justly regarded as one of the most crucial divisions in healthcare settings. The professionals working in this direction are highly skilled and can perform a number of roles related to improving patient outcomes. However, new specialties, which have emerged and evolved recently, need to be assimilated by APN professionals to make sure that the process of health care is complete. Forensic nursing is one of the specialties that have evolved in a different direction from APN.

Forensic Nursing

Forensic nursing has developed in a direction different from APN due to its close focus on legal aspects of the profession. Previously, forensic nursing was not recognized as a formal nursing practice (Amar & Sekula, 2016).

However, a modern view of this healthcare area is different. The practice is now recognized as a crucial specialty, and the professional duties of forensic nurses are defined as different from APNs’ ones. Forensic nursing emerged in the USA in the middle of the 20th century (Amar & Sekula, 2016). At first, it was considered only as physicians’ domain, but later, it started involving nurses, as well. Forensic nurse specialists perform a variety of roles, including a sexual assault nurse examiner, a legal nurse attorney, a forensic psychiatric and correctional nurse, and a risk manager.

Key Differences in the Evolution

The main distinction between forensic nurses’ and APNs’ divisions is their scope of practice. Schober (2016) describes the major requirement to APN specialists as the application of evidence-based practice knowledge and clinical management proficiency with the aim of giving appropriate care to patients. What concerns forensic nurses, their first task is identifying the cause of a patient’s injury (Cucu, Daniel, Paduraru, & Galan, 2014).

A distinctive feature of forensic nurses’ duties is their readiness to work with people who have suffered from violence or disasters. The second large difference between the two branches of nursing is their educational preparation (Amar & Sekula, 2016; Schober, 2016). Unlike APNs, forensic nursing specialists do not have to complete a doctoral program. However, they need to be certified in a sexual assault nurse examination and hold a degree in forensic nursing to be eligible for the position.

The Future Vision and Unique Challenges

Both of the specialties under analysis have a promising future vision due to their utmost significance. It is predicted that the APN direction will constantly evolve to include emerging trends in health care. As for forensic nursing, it is expected that these professionals will be required to widen their educational horizons so as to collaborate with APNs more effectively. The vision of both trends is promising, and it may be assumed that APNs and forensic nurses will gain more independence in the future. What concerns challenges in the state, it is impossible to single out some unique issues. In all states of the USA, the promotion of cooperative relationships is likely to be affected by political and social changes. Thus, the promotion of effective cooperation will require adjustment to the alterations of this kind.


It is impossible to overestimate the role of advanced practice and forensic nurses in the process of patient care. The investigation of both directions makes it possible to deduce that their cooperation is needed to obtain better patient outcomes. When APNs and forensic nurses gain the realization of one another’s duties and scope of practice, they will be able to work together in the direction of gaining the highest level of patient satisfaction.


Amar, A. F., & Sekula, L. K. (2016). A practical guide to forensic nursing: Incorporating forensic principles into nursing practice. Indianapolis, IN: Sigma Theta Tau International.

Cucu, A., Daniel, I., Paduraru, D., & Galan, A. (2014). Forensic nursing emergency care. Romanian Journal of Legal Medicine, 22(2), 133-136.

Schober, M. (2016). Introduction to advanced nursing practice: An international focus. Cham, Switzerland: Springer.

Roy’s Adaptation Model Vs. Kolcaba’s Comfort Theory


As valuable and useful guidelines used in nursing practice, special theories and models are utilized, which are designed to address specific cases and promote the necessary principles of work. The evaluation of individual concepts can reveal their significance in relation to a specific care environment, thereby helping to choose an optimal approach. As objects for analysis, one grand nursing theory (Roy’s adaptation model) and one middle-range nursing theory (Kolcaba’s theory of comfort) will be reviewed within a research study. The goals of this work are to compare the possibilities of applying the proposed concepts and assess their significance in relation to nursing practice in general and my professional activities in particular.

Application of the Theories in the Research Study

As a research work for analysis, the study “Aromatherapy Hand Massage for Test Anxiety and Self-Efficacy in Nursing Students: A Pilot Study” by Farner, Reed, Abbas, Shmina, and Bielawski (2019) will be applied. The authors consider the use of aromatherapy as a practice that may be useful to minimize stress and a means to increase self-efficacy (Farner et al., 2019). To substantiate specific hypotheses and assumptions, several theories have been utilized, including the aforementioned concepts by Roy and Kolcaba.

The first model is the key one in the framework of the study and is applied as a methodology that allows evaluating external and internal stimuli forming adaptation to a specific condition or environment. According to Farner et al. (2019), this theory helps highlight special factors that determine a person’s tendency to accept the necessary circumstances. Such a use of the theory is classical and justified.

Kolcaba’s theory of comfort is another concept utilized in the research study in question. Farner et al. (2019) resort to this model in order to substantiate a special protocol aimed at improving comfort among patients in nursing homes. In particular, this theory helps compare the basic parameters of care perception and enhance these psychological aspects due to the proposed concept. Both models are relevant approaches to achieve the objectives of the study.

Using Grand and Middle-Range Theories to Advance General and Personal Nursing Practice

The application of grand and middle-range theories is an important aspect of nursing practice. As Smith and Parker (2015) note, grand concepts allow describing a specific condition or environment from personal, organizational, professional, and other value orientations. Middle-range theories are more specialized and, according to Smith and Parker (2015), help delve into specific topics raised in more abstract grand models. Therefore, in both cases, these types of theories complement each other and contribute to expanding the range of nursing interventions, thereby creating a favorable care environment.

As applied to my personal practice, utilizing the two categories of nursing theories also has significant benefits. Since these concepts differ in the specifics of the formation of goals and methods for implementing their basic provisions, I can carry out interventions at different levels. Grand theories may help me form an idea of ​​the most common problems of patients and their causes, while middle-range models can allow me to assess a specific situation in more detail and choose the best course of work.


The considered grand and middle-range nursing theories used in the chosen study fulfill their functions and are valuable concepts for achieving research goals. As applied to general practice, these two categories are highly relevant due to their distinctive focus and degree of deepening into a specific problem. Regarding my personal activities, I can utilize these types of theories effectively and increase my professional competence by conducting nursing interventions at different levels.


Farner, J., Reed, M., Abbas, J., Shmina, K., & Bielawski, D. (2019). Aromatherapy hand massage for test anxiety and self-efficacy in nursing students: A pilot study. Teaching and Learning in Nursing, 14(4), 225-230. Web.

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: FA Davis.

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