Draft Prospective

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Direct Practice Improvement Project Prospectus

Antimicrobial Stewardship program (ASP): An evidence based quality assurance measure in combating Healthcare Associated Clostridium Difficile Infection in an acute care facility and the role of the Staff Nurse.

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Prospectus Instructions:

1. Read the entire Prospectus Template to understand the requirements for writing your Prospectus. Each section contains a narrative overview of what should be included in the section and a table with criteria required for each section. These criteria will be used to assess the prospectus for overall quality and feasibility of the proposed research study.

2. As you draft each section, delete the narrative instructions and insert your work related to that section. Use the criteria table for each section to ensure that you address the requirements for that particular section. Do not delete/remove the criteria table as this is used by you and your Committee to evaluate your prospectus.

3. Prior to submitting your prospectus for review by your Chair or Methodologist, use the criteria table for each section to complete a self-evaluation, inserting what you believe is your score for each listed criteria into the Learner Self-Evaluation column.

4. The scoring for the criteria ranges from a 0-3 as defined below. Complete a realistic and thoughtful evaluation of your work. Your Chair and Methodologist will also use the criteria tables to evaluate your work.

5. Your Prospectus should be between 6-10 pages when the tables are deleted.

Score	Assessment
0	Item Not Present
1	Item is Present, But Does Not Meet Expectations: Not all components are present. Large gaps are present in the components that leave the reader with significant questions. All items scored at 1 must be addressed by learner per reviewer comments.
2	Item Approaches Meeting Expectations, But Needs Revision: Component is present and adequate. Small gaps are present that leave the reader with questions. Any item scored at 2 must be addressed by the learner per the reviewer comments.
3	Item Meets Expectations: Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. No changes required.

Introduction

The world today is faced with very dangerous infectious diseases due to antibiotic resistance and in the United States, the Centers for Disease Control and Prevention (CDC), has named this escalating antibiotic resistance as one of the top five threats in the country (CDC, 2017). According to statistics from the CDC, drug-resistant bacteria cause more than 20, 000 deaths annually and result to 2 million cases of disease recurrence annually (Lagier et al., 2015). For this reason, there is an increased need to make changes to the clinical practice to encourage appropriate use of antibiotics. In late 2014, the President’s Council of Advisors on Science and Technology (PCAST) published a report on how to combat antibiotic resistance (Khoruts et al., 2014). The President then gave orders to the health sector on the implementation of antibiotic stewardship programs in the healthcare settings. In early 2015, the White House gave out a National Action Plan on the management of antibiotic-resistant bacteria that established goals that slow the emergence and spread of resistant bacteria and promote antibiotic stewardship in inpatient and outpatient care settings, mandating this ASP to be in all acute care facilities by 2020 (CDC, 2017).

There is a need to identify different approaches to motivate staff nurses to take action to prevent health care associated clostridium difficile infections and other health care-associated infections. Nurses are on the forefront and they are the last people who evaluate the medications before giving them to patients, more so antibiotics. So they should be recognized and utilized as members of ASPs by being trained and kept engaged (Mostaghim et al, 2017). In their work on inpatient infections, Monsees , Goldman, & Popejoy, (2017) developed an argument that staff nurses should have awareness of the antimicrobial stewardship measures. Their argument has relevance to the present study which purpose is to create awareness regarding the antimicrobial stewardship in clinical settings.

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Introduction This section briefly overviews the research focus or problem, why this study is worth conducting, and how this study will be completed. The recommended length for this section is one paragraph.
1. Dissertation topic is introduced.
2. Describes how the study extends prior research or fills a “need” or “defined gap” from current literature.
NOTE: This Introduction section elaborates on Point #1(the Topic) from the 10 Strategic Points. This Introduction section provides the foundation for the Introduction section in Chapter 1 of the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Background of the Problem

Healthcare-associated infections (HAIs) are infections that patients get while receiving care for a different diagnosis in healthcare facilities. They affect 1 out of every 25 hospital patients at any time. These infections have become a threat to patients’ health because they have led to increased morbidity and mortality, yet they can be preventable. Over 1million HAIs occur across the U.S. health care system every year, leading to the loss of tens of thousands of lives and adding billions of dollars to health care costs (CDC, 2016). HAIs can happen in any health care facility, including hospitals, ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities. HAIs can be caused by bacteria, fungi, viruses, or other less common pathogens.

The risk factors to HAIs include: exposure to internal catheters into bloodstream, endotracheal, urinary, surgeries, injections, contaminated healthcare environments, communicable diseases without proper personal protective equipment, and importantly overuse or improper use of antibiotics. Some of the common HAIs patients get while hospitalized include: Central-line associated bloodstream infections (CLABSI), Catheter-associated urinary tract infections (CAUTI), Ventilator-associated Pneumonia (VAP), and Surgical site infections (SSI) (CDC, 2017). All these infections are treated with antibiotics which in the past century eradicated most of the diseases. But now, we are seeing resistance to these antibiotics which are a health epidemic to the entire world. Not only do these antibiotics become resistant but because of their frequent use, serious HAIs such as carbapenem-resistant Enterobacteriaceae (CRE), Vancomycin resistant E (VRE), methicillin resistant Staphylococcus aureus (MRSA), and Clostridium difficile have emerged.

The Centers for Disease Control and Prevention (CDC) estimates that drug-resistant bacteria cause two million illnesses and approximately 23,000 deaths each year in the United States alone. That is why this challenge led to an action plan, “the National Action Plan for Combating Antibiotic-resistant Bacteria, to provide a roadmap to guide the Nation in rising to this challenge.” The National Action Plan, signed by President Obama on September 18, 2014, outlines steps for implementing the National Strategy for Combating Antibiotic-Resistant Bacteria and addressing the policy recommendations of the President’s Council of Advisors on Science and Technology (PCAST) (The White House, 2015).

Although its primary purpose is to guide activities by the U.S. Government, the National Action Plan is also designed to guide action by public health, healthcare, and veterinary partners in a common effort to address urgent and serious drug-resistant threats that affect people in the U.S. and around the world. Implementation of the National Action Plan will also support World Health Assembly resolution 67 .25 (Antimicrobial Resistance), which urges countries to take urgent action at the national, regional, and local levels to combat resistance. By 2020, implementation of the National Action Plan will lead to major reductions in the incidence of urgent and serious threats, including carbapenem-resistant Enterobacteriaceae (CRE), methicillin resistant Staphylococcus aureus (MRSA), and Clostridium difficile. The National Action Plan will also result in improved antibiotic stewardship in healthcare settings, prevention of the spread of drug-resistant threats, elimination of the use of medically-important antibiotics for growth promotion in food animals, and expanded surveillance for drug-resistant bacteria in humans and animals (The White House, 2015)

Informed by this action plan, in the proposed study the researcher will critically evaluate the Antimicrobial Stewardship program in combating HAIs with emphasis on Clostridium Difficile prevention and the nurses’ role. Antimicrobial/Antibiotic Stewardship Program was put in place as a set of inter-professional coordinated strategies that see to it that practitioners and clinicians get involved in stopping the spread of antibiotic infections in health care facilities. The program can be defined as, “coordinated interventions designed to improve and measure the appropriate use of antibiotic agents by promoting the selection of the optimal antibiotic drug regimen, including dosing, duration of therapy, and route of administration.” (Fishman, 2012). There is evidence based research that these programs can reduce microbial resistance, decrease the spread of infections caused by multidrug-resistant organisms (MDROs) and improve patient outcomes. “Antibiotic stewardship programs significantly reduce the incidence of infections and colonization with antibiotic-resistant bacteria and C difficile infections in hospital inpatients” (Baur et al, 2017).

How does the performance of the government influence antimicrobial/antibiotic stewardship programs? The CDC recommends that ASP leadership consist of a program leader (an ID physician) and a pharmacy leader, who co-lead the team. In addition, the Joint Commission recommends that the multidisciplinary team should include an infection preventionist (i.e. infection control and hospital epidemiologist) and practitioner. These specialists have a role in prevention, awareness, and policy (Eckart, Hogan, Mao, Toscani, & Brunetti, 2017). Nonetheless, with all these health professionals there is one important person missing on this team, who is underutilized and unrecognized but very important for this ASP to function—the staff nurse. Hence the question: Are the staff nurses being underutilized as members of the antimicrobial stewardship program team related to the rise in health care associated C. difficile?

Antimicrobial/antibiotic stewardship measures are enforced to combat clostridium difficile infections but it is not known how the rise in health care associated c-diff and its impact on patients is related to the nurses being underutilized and not recognized as members of the team. Nurses are on the forefront and they are the last people who evaluate the medications before giving them to patients, more so antibiotics. So they should be recognized and utilized as members of ASPs by being trained and kept engaged (Mostaghim et al, 2017). In their work on inpatient infections, Monsees , Goldman, & Popejoy, (2017) , developed an argument that staff nurses should have awareness of the antimicrobial stewardship measures. Their argument has relevance to the present study which purpose is to create awareness regarding the antimicrobial stewardship in clinical settings.

Prior studies show that the role of inpatient staff nurses as antimicrobial stewards is unexplored. Siegel & Kahn, (2014) identified the need for future studies on how the rise in health care associated c-diff and its impact on patients is related to the nurses being underutilized and unrecognized as members of the Antimicrobial Stewardship Program (ASP) team. A study by the American Nurses Association (ANA) and the Centers for Disease Control and Prevention (CDC) presents a strong argument that “the urgent need to improve appropriate, evidence-based antibiotic use cannot be overstated.” The authoritative and informative report advises that “with the current worldwide expansion of multidrug-resistant organisms, the question is not whether to involve nursing in antimicrobial stewardship, but how.” (ANA/CDC, 2017)

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Background of the Problem The background section explains both the history of and the present state of the problem and research focus. The recommended length for this section is two-three paragraphs.
1. Identifies the “need,” or “defined gap” that will lead to the research problem statement in a following section. Citations from the literature in the last 5 years describe the problem as a current “need” or “gap” for further research.
2. Discusses how the “need” or “defined gap” has evolved historically into the current problem or opportunity to be addressed by the proposed study.
3. ALIGNMENT: The problem statement for the dissertation will be developed from and justified by the “need” or “defined gap” that is described in this section and supported by the Literature.
NOTE: This Background of the Problem* section uses information from Point #2 (Literature Review) in the 10 Strategic Points.* This Background of the Problem section becomes the Background of the Study in Chapter 1 in the Proposal. It is then expanded to develop the comprehensive Background to the Problem section in Chapter 2 (Literature Review) in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as, uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Theoretical Foundations and Review of the Literature/Themes

The pattern of analysis that will inform and guide the present work is the Health Belief Model (HBM) and Nightingales Theory. The HBM is by far the most commonly used theory in health education and health promotion (Pamer, 2016). The HBM model is considered to be an ideal explanatory framework for the purpose to communicate research in health care. However, its uses have been limited by theoretical limitations in this field. Nonetheless, it is a psychological model that allows to predict and further explain health behaviors. This is carried out by directly focusing on an individual’s attitudes and beliefs. The psychological model signifies that the health related behaviors of an individual is dependent on the perception of four critical areas: (a) severity of potential illness. (b) the individual’s’ own susceptibility to that disease, (c) advantages of taking preventive action, and (d) barriers for taking that action.

The proposed study will adopt the HBM model to answer the research question because it is a model often applied in nursing, particularly in addressing issues related to patient compliance and preventive health care practices. Thus, this model will be used in the proposed study to explore the role of inpatient staff nurses as antimicrobial stewards. The model further aids to identify the rise in health care associated infections in hospitals (Magill et al., 2014).

It is clear that this model that explains health behaviors can be formulated in terms of how the staff nurses being underutilized and not recognized as members of the antimicrobial/antibiotic stewardship program team is related to the rise in health care associated c-diff. The HBM model is considered as a great tool for nurses, which offers them a theoretical framework to raise questions about the problem of health care-associated infections. The model allows nurses to help their patients in preventing chronic diseases or, in case of having disease it aids to improve quality of life (Lessa et al., 2015). In addition, nurses could use this model to clarify risk perceptions of patients and their behavior that is risky or harmful. This further helps nurses to apply strategies that might influence patients in making healthy lifestyle changes. The perceptions of patients can be broadly affected by personality, age and sex.

Nightingales theory raised questions about the problem under study. The theorist suggestion that nurses need to know about the disease process will inform and guide the present work. Katz and his fellow researchers alluded to a relationship between Nightingales theory of nursing practice and preventing hospital borne infections. “Does Nightingales theory of nursing practice influence the staff nurses’ attitude and or believe that antimicrobial stewardship is not their function because they do not perceive themselves as antibiotic prescribers?” (Katz et al., 2017).

The main focus of the Nightingale theory is on environment and she provides an in depth description of every aspect of environment. Nightingale believed that the role of the nurse was to provide an environment to their patients in which perfection might be achieved. Thus the role of the nurse as an antimicrobial steward is considered important in combating nosocomial infections. Nursing needs a specific educational background and can be achieved by means of environmental alterations.

Nosocomial Infections and Clostridium Difficile

In the US, Clostridium difficile infection (C. difficile, also abbreviated as CDI) is one of the major nosocomial or hospital acquired infections, mainly due to the increased use of antibiotics. C. difficile infection is a disease that is common in acute hospital settings and, in most cases, causes severe diarrhea and weight loss. The disease is caused by the disruption and destruction of the gastrointestinal microbiome. C. difficile is an anaerobic, spore-forming bacillus that is known for causing pseudomembranous colitis and diarrhea. C difficile infection is fatal and is mostly caused by unsanitary hospital settings (Karadshe & Sule, 2013).

The C. difficile incidences are on the increase and have triggered an increase in the antibacterial-related diarrhea cases and antibiotic-related pseudomembranous colitis cases. As Karadshe & Sule (2013) noted, the major contributing factor to the increasing incidences of C. difficile is the development of new antibiotic-resistant viral strains. The disease is a major health issue that has for long continued to cause deaths and increased health costs to patients, yet, Sir Alexander Fleming, the person who invented the penicillin antibiotic himself, warned of this danger in his speech during his noble award in 1945.

But I would like to sound one note of warning. Penicillin is to all intents and purposes non-poisonous so there is no need to worry about giving an overdose and poisoning the patient. There may be a danger, though, in under dosage. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant (Fleming, 1945).

The incidences of C. difficile have been on the rise over the past decade. In the US alone, more than 500,000 cases of the infection are reported annually in acute healthcare settings. In 2010, for example, C. difficile incidences were approximated at about 500, 000 cases, a mortality of 20, 000 to 50, 000, and the cost of managing the disease at $ 1.2 billion. Over the past years, there has been an increase in the incidences of C. difficile in hospital settings, especially in acute healthcare settings. Pepin et al. (2005) found that almost 18% of all deaths among patients with C. difficile are directly attributed to the infection. C. difficile is directly attributed to patient deaths in acute healthcare settings.

Because of the continued deaths and morbidity due to C. difficile, there has been advancement toward establishing more effective prevention technologies and strategies. The process of prevention and management of C. difficile, however, has not been smooth and there have been numerous challenges. The epidemiology of C. difficile has been changing and its continued presence in the acute care environment is a concern among health practitioners and policy makers. This has led the healthcare practitioners to re-evaluate the strategies and technologies used in the prevention and treatment of C. difficile (Rao & Young, 2015). Hence the formation of Antibiotic/Antimicrobial Stewardship Programs.

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Theoretical Foundations and/or Conceptual Framework This section identifies the theory(s) or model(s) that provide the foundation for the research. This section should present the theory(s) or models(s) and explain how the problem under investigation relates to the theory or model. The theory(s) or models(s) guide the research questions and justify what is being measured (variables) as well as how those variables are related (quantitative) or the phenomena being investigated (qualitative). Review of the Literature This section provides a broad, balanced overview of the existing literature related to the proposed research topic. It describes the literature in related topic areas and its relevance to the proposed research topic findings, providing a short one-two sentence description of each theme/topic and identifies its relevance to the research topic supporting it with at least one citation from the literature. The recommended length for this section is two-three paragraphs
1. Theoretical Foundations section identifies the theory(s), model(s) relevant to the variables (quantitative study) or phenomenon (qualitative study). This section should explain how the study topic or problem coming out of the “need” or “defined gap” in the Background to the Problem section relates to the theory(s) or model(s). (One paragraph)
2. Review of the Literature Themes/Topics section: This section lists the major themes or topics related to the research topic. It provides a short one-two sentence description of each theme/topic and identifies its relevance to the research topic supporting it with at least one citation from the literature. (One or two sentences per theme/topic).
3. ALIGNMENT: The Theoretical Foundations models and theories need to be related to and support the problem statement or study topic. The sections in the Review of the Literature are topical areas needed to understand the various aspects of the phenomenon (qualitative) or variables/groups (quantitative) being studied; to select the design needed to address the Problem Statement; to select surveys or instruments to collect information on variables/groups; to define the population and sample for the study; to describe components or factors that comprise the phenomenon; to describe key topics related to the study topic, etc.
NOTE: The two parts of this section use information from Point #2 (Literature Review) from the 10 Strategic Points. This Theoretical Foundations section is expanded upon to become the Theoretical Foundations section in Chapter 2 (Literature Review). The Theoretical Foundations section is also used to help create the Advancing Scientific Knowledge section in Chapter 1. This Review of Literature Themes/Topics section is expanded upon to provide the Review of the Literature section in Chapter 2 (Literature Review). The Review of the Literature Themes/Topics section is also used to provide the basis for the Significance of the Study section in Chapter 1.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Problem Statement

Antimicrobial stewardship measures are enforced to combat clostridium difficile infections but it is not known how the rise in health care associated c-diff and its impact on patients is related to the nurses being underutilized and not recognized as members of the ASP. Antimicrobial stewardship education is very important for every health care worker, legislators, policy makers for public health, and the public at general. It should not be for only physicians. Olans, Olans & DeMaria (2016) researched the topic and concluded that “As the largest single group of healthcare providers, nurses should be included in this educational effort.” The authors urged that “Antimicrobial stewardship education is particularly important for nurses, however, who may not identify themselves as antibiotic prescribers, and therefore not view their activities as contributing to antimicrobial stewardship”.

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Problem Statement This section includes the problem statement, the population affected, and how the study will contribute to solving the problem. The recommended length for this section is one paragraph.
1. Presents a clear declarative statement that begins with either: “It is not known how or why…” (qualitative), or “It is not known if or to what degree/extent…” (quantitative).
2. Clearly describes the magnitude and importance of the problem, supporting it with citations from the literature.
3. ALIGNMENT: The problem statement is developed from and justified by the “need” or “defined gap” defined by the Literature that is discussed in the Background to the Problem section above.
NOTE: This section elaborates on Points #3 (Problem Statement) from the 10 Strategic Points. This section becomes the foundation for the Problem Statement section in Chapter 1(and other Chapters where appropriate) in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format
Comments from Evaluator:

Research Questions, Hypotheses, and Variables

Research Question

PICOT: P) For staff nurses in an acute care hospital being underutilized and not recognized as members of the antimicrobial stewardship program team I) take an educational intervention program C) compared to nurses in another acute care hospital without taking the educational intervention program, O) related to the rise in health care associated c-diff in acute care hospitals T) within three months.

Hypothesis

If staff nurses in inpatient hospitals are being underutilized and not recognized as members of the antimicrobial stewardship program then this may lead to the ineffectiveness of antimicrobial stewardship programs and infection or disease control measures, which may contribute to a rise in health care associated c-diff.

Sub-Research Questions and Associated Hypotheses

Sub-question 1: Are the staff nurses in inpatient hospitals being underutilized and not recognized as members of the antimicrobial stewardship program? Additionally are the staff nurses in inpatient hospitals not familiar with the concept of antimicrobial stewardship?

H1A: There would be a significant correlation between the staff nurses in inpatient hospitals being underutilized and not recognized as members of the antimicrobial/antibiotic stewardship program and the rise in health care associated c-diff.

H10: There would be no significant correlation between the staff nurses in inpatient hospitals being underutilized and not recognized as members of the antimicrobial/antibiotic stewardship program and the rise in health care associated c-diff.

Sub-question 2: Are the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial stewardship program?

H2A: There would be a significant correlation between the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial/antibiotic stewardship program and the rise in health care associated c-diff.

H20: There would be no significant correlation between the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial/antibiotic stewardship program and the rise in health care associated c-diff.

Sub-question 3: Is the problem of the staff nurses in inpatient hospitals being underutilized and not recognized as members of the antimicrobial stewardship program impacting the health of the inpatients,

H3A: There would be a significant correlation between the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial/antibiotic stewardship program and the health of the inpatients.

H30: There would be no significant correlation between the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial/antibiotic stewardship program and the health of the inpatients.

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Research Question(s) and/or Hypotheses This section narrows the focus of the study and specifies the research questions to address the problem statement. Based on the research questions, it describes the variables or groups and their hypothesized relationship for a quantitative study or the phenomena under investigation for a qualitative study. (2-3paragraphs) · The recommendation is a minimum of two research questions along with related hypotheses and variables is required for a quantitative study. · Also recommended is a minimum of two research questions along with the phenomenon description is required for a qualitative study. · Put the Research Questions in the appropriate Table in Appendix B based on whether the study is qualitative or quantitative.
1. Qualitative Designs: States the research question(s) the study will answer, and describes the phenomenon to be studied. or 2. Quantitative Designs: States the research question(s) the study will answer, identifies the variables, and presents the hypotheses.
3. ALIGNMENT: The research questions are based on both the Problem Statement and Theoretical Foundation model(s) or theory(s). There should be no research questions that are not clearly aligned to the Problem Statement.
NOTE: This section elaborates on Points #5 (Research Questions) & #6 Hypothesis/variables or Phenomena) from the 10 Strategic Points. This section becomes the foundation for the Research Question(s) and/or Hypotheses section in Chapter 1 in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Significance of the Study

A review of the available literature shows that there is little information on the roles of the inpatient nurses in antimicrobial stewardship. Additionally, there is little information that can help determine whether the staff nurses are underutilized (Olans et al., 2016). For this reason, this study will seek to offer a guide on the role of the nurses as part of the antimicrobial stewardship program that will be used to guide the clinical practice, inform hospital management and give focus to the nursing education.

This research will (a) demonstrate the relationship between staff nurses actively participating in Antimicrobial stewardship programs and preventing health care associated clostridium difficile infections and also empower nurses in facilitating open communication with physicians regarding antibiotic prescriptions, (b) Remind and educate nurses on infection control practices such as i) hand hygiene, ii) Isolation protocols and proper donning of PPE, (c) Remind and educate nurses on types of antibiotics and their indications, emphasizing multidrug resistance organisms, (d) Empower nurses in participating in ASP in hospital setting to advocate for a stronger nursing presence. “All healthcare facilities are encouraged to begin to make responsible utilization of antimicrobial drugs the responsibility of every healthcare provider” (Hamilton, Gerber, Moehring, Anderson, Calderwood, Han, … Lautenbach, 2015).

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Significance of the Study This section identifies and describes the significance of the study and the implications of the potential results based on the research questions and problem statement, hypotheses, or the investigated phenomena. It describes how the research fits within and will contribute to the current literature or body of research. It describes potential practical applications from the research. The recommended length for this section is one paragraph.
1. Describes how the proposed research will contribute to the Literature, relating it specifically to other studies from the Background to the Problem and Problem Statement above.
2. Describes how the proposed research will contribute to the literature on the selected theory(s) or model(s) that comprise the Theoretical Foundation for the study.
3. Describes how addressing the problem will have practical value for the real world considering the population, community, and/or society.
4. ALIGNMENT: Part 1 is based on specific studies from the Background to the Problem and Problem Statements sections above and identifies how this research will contribute to that Literature. Part 2 is based on specific model(s), theory(s) or variables from the Theoretical Foundations section above and identifies how this research will contribute to the knowledge on those model(s) or theory(s). Part 3 reflects on potential practical applications of the potential research findings based on Literature in the field of practice.
NOTE: This section does not directly come from any section of the 10 Strategic Points. However it does build on the Background to the Problem, Problem Statement and Theoretical Foundations sections that are developed from the 10 Strategic Points. This section becomes the Significance of the Study section in Chapter 1 in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Rationale for Methodology

The methodology will be quantitative using a Quasi-Experimental Design which seeks establishing a relationship that is cause-effect between two or more variables and using a two tail t-test (Creswell & Creswell, 2018). A quantitative study methodology assesses what it is presumed to be a statistic reality with the expectation of coming up with universal laws (Flick, 2015). Conversely, the qualitative research method purposes to discover what is presumed dynamic reality while centering majorly on comprehending essentials in contrast to generalizing collective laws of behavior. The purpose of this study is to determine the role of the nurses in the antimicrobial stewardship program. The researcher will employ non-probability sample through a purposive sample. Information will be obtained through semi-structured interviews and questionnaires (Wilson, 2010). The information obtained will be recorded and transcribed. The researcher will review the transcripts used in the interviews and the questions used in the questionnaires to aid in the identification of the roles of the nurses in the antimicrobial stewardship programs before and after the educational intervention program. The researcher will be comparing the before and after of the survey results at the two hospital sites, comparing the rates before and after training of the C. Difficile infections. Next, the researcher will compare the two sites to see if there is a significant difference between the rates of C. Difficile infections.

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Rationale for Methodology This section clearly justifies the methodology the researcher plans to use for conducting the study. It argues how the methodological framework is the best approach to answer the research questions and address the problem statement. It uses citations from textbooks and articles on research methodology and/or articles on related studies. The recommend length for this section is one paragraph and completion of Table 1 (quantitative) and/or Table 2 (qualitative) in Appendix B.
1. Identifies the specific research methodology for the study (quantitative, qualitative, or mixed).
2. Justifies the research methodology to be used for the study by discussing why it is the best approach for answering the research question and addressing the problem statement. Uses citations from original sources in the literature on the specific research methodology to support the arguments. (NOTE: Books such as those by Creswell, which are secondary sources summarizing others approaches to research, may not be used as sources in this section).
3. ALIGNMENT: The selected methodology should be justified based on the Problem Statement and Research Questions.
NOTE: This section elaborates on the methodology part of Point #7(Methodology and Design) in the 10 Strategic Points. This section becomes the foundation for the Research Methodology in Chapter 1 of the Proposal and the basis for developing Chapter 3, Research Methodology.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format
Comments from the Evaluator:

Nature of the Research Design for the Study

The methodology will be quantitative using a Quasi-Experimental Design which seeks establishing a relationship that is cause-effect between two or more variables and using a two tail t-test (Creswell & Creswell, 2018). The tools for data collection that the researcher will employ, will include a questionnaire and interviews that consist of open-ended questions and interview questions to the nurses on their reflections on their role in the antimicrobial stewardship programs (Easterby-Smith & Thorpe, 2008). The target population will be the staff nurses in two hospitals within the Napa County, one hospital receiving the educational interventional program and the other with no educational intervention. A sample size of 50 nurses will be selected from the hospitals. Nurses’ knowledge and attitudes on ASP with C-diff rates will be assessed before and after the educational intervention program.

This study will also use the deductive approach. Flick (2015) defines this approach as one that involves testing principles against known theories while showing facts. This research design will be most appropriate to respond to the question on the role of the staff nurses in the antimicrobial stewardship program. The deductive approach will test the hypothesis of the study against the theories while at the same time showing the results of the study. The dependent variable will be the increase in the level of the healthcare-associated Clostridium difficile infections and the independent variables will be the engagement of the staff nurses as antimicrobial stewards, familiarity of the nurses to the concept of antimicrobial stewardship, the security nurses have on their knowledge on antibiotic and microbiology use, the perceived impact of the nurses on the antimicrobial stewardship programs and the attitude of the nurses towards the antimicrobial stewardship programs and the education.

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Nature of the Research Design for the Study This section describes the specific research design to answer the research questions and why this approach was selected. It describes the research sample being studied as well as the process that will be used to collect the data on the sample. The recommend length for this section is one paragraph and completion of Table 1 (quantitative) and/or Table 2 (qualitative) in Appendix B.
1. Identifies the specific type of research design chosen for the study as well as a sample appropriate for the design. (e.g., Quantitative designs include descriptive/survey, correlational, causal-comparative, quasi-experimental, and experimental. Qualitative designs include case study, narrative, grounded theory, historical, and phenomenological.) Although other designs are possible, these are the designs GCU recommends doctoral learners use to help ensure a doable study.
2. Discusses why the selected design is the best design to address the research questions as compared to other designs.
3. ALIGNMENT: The selected Research Design should be justified based on the research questions as well as the hypotheses/variables (quantitative) or phenomenon (qualitative). It should also be aligned with the selected Research Methodology.
NOTE: This section also elaborates on the Design part of Point #7 (Methodology and Design) in the 10 Strategic Points . This section provides the foundation for Nature of the Research Design for the Study in Chapter 1.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from Evaluator:

Purpose of the Study

The purpose of this quantitative Quasi-Experimental Design study is to examine to what extent the level of staff nurses being underutilized and unrecognized in Antimicrobial Stewardship programs is a factor that affects the rise in health care associated clostridium difficile infections in acute care facilities. The dependent variable will be the increase in the level of the healthcare-associated Clostridium difficile infections and the independent variables will be the engagement of the staff nurses as antimicrobial stewards, familiarity of the nurses to the concept of antimicrobial stewardship, the security nurses have on their knowledge on antibiotic and microbiology use, the perceived impact of the nurses on the antimicrobial stewardship programs and the attitude of the nurses towards the antimicrobial stewardship programs and the education.

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Purpose of the Study The purpose statement section provides a reflection of the problem statement and identifies how the study will be accomplished. It explains how the proposed study will contribute to the field. The recommend length for this section is one paragraph.
1. Presents a declarative statement: “The purpose of this _______study is….” that identifies the research methodology, research design, target population, variables/groups (quantitative), or phenomena (qualitative) to be studied, and geographic location. It often includes a version of the Problem Statement as a way to define the phenomenon or variables/hypotheses.
2. ALIGNMENT: The Purpose Statement includes: Research Methodology, Research Design, and Problem Statement from the previous sections. It also includes the target population, which should be of sufficient size to provide a large enough sample to complete the study and provide significant (quantitative) or meaningful (qualitative) results.
NOTE: This section elaborates on Points #8 (Purpose Statement) in the 10 Strategic Points. This section becomes the foundation for the Purpose of the Study in Chapter 1 of the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Instrumentation

The primary materials that will be used in the study will be the questionnaires and the interview questions. The questions will be designed to assist with the collection of data that would aid in the determination of the role of the nurses in the antimicrobial stewardship programs. The semi-structured interviews and the questionnaires contained questions will cover the research questions and objectives stated in the study to facilitate a discussion on the topic. The questionnaires will contain both closed-ended and open-ended questions that will offer focus to the participants and allow the researcher to examine a broad array of topics (Doody & Noonan, 2013). The study objectives will be to determine the role of the nurses in ASP’s as well as the perspectives, attitudes, and knowledge and determine how the role of the nurses can be supported and developed to ensure achievement of the antimicrobial stewardship programs.

a. Dependent Variable: The rise in health care associated clostridium difficile infections will be measured by the CDC Vital Signs Scale (CDC, 2017).

b. Independent variables: Staff nurses underutilized and unrecognized in clostridium difficile infections control. Data will be collected using one of the standard instruments/surveys currently used for similar studies that measure inpatient hospital care (The CDC National Hospital Care Survey) (CDC, 2017).

c. Independent variables: Staff nurses not being engaged as members of the antimicrobial/antibiotic stewardship program. Data will be collected using one of the standard instruments/surveys currently used for similar studies that measure inpatient hospital care (The CDC National Hospital Care Survey) (CDC, 2017).

d. Independent variables: Staff nurses unfamiliar with the concept of antimicrobial stewardship. Data will be collected using one of the standard instruments/surveys currently used for similar studies that measure inpatient hospital care (The CDC National Hospital Care Survey) (CDC, 2017).

e. Independent variables: Staff nurses being insecure about their knowledge of microbiology and antibiotic use. Data will be collected using one of the standard instruments/surveys currently used for similar studies that measure inpatient hospital care (The CDC National Hospital Care Survey) (CDC, 2017).

f. Independent variables: Staff nurses’ attitude that antimicrobial stewardship is not their function because they do not perceive themselves as antibiotic prescribers. Data will be collected using one of the standard instruments/surveys currently used for similar studies that measure inpatient hospital care (The CDC National Hospital Care Survey) (CDC, 2017).

g. Independent variables: The lack of metrics that quantify nurses’ impact on stewardship efforts. Data will be collected using one of the standard instruments/surveys currently used for similar studies that measure inpatient hospital care (The CDC National Hospital Care Survey).

h. Independent variable: Age

i. Independent variable: Education

j. Independent variable: Location

k. Independent variable: Gender

l. Independent variable: Years of practice/experience

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Instrumentation or Sources of Data Describes, in detail, all data collection instruments and sources (tests, questionnaires, interviews, data bases, media, etc.). Discusses the specific instrument or source to collect data for each variable or group (quantitative study). Discusses specific instrument or source to collect information to describe the phenomena being studied (qualitative study). The recommend length for this section is one paragraph AND completion of Table 1 (quantitative) and/or Table 2 (qualitative) in Appendix B.
1. Identifies and describes the types of data that will be collected to answer each Research Question for a qualitative study. Identifies the data that will be collected for each Variable/Group in a quantitative study.
2. Identifies tools, instruments, or databases to be used to collect the data (e.g., observations, interviews, questionnaires, documents, media (qualitative), standardized tests, surveys, and databases (quantitative)). For a qualitative study, identify the specific tools, instruments, or databases for each research question in a qualitative study. For a quantitative study, identify the name of the specific “validated” and “previously used in quantitative research” survey or data source to be used to collect data for each variable, providing a citation for the instrument or data source.
3. ALIGNMENT: Aligns with the Research Questions (qualitative) or Variables (quantitative) previously described in the Research Question(s) and Phenomena or Research Questions, Hypotheses, and Variables section above. Identifies and describes the data and data source that will be used to answer each Research Question for a qualitative study. Identifies, describes, and names the type of numerical data and specific data collection instrument or source that will be used for each variable and group in a quantitative study.
NOTE: This section elaborates on Point #9 (Data Collection) from the 10 Strategic Points. This information is summarized high level in Chapter 1 in the Proposal in the Nature of the Research Design for the Study section. This section provides the foundation for Instrumentation (quantitative) or Sources of Data (qualitative) section in Chapter 3.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Data Collection Procedures

1. Descriptive statistics will be used to summarize the sample descriptive data and the data on the variables, with a sample size of 100 Nurse participants

a. To test the hypotheses and research questions, inferential statistics will be calculated for the hypothesis (H1A, H2A, H3A. tested using simple linear regression analysis.

b. A test for univariate outliers will be conducted to determine if any cases may not statistically be part of the sample collected.

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Data Collection Procedures This section details the entirety of the process used to collect the data. It describes each step of the data collection process in a way that another researcher could replicate the study. NOTE: It is recommended that the researcher get written approval (or at the very least unofficial approval) to conduct their research study in their selected organization. Ensure the person (who is usually a school superintendent, school boards, or corporate officer) providing approval is authorized by the organization to grant approval for research. Do not assume your organization will allow you to collect data since many organization do not allow research to be completed within the organization. The recommended length for this section is two paragraphs.
1. Defines the target population and the expected sample size, which comprises the people or organizations being studied , as defined in the problem statement. For quantitative studies, it justifies why the target population and expected sample size (final number of people or organizations being studied for which data will be collected) is large enough to produce statistically significant results (quantitative) or meaningful results (qualitative).
2. Provides an overview the proposed step-by-step procedure to collect data using the tools, instruments, or databases from the section above. Includes the steps (e.g., obtaining initial informed consent from participating organization; IRB review; sample selection; groupings; protecting rights/well-being; maintaining data security; sample recruitment; data collection instruments and approaches; field testing instruments; notifying participants; collecting the data, etc.) in a way another researcher can replicate the study. Steps may be provided in a list format.
3. ALIGNMENT: Shows the steps and approach to collect data for each and every data source identified in the Instrumentation or Sources of Data section. Defines the sample as the set of people or organizations being studied for which data will be collected. The sample size must be correct for the type of design selected to get statistically significant (quantitative) or meaningful (qualitative) results.
NOTE: This section elaborates on Points #4 (Sample and Location) and #9 (Data Collection) in the 10 Strategic Points . This section provides the foundation for the Data Collection Procedures section in Chapter 3 in the Proposal. And it is summarized high level in Chapter 1 in Nature of the Research Design for the Study in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Data Analysis Procedures

The data obtained from the interviews will be transcribed from voice to print. The researcher will listen to the voice recordings and write them down immediately after the interviews. Additionally, the data that will be obtained from the questionnaires will be fed into excel sheet. The researcher will listen to the recordings more than twice then record the responses. According to Elo and Kynga (2008), repeated listening of the recordings allows the researcher to record the accurate data contained in the responses of the participants.

The t- tailed test will be used to compare the two groups of nurses. The data that will be obtained will then be categorized according to the themes of the study which include the clinical skills, monitoring, advocacy, attitudes, knowledge, and collaboration as well as communication.

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Data Analysis Procedures This section describes how the data were collected for each variable or group (quantitative study) or for each research question (qualitative study). It describes the type of data to be analyzed, identifying the descriptive, inferential, and/or non-statistical analyses. Demonstrates that the research analysis is aligned to the specific research design. The recommend length for this section is one paragraph AND completion of Table 1 (quantitative) and/or Table 2 (qualitative) in Appendix B.
1. Describes the analysis to examine each stated research question and/or hypothesis. For quantitative studies, describes the analyses including the inferential and/or descriptive statistics to be completed. For qualitative studies, describes the specific analytic approach appropriate for the Research Design and each research question to be completed. In qualitative research the different research questions may require different approaches to doing qualitative data analysis, as well as descriptive statistics.
2. ALIGNMENT: For qualitative studies, there is a clear and obvious alignment between each research question, data to be collected, tool or data source, as well as data analysis to understand/explain the phenomenon. For quantitative studies, there is a clear and obvious alignment between each variable, data to be collected, instrument or data source, as well as data analysis for each hypothesis.
NOTE: This section elaborates on Point #10 (Data Analysis) from the 10 Strategic Points. This section provides the foundation for Data Analysis Procedures section in Chapter 3 in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Ethical Considerations

It is essential to undertake ethical guidelines while carrying out any research (Östlund et al. 2011). Some of the ethical factors that the researcher will take into consideration include confidentiality, security, and consent. The role of ethical consideration is to protect the rights of the experimental subjects. Permission will be sought from the Grand Canyon University ethics committee and the IRB. Additionally, the researcher will educate the participants on the importance of taking part in the research while introducing the study. The researcher also will give the participants the freedom to choose whether to participate in the study or not and they will be informed that the information collected will be confidential and only utilized for the study purposes (Wilson, 2010).

*Criteria (Required Components): score 0-3*	*Learner Self-Evaluation Score* *(0-3)*	*Chair or Reviewer Evaluation Score* *(0-3)*
Ethical Considerations This section discusses the potential ethical issues surrounding the research, as well as how human subjects and data will be protected. It identifies how any potential ethical issues will be addressed. The recommended length for this section is one paragraph.
1. Discusses potential ethical concerns that might occur during the data collection process.
2. Describes how the identities of the participants in the study and data will be protected.
3. Describes subject recruiting, informed consent and site authorization processes.
4. ALIGNMENT: Ethical considerations are clearly aligned with, and relate directly to the specific Data Collection Procedures. This section also identifies ethical considerations related to the target population being researched and organization or location as described in the Purpose Statement section.
NOTE: This section does use information from any of the 10 Strategic Points. This section provides the foundation for Ethical Considerations section in Chapter 3 in the Proposal.
NOTE: When writing this section ensure it has a logical flow, as well as uses correct paragraph structure, sentence structure, tense, punctuation, and APA format.
Comments from the Evaluator:

Appendix A

The 10 Strategic Points for the Prospectus, Proposal, and Dissertation

DPI Project Milestone: 10 Strategic Points Revised Working Draft

Grace Senoga

Grand Canyon University

DNP 820

Research Topic

Antimicrobial Stewardship program: An evidence based quality assurance measure in combating Healthcare Associated Infections (HAI) with emphasis in Clostridium Difficile prevention. An Educational Tool Kit for staff nurses becoming more engaged and taking a leadership role in HAI programs.

Literature Review

Background of the problem/gap

i. Prior studies show that “the role of inpatient staff nurses as antimicrobial stewards is unexplored” identified the need for future studies on how the rise in health care associated c-diff and its impact on patients is related to the nurses being underutilized and unrecognized as members of the Clostridium Difficile Infections Antimicrobial Stewardship (AMS) team. (Monsees, E. et al., 2017). “Good nursing is good antibiotic stewardship” (Olans, Olans, & Witt, 2017).

ii. A study by the American Nurses Association (ANA) and the Centers for Disease Control and Prevention (CDC) presents a strong argument that “the urgent need to improve appropriate, evidence-based antibiotic use cannot be overstated.” The authoritative and informative report advises that “with the current worldwide expansion of multidrug-resistant organisms, the question is not whether to involve nursing in antimicrobial stewardship, but how.” (ANA/CDC, 2017)

iii. Antimicrobial stewardship education is very important for every health care worker, legislators, policy makers for public health, and the public at general. It should not be for only physicians. Olans, Olans & DeMaria (2016) researched the topic and concluded that “As the largest single group of healthcare providers, nurses should be included in this educational effort.” The authors urged that “Antimicrobial stewardship education is particularly important for nurses, however, who may not identify themselves as antibiotic prescribers, and therefore not view their activities as contributing to antimicrobial stewardship”.

“The CDC estimates that 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year. That puts hospital-acquired infections in the ten top category of leading causes of death in the US.” (CDC, 2017)

iv. The CDC reports that “C. difficile has become the most common microbial cause of healthcare-associated infections in U.S. hospitals and costs up to $4.8 billion each year in excess health care costs for acute care facilities alone.” (CDC, 2015).

v. “Nursing’s perspective and active engagement are crucial for successful antibiotic stewardship programs”(Manning, 2016).

Theoretical foundations

i. “The Health Belief Model (HBM) is by far the most commonly used theory in health education and health promotion” (Glanz, Rimer, & Lewis, 2002).

ii. Nightingales Theory: The theorist suggestion that nurses need to know about the disease process will inform and guide the present work. “How does this theory influence the evidence based staff nurses’ attitude and or believe that antimicrobial stewardship is not their function because they do not perceive themselves as antibiotic prescribers?” (Petiprin, 2016).

Review of Literature topics with key theme

“Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an inter professional stewardship workforce” (Monsees, E. et al., 2017).

Summary

i. Gap/problem: There is a need to identify different approaches to motivate staff nurses to take action to prevent health care associated clostridium difficile infections and other health care-associated infections.

ii. The way to prevention of health care associated clostridium difficile infections, other health care-associated infections, and antibiotic resistance is to engage staff nurses as active participants in the AMS and other related safety measures.

iii. Quantitative study: Instruments and sources of data exist to collect survey data on the twelve variables.

iv. Significance: research will (a) demonstrate the relationship between staff nurses actively participating in health care-associated infections stewardship programs and preventing health care associated clostridium difficile infections. (b) add to the broad area of superbugs in hospitals, (c) identify specific approaches as educational tool kit for nurses to be used by hospital administrators to protect patients from deadly superbugs.

Problem Statement

Sample and location

a. Location: Napa County, California, United States

b. Population: Staff nurses in two Acute care hospitals in Napa county

c. Sample: The survey will be conducted on 100 participants. The sample sizes as representative of the study population and large enough to make accurate statistical conclusions.

Research Question

PICOT: P) For staff nurses in an acute care hospital being underutilized and not recognized as members of the antimicrobial stewardship program team, I) take an educational intervention program C) compared to nurses in another acute care hospital without taking the educational intervention program, O) related to the rise in health care associated c-diff in acute care hospitals T) within three months.

Hypothesis

Sub-Research Questions and Associated Hypotheses

H1A: There would be a significant correlation between the staff nurses in inpatient hospitals being underutilized and not recognized as members of the antimicrobial/antibiotic stewardship program and the rise in health care associated c-diff.

H10: There would be no significant correlation between the staff nurses in inpatient hospitals being underutilized and not recognized as members of the antimicrobial/antibiotic stewardship program and the rise in health care associated c-diff.

Sub-question 2: Are the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial stewardship program?

H2A: There would be a significant correlation between the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial/antibiotic stewardship program and the rise in health care associated c-diff.

H20: There would be no significant correlation between the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial/antibiotic stewardship program and the rise in health care associated c-diff.

H3A: There would be a significant correlation between the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial/antibiotic stewardship program and the health of the inpatients.

H30: There would be no significant correlation between the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial/antibiotic stewardship program and the health of the inpatients.

Methodology and Design

Purpose Statement

The purpose of this quantitative method using a Quasi-Experimental Design study is to examine to what extent the level of staff nurses being underutilized and unrecognized in Antimicrobial/Antibiotic Stewardship programs is a factor that affects the rise in health care associated clostridium difficile infections.

Data Correction

a. Dependent Variable: The rise in health care associated clostridium difficile infections will be measured by the CDC Vital Signs Scale (CDC, 2017).

h. Independent variable: Age

i. Independent variable: Education

j. Independent variable: Location

k. Independent variable: Gender

l. Independent variable: Years of practice/experience

Data Analysis

a. Descriptive statistics will be used to summarize the sample descriptive data and the data on the variables

b. To test the hypotheses and research questions, inferential statistics will be calculated for the hypothesis (H1A, H2A, H3A. H4A, H5A, H6A, H7A, H8A, H9A, H10A, H11A, H12A) tested using simple linear regression analysis.

c. A test for univariate outliers will be conducted to determine if any cases may not statistically be part of the sample collected.

Appendix B

Research Questions:

State the research Questions

Hypotheses:

State the hypotheses to match each Research question

List of Variables/Groups to Collect Data For:

Independent and Dependent Variable(s)

Instrument(s)

To collect data for each variable

Analysis Plan

Data analysis approach to (1) describe data and (2) test the hypothesis

1. Are the staff nurses in inpatient hospitals being underutilized and not recognized as members of the antimicrobial stewardship program? Additionally are the staff nurses in inpatient hospitals not familiar with the concept of antimicrobial stewardship?

The dependent variable will be the increase in the level of the healthcare-associated Clostridium difficile infections

The independent variables will be the engagement of the staff nurses as antimicrobial stewards, familiarity of the nurses to the concept of antimicrobial stewardship, the security nurses have on their knowledge on antibiotic and microbiology use, the perceived impact of the nurses on the antimicrobial stewardship

Questionnaires and the interview questions.

t- tailed test

The Likert test

2. Sub-question 2: Are the staff nurses in inpatient hospitals not being engaged as members of the antimicrobial stewardship program?

Questionnaires and the interview questions.

3. Is the problem of the staff nurses in inpatient hospitals being underutilized and not recognized as members of the antimicrobial stewardship program impacting the health of the inpatients.

Questionnaires and the interview questions.

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American Nurses Association/Centers for Disease Control and Prevention (ANA/CDC) (2017).

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Gibson, C. B. (2017). Elaboration, Generalization, Triangulation, and Interpretation: On enhancing the value of mixed method research. Organizational Research Methods, 20(2), 193-223.

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Draft Prospective

Introduction

Background of the Problem

Theoretical Foundations and Review of the Literature/Themes

Problem Statement

Research Questions, Hypotheses, and Variables

Significance of the Study

Rationale for Methodology

Nature of the Research Design for the Study

Purpose of the Study

Instrumentation

NOTE: This section elaborates on Point #9 (Data Collection) from the 10 Strategic Points.

Comments from the Evaluator:

Data Collection Procedures

Data Analysis Procedures

Ethical Considerations

Appendix A