Influence of Nursing Workload on Quality of Patient Care

This research aims to identify the relationship between nursing workload and patient safety. It specifically focuses on the significance of promoting hand hygiene among healthcare professionals for managing and preventing hospital acquired infections. The literature review highlights the importance of hand hygiene in preventing the transmission of infections and the factors that contribute to poor compliance. The research design is a systematic review, and the methodology involves conducting an online search and analyzing the collected data. The study emphasizes the significance of hand hygiene in patient care and the need for healthcare staff to prioritize patient safety.

Influence of Nursing Workload on Quality of Patient Care

Abstract
Patient safety and maintaining the quality of care is the main aim of the nursing care. Patient
safety has been the main priority for the healthcare system in order to improve the patient
outcomes and for delivering patient centred care. Patient care, patient safety and well-being
can be affected by various factors in the healthcare system. One of the most important factors
that affect patient safety and quality of care is nursing workload. Nursing workload is mainly
associated with the staffing issues that negatively influence patient outcomes. Therefore, this
research will significantly focus on identifying the relationship or the link between nursing
workload and patient safety.

Research Aim
According to the evidences in the study of hospital acquired infections are considered as the
major concern in the New Zealand Hospitals due to their association with antimicrobial
resistance (Pullon et al, 2016). Hospital acquired infections are also considered as the sixth
highest priority category of infectious diseases (Williamson et al, 2014). Hospital acquired
infection mainly occur in the bloodstream, surgical wounds, lungs and urinary tract (Chen,
2018). Such infections significantly affect the health and well-being of the patients and also
increase the hospital stay and financial burden for the patients, families and healthcare
systems (Fernando, Gray, & Gottlieb, 2017). Therefore, Clark, Haisman-Welsh & White
(2018) has also identified that promoting the hand hygiene practice among the health
professionals could be significant in preventing and managing the risk of hospital acquired
infections. Therefore, this research aims towards understanding the significance and
importance of hand hygiene practice among health professionals for managing and
preventing the risk of hospital acquired infections.
Research Question
Primary Research Question:
1. What is the significance of promoting hand hygiene technique among the healthcare
professionals for the management and prevention of hospital acquired infections?
Secondary Questions:
1. What is hospital acquired infections?
2. What is the role of maintaining effective hand hygiene practice among health
professionals to prevent and manage hospital acquired infections?

Literature Review
Healthcare associated infections or hospital acquired infections are the major problem
worldwide and it has been identified that 10% of the total patient admitted to hospitals suffer
from such infections (Freeman et al, 2016). Such infections not only affect the well-being of
the patients but also increase the hospital stay and financial burden of care. Hospital acquired
infections can significantly increase distress, pain and other physical and psychological
consequences that can have long term impact on physical, social and financial condition of
patients (Freeman et al, 2016).
Studies have identified that hand hygiene is the single most important measure to be taken
for preventing the cross-transmission of the microorganism from one person to another. It has
also been identified that transfer of the micro-organism from the hands of the hospital staff is
that major reason behind the transmission of hospital acquired infections (Anitha et al, 2015).
Therefore, hand hyenine is considered as the most significant measure for the prevention of
infections associated with care provided in hospitals. However, a gap in the research has been
identified regarding the practice of hand hygiene in different setting and its impact of patient
well-being (Anitha et al, 2015). Hand hygiene is also important for ensuring the patient’s
safety is maintained and quality of care is delivered (Mehta et al, 2014).
However, McLaws, (2015) has argued that though hand hyenine is considered as the
approach for the prevention of hospital acquired infections, which requires effective
compliance of quality and safety guidelines and standards. A study conducted by Salama et al
(2013) has informed that one of the major reasons behind the increasing incidence of
Nosocomial infections is poor hand hyenine practice among hospital staff (Wearn,
Bhoopatkar & Nakatsuji, 2015). However, most of the studies have identified that
compliance to hand hyenine procedures and standards is very low among the healthcare

workers. There are various factors associated with poor hand hygiene, such as lack of
knowledge, limited resources and workload (Wearn, Bhoopatkar & Nakatsuji, 2015).
Study conducted by Yawson & Hesse (2013) identified that problem of poor hand hygiene
among the hospital staff is very high in developing countries. The lack of resources and
culture specific issues are mainly responsible for influencing nursing practice, due t which
hospital staff display poor compliance to hand hygiene protocol. Vikke et al (2019)
conducted a multicentre prospective observational study and collected the data from the
ambulance services of Australia, Sweden, Finland and Denmark. This study informed that
hand hygiene is the most effective measure to prevent the spread of microbes and routine
practice helps in improving patient care and patient outcomes. Vikke et al (2019) further
identified that emergency management service providers have been more conscious about
personal safety instead of promoting patient’s safety, as the staff have displayed hand hygiene
procedure to be more effectively followed after patient contacts than before coming in patient
contact.
Musu et al (2017) conducted a perspective observational study in six different intensive care
unit, in order to observe the compliance of the hospital staff towards hand hyenine and
maintaining patient safety. This study identified that ICU is an important unit for maintaining
hand hygiene due to the risk profile of the patients admitted to ICUs, such as the age of the
patient, use of invasive devices, unstable immunological condition of the patients etc (Musu
et al, 2017). However, this study identified that despite of high risk to patient’s health and
well-being, hospital staff had low level compliance to hand hygiene protocol. The one
significant reason of such practice, was the organisational culture and lack of focus on
patient’s safety. Similar findings were reported by the study of Wałaszek et al (2017), who
informed that lack of knowledge and education and poor organisational culture are the major
reason of low compliance to hand hygiene among the hospital staff. Study further informed

that lack of adherence to hand hygiene measures and recommendation increase the risk of
hospital acquired infection among patients (Wałaszek et al, 2017).
WHO (2009) has also recommended that appropriate hand hygiene is the most important
measure to control hospital acquired infections. This measure helps in preventing the spread
of microorganisms and also reduces the risk of various morbidities. WHO (2009) also
recommended that hospital staff should be trained and must be provided with appropriate
knowledge and understanding about the importance of hand hygiene and must involve a
multidisciplinary approach in achieving quality of care. Rocha, Nunes & Gontijo Filho
(2012) identified that limited resources are the major reason behind the nosocomial infection
and colonization mainly by the presence of methicillin resistant Staphylococcus
aureus (MRSA). Therefore, such problems require significant attention from the hospital
staff in order to reduce the healthcare burden associated with hospital acquired infections.
Studies also identified that poor hand hygiene can not only affect the well-being of the adults,
but can also increase the risk of sepsis among the new born babies. The infection can be
transferred to new born through their mothers or through poor hand hygiene compliance in
the labour rooms (Tyagi et al, 2018). Therefore, the evidences significantly inform about the
various risks that can cause or increase the prevalence of hospital acquired infections among
patients due to poor hand hygiene practice. Hospital management and staff is significantly
require to focus on providing high quality patient centred care in order to prevent such
problems and reducing prevalence of infections.
Research Design
Systematic review design has been selected for this study, as the studies have informed that
systematic reviews are the best designs to collect the high-quality evidences in nursing
research. The qualitative systematic review is based on the interpretative approaches, as the

interpretation of the data helps in developing new understandings and can also lead to theory
development (Hannes & Lockwood, 2011).
Methodology
Methods
The methodology is the most significant part of the research, as it provides the blueprint of
complete research and how data will be collected and analysed. This paper will be based on
conducting the systematic review of the existing literature. Systematic reviews are important
for systematically collecting the evidences, conducting a critical analysis of all evidences and
synthesising the findings through qualitative approach (Smith et al, 2011). Studies have
identified that a systematic review can be valuable in bringing together the evidences from
literature and promoting evidence-based practice (Seers, 2015). Methodology of the study
therefore, helps in collecting, analysing the data and answering the research question
(Ivankova & Wingo, 2018). Butler, Hall, & Copnell (2016) “qualitative systematic review is
a rapidly developing area of nursing research. In order to present trustworthy, high
‐quality
recommendations” (p. 241), and as such reviews are based on the review protocols, they
enhance the quality of findings, reduce biases and improve transparency.
Search Strategy
The online search strategy is identified and employed in this research for gathering the
valuable data from the literature. The online search will be conducted on the online databases
that include CINHAL, PubMed, Google Scholar and EBSCO. This research will only include
the peer reviewed articles and papers that are available with free access to full text.
According to the study of Haddaway et al (2015) online search in the different search engines
could be biased, as they may provide the results according to priority or according to most

searched data. Therefore, this study will focus on conducting the bibliographic search in
quality databases.
Significance
Hand Hyenine is considered as the most significant element of patient care, which is required
to be effectively reinforced in the healthcare systems. The evidences from the study has
informed that hand hygiene should be applied in the daily practice and must be reinforced till
the time it becomes an autonomous behaviour of the staff. Researchers have conducted many
experimental, observational and clinical studies in order to understand the implementation of
hand hygiene in different setting. The evidences included in this study inform that problem of
poor hand hygiene is significantly prevalent not only in developing countries like India and
Ghana, but also in some developed nations like Australia, New Zealand and various British
countries.
Systematic review studies may have some significant limitations, which are required to be
acknowledged while reading such studies. The systematic review is mainly based on
collecting the data from the limited number of the databases for the identification of
potentially eligible studies. This may result in excluding some important studies that may not
be published in identified databases. Another limitation of this study is that it will include the
studies on the basis of online keyword research. Therefore, the included for the research may
have some inherent biases, which is not addressed in this study.
Ethical Consideration

Ethical consideration is the process through which researcher consider their claims that they
will make in the study and how those claims can affect or influence other people, researchers
or information. Ethical consideration ensures that researcher takes the appropriate measures
to maintaining the ethical validation of the study. Mertz, Kahrass, & Strech (2016) further
inform that systematic reviews used in the nursing research, do not specifically require the
ethical approval from any department or organisation, as most of the responsibility of
maintain ethics is researcher’s responsibility. Research will also focus on adopting the
clinical research guidelines that are important for maintaining the ethics in conducting the
systematic review (Mertz, Kahrass, & Strech, 2016).
Hospital acquired infection is the problem that can spread through hands and by inappropriate
use of hand hyenine equipment. This paper collected the evidences from various settings such
as hospital wards, ICUs, emergency care units and antenatal units. All the studies have shown
that poor hand hygiene is prevalent all most every setting that risks the life of patients. Poor
hand hygiene has also been found to be associated with the risk of morbidity and mortality
among the frail and immune deficient patients. Some important reasons of poor hand hygiene
among the hospital staff were, non-compliance of non-adherence to protocols and standards,
lack of knowledge and skills and lack of resources to maintain hand hygiene. Lack of
resources was mainly associated with developing countries, while lack of knowledge is
mainly prevalent in developed nations.

Time Frames
Week 1 Week
2
Week 3 Week 4 Week 5 Week 6
Research
Aim and
Research
Question
Literature
Review
Methodology
an Design
Data
Analysis
Conclusion
Costing
This research is based on the online search and qualitative review of the studies that would
not require any kind of significant funding.

References
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